Cognitive Behavioral Therapy for Attention-Deficit/Hyperactivity Disorder in College Students: A Review of the Literature

The current review presents a theory-guided review of the existing cognitive behavioral therapy (CBT) interventions for attention-deficit/hyperactivity disorder (ADHD) in college students. Across the eight studies that investigated this topic, moderate reductions were shown in inattentive symptoms but little to no change was reported in hyperactive/impulsive symptoms. Results indicated a moderate treatment effect on self-reported quality of life and school/work functioning, yet less of an impact on GPA, response inhibition, social functioning, and executive functioning. Methodological and statistical problems and inconsistencies were noted. Since college students are emerging adults, it is likely that the optimum CBT intervention for college students with ADHD lies somewhere in between the existing clinic-based adult ADHD CBT interventions as well as the school-based adolescent ADHD psychosocial interventions. Directions for future research and recommendations for clinicians in university settings are provided in an attempt to further develop the existing college students CBT clinical research evidence base.     

ADHD,strain, and criminal behavior: a test of general strain theory

This study explores the relationship between attention deficit/hyperactivity disorder (ADHD), strain, and criminal behavior. This is an attempt to introduce ADHD, a psychological disorder, into the framework of general strain theory. Using a purposive sample of college students, we tested the hypothesis that individuals with self-reported symptoms of ADHD were more likely to participate in criminal behaviors when experiencing strain. We found that ADHD symptoms conditioned the effect of strain on crime. The results suggest that individuals at risk for ADHD may be less able to legitimately cope with strain compared to the rest of the population.     

A New Organizational and Study Skills Intervention for College Students with ADHD

The transition to college can be very challenging for individuals with ADHD. Increased task and life demands happen in tandem with deficits in time management, study skills and habits, and delaying rewards to achieve longer-term goals. Cognitive-behavioral treatment (CBT) holds promise for targeting these and related challenges. Psychosocial interventions exist for the general population of adults with ADHD, but not college students. Importantly, an intervention designed for college students should be manageable in terms of time and cost. We developed such an intervention specifically for college students with ADHD; organizational, time management, and planning (OTMP) skills were the focus of this largely behavioral treatment, as these most directly relate to the executive function deficits characteristic of ADHD and to the demands of college. Academic study skills and psychoeducation regarding ADHD and medication management were also included. The intervention was tested with 30 undergraduate, post-baccalaureate, and graduate students (57% biological males; M age 22.6; 83.3% White/Non-Hispanic) from two public universities in the U.S. Participants completed a battery of self-report measures of ADHD symptoms, impairment, and OTMP skills pre- and post-treatment. Most participants reported a past diagnosis of ADHD (n = 23; including possible comorbidity), with all others reporting at least 5 pre-treatment symptoms of inattention (M for all participants = 6.3). The manualized intervention consisted of 6 group therapy sessions and 2 individual sessions. Results suggested that this new treatment has promise, with t-tests comparing pre- and post-intervention scores indicating significant improvements in inattention symptoms, total ADHD symptoms, self-concept impairment, total impairment, and use of organization, time management, and planning skills. In addition, participants generally reported satisfaction with the intervention and had a very high attendance rate. Future studies of this new intervention should include a randomized controlled trial, the collection of objective outcome measures, and a more diverse sample.     

Identification of Oppositional Defiant Disorder in Young Adult College Students

Long-considered a disorder restricted to children and adolescents, more research is needed to understand how oppositional defiant disorder (ODD) affects adults. Recent research suggests that symptoms of ODD persist into adulthood and are associated with specific negative functional outcomes. This current study seeks to investigate the prevalence and associated impairments of ODD symptoms in young adults. Two large samples of college students between the ages of 18–24 years old (N =?1792; N =?1497) completed self-report measures of ODD symptoms, ADHD symptoms, psychiatric diagnoses, and functional impairments. Rates and internal consistency of ODD symptoms were calculated, and multiple regression was used to estimate the association between high levels of ODD severity scores and social and authority-related impairments, as well as online antagonistic behavior. In the two samples, the proportion of individuals reporting four or more symptoms of ODD was estimated to be 3.39 and 4.12% respectively, and did not vary significantly by gender. Higher ODD severity was associated with social impairment, online antagonistic behavior, and greater conflict with authority figures, even after controlling for ADHD symptoms and self-reported depression or anxiety diagnoses. ODD symptoms measured in college students demonstrate acceptable reliability and are uniquely associated with specific impairments. The findings from this study support greater consideration of ODD symptoms in adult populations.     

