Jenny Meyer

Social services in Sweden are increasingly offering support to neurodivergent young adults in their daily living. Effective methods are needed to encourage young service users to actively engage in their support. This study aimed to (I) describe the process of co-producing a tool to facilitate service user engagement, and (II) explore the tool's feasibility. The co-production phase consisted of workshops with service users (n = 7) and support workers (n = 3) from three municipalities. Feasibility was assessed using a convergent mixed methods approach. Service users aged 18-29 (n = 15) and their support workers (n = 11) were invited to use the tool for four weeks. Service users completed pre- and post-measurements, and both service users (n = 12) and support workers (n = 8) were interviewed. Quantitative and qualitative findings were integrated using a narrative-weaving approach. The co-production phase resulted in a booklet containing questions that explored personal preferences. Despite implementation difficulties during the feasibility assessment, which led to a lower-than-expected completion rate (n = 10), both service users and support workers found the tool relevant and helpful. Co-production is a promising approach for enhancing service user engagement in this service setting. In further evaluation of the tool, organizational-level implementation barriers must be addressed.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience difficulties with emotion regulation, but treatment alternatives remain limited. This study investigates the feasibility and effectiveness of a newly developed psychological intervention aiming to increase emotion regulation skills in adolescent ADHD. A single-case experimental design with multiple baselines across participants was employed. Seven girls aged 13-17 years with ADHD completed the intervention. Outcomes of feasibility included attrition and retention rates, therapist-rated adherence, homework completion and engagement with the intervention material, as well as self- and caregiver ratings of client satisfaction and adverse outcomes. Primary outcomes of emotion dysregulation included weekly self- and caregiver ratings of the Difficulties in Emotion Regulation Scale Short Form during baseline, the intervention and a follow-up period of 2 weeks. Data was analyzed through descriptive statistics, visual inspection and effect size (Tau). The intervention was deemed feasible, although homework completion and engagement between sessions proved challenging. Six adolescents and caregivers reported lower emotion dysregulation after the intervention. However, six adolescent and four caregiver ratings demonstrated improvement before the intervention during baseline, complicating determination of intervention effects. Nevertheless, four participants showed a visual and/or statistical improvement from the intervention. Sensitivity analyses suggest that the intervention may have positive effects on emotional clarity.

Background: An increasing number of young adults in Sweden are being granted support in daily living through social services. To enhance service planning and resource allocation for this growing group of young service users, we aimed to provide an overview of the social and health-related circumstances of young adults recently granted support in daily living. We had a particular focus on mental health service utilization and whether socio-demographic factors influence the use of care. Methods: Swedish nationwide register data were used to describe the sociodemographic characteristics and utilization of mental health services, including outpatient and inpatient care, treatment for suicidal behavior and pharmacological treatment. Sociodemographic predictors (sex, age, country of birth, education, and parental education) of mental health service utilization were explored using binary logistic regression. Results: All young adults (ages 18–29) granted support between 2017 and 2021 (N = 15,024; 49.2% female) were included. Unfavorable social circumstances were common, including truncated education, unemployment, and the need for financial assistance. Many had a history of psychiatric inpatient care (40.0%) and treatment for suicidal behavior (15.7%). The majority received psychiatric outpatient care (71.6%) and psychopharmacological treatment (73.9%) during their granting year. Common conditions for care included attention deficit hyperactivity disorder, anxiety and fear-related disorders, mood disorders, and autism spectrum disorder. Co-occurring conditions were prevalent. Utilization of mental health services was more common among females, particularly regarding treatment for suicidal behavior (adjusted OR 2.52; 95% CI 2.16–2.93). Higher educational level and being Swedish-born were associated with a greater likelihood of utilizing outpatient care and psychopharmacological treatment. In contrast, those born in Sweden were less likely than foreign-born to be admitted to inpatient care (adjusted OR 0.66; 95% CI 0.59–0.74). Conclusions: While social services recognize the support needs of this group of young adults, our findings suggest that sociodemographic characteristics such as sex, education level, and country of birth may facilitate or obstruct their access to mental health services. It is essential to coordinate efforts so that young adults with support in daily living can seek and access the mental health services they need. Clinical trial number: Not applicable.

