Symptoms of ADHD and Other Common Mental Disorders Influence Academic Success in South African Undergraduates

OBJECTIVE

ADHD symptoms are highly prevalent among university students. These symptoms, particularly the inattentive cluster, predispose students to poorer academic performance and worse academic adjustment. Moreover, ADHD symptoms are often comorbid with other common mental disorders; this comorbidity also leads to poor outcomes. South African students often have fewer resources to successfully transition to university. Hence, our longitudinal study used data from a sample of South African first-year undergraduate students to investigate (a) associations between ADHD symptoms and academic performance/adjustment, (b) separate influences of the inattentive and hyperactivity-impulsivity clusters on academic performance/adjustment, and (c) the influence of the combination of ADHD and psychiatric comorbidities on academic performance/adjustment.

METHOD

We collected data three times through the first semester of 2023. Predictors within our regression models included sociodemographic variables, psychological variables (self-reported symptoms of ADHD, depression, anxiety, and risky alcohol use), and high school academic performance. Outcomes were first-semester GPA and self-reported academic adjustment (magnitude of change across the semester and overall adjustment at the end of the semester).

RESULTS

Analyses showed that, unlike academic performance (N = 506), magnitude of change in academic adjustment (N = 180) was significantly predicted by ADHD symptoms and the combination of ADHD (p = .02), depression (p < .001), and anxiety symptoms (p = .01). Inattentive ADHD symptoms predicted both academic performance and magnitude of change in academic adjustment.

CONCLUSIONS

Our findings suggest that the presence of ADHD symptoms (both with and without other common mental disorders) is associated with a smaller magnitude of academic adjustment, and that the presence of inattentive symptoms of ADHD is associated with both poorer academic performance and smaller magnitude of academic adjustment. These findings are significant in informing future interventions targeting the academic outcomes of first-year university students.

The Task Matters: A Scoping Review on Reading Comprehension Abilities in ADHD

OBJECTIVE

A broad range of tasks have been used to classify individuals with ADHD with reading comprehension difficulties. However, the inconsistency in the literature warrants a scoping review of current knowledge about the relationship between ADHD diagnosis and reading comprehension ability.

METHOD

A comprehensive search strategy was performed to identify relevant articles on the topic. Thirty-four articles met inclusion criteria for the current review.

RESULTS

The evidence as a whole suggests reading comprehension is impaired in ADHD. The most prominent effect was found in studies where participants retell or pick out central ideas in stories. On these tasks, participants with ADHD performed consistently worse than typically developing controls. However, some studies found that performance in ADHD improved when reading comprehension task demands were low.

CONCLUSION

Results suggest that performance in ADHD depends on the way reading comprehension is measured and further guide future work clarifying why there are such discrepant findings across studies.

The academic journey of students with specific learning difficulties undertaking pre-registration nursing programmes in the UK: A retrospective cohort study

BACKGROUND

The prevalence of nursing students with specific learning difficulties enrolled on pre-registration nursing programmes and the impact that this diagnosis has on their programme outcomes are currently unknown.

OBJECTIVES

The aim of this paper is to report on data that explored and compared the academic journey of students with and without learning difficulties on pre-registration nursing degree programmes.

DESIGN

A retrospective cohort design.

SETTINGS

One university in the UK offering BSc Honours Degree programmes in Adult and Mental Health Nursing.

PARTICIPANTS

Pre-registration adult and mental health nursing students (n = 1152) enrolled in the programmes between 2012 and 2016.

METHODS

Pearson's Correlation, ANOVA and crosstabulation were used to identify the differences and associations between each group of students with the outcome variables grade percent average and programme completion.

RESULTS

A total of 12.5% of the students were identified as having a diagnosed specific learning difficulty and were entitled to reasonable adjustments. The analysis shows that their grade percent average and completion rates are equivalent to students without a specific learning difficulty.

CONCLUSIONS

The differences between students with a specific learning difficulty and those without are small across the variables measured. Reasonable adjustments appear to mitigate the learning difficulties that students with specific learning difficulties have. Educators need to continue to promote ways of identifying students with specific learning difficulties as early as possible in the student's academic journey. Responsive adjustments in teaching and assessment in theory and practice components should be implemented to ensure that all students' opportunities to succeed are maximised.

