- Some work and organizational problems associated with ADHD (including forgetting homework, difficulty finishing long-term projects, and keeping materials organized) are closely related to procrastination behavior, and can manifest themselves clinically as procrastination. 
- Procrastination is an important aspect of several therapeutic interventions for people with ADHD, indicating that it is a commonly-faced deficit and function problem for adults with ADHD.
- Most research so far has examined the relationship between procrastination and impulsivity, suggesting a positive association between the two variables.
- The relationship between procrastination and inattention, as well as hyperactivity, has not been studied.


Procrastination and Symptoms of ADHD: Introduction

The current study aims at exploring the relationship between procrastination and ADHD-related symptoms of inattention, hyperactivity, and impulsivity in an undergraduate college population.

The study proposes 2 hypotheses:
- Researchers predict a positive correlation in the number/severity of ADHD-related behaviors and procrastination, specifically symptoms of impulsivity and impulsivity/hyperactivity symptom domain of ADHD.
- Researchers predict that participants with high levels of impulsivity are more likely to procrastinate.

54 participants (4=male, 50=female),with an mean age of 19.72 were recruited from the Radboud University Nijmegen in the Netherlands (primarily psychology and pedagogy students).
- Participants all scored either high, medium, or low on a self-report questionnaire of ADHD-related behaviors, including impulsivity, hyperactivity, and inattention.
- Participants who scored within the highest 33% of symptoms experienced were invited, and only a small random subset of participants who scored within the middle 33% and lowest 33% were invited.

Procrastination and Symptoms of ADHD: Study Aims, Hypotheses, and Participants

In the first part, procrastination behavior was covertly observed while participants were asked to solve math problems:
- Participants were told the problems would take about 10 minutes, but they would be given 30 minutes.
- Researchers gave them the opportunity to perform “nice” tasks, such as playing games and reading magazines to reduce the stress or discomfort of solving math problems.
- Two variables were recorded to indicate academic procrastination: the time before solving math problems (seconds), and the time between solving the math problems.

Participants were then asked to complete several questionnaires regarding procrastination and temptation behavior:
- Procrastination Assessment Scale for Students (PASS) assesses the prevalence of procrastination, problems related to procrastination, and the desire to reduce procrastination.
- Participants were asked about an important assignment they completed in the past semester, and were asked to elaborate about how long they were given to complete the assignment and how long before the deadline did they start the assignment.
- Pure Procrastination Scale (PPS) measures a general level of procrastination across all life domains, combining some measures on decisional procrastination, general procrastination, and adult inventory of procrastination.
- The Susceptibility of Temptation Scale (STS) measures the tendency of participants to be focused on short-term pleasurable activities.

Procrastination and Symptoms of ADHD: Methods

- Inattention was associated with higher scores on all subscales of the PPS, with a greater susceptibility to temptation.
- The strongest correlation in the study is between inattention and specifically general procrastination as part of the PPS.
- Correlations between hyperactivity/impulsivity and procrastination and susceptibility to temptation were not significant.
- Unlike what was predicted, symptoms of impulsivity were not related to procrastination.
- 23 participants showed some degree of procrastination while solving math problems. 5 students were conscious of their observation, but they were not excluded from the analysis.


Procrastination and Symptoms of ADHD: Results and Discussion

- The study did not control for activities outside university, which could account for the levels of academic procrastination seen.
- The study did not use distinct measures for everyday and decisional procrastination.
- The study was primarily composed of female participants, possibly skewing the results since women are more commonly diagnosed with inattentive type ADHD.

Procrastination and Symptoms of ADHD: Limitations

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.

Boston College

Pulling from the Latin roots "*pro*" (meaning forward, forth, in favor of) and "*crastinus*" (of tomorrow), procrastination is an irrational, but voluntary decision to delay an intended behavior or task.
- *Irrationality* is defined as "... choosing course of action[,] despite expecting that it will not maximize your utilities..."
- *Intended* is defined as something that one wants to interact with; the avoidance of random or irrelevant tasks would not be considered procrastination.

Procrastination

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

Niermann, H. C.M., and Scheres, A. (2014), The relation between procrastination and symptoms of attention‐deficit hyperactivity disorder (ADHD) in undergraduate students, Int. J. Methods Psychiatr. Res., 23, 411–421. doi: 10.1002/mpr.1440

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

Temporal Motivation Theory (TMT) explains the behavior of procrastination by providing a quasi-mathematical framework, by examining the underlying behavioral components that contribute to (or combat) procrastination. The five components are:
- Value: the tangible and intangible rewards that an individual would receive from completing a task.
- Expectancy: the individual's belief and self-confidence in completing said task.
- Delay: the the period of time an individual needs to wait before receiving the reward from completing said task.
- Sensitivity to delay: the willingness of an individual to tolerate longer delays.
- Utility: the likeness for the individual to perform said task.

Temporal Motivation Theory

References on Procrastination

Where one intentionally delays studying or completing the academic work that they need to submit. 
Factors that contribute to procrastination levels:
- time management
- self-regulation
- participation levels

Procrastination in an Academic Setting

Note that, in addition to causing people to put off their work till the last minute, procrastination causes people to postpone engaging in healthy behaviors (e.g., exercising, meditation, improving eating habits) until the "last minute" (e.g., when they are diagnosed with a life-threatening chronic illness). "1 day later" often becomes "1 year later," which then usually becomes "1 decade later." Hence, overall health is harmed, and the risk for chronic diseases increase.

Procastination | Connection to Health and Chronic Diseases

People can be any combination of -

- Productive/Unproductive procrastinators

- Active/Passive procrastinators

Types of procrastination

Much of the research has been conducted on binary gender identifying participants. The data has problems with inconsistent results, but it appears that men have greater risk for procrastinating in academic life. 

- men are more likely than women to procrastinate
- women show higher levels of academic performance, correlated with less procrastination
- men's procrastination adversely impacts their performance and satisfaction

Gender differences with procrastination

Academic procrastination is the practice of avoiding or postponing academic tasks. It is associated with various negative impacts, including a reduction in the quality and quantity of a student's work, lower goal commitment, less time allotted to studying, decreased course achievement, and a decline in long-term learning. In addition to poor academic performance, academic procrastination can elicit negative emotional reactions such as frustration, anxiety, shame, and guilt.

Academic Procrastination

Procrastination can help promote creativity when intrinsic motivation is low.

Creativity and Procrastination

The expectation that a person who is intrinsicly motivated will show less procrastination is not backed by research. Less than 10 persent of variance in procrastination is due to high levels of inttrinsic motivation. It may have an influence on how people will directtheir attention during the time they are procrastinating, possibly causing specific types of procrastination or more thought focus on the task.

Intrinsic motivation does not mediate procrastination

There is a curvilinear relationship between procrastination and the quality of work, and the creativity of work. 
- Low procrastination can causally influence low creativity and moderate productivity.
- Moderate procrastination can causally influence high creativity and, with intrinsic motivation, high task efficiency.
- High procrastination tends to influence low creativity and low task efficiency, possibly due to time crunch.

Levels of procrastination

This study aimed to see if self-reported procrastination is correlated with people's actual procrastination behavior. The researchers found this to be the case.

Links between self-reports of procrastination and actual procrastination study

This could consist of learning how to break down large tasks into smaller chunks, how to set more realistic deadlines for themselves, and reconsidering perfectionistic beliefs.

Procrastination Mitigation CBT Training for ADHD

- 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

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.

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

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?

 - 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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