 - Individual CBT for ADHD usually follows the model of 10-16 weekly 1-h sessions including components such as:  (1) psycho-education, (2) enhancing motivation for change, (3) training and practice of skills/coping strategies, (4) cognitive restructuring of maladaptive thoughts, and (5) accessing/ utilizing support.
 - Results suggest that this approach is effective for treating both core symptoms of ADHD and the complications related to depression and anxiety.
 - The treatment also shows good stability of effects for at least 1-tear follow-up period.

Colby 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

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 

Individual CBT

 - Compared to the traditional individual CBT, the group format of group CBT permits less individually targeted intervention, but provides added benefits of peer normalization, support, and modeling, as well as greater cost-effectiveness.
 - Results have shown the group CBT is acceptable, feasible, and efficacious in reducing both primary and secondary symptoms of ADHD.
 - The improvement in core ADHD symptoms among subjects who receive group CBT is consistent across all levels of baseline severity, while higher baseline severity was associated with greater improvement among subjects receiving group CBT.


Group CBT

 - Adults with ADHD show significant deficits in mindfulness skills, particularly in ‘‘acting with awareness" and "describing the inner experience". In addition, inattentive symptoms appear to be the primary driver of functional impairment among both college students and adults with ADHD.
 - Mindfulness practice of purposeful, non-judgmental attention to the present moment strengthens these skills and improves performance on neuropsychological tests of attention performance. (e.g. the Attention Network Test which activates key components of the frontostriatal circuit that supports executive functioning.)
 - Interventions including mindfulness training (either as a stand-alone or as part of a larger intervention) lead to reductions in inattentive symptoms among adolescents and adults with ADHD.
 -Mindfulness training leads to collateral benefit in areas often affected by ADHD (e.g., mood regulation, anxiety).

Mindfulness Training

 - ADHD coaching refers to the focused relationship designed to help clients implement effective strategies to manage their daily lives.
 - One research reported promising results from a peer-based coaching program for college students with ADHD and/or learning disabilities, suggesting that this approach may be useful in supporting adaptive coping strategies and study skills among college students with ADHD.
 - Although the coaching approach may be a potential treatment for college students with ADHD, more researches are needed to investigate its effectiveness and discriminations from the typical individual/group CBT treatment.

Coaching

 - There are two general categories in the psychosocial treatment for adolescents with ADHD--family based intervention and school-based interventions.
 - In family settings, behavior management training, problem-solving and communication training, and structural family therapy programs have all shown pre- to post-treatment improvement in several key areas.
 - The school-based interventions include behavioral strategies for teachers, counseling, and parents. Adolescents also receive instructions in study skills and basic social skills. These strategies showed moderate-to-large effect sizes in improvement on measures of academic and classroom functioning.
 - These results from psychosocial interventions suggest that external management of behavior contingencies is a key component in improving the functions of students with ADHD. However, it's hard to impose the same level of control on college students with ADHD as that imposed on adolescents due to their loss of family and teacher-provided contingency management.
 - However, leveraging contextual supports must remain an important theme in the intervention. College students with ADHD may need to learn how to generate external contingencies for themselves (e.g., a study group), rather than relying on parents or teachers to create these contingencies for them.


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