 - Approximately 6% of first-year college students report having been diagnosed with ADHD.
 - Students with ADHD may be more susceptible to risk factors, including additional psychological disorders and poor executive functioning skills, that predict lower academic success.
- Students with ADHD are less likely to enroll in post-secondary institutions, and those who do earn lower GPAs, withdraw from courses more often, and are less likely to graduate than non-ADHD peers.
- Current literature on ADHD in college students is limited.
-  Most available longitudinal studies follow children with ADHD into adulthood, but they tend to neglect ADHD in specifically college-age students.
- Current studies that exist on college students with ADHD do not explore how academic performance is impacted over time, and whether their academic trajectories are affected by individual differences.

Academic Trajectories and ADHD: Introduction

The primary purposes of the current study are to:
- Explore the academic trajectories of students with ADHD and those without ADHD.
- Identify predictors of academic performance over time, and how those can be used to inform prevention and intervention strategies.

The academic outcomes assessed as part of the study include:
- GPA by semester
- Progress toward graduation
- Self-reported study skills
- College-drop out rates

Seven hypotheses were proposed by this study:
- College students with ADHD would earn lower GPAs and show lower rates of enrollment relative to non-ADHD peers.
- Medical treatment for students with ADHD would result in better academic trajectories.
- Demographic predictors would be associated with better academic outcomes.
- Students meeting the criteria for anxiety or mood disorders would have worse relative outcomes to peers without a diagnosis.
- Maladaptive cognitions would be negatively correlated with academic outcomes.
- Executive functioning would be positively correlated with academic outcomes.
- Psychosocial and academic service use would not be correlated with improved academic outcomes.


Academic Trajectories and ADHD: Study Purpose and Hypotheses

There was a total of 456 first-year college student participants enrolled in the study (220 = male, 236 = female) between the ages of 18 and 22, recruited across three eastern states in the US.
- At year one of the study, 228 students met the criteria for the ADHD group, 228 students met the criteria for the comparison (non-ADHD) group.
- The ADHD group was subdivided into groups based on self-reported medication use, with 94-99 students reporting medication use (ADHD-Med), and 96-105 not using medication (ADHD-NoMed).

Screening measures for the study include:
- Demographic information, including age, gender, race, ethnicity, etc.
- ADHD Rating Scale-Self-Report Version, assessing inattention symptoms, and hyperactive-impulsive symptoms.
- ADHD Rating Scale-IV, which is sent to parents to obtain additional diagnostic information from the participant’s childhood, and symptoms from the past six months.
- Semi-structured ADHD interview, created to address symptom presentation and impairment for each participant.
- Structured clinical interview for DSM disorders, which is sued to test for clinically significant presentations of psychiatric disorders.

Dependent measures for the study include:
- GPA on a four-point scale, recorded for each of the first four semesters of college.
- Progress toward graduation, determined by the percentage of credits earned relative to credits needed for graduation, relative to each university that the participants attended.
- Learning and study strategies inventory, which collects information on the students’ awareness about and use of learning and study strategies.
- Enrollment status, collected yearly for each participants.

Students were also asked to self-report if they received any pharmacological (medication), psychological, and academic treatment and support, including individualized education program services, and Section 504 accommodations.

Academic Trajectories and ADHD: Participants and Methods

For semester GPA, the comparison group had a significantly higher average GPA compared to ADHD-Med and ADHD-NoMed groups.
- Over time, there was a negative trend to GPA trajectories for the comparison and ADHD-Med groups, while the ADHD-NoMed group did not show a change.

There were no differences between all groups regarding progress toward graduation at the year 1 check-in.
- Significant predictors of graduation progress (and GPA) include higher parent education and receipt of academic services.

There were tiered results in terms of academic persistence:
- 59.1% of comparison participants persisted through eight semesters or graduated during the study period, for an average of 6.4 semesters persisted.
- 54% of ADHD-Med participants persisted through graduation/eight semesters, for an average of 5.9 semesters persisted.
- Only 49% of ADHD-NoMed participants persisted through graduation/eight semesters, with an average of 5.6 semesters persisted.


Academic Trajectories and ADHD: Results

College students with ADHD obtained significantly lower GPAs and reported less frequent use of study skills. Academic service receipt was associated with increasing GPA trajectory, but only for students with ADHD not receiving medication. Progress toward graduation was similar across groups, but students with ADHD not on medication showed diminished progress over time.

Only a few predictors of academic outcomes for students with ADHD were identified:
- Higher parent education predicted GPA for both ADHD groups.
- Better executive functioning, receipt of high school 504 accommodations, and participation in academic services predicted greater study skills, especially for ADHD students on medication.
- Several predictors identified may be potential targets for intervention before and during college, such as executive functioning deficits and maladaptive cognitions.

Limitations of this study include:
- Participants were all from four-year institutions, so the findings may not be applicable to students attending two-year institutions.
- All participants attended college in the eastern region of the US.
- Medication status may have fluctuated over the course of the study.

Because students with ADHD show significant academic challenges beginning in the first semester, intervention programs for transition support are very important to influence academic performance trajectory. It is also extremely important to connect students with ADHD to support services from the onset of their college education, especially for ADHD students who are not medicated, who show more frequent and more significant academic problems.