How psychological resources mediate and perceived social support moderates the relationship between depressive symptoms and help-seeking intentions in college students

There is a high prevalence of depression among college students, which is linked to lower levels of help-seeking intentions. However, there has been a lack of research examining variables that may help explain this relationship. The present study aimed to address this gap by examining whether psychological resources (optimism and self-esteem) mediate the relationship between depressive symptoms and help-seeking intentions, and whether this relationship is moderated by perceived social support. Participants were 8121 college students (66% female) aged 17–25 years (M?=?20.42, SD?=?1.90), who completed the My World Survey Post-Second Level, a national survey on youth mental health. Linear regression analysis confirmed that depressive symptoms predicted lower informal help-seeking intentions. Moderated mediation indicated that social support moderated the direct relationship between depressive symptoms and informal help-seeking intentions and that optimism and self-esteem mediated this relationship, when gender was controlled for. Findings indicate that social support and psychological resources help further our understanding of the relationship between depressive symptoms and help-seeking in young people. Campaigns promoting help-seeking in college students should focus on the beneficial role of social support and on fostering optimism and self-esteem as facilitators of help-seeking intentions.     

Developmental Context and Treatment Principles for ADHD Among College Students

Attention-deficit/hyperactivity disorder (ADHD) affects between 2 and 8?% of college students. ADHD is associated with impaired academic, psychological, and social functioning, and with a wide array of negative outcomes including lower GPAs, graduation rates, and self-reported quality of life. The college environment often brings decreased external structure and increased availability of immediate rewards, presenting added demands for behavioral self-regulation—an area in which students with ADHD are already vulnerable. Despite the significant impact of ADHD in college and the unique challenges presented by the college context, virtually no treatment development research has been conducted with this population. In order to provide a framework to guide intervention development, this comprehensive review integrates research from three key domains that inform treatment for college students with ADHD: (1) functional impairment associated with ADHD among college students, (2) etiology of ADHD and the developmental context for ADHD among emerging adults (age 18–24), and (3) treatment outcome research for ADHD among adolescents and adults. A detailed set of proposed treatment targets and intervention principles are identified, and key challenges associated with treatment development in this population are discussed.     

Acculturative stress, social support, and coping: relations to psychological adjustment among Mexican American college students

This study examined the relations between acculturative stress and psychological functioning, as well as the protective role of social support and coping style, in a sample of 148 Mexican American college students (67% female, 33% male; mean age = 23.05 years, SD = 3.33). In bivariate analyses, acculturative stress was associated with higher levels of anxiety and depressive symptoms. Moreover, active coping was associated with better adjustment (lower depression), whereas avoidant coping predicted poorer adjustment (higher levels of depression and anxiety). Tests of interaction effects indicated that parental support and active coping buffered the effects of high acculturative stress on anxiety symptoms and depressive symptoms. In addition, peer support moderated the relation between acculturative stress and anxiety symptoms. Implications for reducing the effects of acculturative stress among Mexican American college students are discussed.     

The relationship between Facebook and the well-being of undergraduate college students

We investigated how Facebook use and attitudes relate to self-esteem and college adjustment, and expected to find a positive relationship between Facebook and social adjustment, and a negative relationship between Facebook, self-esteem, and emotional adjustment. We examined these relationships in first-year and upper-class students and expected to find differences between the groups. Seventy undergraduate students completed Facebook measures (time, number of friends, emotional and social connection to Facebook), the Rosenberg Self-Esteem Scale, and the Student Adaptation to College Scale. First-year students had a stronger emotional connection to and spent more time on Facebook while they reported fewer friends than upper-class students did. The groups did not differ in the adjustment scores. The number of Facebook friends potentially hinders academic adjustment, and spending a lot of time on Facebook is related to low self-esteem. The number of Facebook friends was negatively associated with emotional and academic adjustment among first-year students but positively related to social adjustment and attachment to institution among upper-class students. The results suggest that the relationship becomes positive later in college life when students use Facebook effectively to connect socially with their peers. Lastly, the number of Facebook friends and not the time spent on Facebook predicted college adjustment, suggesting the value of studying further the notion of Facebook friends.     

