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

ADHD Assessment and Treatment Services in a Sample of U.S. Colleges and Universities

OBJECTIVE

Up to 2 million college students in the United States have been diagnosed as having attention-deficit hyperactivity disorder (ADHD), a condition associated with negative academic, social, and psychiatric outcomes. The authors investigated the online availability and content of policies governing ADHD services at college clinics.

METHODS

Using a stratified sample of 200 colleges and universities, the authors reviewed clinic websites and invited clinical staff to participate in a survey. They weighted percentages to account for oversampling and used regression modeling to examine associations with policy availability.

RESULTS

Only 70 institutions (32%, weighted percentage) provided information about ADHD services online. Institutions with <1,000 students had significantly lower odds of providing information online (adjusted odds ratio [AOR]=0.04, 95% CI=0.01-0.26), as did institutions that accepted >67% of applicants (AOR=0.18, 95% CI=0.07-0.48). After merging data from the Web review and survey, the authors noted that 14% (N=11 of 75 institutions with data available for this variable) facilitated neuropsychological assessments on campus, 49% (N=33 of 72) did not allow stimulant medications to be prescribed, 73% (N=43 of 61) did not offer clinical evaluations for ADHD, and 89% (N=32 of 35) required a neuropsychological assessment to receive prescription stimulants.

CONCLUSIONS

Information about the assessment and management of ADHD is rarely available online, and ADHD services on U.S. college campuses appear to be limited.

Examining the effectiveness of a social-play-based programme to reduce symptoms of Attention-Deficit/Hyperactivity Disorder in Saudi elementary school children

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions in children, and can profoundly affect their social interactions, well-being, and relationships with parents, peers, and teachers.

OBJECTIVE

This study investigated the effectiveness of a social-play-based intervention programme in reducing ADHD symptoms in a sample of 67 Saudi boys aged 8-10 diagnosed with ADHD.

METHODS

The programme consisted of ten 60-minute sessions of play-based activities, delivered to the experimental group twice weekly for 5 weeks. The control group followed the usual school curriculum. Teachers and parents completed the Conners' Teacher Rating Scale-Revised: Short Form and Conners' Parent Rating Scale-Revised: Short Form for all participants at pre-test, post-test, and follow-up.

RESULTS

The experimental group showed a significant reduction in ADHD-associated behavioural problems over time, with moderate to large effect sizes. No significant changes over time were found for the control group. The results were maintained at a 2-month follow-up.

CONCLUSIONS

We recommend incorporating social-play-based activities and skill training into the school context. Reducing ADHD symptoms may improve children's academic performance and perspective on school.

A systematic review of actions aimed at university students with ADHD

University students with Attention Deficit Hyperactivity Disorder (ADHD) need to have a range of actions at their disposal that are tailored to their needs. The aim of this study is to analyse the actions of support for university students with ADHD by means of a systematic review of ERIC, WOS, and Scopus from 2017 to 2022, following the PICOC and PRISMA guidelines. A sample of 24 studies are analysed through the MAXQDA 2022 software. The results show two types of studies, on the one hand, supporting actions offered directly by universities to their students and, on the other, intervention programs from which university students have benefit but outside the university settings. Concerning the first type, universities mainly offer accommodations linked to exams, tutoring and online courses adapted to ADHD students. About the second type, programmes focused on cognitive-behavioural therapy, coaching and mindfulness have proven to be useful with ADHD university students. In this sense, further research is needed to analyze the viability of including these intervention programs for ADHD students at universities.

Motives for nonmedical use of prescription stimulants in community college students

Objective: The present study identified common motives for nonmedical use of prescription stimulants (NMUS) among community college (CC) students and examined behavioral and demographic correlates of certain motives. Participants: The survey was completed by 3,113 CC students (72.4% female; 81.7% White). Methods: Survey results from 10 CCs were evaluated. Results: NMUS was reported by 9% (n = 269) participants. The most common motive for NMUS was to "focus on studies or to improve academic performance" (67.5%) followed by to "have more energy" (52.4%). Females were more likely to report NMUS for weight loss, and males were more likely to report NMUS to experiment. The motive "to feel good or get high" was linked to polysubstance use. Conclusions: CC students report similar motives for NMUS to those commonly endorsed by 4-year university students. These findings may help identify CC students susceptible to risky substance use.

The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review

Psychological theory and interpretation of research are key elements influencing clinical treatment development and design in Attention Deficit Hyperactivity Disorder (ADHD). Research-based treatment recommendations primarily support Cognitive Behavioural Therapy (CBT), an extension of the cognitive behavioural theory, which promotes a deficit-focused characterisation of ADHD and prioritises symptom reduction and cognitive control of self-regulation as treatment outcomes. A wide variety of approaches have developed to improve ADHD outcomes in adults, and this review aimed to map the theoretical foundations of treatment design to understand their impact. A scoping review and analysis were performed on 221 documents to compare the theoretical influences in research, treatment approach, and theoretical citations. Results showed that despite variation in the application, current treatments characterise ADHD from a single paradigm of cognitive behavioural theory. A single theoretical perspective is limiting research for effective treatments for ADHD to address ongoing issues such as accommodating context variability and heterogeneity. Research into alternative theoretical characterisations of ADHD is recommended to provide treatment design opportunities to better understand and address symptoms.