Academic Trajectories and ADHD: Discussion and Conclusion

Approximately 6% of first-year college students report having been diagnosed with ADHD in their life. Students with ADHD may be more susceptible to certain risk factors that could potentially affect their academic performance, but the current literature is limited on just how much of an effect it has. The existing longitudinal studies on ADHD follow children into adulthood, but tend to neglect college-age people with ADHD, and the studies do not explore the long-term academic impact of a diagnoses. 

This longitudinal study follows college students with and without an ADHD diagnosis over the course of four years, to explore their academic performance trajectories, as well as identifying predictors of academic performance over time to inform future intervention development. Findings suggested that college students with ADHD obtained significantly lower GPAs compared to their non-ADHD peers, and in addition, only a few predictors of academic outcomes for students with ADHD were identified, including parent educational attainment and receipt of academic support services.

Boston College

According to the APA, 3-7% of school-age children have ADHD, and many display significant symptoms throughout adolescence. However, there is little known about the symptomology of ADHD in adolescence and adulthood, particularly in college-aged populations. This article is designed to summarize major research findings about ADHD in college-aged populations, including prevalence of symptoms, psychological functioning, and potential influence on academic performance. Findings suggest college students with ADHD are at greater risk for academic and psychological difficulties, but these findings are merely preliminary.

ADHD in College Students

George J. DuPaul, Matthew J. Gormley, Arthur D. Anastopoulos, Lisa L. Weyandt, Jeffrey Labban, Aliza Jaffe Sass, Chelsea Z. Busch, Melanie K. Franklin & Kaicee B. Postler (2021) Academic Trajectories of College Students with and without ADHD: Predictors of Four-Year Outcomes, Journal of Clinical Child & Adolescent Psychology, DOI: 10.1080/15374416.2020.1867990 

Academic trajectories of college students with and without ADHD: predictors of four-year outcomes

- Prior to the 1970s, ADHD was believed to be a childhood disorder that was outgrown with the onset of puberty. 
- Longitudinal research suggests that the majority of children and adolescents diagnosed with ADHD display symptoms into adulthood.
- It is estimated that ADHD symptoms affect 2-4% of the college student population.

The purpose of this review is to summarize research findings of ADHD in college student populations, including:
- The prevalence of ADHD symptoms in this population.
- The results concerning the psychological and neuropsychological functioning of college students with ADHD.

ADHD in College Students: Introduction

- Students with ADHD are not required to report to student disability support services, therefore the actual number of college students with ADHD is speculative.
- In general, approximately 25% of students receiving disability support services receive support for ADHD, increasing substantially since 1975.
- In a preliminary study of the percentage of college students who report clinically significant levels of ADHD symptoms, findings suggested 7-8% of participants experience significant ADHD symptoms.
- Collectively, studies suggest that approximately 2-8% of college students self-report clinically significant symptoms associated with ADHD, although these numbers do not reflect the actual percentage of college students with documented ADHD.

ADHD in College Students: Results: Prevalence of ADHD and ADHD Symptoms in College Students

Academic Performance:
- Preliminary studies suggest that college students with ADHD tend to have significantly lower GPAs, and report more academic problems than their neurotypical counterpart.
- College students with ADHD are more likely to be on academic probation, and are less likely to attend and graduate from college. 
- The underlying factors that contribute to poorer academic performance in college students with ADHD  are poorly understood, but may be related to impaired organizational skills, study skill deficits, deficits in executive functioning, and other cognitive deficits.
- Students who self-reported high symptoms of ADHD used significantly fewer academic coping behaviors, were less organized, less methodical, and procrastinated significantly more.
- Not all studies, however, indicate that college students with ADHD are at an increased risk for academic problems, indicating contradictions in preliminary research.

Psychological Functioning:
- The findings on psychological functioning have been fairly inconsistent, with some studies reporting that they experience greater psychological distress, and others not supporting these findings, indicating additional contradictions.
- One study suggests that students with ADHD reported other comorbid disorders, such as depressive disorders, anxiety disorders, substance dependency/abuse disorders, or eating disorders.
- However, a different study suggests that, although students with ADHD had significantly lower GPAs, they did not differ from their neurotypical counterparts with regard to psychosocial functioning.

ADHD in College Students: Results: Academic and Psychological Functioning

- Similar to other areas of research with college students with ADHD, the literature concerning neuropsychological functioning is sparse.
- One study indicated that contrary to popular belief that those with ADHD have superiors divided attention skills, college students with ADHD and their neurotypical counterpart performed similarly on tasks of divided attention performance.

Neuropsychological functioning in college students with ADHD symptoms:
- Several studies have compared the neuropsychological functioning of college students who self-report high and low ADHD symptoms, many of which reveal very little significant results.
- In summary, little information is available concerning the neuropsychological functioning of college students with ADHD.
- Findings are mixed with respect to performance on specific neuropsychological tests, and additional studies with larger sample sizes are needed to further explore this topic.