Reported prevalence of attentional difficulties in a general sample of college students

The present study investigated the self-reported prevalence of attention-deficit hyperactivity disorder (ADHD)symptoms in 770 college students using the Adult Rating Scale and the Wender Utah Rating Scale. Psychometric properties of these scales were explored. The study also investigated the performance of students with ADHD symptoms, relative to students without ADHD symptoms, on a battery of neuropsychological tasks. Results revealed that 7 and 8% of the students reported significant symptoms (i.e., 1.5 SD above the mean) on the Adult Rating Scale and the Wender Utah Rating scale, respectively, and 2.5% reported significant symptoms on both the Adult Rating Scale and the Wender Utah Rating Scale. Using more stringent criteria (two standard deviations), fewer (i.e, 4, 3.8%, and 0.5%) subjects reported significant symptoms associated with ADHD. Between-group differences were found on one of the neuropsychological tasks. The construct validity of the rating scales was supported. Limitations and implications for future research are advanced.Presented at the International Neuropsychological Society's Sixteenth European Conference, Angers, France, June 1994, and the Annual Convention of the American Psychological Association, Los Angeles, CA, August 1994.     

The relationship between ADHD symptoms and driving behavior in college students: The mediating effects of negative emotions and emotion control

Previous research has shown a relationship between attention deficit-hyperactivity disorder (ADHD) symptoms and driving anger and adverse driving outcomes. Moreover, adults with ADHD symptoms express their emotions in more aggressive ways, indicating a lack of emotion control. The present study surveyed 246 college students to examine the relationship among ADHD symptoms, negative emotions, emotion control, and driving anger and safe driving behavior. Mediating effects of negative emotions and emotional control on the relationship between ADHD symptoms and self-reported driving anger and safe driving behavior were also examined. Both negative emotions and emotion control were significant mediators of the relationship between ADHD symptoms and driving anger, but not safe driving behavior. Mediation was stronger for ADHD-Hyperactive/Impulsive symptoms than for ADHD-Inattention symptoms. These results may provide some insight on how to design training programs for individuals with ADHD symptoms to increase driving safety.     

ADHD in college students

OBJECTIVE: According to the American Psychiatric Association, 3% to 7% of the school-age population has ADHD and many children continue to display significant symptoms throughout adolescences and adulthood. Relative to the childhood literature, less is known about ADHD in adults, especially college students with ADHD. The principle purpose of this review articles is to summarize the major research findings concerning ADHD in the college student population with regard to prevalence of symptoms, neuropsychological and psychological functioning. Overall, findings suggest that college students with ADHD are at greater risk for academic and psychological difficulties, and they perform similar to non-ADHD controls on many neuropsychological tasks. These findings are preliminary, however, and are tempered by the small number of studies that have been conducted as well as the methodological limitations of these studies. CONCLUSION: Future research using larger sample sizes, rigorous assessment criteria, and a longitudinal design is needed to better understand the psychological, academic, and neuropsychological functioning of college students with ADHD. Studies are also needed to elucidate the effects of pharmacological and nonpharmacological effects of treatment on the functioning of college students with this disorder.     

Social Support,Positive College Events,and College Satisfaction: Evidence for Boosting Effects1

On the basis of previous research on college satisfaction and Cohen and Wills'(1985) social support framework, we hypothesized that structural social support has a main effect on college satisfaction and that the effect of positive college events on college satisfaction is boosted by self-esteem and belonging functional social support. Analyses were based upon a convenience sample of 392 community college students enrolled in psychology courses. Structural social support had a main effect on college satisfaction, and positive college events interacted with self-esteem functional social support. The beneficial effect of positive college events on college satisfaction increased as the level of self-esteem functional social support increased.     

Parenting Behavior and Cognitions in a Community Sample of Mothers with and without Symptoms of Attention-deficit/Hyperactivity Disorder

Although attention-deficit/hyperactivity disorder (ADHD) in adults has recently emerged as an important area of research, little attention has been given to the family functioning of women with ADHD, particularly in their role as mothers. We examined parenting self-esteem, locus of control, and disciplinary styles in a community sample of mothers with varying levels of ADHD symptoms. Women with high levels of ADHD symptoms reported more occupational and psychiatric problems than women with lower levels of ADHD symptoms. They also reported lower parenting self-esteem, a more external parenting locus of control, and less effective disciplinary styles. The findings suggest that women with ADHD symptoms may face a number of difficulties within the parenting domain.     

