Towards Digital Psychiatry in Adult Attention-Deficit/Hyperactivity Disorder

Abstract

The field of digital psychiatry and psychotherapy has generated increasing interest given its potential to improve mental health care, for instance, by enhancing accessibility, scalability, and cost-effectiveness. In particular for heterogeneous disorders such as adult attention-deficit/hyperactivity disorder (ADHD), providing a large number of affected individuals early access to treatments with high personalization potential holds promise. In this project, digital psychoeducation and a novel attention training based on eye-tracking in virtual reality were evaluated in three separate clinical trials to determine their efficacy for the treatment of adult ADHD. <br /> The first study aimed to evaluate a newly developed psychoeducation smartphone application (app) in a randomized controlled trial. To this end, 60 adults with ADHD were assigned to psychoeducation groups supported by either the smartphone app or traditional paper-based brochures. After eight weekly one-hour group sessions and additional homework, a significant reduction in the primary outcome measure, observer-rated ADHD symptom severity, was demonstrated. In addition, smartphone-based psychoeducation was found to be more effective in improving ADHD symptoms and showed higher homework compliance than brochure-based psychoeducation. <br /> The second study examined digital, self-guided psychoeducation over a three-week period in 40 participants randomized to use either an interactive chatbot or the psychoeducation app employed in the first study. Results showed significant reductions in observer- and patient-rated ADHD symptoms but no interaction effects, thereby suggesting similar efficacy. <br /> The third study investigated a novel gaze-based attention refocusing training in virtual reality in 18 adults with ADHD and 18 healthy controls under three different feedback conditions: gaze-based feedback, sham feedback, or no feedback. Although patients with ADHD showed more omission errors, higher reaction times, longer distractor-related gaze dwell times, and more head movements than healthy controls, the gaze-based feedback did not improve task performance. <br /> In conclusion, the psychoeducation studies provided initial clinical evidence for the efficacy of digital psychoeducation and revealed no safety concerns. Specifically, the finding from the first study that a psychoeducation app is superior to traditional paper-based materials in supporting clinical psychoeducation indicate the applicability of the digital format. Despite symptom improvements under both intervention types in the second study, further research is needed on the use of self-guided digital psychoeducation, particularly in the case of patient interaction with a chatbot. Regarding the use of virtual reality for the potential treatment of adults with ADHD, a single-session investigation of a novel gaze-based attention refocusing training in virtual reality did not result in immediate improvements in attention performance, but showed potential in the multimodal registration of ADHD symptoms. Results suggest that further refinement of the system could lead to improved outcomes in a future multisession treatment trial.