Symptoms of ADHD and academic concerns in college students with and without ADHD diagnoses

Test-Taking Speed: Predictors and Implications

Students often feel time pressure when taking tests, and students with disabilities are sometimes given extended time testing accommodations, but little research has been done on the factors that affect students’ test-taking speed. In the present study, 253 students at two colleges completed measures of processing speed, reading fluency, and self-reports of their reading and test-taking skills, as well as a standardized paper-and-pencil reading comprehension task. The time taken to complete the reading comprehension task was not significantly related to students’ accuracy on the task, but it was predicted by students’ reading fluency and by their self-reports of problems with timed reading/test-taking. Students’ processing speed did not significantly predict comprehension task completion time or accuracy when reading fluency and self-reports were held constant. We discuss the implications of these and other results for making determinations about extended time testing accommodations, as well as for future research studies.

Postsecondary ADHD Documentation Requirements: Common Practices in the Context of Clinical Issues, Legal Standards, and Empirical Findings

OBJECTIVE

To evaluate the information postsecondary institutions require when determining disability service eligibility for students with reported ADHD.

METHOD

ADHD documentation requirements of 200 U.S. institutions were surveyed by reviewing guidelines posted on disability services websites.

RESULTS

Whereas virtually all institutions required documentation, findings revealed significant variability in requirements across institutions. Required variables most often included a qualified evaluator (80%), diagnostic statement (75%), and identification of substantial limitations (73%), but only 5 of 46 evaluated variables were required by at least 50% of institutions. Supportive data such as diagnostic criteria, standardized assessment results, and rationale for accommodations were rarely required.

CONCLUSION

The majority of institutions required little to verify ADHD as a disability. Furthermore, there was little agreement on what components are essential for verification. When integrated with research, a large portion of guidelines failed to address identified weaknesses in ADHD diagnosis and disability determination.

ADHD in the College Setting: Current Perceptions and Future Vision

OBJECTIVE

To assess perceptions concerning ADHD among U.S. college healthcare providers.

METHOD

A 37-question survey was conducted from October 4 to December 2, 2010. Participants were contacted via mail or telephone and compensated for participation.

RESULTS

Thirty-eight percent of the respondents (physicians, n = 59; nurses, n = 138; directors, n = 101) viewed ADHD as a "problem"/"very much a problem" at their institution. Referrals for evaluation came from students (84%), psychologists/counselors (68%), or the institution (68%). Although 48% of respondents felt "comfortable"/"very comfortable" in their ability to recognize ADHD, 92% referred students for evaluation. Most respondents (>90%) agreed medication use may be warranted; 52% of respondents who treat ADHD or consult with a specialist (from 95% of physicians to 31% of directors) prescribed pharmacotherapy.

CONCLUSION

Although college healthcare providers recognize the importance of treating ADHD, their discomfort in diagnosing and treating ADHD represents a barrier to care for college students.

Effects of Extended Time for College Students With and Without ADHD

OBJECTIVE

The number of students with a disability requesting test accommodations has been steadily increasing in higher education settings. The present study examined the effects of extra time on the reading comprehension performance of college students with and without ADHD.

METHOD

A modified version of The Nelson-Denny Reading Test was completed by 38 college students with ADHD and 38 matched controls under three conditions: standard time, time and one half, and double time.

RESULTS

Groups did not differ in the number of items attempted or correctly answered at standard time, time and one half, or double time. Comparing the ADHD group at extended time to non-ADHD peers at standard time, the ADHD group attempted and answered significantly more test items.

CONCLUSION

Extra time conferred an advantage to the ADHD group, suggesting that extended time accommodations are not specific and perhaps not necessary for all college students with an ADHD diagnosis.

The Link Between ADHD and the Risk of Sexual Victimization Among College Women

Using data from a nationally representative sample of college women, the current study examines attention deficit hyperactivity disorder (ADHD) as a potential risk factor in the prediction of sexual victimization among college women and as an extension of the lifestyles/routine activities framework. The findings indicate that college women with ADHD experienced sexual victimization at significantly higher rates than college women without ADHD. Furthermore, ADHD emerged as a significant predictor of sexual victimization across models. The lifestyles/routine activities theory also received general support, particularly for the concepts of exposure, proximity, and guardianship. This research suggests that other risk factors outside the lifestyles/routine activities framework are important in the prediction of sexual victimization in college women.

