 - Individuals with ADHD tend to show greater difficulty managing emotions than their peers without ADHD.
 - In particular, college students with ADHD experience more depressive symptoms and overall psychological distress and show more ineffective expressions of anger.
 - Cognitive restructuring of maladaptive or depressogenic thoughts—a mainstay of CBT treatment for anxiety and depression--is effective to reduce symptoms of ADHD, anxiety and depression. Mindfulness training has also been found to provide broad-based benefits in psychological functioning, in addition to its enhancement of attention control.

Colby College

 - 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.

ADHD in College Students: Proposed Treatment Target and Principles for Intervention with College ADHD

Fleming, A. P., & McMahon, R. J. (2012). Clinical Child and Family Psychology Review, 15(4), 303-329. https://doi.org/10.1007/s10567-012-0121-z 

Developmental Context and Treatment Principles for ADHD Among College Students 

 - Inattentive/disorganized symptoms have been shown to account for significant variance in overall adaptive functioning, academic concerns, depressive symptoms, and GPA.
 - Inattentive/disorganized symptoms hinder academic functioning in several ways: (1) difficulty sustaining attention during class, reading, and other activities, leading to impaired learning of necessary knowledge and skills; (2) difficulty organizing, initiating and sustaining motivation and effort on academic tasks, leading to late, incomplete, or lower-quality work; and (3) poor time management, leading to lateness or absences from class, meetings, or other activities.
 - The treatment toward the inattentive/disorganized behavior should include key domains of response inhibition, working memory, delay aversion, and temporal processing. Clinicians should attempt to gauge the degree to which the proximal behaviors map onto these domains and discuss these possible pathways when delivering psychoeducation on the etiology of ADHD. By applying this conceptual framework to the process of treatment, it may be possible to more efficiently identify key problematic behaviors and more effectively target interventions to those behaviors.


Inattentive/Disorganized Behavior

 - Students with ADHD tend to have less effective study skills in key areas than both typical students and students with learning disabilities. These key areas of deficit include: (1) time management, (2) concentration, (3) selection of main ideas, and (4) test-taking strategies.
 - One of the suggested treatment targets for the time managements skills is teaching students with ADHD to effectively manage time in college context. For example, strategies for scheduling work and structuring contingencies to support follow-through. 
 - Treatment strategies to improve the concentration for students with ADHD include mindfulness practice and structuring the environment effectively. 
 - Difficulties with response inhibition, working memory, and delay aversion may all contribute to difficulty in identifying main ideas and using effective test-taking strategies. Effective intervention for ADHD in college should include assessment and training in effective use of study skills related to the functions listed above. (e.g. the RAP paraphrasing strategy)

College Academic-Specific Skills

 - The college environment increases risk for disrupted daily life routines in several domains for many students, particularly sleep, eating, exercise, medication adherence, and substance use. College students with ADHD are more prone to this type of dysregulation in daily life routines due to their unique developmental and psychosocial context. 
 - Supporting healthy daily life behavior is a key target of effective intervention with this population, including balanced sleep, balanced eating, balanced exercise, and medication adherence. 
 - College students with ADHD also show a higher risk for addictive behaviors and a greater vulnerability to impaired executive functions. A harm reduction approach including motivational interviewing and personalized normative feedback may be useful in addressing the substance use for the population.

Disrupted Daily Life Functions

Emotional Dysregulation

 - College students with ADHD report lower social skills and greater difficulty in social and romantic relationships, and non-ADHD students tend to report more negative associations and unfavorable attitudes toward their ADHD peers, both of which represents the difficulties students with ADHD have on social relationships.
 - Although seems irrelevant, difficulties with social relationships may also contribute to some college students’ poor academic performance and higher dropout rates.
 - Training in mindfulness, emotional regulation skills, expectation management, reliability improvement, and using effective apology can be helpful in addressing some of the ADHD-related impairment in interpersonal relationships.
 - Research have found that greater frequency of contact with individuals with ADHD is associated with more positive attitudes toward those with ADHD. This suggests that college students with ADHD may benefit particularly from group-based treatment that facilitates peer normalization, and that experience of living with ADHD may ameliorate some of the negative bias toward ADHD that exists among other peers.
 - A support person or an individual coaching intervention may be useful to assist students in connecting to individuals in their immediate environment who can offer support, particularly for effective organization and time management.

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