Accommodation decision-making for postsecondary students with ADHD: Implications for neuropsychologists

Neuropsychologists are often asked to evaluate students for attention-deficit/hyperactivity disorder (ADHD) and to provide documentation to support their requests for academic accommodations in college. Research points to the importance of multi-method, multi-informant data when evaluating ADHD and determining the need for accommodations. However, the Association on Higher Education and Disability (AHEAD) directs disability service providers to give primacy to students' self-reports and their own impressions of students' narratives over objective, third-party data when rendering accommodation decisions. The organization asserts that in many cases information from parents, teachers, and psychologists is not needed to confirm the existence of a disability or students' need for accommodations. In this article, we describe the way disability service providers are directed to evaluate accommodation requests, the limitations of these procedures, and the dangers of well-intentioned, but indiscriminate accommodation-granting. We then provide recommendations for neuropsychologists who conduct ADHD evaluations for college students in light of these professional guidelines.

Profiles of Diagnosed and Undiagnosed College Students Meeting ADHD Symptom Criteria

Objective: This study compared the psychological profiles of college students who self-reported an ADHD diagnosis in contrast to students without a diagnosis who reported above-threshold ADHD symptoms. Method: A large sample of college students yielded four subgroups: students with a self-reported diagnosis who met symptom criteria (Diagnosed, n = 40), students with a self-reported diagnosis who did not meet symptom criteria (Low Symptoms, n = 47), students who had no diagnosis and did not meet symptom criteria (Controls, n = 87), and students who had no diagnosis yet met symptom criteria (Undiagnosed, n = 38). All participants completed a battery of self-report rating scales assessing a variety of symptom and impairment domains. Results: The Diagnosed and Undiagnosed groups differed significantly from Controls on all domains, while the Low Symptom group did not differ significantly from Controls in any domain. Conclusion: Implications for engaging with reported diagnosis of ADHD in the college population are discussed.

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.

First-Year GPA and Academic Service Use Among College Students With and Without ADHD

Objective: ADHD is a chronic neurodevelopmental disorder that typically results in persistent academic difficulties over time. Although most colleges offer support services, students often do not use the available services or those to which they are entitled. The present study examined predictors of academic performance among college students with and without ADHD. In addition, the rate, predictors, and outcomes of academic service use were explored. Methods: A series of multivariate analyses of variance (MANOVAs) and regression analyses were conducted using SPSS v. 21 ® software. Results: First year college students with ADHD earned significantly lower grade point averages (GPAs) relative to students without ADHD. Additionally, ADHD combined with other disorders, but not ADHD alone, predicted higher rates of service use relative to students without ADHD. Finally, the findings suggest that typically available academic services are not independently related to GPA among first-year college students with or without ADHD. Conclusion: This study replicates previous work demonstrating significantly lower GPAs among a rigorously defined sample of students with ADHD relative to students without ADHD. Second, this study indicates that traditional predictors of college success may be less meaningful for students with ADHD relative to those without ADHD. Finally, additional research needs to be conducted regarding the use and effectiveness of academic services on college campuses.

The Implementation of Extended Examination Duration for Students With ADHD in Higher Education

OBJECTIVE

Recently, research indicated that extended examination duration was perceived as effective by students with ADHD. However, the objective effectiveness of this accommodation has not been researched extensively. This study addresses this gap in literature.

METHOD

A total of 30 students with ADHD and 30 matched typically developing controls (TDC) participated in a simulation of a real-life examination. They filled in three parallel versions of a paper-and-pencil test in three time conditions: 1 hr (+0%), 1 hr 20 min (+33%), and 1 hr 30 min (+50%).

RESULTS

When granted extended examination duration, students with ADHD and TDC use extra time but their performance does not increase. In addition, test-taking strategies were altered to a limited extent, and strategies that are perceived as effective (e.g., marking key words) were rarely used by the students.

CONCLUSION

It is concluded that extended examination duration is not objectively effective in an experimental design. Limitations and guidelines for future research are formulated.

