Cognitive-Functional Intervention for Adults With ADHD (Cog-Fun-A): An Extreme Case Series Analysis.
Ifat Velder Shukrun, Jennifer R Budman, Adina Maeir
Three adult men with ADHD received 15 weekly OT sessions; two improved meaningfully, one barely changed.
The authors point to motivation, routine stability, and self-attribution as possible differentiators. With three people and no statistical testing, this cannot establish whether the treatment works.
Key findings
1Two of the three participants showed clinically meaningful gains in occupational performance (COPM gains exceeding 5 and 7 points respectively) and ADHD-specific quality of life, while the third showed no clinically meaningful COPM improvement and some worsening on executive-function subscales.
2The authors interpret the contrast as suggesting that metacognitive awareness alone was insufficient for change; rather, adaptive attribution (framing difficulties as modifiable rather than personal failure), motivation, stable daily routines, and environmental support appeared to differentiate the two responders from the non-responder.
3No statistical analyses were conducted; the authors explicitly state the findings are descriptive and hypothesis-generating rather than evidentiary, and that larger controlled studies are needed.
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What it does not show
Only three participants, all men, so nothing can be said about women or about the full range of adult ADHD presentations. Cases were selected retrospectively from a single pilot trial specifically because two improved and one did not; they are not a random or representative sample. No control group, no statistical analyses, and no blinding; any observed change could reflect time, expectancy, or other factors. The non-responder did not complete the post-intervention SRSI, so his metacognitive change is unmeasured. The authors themselves state the findings are descriptive and hypothesis-generating, not evidentiary, and that larger controlled studies are needed.
Declared interests
The authors received no financial support and declared no conflicts of interest.
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