TRANSITION is a structured behavioral and educational program to support young adults with mental, behavioral, and neurodevelopmental conditions transitioning into adulthood. This study investigated its feasibility as an add-on to regular daily living support in social services. A non-randomized single-arm mixed method design was used. Twenty-eight service users, aged 19-29, were enrolled to participate in the program for 20 weeks alongside their support workers. They rated their engagement and satisfaction and reported any adverse effects. Eighteen support workers received training in the program. A subsample of service users (n = 11) and support workers (n = 9) was interviewed about their experiences. Qualitative content analysis using an abductive approach and quantitative analyses with descriptive statistics was integrated and mapped to specific feasibility areas in a joint display. Service users completing the study (n = 26) generally rated satisfaction and engagement highly. While some service users experienced stress related to their participation, no serious adverse events were reported. Service users and support workers highlighted the program's clear structure and focus on specific goals as particularly valuable. The results indicate that TRANSITION is a feasible complement to regular support in social service settings. Further evaluation of the program is justified.Implications for rehabilitationThe TRANSITION program is a feasible add-on to regular support in daily living for young adults with mental, behavioral, and neurodevelopmental conditions.Support workers can deliver the program, although training, practice, and regular supervision are needed.Service users perceive that the program adds clarity and valued direction to their support.The program may help service users and support workers become more aware of the inherent benefits of user engagement in daily living support.

Purpose: Information technology is increasingly being employed for providing support and interventions in disability and health service contexts. This study aimed to investigate service users’ and support workers’ perspectives on remote support in daily living for young adults with neurodevelopmental conditions. Methods: Using a convergent mixed methods approach, we integrated qualitative and quantitative findings from survey responses and focus groups. Young service users (aged 18 to 29) diagnosed with ADHD and/or autism (n = 35) and support workers (n = 64) from four municipalities in Sweden responded to a survey designed to tap into their lived experiences and views. The topic was explored further in focus groups with young service users (n = 7) and support workers (n = 3). Open-ended survey questions were analyzed using qualitative content analyses and complemented with information from the focus groups, while closed survey questions were summarized descriptively. Inferences were merged in a joint display. Results: While participants reported having access to digital devices, service routines for remote contact were not in place. Service users were more hesitant than support workers in endorsing remote support, expressing concerns that this approach would be inferior to in-person support (e.g., owing to miscommunications and insufficient social and emotional contact). Still, both groups expressed that remote contact may at times be a beneficial complement to in-person meetings, increasing accessibility and user choice. Conclusion: Service providers planning to implement remote support elements should explore the demand, acceptability, and organizational readiness for this approach. Moving forward, user engagement will be crucial to meet individual preferences, values, and needs.

Background: Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with functional impairment in several domains of life. To enable development of interventions that more effectively target functional impairment in this age group, the associations between clinical characteristics and impairment need to be clarified. The aim of this study was to investigate the associations between ADHD and functional impairment, if they varied by sex, and the potential impact of comorbid psychiatric symptoms on the associations. Methods: This was a cross-sectional study including adolescents with ADHD (n = 164) and a reference group of adolescents without ADHD (n = 106). Self-ratings and parental ratings of functional impairment in different life domains were used as outcomes in all analyses. Differences between groups were investigated with comparative analyses. General linear models (GLMs) were used to explore associations between ADHD symptoms and functional impairment in adolescents with ADHD, while adjusting for of comorbid symptoms, sex, and medication. Results: Adolescents with ADHD displayed higher levels of functional impairment than peers without ADHD, and girls with ADHD rated higher impairment than their male counterparts. The combined ADHD presentation was associated with the highest levels of self-reported impairment, while parental ratings indicated comparable levels of overall impairment across presentations. In the adjusted GLMs, symptoms of inattention were strongly associated with self- and parent-rated impairment in school, but symptoms of hyperactivity/impulsivity were not, whereas symptoms of both inattention and hyperactivity/impulsivity were modestly associated with self-rated impairment with friends. Further, both emotional and conduct problems were associated with impairment in daily life. Conclusions: Our results suggest that attention difficulties, in particular, seem to impair academic functioning in adolescents with ADHD, and interventions targeting such difficulties are warranted. In addition, comorbid symptoms need to be assessed and treated, and self-reports of functioning should be included in research and clinical practice involving adolescents.