Validation of curriculum-based reading passages and comparison of college students with and without dyslexia or ADHD

Although reading is an essential skill for college success, little is known about how college students with and without disabilities read within their actual college curriculum. In the present article, we report on two studies addressing this issue. Within study 1, we developed and validated curriculum-based oral reading fluency measures using a sample of college students without disabilities (N = 125). In study 2, we administered the curriculum-based measures to four groups (each with n = 25): college students without disabilities, college students with dyslexia, college students with ADHD, and a clinical control group. Study 1 results indicated that the curriculum-based measures demonstrated good reliability and criterion validity. Results from study 2 indicated that college students with dyslexia were substantially slower readers than all groups without dyslexia (ds > 1.8). The curriculum-based measures demonstrated high accuracy in classifying participants with dyslexia and with impaired oral reading fluency (area under the curve > .94). Implications for incorporating curriculum-based measures in postsecondary settings are discussed.

Pay attention to digital text: The impact of the media on text comprehension and self-monitoring in higher-education students with ADHD

BACKGROUND

Higher-education students with attention deficit hyperactivity disorder (ADHD) often face difficulties in self-regulation of learning (SRL). Studies of typical students have shown that SRL is less effective for digitally displayed texts. The current study investigated the influence of the media (digital, print) on reading comprehension and self-monitoring (a component of SRL) in higher-education students with and without ADHD.

METHODS

Forty-five students with ADHD and 61 matched controls read an expository text displayed digitally or in print. Then, they predicted their performance score and answered comprehension questions. Sustained attention and set-shifting abilities were also assessed.

RESULTS

In the digital condition, students with ADHD had significantly lower comprehension scores and were overconfident in their predictions of success relative to controls. In the print condition, the ADHD group spent more time reading the text, but their predictions of performance and comprehension scores were comparable to those of the control group. Poor sustained attention was significantly correlated with lower comprehension scores in both media conditions, whereas set-shifting correlated only with comprehension of the printed text.

CONCLUSIONS

Understanding a digitally displayed text is more challenging for students with ADHD than their peers, particularly when the conditions of the comprehension task favor good SRL skills.

Predicting the Extended Time Use of College Students With Disabilities

This study investigated the extent to which standardized reading performance, individual perceptions of reading and test taking skills, and test anxiety predict the amount of extended time needed to equalize test access for college students with disabilities. Thirty-seven college students with a specific learning disorder (LD) and/or an attention deficit hyperactivity disorder (ADHD) diagnosis who received university test accommodations were recruited to participate in this study, along with 37 controls. All participants individually completed standardized reading tests and rating scales, and a timed reading comprehension task in a group setting. Results indicated that participants receiving test accommodations utilized approximately 14% more time than control participants to complete the timed reading task. Regression analyses indicated that the differences in time required to complete the reading comprehension task were related to participants’ reading fluency and decoding, as well as perceptions of the strength of their reading and test taking skills.

Separate Room Testing Accommodations for Students With and Without ADHD

Students with attention-deficit/hyperactivity disorder (ADHD) are frequently provided a separate room in which to take exams, to reduce external distractions. However, little research has explored the efficacy of this accommodation. In the present study, college students with ( n = 27) and without ( n = 42) ADHD diagnoses were administered two parallel forms of a timed silent reading comprehension test, one in a classroom with other students, and one in a private, proctored setting. A two-way analysis of variance found no significant main effects for either ADHD status or test setting on performance, and no significant interaction between the factors either. However, inspection of student-level data and exploration of continuous relationships between self-reported ADHD symptoms and test performance patterns suggested that separate room accommodations may be beneficial for a subgroup of students with ADHD.

Challenges From and Beyond Symptomatology: Stereotype Threat in Young Adults With ADHD

OBJECTIVE

Stereotype threat-faced when one confronts a personally relevant stereotype in a domain-relevant context-can significantly jeopardize individual performance in test-taking situations. Research has overlooked the potential for mental health labels to serve as bases for stereotype threat in such situations. This study examines whether ADHD, a disorder frequently serving as a basis for standardized testing accommodation, may trigger stereotype threat in testing situations.

METHOD

Drawing from a sample of 114 participants (53 reporting a history of ADHD and 61 not reporting a history of ADHD), this study considers whether stereotype threat invoked on the basis of ADHD hinders performance on Graduate Record Examination (GRE) questions beyond the impact of symptomatology.

RESULTS

Participants reporting ADHD achieved significantly lower scores on verbal and quantitative GRE questions than participants without ADHD. Participants between the ages of 18 and 24 reporting ADHD who were explicitly exposed to stereotype threat achieved significantly lower scores on quantitative GRE questions than their ADHD-reporting peers who were not explicitly exposed to stereotype threat.