Repercussões do Transtorno de Déficit de Atenção/Hiperatividade (TDAH) na Experiência Universitária

Buscou-se verificar de que forma o diagnóstico do Transtorno de Déficit de Atenção/Hiperatividade (TDAH), ou a presença dos sintomas do transtorno, interfere na vida acadêmica de estudantes universitários. Realizou-se uma revisão sistemática de literatura com os descritores estudantes universitários/college students e TDAH/ADHD nas bases de dados Scielo Brasil, Index Psi, Redalyc, Medline, ePsycARTICLES no período de 2004 a 2014. Foram encontrados 53 artigos e, destes, 15 foram analisados. Os trabalhos visavam apontar as semelhanças e as diferenças entre estudantes universitários com e sem sintomas ou diagnóstico de TDAH quanto a variáveis que podem afetar a experiência universitária, bem como descrever o transtorno nessa população. Os jovens com e sem TDAH tendem a ser semelhantes no que se refere ao autoconceito e ao bem-estar psicológico, mas diferentes quanto à adaptação à universidade e às preocupações com o desempenho acadêmico. Esta revisão oferece um panorama sobre o que já se sabe sobre TDAH em estudantes universitários e sobre a forma como os estudos com esse público têm sido realizados.

Documenting Hidden Disabilities in Higher Education

Once students with disabilities leave high school, they must take proactive steps to document their disabilities to educational institutions or employers when requesting accommodations. The Association on Higher Education and Disability (AHEAD) has been the principal organization offering suggestions on documentation requirements, and AHEAD’s recently revised guidance involves radical changes to the suggested requirements. AHEAD now recommends that students’ self-reports and disability services professionals’ impressions take precedence over external, objective records. This article reviews the relevant research to evaluate the evidence base for the revised guidance, finding it lacking in important ways as it applies to hidden disabilities (learning, cognitive, and psychiatric disabilities). The evidence supporting various sources of disability documentation is reviewed, and implications for policy and practice are discussed.

Test Anxiety and College Students With Attention Deficit Hyperactivity Disorder

Test anxiety was examined in college students with and without attention deficit hyperactivity disorder (ADHD). Results indicated that, relative to college students without ADHD, college students with ADHD reported higher total test anxiety as well as specific aspects of test anxiety, including worry (i.e., cognitive aspects of test anxiety) and emotionality (i.e., physiological aspects of test anxiety). Effect sizes were large for total test anxiety and the worry aspect of test anxiety. Nearly half of college students with ADHD reported clinically significant levels of the worry aspect of test anxiety. Females with ADHD reported higher levels of the emotionality aspect of test anxiety than did males with ADHD. Those with combined type and inattentive type ADHD did not differ on any aspect of test anxiety. Implications for assessment and intervention are discussed.

Correlation of symptomatic improvements with functional improvements and patient-reported outcomes in adults with attention-deficit/hyperactivity disorder treated with OROS methylphenidate

OBJECTIVES

To evaluate correlations between symptom severity and daily functioning in adults with ADHD.

METHODS

In the 5-week, double-blind LAMDA study, 401 adults with ADHD were randomly assigned to Osmotic-Release Oral System (OROS) methylphenidate (MPH) 18, 36 or 72 mg/day, or placebo. The primary variable - investigator-rated Conners' Adult ADHD Rating Scale (CAARS:O-SV) - has been presented previously. Secondary endpoints included the self-reported version of CAARS (CAARS-S:S) and Clinical Global Impression - Severity (CGI-S). Daily functioning and quality of life were assessed using the Sheehan Disability Scale (SDS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Relationships between symptom and functional outcomes were evaluated in post-hoc Pearson partial correlation, multivariate regression and mediator analyses.

RESULTS

Improvements in CAARS-S:S, CGI-S and SDS scores were significantly greater in each OROS MPH arm versus placebo (P < 0.01 for all comparisons). Correlations between symptom and functioning scores were significant for all comparisons (P < 0.0001). In regression analyses, CAARS Hyperactivity/Impulsivity subscale and CGI-S were correlated with SDS (P < 0.05). CAARS Inattention was correlated with the SDS Family Life domain (P < 0.05). In a mediator analysis, the impact of treatment on SDS scores was fully mediated by improvement in CAARS:O-SV score.

CONCLUSIONS

OROS MPH 18-72 mg/day was associated with significant improvements in ADHD symptoms, which correlated with improved daily functioning and health-related quality of life.

An examination of prescription stimulant misuse and psychological variables among sorority and fraternity college populations

OBJECTIVE

The objective of this study was to examine nonmedical stimulant use among fraternity/sorority members and nonmembers and whether psychological variables (e.g., internal restlessness, depression, anxiety, and stress) were related to nonmedical stimulant use.