We examined perceived stress and sleep problems in adolescent ADHD and whether this varies as a function of ADHD presentation and sex. Further, we mapped structural associations between ADHD symptoms, comorbid symptoms, perceived stress, and sleep problems. Participants were 306 adolescents aged 13–19 years (66.8% females, 193 had an ADHD diagnosis, 113 were controls). Parents rated ADHD symptoms, all other constructs were self-rated. Adolescents with ADHD had elevated levels of perceived stress and sleep problems. Girls with ADHD reported the highest levels of perceived stress. Emotional symptoms mediated the effect of inattention whereas conduct problems mediated the effect of hyperactivity/impulsivity on stress and sleep. Perceived stress and sleep problems should be considered when mapping ADHD-related problems. Comorbid symptoms are potential intervention targets that may increase treatment response.

Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with behavioural, emotional and interpersonal problems, and non-pharmacological treatments targeting these difficulties have been requested. The objective of this study was to evaluate the effectiveness and acceptance of an age-adapted structured skills training group (SSTG) for adolescents with ADHD. Adolescents (n = 184, ages 15–18 years) with a diagnosis of ADHD were randomly assigned to either the SSTG, which is based on dialectical behavioural therapy, or an active control group based on psychoeducation. Symptoms of ADHD, behavioural and emotional problems, functional impairment, and health-related outcomes were assessed with self-ratings and parental ratings two weeks before, two weeks after, and six months after treatment. All participants who completed the pre-treatment measurements (n = 164) were included in the main analyses, which were conducted using a linear mixed model. Our results demonstrated no significant group differences in favour of the SSTG for any of the study outcomes. A majority of the participants in both groups reported that they had increased their knowledge about ADHD, improved their ability to manage problems related to the diagnosis, and would recommend the treatment to others. We conclude that the SSTG seems to be acceptable for adolescents with ADHD in a clinical context. However, the treatment was not proved to be more effective or more acceptable than the psychoeducational control intervention.Trial registration: http://www.isrctn.com/ISRCTN17366720,11/05/2016, retrospectively registered.

Little is known about how adolescents with attention deficit/hyperactivity disorder (ADHD) experience participating in group therapy, an important factor to consider when developing treatment methods for this age group. This study aimed to explore how adolescents with ADHD experience participating in a structured skills training group program based on dialectical behavioral therapy. Semi‐structured interviews were conducted with 20 adolescents (15–18 years of age) with ADHD after participating in a structured skills training group. The interviews were transcribed verbatim and qualitative content analysis were used to analyze the text. The participants emphasized the value of meeting other adolescents with ADHD and the opportunity to exchange experiences, strategies and tips. Participating in the group treatment made the adolescents realize that they were not alone, and feelings of togetherness and an increased acceptance of themselves were described. The participants associated the treatment with elevated knowledge and understanding, for example, about ADHD, their own functioning and helpful strategies. They also described emotional and behavioral changes, such as higher self‐esteem, fewer inter‐personal conflicts and improved concentration. Activating and experiential exercises were considered important elements of the treatment, and the participants expressed a need for a variation of exercises, as well as more time for practicing skills, discussions and breaks. The results indicate that the group format add an extra value to the treatment and that the use of an active approach throughout the treatment is of importance for this group of patients.