CONCLUSION

Domain-relevant mental health labels may trigger stereotype threat in test-taking situations.

ADHD Assessment in College Students: Psychologists’ Adherence to DSM-5 Criteria and Multi-Method/Multi-Informant Assessment

The evidence-based assessment of attention-deficit/hyperactivity disorder (ADHD) depends on adherence to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) diagnostic criteria and reliance on multi-method/multi-informant data. Although nearly all psychologists endorse these practices, college students with ADHD may lack documentation supporting their diagnoses. We reviewed the documentation submitted by 214 undergraduates diagnosed with ADHD and receiving academic accommodations for this condition. Their clinicians also completed a checklist that described their assessment procedures. Relatively few psychologists assessed all DSM-5 criteria, based on either the psychologist’s self-reported assessment procedures (23.4%), written documentation (14.0%), or multi-method/multi-informant data (10.3%) such as educational/medical records, results of rating scales, or interviews with other informants. Psychologists were least likely to assess students’ areas of impairment or to rule out alternative causes for students’ self-reported symptoms. This lack of adherence to DSM-5 criteria and overreliance on students’ self-reports can threaten the reliability of diagnosis and the appropriateness of medication and accommodations that follow.

Sluggish Cognitive Tempo and Speed of Performance

OBJECTIVE

This study examined whether college students who reported higher levels of sluggish cognitive tempo (SCT) symptoms were actually more "sluggish" in their performance while completing speeded cognitive and academic measures.

METHOD

College students ( N = 253) completed self-reports of SCT and their reading and test-taking abilities as well as tests of processing speed, reading fluency, and reading comprehension.

RESULTS

Across all variables, SCT symptoms were most significantly associated with self-reported difficulty on timed reading tasks. However, students with high SCT scores were not significantly slower than controls on any of the timed tasks.

CONCLUSION

In college students, self-reports of high SCT levels do not suggest actual slow performance on cognitive and academic tasks.

Test-Taking Skills of High School Students With and Without Learning Disabilities

This study assessed the test-taking skills of 776 high school students, 35 of whom were diagnosed with learning disabilities (LD). Students completed a computerized battery of timed reading tests as well as scales that assess test anxiety and test-taking perceptions. Students with LD obtained lower scores than the nondisabled group on all of the reading tasks (speed, comprehension, vocabulary, and decoding), spent more time reviewing comprehension questions, and were less active in looking for answers in the passages. Both groups favored the same comprehension strategy of reading the entire passage and then answering questions. The groups did not differ in their levels of test anxiety or confidence in taking tests under timed conditions. Vocabulary score best discriminated between groups and best predicted reading comprehension performance, suggesting a potential target for intervention.

Psychological and cortisol reactivity to experimentally induced stress in adults with ADHD

Individuals with ADHD suffer from increased vulnerability to environmental and mental stressors and may be at increased risk for chronic stress in everyday life. The Hypothalamic-Pituitary-Adrenal (HPA) axis is a critical physiological system that mediates responses to stress. The present study seeks to examine test performance, test anxiety, self-reported psychological stress and cortisol reactivity to mental-cognitive stress in adults with ADHD when compared with healthy controls. Stress was induced by an arithmetic ability test. Psychological stress was assessed repeatedly throughout the experimental session. Salivary cortisol, an indicator of the HPA axis function, was evaluated immediately upon arrival, as well as 1 min and 20 min post-test completion. Results revealed higher levels of test anxiety and poorer performance on the test in the ADHD group. The ADHD and control groups showed no difference in base-line levels of subjective stress and in subjective stress levels 20 min after the test. In contrast, individuals with ADHD reported significantly higher levels of stress at the test anticipation phase and 1 min post-test completion. Cortisol response to stress differed according to group: in the ADHD group, 20 min post-test cortisol levels were significantly higher than base-line cortisol levels. This was not evident in the control group. These results suggest greater activation of the HPA axis in response to stress in adults with ADHD when compared with healthy controls. Adults with ADHD do not differ from controls in basal levels of subjective stress and cortisol, but do have stronger psychophysiological reactions in response to stressful challenges. The present findings are among the first to demonstrate significant alterations in cortisol reactivity to stress in adults with ADHD.

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.

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.

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.