Occupational therapy metacognitive intervention for adolescents with ADHD: Teen Cognitive-Functional (Cog-Fun) feasibility study

Introduction: Adolescents with attention deficit hyperactivity disorder face neurocognitive impairments that impede their occupational functioning. The Cognitive-Functional model is a metacognitive occupational therapy intervention for individuals with attention deficit hyperactivity disorder that harnesses self-awareness and strategy behavior to support participation in an individualized occupational context. This study explored preliminary feasibility and efficacy of the Cognitive Functional model adapted for adolescents with attention deficit hyperactivity disorder, the Teen Cognitive-Functional intervention. Method: A mixed method feasibility study including 22 adolescents with attention deficit hyperactivity disorder and their parents was conducted. Pre–post assessments included: occupational performance (Canadian Occupational Performance Measure); executive functioning (Behavior Rating Inventory of Executive Function); self-awareness and strategy behavior (Self-Regulation Skills Interview). Results: Modest attrition and high satisfaction from Teen Cognitive-Functional intervention were found. Significant improvements were reported in adolescents’ occupational performance, executive functioning and strategy behavior. No significant gains were found in adolescents’ self-awareness. Adolescents’ strategy behavior was correlated with parent-rated occupational performance. Qualitative analysis of the strategies reported by the adolescents after intervention revealed three categories: “self-determined choices”; “plan and organize” and “adaptations.” Conclusion: This study provides initial support for feasibility of the Teen Cognitive-Functional intervention and its potential efficacy in promoting occupational performance, executive functioning and strategy behavior. Controlled studies are needed to further validate these findings.