(PS1-67) Functional Impairment Associated with Diagnosed and Subthreshold ADHD in Adults Is Mediated by Tech Use Focused on Mental Health

Introduction: Estimated rates of adult ADHD range from 2.5% to 6.76%, affected by methodological factors and diagnostic validity concerns contributing to underreporting (Polanczyk et al., 2014; Simon et al., 2018; Song et al., 2021). Research indicates functional impairment is crucial in addressing underreporting (Sibley et al., 2016). Adjusting persistent ADHD to include partial remission and subthreshold criteria, estimated rates of adult ADHD range from 40%-60%, with significant functional impairment (Faraone et al., 2006). Functional impairment associated with adult ADHD differs from pediatric ADHD, due to increased independence, and is marked by decreased optimism, life satisfaction, and quality of life, and increased loneliness (Kosheleff et al., 2023; Stickley et al., 2017). ADHD symptoms in emerging adults is linked to lower social support, increased suicidal ideation, and emotional distress (Cheng et al., 2016). Addressing functional impairment in the adult and emerging adult populations is a critical gap, which internet-based interventions (IBIs) may bridge. IBIs are cost-effective, improve accessibility to mental health care, and demonstrate increasing efficacy in addressing functional impairment in adults (Firth et al., 2017; Shelton et al., 2022). Specifically, internet-based CBT has shown great potential for treating adult ADHD and functional impairment (Pattersson et al., 2016). This study examines the mediating effects of self-reported tech use with IBIs on the relationship between diagnosed and subthreshold ADHD, respectively, and functional impairment.

Method: Data collection is ongoing at a Mid-Atlantic university in the U.S. and will be completed by May 2024 (n ≈ 1,000). The survey includes demographic questions, the Barkley Adult ADHD Rating Scale – IV, the Barkley Functional Impairment Scale, a tech-use survey, and an additional qualitative survey querying experiences with IBIs. Linear Regression will assess the relation between diagnosed and subthreshold ADHD and functional impairment, with the PROCESS macro (Hayes, 2013) examining mediating effects of tech use. Qualitative analysis will inform on themes of IBI use.

Results: Anticipated results will indicate significant correlations between diagnosed and subthreshold ADHD with functional impairment. Tech use will mediate the relationship between ADHD status and functional impairment, such that IBIs are a protective factor against functional impairment. Qualitative results will reveal features most beneficial to this population, driving future application design. 

Discussion: IBIs have been rated more preferably than face-to-face treatment for adults with ADHD (Shelton et al., 2022) and may be particularly useful in stepped care treatment models for ADHD, where initial interventions address lower levels of functional impairment and intensity of care increases as impairment persists (Gonzalez et al., 2024). Finally, relationships between functional impairment and DSM symptom thresholds are not significantly different, suggesting functional impairment warrants treatment regardless of diagnosis, where IBIs and digital mental health apps offer cost-effective, timely treatment (Hartung et al., 2016).