Educational level, attention problems, and externalizing behaviour in adolescence and early adulthood: the role of social causation and health-related selection-the TRAILS study

Social causation and health-related selection may contribute to educational differences in adolescents' attention problems and externalizing behaviour. The social causation hypothesis posits that the social environment influences adolescents' mental health. Conversely, the health-related selection hypothesis proposes that poor mental health predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as attention problems and externalizing behaviour have the potential to interfere with educational attainment, but may also be affected by differences in the educational context. Furthermore, educational gradients in mental health may reflect the impact of 'third variables' already present in childhood, such as parental socioeconomic status (SES), and IQ. We investigated both hypotheses in relation to educational differences in externalizing behaviour and attention problems throughout adolescence and young adulthood. We used data from a Dutch cohort (TRAILS Study; n = 2229), including five measurements of educational level, externalizing behaviour, and attention problems from around age 14-26 years. First, we evaluated the directionality in longitudinal associations between education, externalizing behaviour, and attention problems with and without adjusting for individual differences using fixed effects. Second, we assessed the role of IQ and parental SES in relation to attention problems, externalizing behaviour, and educational level. Attention problems predicted decreases in education throughout all of adolescence and young adulthood. Differences in parental SES contributed to increases in externalizing behaviour amongst the lower educational tracks in mid-adolescence. Childhood IQ and parental SES strongly predicted education around age 14. Parental SES, but not IQ, also predicted early adolescent attention problems and externalizing behaviour. Our results provide support for the health-related selection hypothesis in relation to attention problems and educational attainment. Further, our results highlight the role of social causation from parental SES in determining adolescent educational level, attention problems, and externalizing behaviour.

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.

Academic Trajectories of College Students with and without ADHD: Predictors of Four-Year Outcomes

Objective: Completing a college degree is associated with success in employment, financial earnings, and life satisfaction. Mental health difficulties, including attention-deficit/hyperactivity disorder (ADHD), can compromise degree completion.Method: We examined 4-year academic performance trajectories of 201 college students with ADHD (97 receiving medication [ADHD-Med], 104 not receiving medication [ADHD-NoMed]) relative to 205 non-ADHD Comparison students. Demographic (e.g., sex, race/ethnicity), psychological (e.g., self-reported depression and anxiety symptoms), and service-related (e.g., receipt of academic support) variables were included as predictors of intercept (i.e., Year 1 performance) and slope (yearly change) of semester GPA, progress toward graduation, and self-reported study skill strategies.Results: College students with ADHD obtained significantly lower GPAs (Hedge's g = -0.46 and -0.63) and reported less frequent use of study skills strategies (Hedge's g range from -1.00 to -2.28) than Comparison students. Significantly more Comparison students (59.1%) persisted through eight semesters relative to ADHD-NoMed students (49%). Multiple variables predicted outcomes with parent education, fewer depressive symptoms, better executive functioning, and receipt of high school Section 504 accommodations and college academic support services among the strongest predictors.Conclusions: Findings suggest support services for students with ADHD should begin prior to college matriculation and focus on improving executive functioning skills and depressive symptoms to increase chances of academic success.

Dependent Stress Mediates the Relation Between ADHD Symptoms and Depression

Objective: Depression and attention-deficit hyperactivity disorder (ADHD) are prevalent and highly comorbid. ADHD symptoms are associated with specific dependent (i.e., self-generated) stressors in children, and there is a strong link between dependent stress and depression. Despite continued comorbidity of ADHD and depressive symptoms into adulthood, it is unknown whether stress generation mediates the relation between ADHD and subsequent depressive symptoms in emerging adulthood, a period of heightened stress. Method: We tested this mediation model in a semester-long longitudinal study of 224 college students (aged 18-23 years). We additionally tested whether this model differed between inattentive versus hyperactive/impulsive ADHD symptoms given evidence that they vary in their relations to stress and depression. Results: Dependent stress mediated the association between total ADHD symptoms at baseline and later depressive symptoms; these effects were equivalent for inattentive versus hyperactive/impulsive ADHD symptoms. Conclusion: These findings suggest stress generation as a mechanism for increased depression in individuals with ADHD symptoms.

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.