ADHD in College Students: Neuropsychological Findings

Although the empirical study of ADHD in a college student population is in “relative infancy,” this particular review supports several tentative conclusions:
- Approximately 2-8% of college students in the US report clinically significant levels of ADHD symptoms, and the prevalence of these symptoms vary across genders and fluctuates depending on the criteria for clinical significance.
- There is preliminary evidence that self-reported symptoms vary across countries, but these are the results of a single study.
- It is unclear how many college students with disabilities have diagnosed ADHD, although preliminary estimates place this figure at about 25%, and the number of students with ADHD is likely to vary significantly across universities.
- College students with significant ADHD symptoms obtain a lower GPA and are less likely to graduate than their neurotypical peers.

Equivocal findings have been found regarding the psychological functioning of college students with significant ADHD symptoms.

Conclusions based on the available literature (as of 2006) are tempered by the small number of studies that have been conducted as well as significant limitations of those investigations that have been completed.

ADHD in College Students: Summary and Future Research Directions

Research on ADHD in college students began in the 1990s and has been steadily increasing in recent years. Accumulating research suggest that college students with ADHD experience less academic success and greater psychological and emotional difficulties, and use substances at higher rates. However, conclusions drawn from this body of research may not be representative of the wider population of students with ADHD. This literature review expands upon the growing body of research on ADHD in college students, and touches upon the results of existing studies.

What do we really know about ADHD in college students?

Procrastination is often acknowledged in therapeutic treatment of ADHD, but it is not officially seen as an ADHD-related symptom. As a result, little is known about the role of procrastination in symptomology of ADHD. This study aims to explore the relationship between procrastination and ADHD-related symptoms of inattention, hyperactivity, and impulsivity in undergraduate college students. Results indicated that only inattention was correlated with general procrastination, as well as susceptibility to temptation.

The relation between procrastination and symptoms of attention-deficit hyperactivity disorder (ADHD) in undergraduate students

 - College students with ADHD tend to show lower social skills and social adjustments than peers matched on age, gender, and GPA.
 - Inattentive symptoms among male college students have been found to be associated with delayed dating onset, lower comfort and assertiveness in heterosocial situations, and lower ratings from female classmates
 - Students with ADHA are evaluated as more ‘‘confrontive’’ and ‘‘aggressive,’’ more independent, less rule-focused, and less influenced by corrective feedback by their peers.
 - College students with ADHD also report poorer parent-child relationships.
 - Some research show that increased contact with students with ADHA can raise their peers' rating on those individuals, which implies the possible efficiency of peer normalization.
 - Negative judgements may result from negative social experiences college students get from the ADHD peers, as numbers of such comments grow over time, highlighting the importance of early intervention.

ADHD in College Students: Results: Social Functioning

 - College students with ADHD report lower confidence in their own career decision-making ability and lower job performances. 
 - Main areas of impairment include: (1) performance of assigned work, (2) management of daily responsibilities, and (3) management of time and work-related deadlines.
 - Interventions targeted at improving students' academic functioning may also be helpful in improving their occupational functioning.

ADHD in College Students: Results: Occupational Functioning



 "Cool" executing functioning:
 - Students with ADHD show poorer working memory performance than normal controls, which is also associated with lower GPAs. However, the same relationship does not show in response inhibition or divided attention, suggesting that cool’’ executive function deficits contribute to ADHD-related impairment in some, but not all, college students.
 - In addition, only about 50 % of adolescents and adults with ADHD show impaired performance on tests of response inhibition, further decreasing the likelihood of this pathway alone to count all cases of ADHD among college students.
Hot" executive functioning:
 - Further research is needed to clarify the connection between delay aversion and ADHD-related functional impairment among emerging adults and adults.


ADHD in College Students: Relation to the etiology of ADHD

The transition from adolescence to adulthood involves important biological and sociological changes. For students with ADHD, such changes may impose a "double deficit" on them in response inhibition, long-term reward motivation, and self-regulation. This provides explanations on why college students with ADHD is a special group of subjects to study and what psychological treatment may be the most efficient for this population.


ADHD in College Students: Developmental Context for ADHD in College

 - The unique developmental and contextual challenges for college students with ADHD, their similarity to both adults (independent of external control) and adolescents (a still-maturing executive function system and heightened vulnerability to the effects of social-emotional arousal on decision making) suggest the need of an intervention uniquely tailored for this population.
 - Although stimulant medication is an effective treatment for ADHD, they are intolerable or ineffective for up to 50% of adults with ADHD, and most adults who do respond to medication still experience significant deficits in executive control and other areas of functioning.
 - Researches suggest that psychosocial interventions are feasible, acceptable, and decrease core symptoms and/or functional impairment among adults who use stimulant medication and those who do not. Leveraging contextual support also seems to be an important component of effective intervention with college students.

ADHD in College Students: Possible treatments

 - This section discusses some intervention targets along with corresponding treatment principles/approaches for each target. Due to the lack of treatment development efforts in this area, it also proposes some feature research directions for ongoing investigations.
 - A principle-based approach in which assessment of key proximal behavior targets and key underlying areas of deficit guides the application of appropriate interventions may be most useful to flexibly respond to the varied presentations in ADAD within college students.

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