Moderators of the adaptiveness of self-enhancement: Operationalization, motivational domain, adjustment facet, and evaluator

The literature includes conflicting perspectives regarding the impact of self-enhancement on adjustment outcomes. To help sort out the disparities, we examined four potential moderators of the enhancement–adjustment association in 123 college students. First was the method of operationalizing self-enhancement, that is, social comparison (rating oneself more positively than one rates others) vs. criterion discrepancy (rating oneself more positively than one is rated by others). Second was the motivational domain of the operationalization—agentic vs. communal attributes. Third was the evaluator of adjustment—self-rating vs. peer ratings. Fourth was the facet of adjustment—personal adjustment (e.g., self-esteem, happiness) vs. interpersonal adjustment (e.g., harmonious social relations). With peer-rated adjustment as the criterion, the social comparison operationalization was associated with better adjustment whereas the discrepancy operationalization was associated with maladjustment. Both operationalizations of self-enhancement were positively associated with self-reported personal adjustment. When trait variance was partialed out, the social comparison index lost its predictive power, but the discrepancy index held up. Motivational domain and adjustment facet played significant but more complex roles in the enhancement–adjustment association. Our firmest conclusion is that the social comparison index is not an appropriate measure of self-enhancement.     

Correlates of minimal dating

Researchers have associated minimal dating with numerous factors. The present author tested shyness, introversion, physical attractiveness, performance evaluation, anxiety, social skill, social self-esteem, and loneliness to determine the nature of their relationships with 2 measures of self-reported minimal dating in a sample of 175 college students. For women, shyness, introversion, physical attractiveness, self-rated anxiety, social self-esteem, and loneliness correlated with 1 or both measures of minimal dating. For men, physical attractiveness, observer-rated social skill, social self-esteem, and loneliness correlated with 1 or both measures of minimal dating. The patterns of relationships were not identical for the 2 indicators of minimal dating, indicating the possibility that minimal dating is not a single construct as researchers previously believed. The present author discussed implications and suggestions for future researchers.     

Development and initial validation of an implicit measure of humility relative to arrogance

Data from two studies describe the development of an implicit measure of humility and support the idea that dispositional humility is a positive quality with possible benefits. In Study 1, 135 college students completed Humility and Self-Esteem Implicit Association Tests (IATs) and several self-report measures of personality self-concept. Fifty-four participants also completed the Humility IAT again approximately 2 weeks later and their humility was rated by close acquaintances. The Humility IAT was found to be internally and temporally consistent. Implicit humility correlated with self-reported humility relative to arrogance, implicit self-esteem, and narcissism (inversely). Humility was not associated with self-reported low self-esteem, pessimism, or depression. In fact, self-reported humility relative to arrogance correlated positively with self-reported self-esteem, gratitude, forgiveness, spirituality, and general health. In addition, self-reported humility and acquaintance-rated humility correlated positively; however, implicit humility and acquaintance-rated humility were not strongly associated. In Study 2, to examine the idea that humility might be associated with increased academic performance, we examined actual course grades of 55 college students who completed Humility and Self-Esteem IATs. Implicit humility correlated positively with higher actual course grades when narcissism, conscientiousness, and implicit self-esteem were simultaneously controlled. Implications and future research directions are discussed.     

Validity of Adolescent and Parent Reports on the Six-Item ADHD Self-Report Scale (ASRS-6) in Clinical Assessments of Adolescent Social Anxiety