The Transition of Youth with ADHD into the Workforce: Review and Future Directions

Previous research suggests that a majority of children with attention-deficit/hyperactivity disorder (ADHD) continue to experience increased impairment across multiple life domains into adulthood. A systematic review of the occupational impairments, and associated educational and financial difficulties, faced by individuals with childhood ADHD was conducted. Systematic searches from PsycINFO and PubMed databases and other sources (i.e., books and consultants with experts) yielded 35 relevant articles that described 19 longitudinal studies on adults with a history of ADHD or related symptoms. Multiple studies indicated that those with a history of ADHD had more educational impairment and were less likely to graduate from high school and college than their peers without a history of ADHD. Subsequently, they faced lower occupational attainment, had more job instability, and demonstrated more impaired job performance, and these outcomes were largely consistent regardless of sex, medication history, or symptom persistence. Similar results were found in clinical and representative national studies in both U.S. and abroad, although older studies tended to indicate less occupational impairment. In addition, ADHD was associated with a number of financial challenges, including lower annual income, more reliance on public aid, and increased risk for homelessness. Future research should use more varied informant sources and utilize innovative measures of occupational impairment at both a macro- and micro-level of analyses. In addition, studies of effective supports and interventions in occupational settings for individuals with ADHD are needed.

A Randomized Controlled Study of a Cognitive Behavioral Planning Intervention for College Students With ADHD: An Effectiveness Study in Student Counseling Services in Flanders

Objective: The effectiveness of a short (six session) individual cognitive behavioral planning intervention for college students with attention-deficit/hyperactivity disorder (ADHD) was tested. Method: In three student counseling services in Flanders, individuals with ADHD (N = 58) were randomized to the intervention or waitlist condition. Pre- and posttreatment assessments were conducted, and within the intervention group, a 4-month follow-up was conducted. Primary outcomes were ADHD symptoms and study skills; secondary outcomes were comorbid symptoms and planning skills on a neuropsychological task. Results: Intent-to-treat analyses showed a significant interaction on one outcome: inattention symptoms. The treatment condition improved from pretest to posttest, whereas the waitlist did not. Other measures showed large significant time effects (improved skills, reduction of symptoms in both groups) but no interactions. Stability analyses were not possible due to substantial dropout at follow-up. Conclusion: Specific treatment effects are on one outcome (inattention) and modest; for further implementation, the treatment needs adaptation.

The Relationship Between Executive Function Deficits and DSM-5-Defined ADHD Symptoms

Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive function deficits (EFDs), to evaluate ADHD characteristics of those with executive dysfunction (ED), and to examine the predictive utility of the Adult ADHD Investigator Symptom Rating Scale (AISRS) in identifying those with adult ADHD and ED. Method: Two samples (referred and primary care practice) were pooled together for present analysis. Results: Final analysis included 297 respondents, 171 with adult ADHD. Spearman correlation coefficients and binary logistic regressions demonstrated that ADHD inattentive (IA) and hyperactive-impulsive (H-I) symptoms were moderately to strongly correlated with and highly predictive of EFDs. Receiver operating characteristic curve analysis showed that an AISRS DSM 18-item score of ⩾ 28 was most predictive of clinical ED. Conclusion: ADHD symptoms were strongly correlated with and predictive of EFDs, clinicians should screen adults with ADHD for EFDs and ADHD treatment providers should track EFD improvement in addition to DSM-5 ADHD symptoms.

A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects approximately 8%–12% of children worldwide. Throughout an individual’s lifetime, ADHD can significantly increase risk for other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. The multifactorial causation of ADHD is reflected in the heterogeneity of this disorder, as indicated by its diversity of psychiatric comorbidities, varied clinical profiles, patterns of neurocognitive impairment and developmental trajectories, and the wide range of structural and functional brain anomalies. Although evidence-based treatments can reduce ADHD symptoms in a substantial portion of affected individuals, there is yet no curative treatment for ADHD. A number of theoretical models of the emergence and developmental trajectories of ADHD have been proposed, aimed at providing systematic guides for clinical research and practice. We conducted a comprehensive review of the current status of research in understanding the heterogeneity of ADHD in terms of etiology, clinical profiles and trajectories, and neurobiological mechanisms. We suggest that further research focus on investigating the impact of the etiological risk factors and their interactions with developmental neural mechanisms and clinical profiles in ADHD. Such research would have heuristic value for identifying biologically homogeneous subgroups and could facilitate the development of novel and more tailored interventions that target underlying neural anomalies characteristic of more homogeneous subgroups.

Prescription stimulant misuse avoidance self-efficacy: Correlates and moderation by race/ethnicity

This study examined whether personality characteristics, attention deficit hyperactivity disorder (ADHD) symptomology, psychological distress, and religiosity were associated with prescription stimulant avoidance self-efficacy and whether these relationships were moderated by race/ethnicity among a probability sample of 1,053 college students. We used regression analyses to examine associations between avoidance self-efficacy and the independent variables of interest, and moderation analyses to identify whether these associations were moderated by race/ethnicity. Inattention, hyperactivity, sensation seeking, and psychological distress were inversely associated with prescription stimulant avoidance self-efficacy, whereas religiosity had a direct association. Moreover, greater inattention was a risk factor for lower self-efficacy among students identifying as White but not for students identifying as Asian. Increased religiosity was a risk factor for students identifying as Latinx, whereas it was a protective factor for students identifying as White. Prevention implications are discussed.