Brief Cognitive Behavioral Therapy for College Students With ADHD: A Case Series Report

Feasibility, Acceptability, and Effectiveness of a New Cognitive-Behavioral Intervention for College Students with ADHD

OBJECTIVE

This purpose of this study was to assess the feasibility, acceptability, and effectiveness of a new group cognitive-behavioral treatment (CBT) to enhance executive function (EF) in college students with ADHD.

METHODS

Eighteen students meeting rigorous DSM-5 criteria for ADHD were enrolled in two nine-member groups. The treatment targeted time-awareness, distractibility, procrastination, and failure to plan, and included strategies to facilitate academic EF skills.

RESULTS

Eighty-four percent of students attended nine or more of the 12 weekly sessions. Repeated measures analyses of change from pre- to posttreatment yielded improvement in clinician- and self-ratings of DSM-5 ADHD inattentive symptoms, with robust effect sizes. Also improved were scores on standardized scales of time-management, concentration, and total EF.

DISCUSSION

Results provide support for the feasibility, acceptability, and effectiveness of a CBT program in reducing inattentive symptoms and enhancing EF in college students with ADHD, and warrant investigation on a larger scale.

An RCT of a CBT Intervention for Emerging Adults with ADHD Attending College: Functional Outcomes

Objective: The current study reports functional outcomes from a multi-site randomized trial of a cognitive-behavioral treatment program for college students diagnosed with ADHD.Methods: A sample of emerging adults (N = 250; ages 18 to 30) currently attending college were comprehensively evaluated and diagnosed with ADHD (M age = 19.7; 66% female, 6.8% Latino, 66.3% Caucasian). Participants were randomized to either a two-semester intervention (Accessing Campus Connections and Empowering Student Success (ACCESS)) or a delayed treatment condition. Participants were assessed with measures of academic, daily life, and relationship functioning prior to treatment, at the end of the first semester, and after the second semester of treatment.Results: Multi-group latent growth curve models revealed moderate effect size improvements on self-report measures of study skills and strategies, as well as on self-report measures of time management, daily functioning, and overall well-being for participants in ACCESS. Importantly, treatment effects were maintained or increased in some cases from the end of the first semester to the end of the second semester. Improvements in self-reported interpersonal functioning were not significantly different across condition and neither condition demonstrated significant change over time in educational record outcomes (GPA and number of credits earned).Conclusions: ACCESS appears to promote improvements in self-reported general well-being and functioning, time management, and study skills and strategies. However, improvements in interpersonal relationships and objective academic outcomes such as GPA were not observed. Clinical implications and future directions for treating ADHD on university and college campuses are discussed.

Psychometric Properties of the Weiss Functional Impairment Rating Scale: Evidence for Utility in Research, Assessment, and Treatment of ADHD in Emerging Adults

Objective: The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Method: Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. Results: The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. Conclusion: The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.

Cognitive-Behavioral Therapy for College Students With ADHD: Temporal Stability of Improvements in Functioning Following Active Treatment

Objective: This study examined the extent to which college students with ADHD continued to benefit from a cognitive-behavioral therapy (CBT) program beyond the active phase of treatment. Method: In successive cohorts over a 4-year period, a total of 88 college students with well-defined ADHD received CBT in an open clinical trial format that included active treatment and maintenance phases delivered across two consecutive semesters. Results: Immediately following active treatment, participants displayed statistically significant reductions in ADHD symptoms, improvements in executive functioning, and declines in anxiety and depression symptoms. Although grade point average did not improve significantly, there were statistically significant increases in the number of credit hours that participants attempted and earned across active treatment. Improvements in symptom severity, executive functioning, and educational functioning remained stable 5 to 7 months after active treatment concluded. Conclusion: Findings from this study support the use of CBT interventions for college students with ADHD.

A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for College Students With ADHD

OBJECTIVE

Between 2% and 8% of college students meet criteria for ADHD, with increased incidence in recent decades. There are very few clinical trials conducted on the meaningful intervention of ADHD in college. Mindfulness-based cognitive therapy (MBCT) effectively treats college students with ADHD and could be more feasibly applied in college mental health clinics.

METHOD

Fifty-four undergraduates with ADHD between ages 19 and 24 were randomized to receive either MBCT or wait-list (WL) during a 6-week intervention phase. ADHD symptoms, neuropsychological performance, and related outcomes were assessed at pre-treatment, post-treatment, and 3-month follow-up.

RESULTS

Participants receiving MBCT group showed greater treatment response rates (57%-71% vs. 23%-31%) and experience less anxiety and depression, and greater levels of mindfulness; MBCT participants show greater improvement on neuropsychological performance.

CONCLUSION

MBCT may be a useful intervention for college students with ADHD, improving participants' ADHD symptoms, mindfulness, and sustained attention.

Financial Dependence of Young Adults with Childhood ADHD

This study used data from the Pittsburgh ADHD Longitudinal Study (PALS) to evaluate financial outcomes of young adults (YA) with ADHD relative to comparisons. Participants for this study included 309 individuals who had been diagnosed with ADHD (DSM-III-R or DSM-IV) in childhood and 208 comparison YA without childhood ADHD diagnoses (total N = 517) who were followed through age 25. Participants were predominately male (88 %) and Caucasian (84 %). Diagnostic interviews were conducted in childhood. Young adults and their parents reported on financial outcomes and a number of predictor variables. Young adults with ADHD experienced greater financial dependence on family members (p < 0.05) and the welfare system (p < 0.01) and had lower earnings (p < 0.05) than comparisons. ADHD diagnostic status, education attainment, and delinquency were significant predictors of financial outcomes. A projection of lifetime earnings indicated that ADHD group participants could expect to earn $543,000-$616,000 less over their lifetimes than comparisons. Due to the propensity of individuals with ADHD to underreport problems, the data are likely to be underestimates. These findings support the need for interventions to improve labor market outcomes as well as the development of interventions that target the management of personal finances for individuals with ADHD in young adulthood.