Adolescents experiencing social anxiety often experience co-occurring attention-deficit/hyperactivity disorder (ADHD) symptoms. Yet, assessing for social anxiety poses challenges given the already time-consuming task of distinguishing social anxiety from other commonly co-occurring internalizing conditions (e.g., generalized anxiety, major depression). Assessors need short screening devices to identify socially anxious adolescents in need of intensive ADHD assessments. A six-item version of the ADHD Self-Report Scale (ASRS-6) was originally developed to identify adults who likely meet diagnostic criteria for ADHD, but its psychometric properties have yet to be examined among adolescents. We tested the psychometric properties of the ASRS-6 when administered in clinical assessments for adolescent social anxiety. Eighty-nine 14–15 year old adolescents and their parents (67.4% female; 62.1% African American; 30 Clinic-Referred; 59 Community Control) completed the ASRS-6, measures of adolescent social anxiety and depressive symptoms, and parent-adolescent conflict. Adolescent self-reported and parent-reported ASRS-6 positively related with scores from established measures of social anxiety, depressive symptoms, and parent-adolescent conflict. Further, adolescent self-reported (but not parent-reported) ASRS-6 scores significantly discriminated adolescents on referral status. Adolescent self-reported (but not parent-reported) ASRS-6 scores incrementally predicted social anxiety over-and-above depressive symptoms, which commonly co-occur with social anxiety. Conversely, parent-reported (but not adolescent self-reported) ASRS-6 scores incrementally predicted parent-adolescent conflict over-and-above depressive symptoms, which commonly co-occur with conflict. When assessing adolescent ADHD symptoms, adolescents’ and parents’ reports meaningfully vary in their links to validity indicators. As such, among adolescents assessed for social anxiety, clinical assessments of adolescent ADHD symptoms should include both parent reports and adolescent self-reports.     

Association of Poor Kin Relations,College Adjustment and Psychological Well-Being among African American Undergraduates

The purpose of this study was twofold. The first was to examine the association of poor kin relations with students’ psychological distress and college adjustment in a sample of 83 African American undergraduates. The second was to assess whether the relationship of poor kin relations with both psychological distress and college adjustment was mediated by perceived stress and self-esteem. Fifty-nine female and 24 male African American undergraduates were administered the study measures via online survey. Findings revealed that poor kin relations were positively associated with psychological distress and negatively related to college adjustment. Evidence of the meditational role of perceived stress and self-esteem was found. Poor relations with kin were linked to increased vulnerability to stress and decreased self-esteem, which in turn, was associated with increase in psychological distress and decrease in college adjustment. For counselors, administrators and faculty concerned with the adjustment and retention of ethnic minority undergraduates, understanding the role of extended family and other off-campus relations in students’ psychological well-being may be highly important.     

Symptoms of Attention-Deficit/Hyperactivity Disorder and Social and School Adjustment: The Moderating Roles of Age and Parenting

This study examined the associations between symptoms of attention-deficit/hyperactivity disorder (ADHD) and social and school adjustment (academic performance, peer relationships, school social problems) and the moderating roles of children’s age and maternal parenting (affection and overprotection) in these associations. The sample consisted of 2,463 students who were in the first to ninth grade in northern Taiwan. Results from the linear mixed models demonstrated that ADHD symptoms were inversely associated with academic performance and positively associated with social adjustment problems. Further, children’s age and maternal parenting moderated the associations between ADHD symptoms and school and social adjustment. For example, maternal overprotection moderated the relation between hyperactivity and negative peer relationships (i.e., difficulty forming and maintaining friendships), such that this relation was stronger for children who experienced higher levels of overprotection than children who did not. Moreover, children’s age moderated the association between attention problems and decreased academic performance, such that this association was stronger for older children and adolescents than for younger children. Furthermore, children’s age and maternal affection interacted to influence the association between attention problems and school social problems (i.e., bullying, aggression, and peer rejection) with maternal affection acting as a buffer for older children (grades 4–6) only. These findings are discussed from a developmental psychopathology perspective.     

微信使用强度与大学生自尊之间的关系:上行社会比较和好友亲密度的作用

为探讨微信使用强度与大学生自尊的关系,采用微信使用强度问卷、上行社会比较问卷、好友亲密度量表和自尊量表,对330名大学生的微信经历和自尊情况进行问卷调查。结果发现：（1）微信使用强度与自尊显著负相关,且上行社会比较在其中起显著中介作用;（2）好友亲密度在上行社会比较与自尊之间起调节作用：在好友亲密度较低的情况下,上行社会比较与自尊显著负相关;在好友亲密度较高时,上行社会比较与自尊相关不显著。结果提示,微信使用程度越强,上行社会比较越多,大学生的自尊水平越低,但是网上亲密的好友关系可以缓解这一关系。