METHOD

The sample consisted of 1,033 undergraduate students from five universities located in the northeastern, southeastern, northwestern, southwestern, and midwestern regions of the United States.

RESULTS

The findings revealed that fraternity and sorority members reported a higher rate of nonmedical stimulant use than nonmembers. In addition, regression analyses revealed that higher ratings of anxiety, stress, internal impulsivity, and internal restlessness significantly predicted nonmedical stimulant use.

CONCLUSION

Current findings support further examination of nonmedical stimulant use among other college student subpopulations (i.e., athletic teams, honor societies, residence halls). In addition, there is a strong need to develop research-based intervention and preventive measures that target college populations identified as being at risk for nonmedical stimulant use.

Risk screening for ADHD in a college population: is there a relationship with academic performance?

OBJECTIVE

The present study examines the relationship between self-reported levels of ADHD and academic outcomes, as well as aptitude.

METHOD

A total of 523 college students took the Adult Self-Report Scale-Version 1.1 (ASRS-V1.1), and their scores were compared with course performance and ACT (American College Test) composite scores.

RESULTS

The measure identified 70 students (13.4%) as being in the "highly likely" category for an ADHD diagnosis. Course exam and ACT scores for the 70 "highly likely" students were statistically identical to the remaining 453 students in the sample and the 77 students identified as "highly unlikely" as well. Only 4 of the "highly likely" 70 students were registered with the university's Office of Student Disability Services as having been diagnosed with ADHD.

CONCLUSIONS

The ASRS-V1.1 failed to discriminate academic performance and aptitude differences between ADHD "highly likely" and "highly unlikely" individuals. The use of self-report screeners of ADHD is questioned in contexts relating ADHD to academic performance.

Cognitive responses to stress, depression, and anxiety and their relationship to ADHD symptoms in first year psychology students

OBJECTIVE

To explore the relationship between levels of reported depression, anxiety, and stress with scores on the Conners's Adult ADHD Rating Scale (CAARS).

METHOD

Information was obtained from 84 1st-year psychology students using the CAARS, the Depression Anxiety and Stress Scale (DASS), and the Life Experiences Survey (LES).

RESULTS

Approximately 23%, 18%, and 12% of students scored above critical values on the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) Inattention Symptoms, the DSM-IV ADHD Symptoms Total, and the Inattention/Restlessness subscales, respectively. CAARS scores were positively related to reported levels of depression, anxiety, and stress, which accounted for significant variance among the three subscales. Only 5% of participants scored above recommended critical values on the ADHD index; however, a significant amount of the variance on this measure was also attributable to the DASS.

CONCLUSION

Mood symptoms such as depression, anxiety, and stress may obscure correct attribution of cause in those being evaluated for ADHD.

Testing Accommodations Under the Amended Americans With Disabilities Act

The 2008 amendments to the Americans With Disabilities Act have now been followed by implementation guidelines from the Department of Justice. These guidelines take strong positions on how testing entities should review requests for testing accommodations from examinees with disabilities. In this article, themes from the guidelines are evaluated against the findings of recent empirical research, highlighting major discrepancies. In general, the Department of Justice places more trust in the accommodations expertise of K–12 schools, clinical professionals, and testing entities than is warranted by empirical research. This trust is likely to lead to excessive recommendation of testing accommodations, even when they threaten a test’s validity. Several implications of these findings for practice and policy are discussed.

What do we really know about ADHD in college students?

Research on ADHD in college students began in the 1990s and has been steadily increasing in recent years. Because young adults with ADHD who attend college have experienced greater academic success during high school than many peers with the disorder, which is likely to be associated with better overall functioning, the degree to which they experience similar patterns of adjustment difficulties was not initially known. Accumulating research suggests that college students with ADHD experience less academic success and greater psychological and emotional difficulties than other students and use alcohol and drugs at higher rates. However, conclusions to be drawn from this research are limited by the use of small samples that may not be representative of the wider population of students with ADHD, and a lack of diagnostic rigor in identifying students with ADHD to be included in such research. Studies of the effectiveness of psychosocial treatments, medication treatment, and academic accommodations are extremely limited or nonexistent. Issues particularly germane to college students include feigning ADHD and the misuse and diversion of stimulant medication. Given that at least 25 % of college students with disabilities are diagnosed with ADHD, methodologically sound investigations are clearly needed in order to better understand the impact of ADHD on college students' adjustment and to develop and implement interventions that can enhance students' success.

Double-blind, placebo-controlled, crossover study of the efficacy and safety of lisdexamfetamine dimesylate in college students with ADHD

OBJECTIVE

To evaluate stimulant medication on symptoms and functioning for college students with ADHD using double-blind, placebo-controlled, crossover design.

METHOD

Participants included 24 college students with ADHD and 26 college students without psychopathology. Lisdexamfetamine dimesylate (LDX) was examined for ADHD participants over five weekly phases (no-drug baseline, placebo, 30-, 50-, and 70-mg LDX per day). Self-report rating scales of functioning and direct assessment of ADHD symptoms, verbal learning/memory, and adverse side effects were collected (baseline only for control students).

RESULTS

LDX was associated with large reductions in ADHD symptoms and improvement in executive functioning along with smaller effects for psychosocial functioning. Reduction in ADHD symptoms was found for 86.4% of participants; however, large differences in symptoms and executive functioning remained relative to controls.

CONCLUSION

LDX is a safe, efficacious treatment for symptom relief in college students with ADHD. Research documenting medication effects on academic functioning and evaluating psychosocial/educational interventions is needed.

Sex differences in the manifestation of ADHD in emerging adults

OBJECTIVE

Given the mixed literature in the area, the aim of the current study was to determine whether sex differences exist in inattention, hyperactivity, and impairment in college adults with ADHD.

METHOD

Individuals from three universities were recruited for the study. Participants with (n = 164) and without ADHD (n = 710) completed on-line measures of symptoms and impairment.

RESULTS

College women with ADHD were shown to have higher rates of inattention, hyperactivity, and impairment than college women without ADHD and college men with ADHD. Analyses revealed that women in college who have ADHD experience higher levels of impairment in the following domains: home life, social life, education, money management, and daily life activities.

CONCLUSION

Overall, clear differences emerged between men and women with ADHD. Implications and future directions are discussed.

The identification of attention complaints in the general population and their effect on quality of life

OBJECTIVE

To provide more insight into subjective attention complaints in a healthy adult and elderly population and how these affect Quality of Life (QoL).

METHOD

A group of 1,550 healthy Dutch participants complete a postal questionnaire including items from the Maastricht Attention and Memory Checklist (MAC). The impact of attention complaints on QoL is investigated in a subsample of 499 participants.

RESULTS

Factor analysis (N = 1,550) reveals two factors: Attention and Memory. Attention complaints are related to depressed mood, anxiety, vitality, and sleep problems that can have serious consequences for daily life functioning and QoL (n = 499). Memory complaints are related to other aspects of health, such as pain and changes in health.

CONCLUSION

Attention complaints in the healthy population are common and related to depression, anxiety, and sleep and several aspects of QoL, such as problems with social functioning, emotional problems, and vitality.

What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD)

The relevant literature concerning cognitive effects of amphetamine and methylphenidate, was reviewed, with an emphasis on research conducted in adults diagnosed with attention-deficit/hyperactivity disorder. As first-line treatment for ADHD, stimulant drugs are well-known to improve attention and concentration. Yet, there is increasing evidence that (as with children and adolescents), they do not promote learning and academic achievement in adult college students with ADHD. A review of neuropsychological studies indicates that, although response latencies are reduced, performance of ADHD adults on tests of 'distractibility' and 'planning' is also not consistently improved by stimulants. Studies in non-ADHD adults suggest that stimulants do not promote acquisition of new information, might improve retention of previously acquired information, and facilitate memory consolidation, but may actually impair performance of tasks that require adaptation, flexibility and planning. It is still not clear if improvement only occurs when there is a baseline deficit. Stimulants may influence cognition by their effects on physiological arousal. Regardless, the evidence does not support the conclusion that stimulants are cognitive 'enhancers.'

College students with ADHD: current status and future directions

Approximately 2 to 8% of the college population reports clinically significant levels of ADHD symptomatology and at least 25% of college students with disabilities are diagnosed with ADHD. A comprehensive review of the literature was conducted with findings consistently indicating academic deficits associated with ADHD in college students. It is less clear whether this disorder significantly impacts social, psychological, and neuropsychological functioning. Although several self- and parent-report measures have been developed for this population, very few studies of assessment methods have been conducted. Similarly, no controlled studies of psychopharmacological, psychosocial, or educational interventions have been completed in samples of college students with ADHD. Non-prescribed use (i.e., diversion) of stimulant medication is a growing problem with approximately 7% of college students reporting this behavior. Studies, to date, are limited by lack of controlled investigations, use of small samples, and lack of confirmation of diagnostic status. Comprehensive and methodologically sound investigations are needed, especially regarding treatment, to promote the success of students with ADHD in higher education settings.