Self-Esteem in Adults With ADHD Using the Rosenberg Self-Esteem Scale: A Systematic Review.

OBJECTIVE: To summarize and analyze recent articles investigating self-esteem in adults with ADHD, focusing on the impact of demographic and clinical characteristics, and methodological issues. METHOD: Following PRISMA guidelines, a systematic search for literature published between 2010 and 2022 was conducted in the Web of Science, Ovid, Pubmed, and EBSCO databases. RESULTS: Eleven studies met inclusion criteria. Five of the six studies including healthy controls reported lower self-esteem in participants with ADHD. ADHD symptoms correlated negatively with self-esteem. Gender differences were not observed. Self-esteem mediated several outcomes associated with ADHD. There was a lack of studies that examined potential mechanisms behind the reduced self-esteem, and studies controlling for confounding variables. CONCLUSION: A robust association between ADHD and low self-esteem in adults emerged, but the lack of control of confounding variables is critical to consider when interpreting the findings. Longitudinal studies addressing the limitations of the current studies are needed.

Posttraumatic stress as a moderator of the association between HPA-axis functioning and alcohol use disorder among a community sample of women currently experiencing intimate partner violence.

Women experiencing intimate partner violence (IPV) experience a heightened prevalence of alcohol use disorder (AUD). Hypothalamic-pituitary-adrenal (HPA)-axis functioning has been associated with increased risk for AUD in other populations, including individuals with posttraumatic stress disorder (PTSD) symptoms. The goal of the present study was to determine whether PTSD symptom severity exacerbates the relationship between HPA-axis functioning and AUD. Participants were 151 community women who had experienced physical or sexual IPV in the past 30 days by their current male partners and used any amount of alcohol or drugs. A two-phase emotion induction protocol was utilized: Neutral mood induction followed by randomly assigned negative, positive, or neutral emotion induction. Saliva cortisol samples were obtained immediately following the neutral mood induction (baseline HPA-axis functioning), 20 min following the individualized emotion induction script (HPA-axis reactivity), and 40 min post the emotionally evocative cue (HPA-axis recovery). Findings revealed that PTSD symptom severity moderated the relations between baseline HPA-axis functioning and HPA-axis recovery and log odds of meeting criteria for AUD. Specifically, baseline HPA-axis functioning was positively associated with log odds of meeting criteria for AUD at high (but not low) PTSD symptom severity, whereas HPA-axis recovery was negatively associated with log odds of meeting criteria for AUD at high (but not low) PTSD symptom severity. Results contribute to our understanding of the biological processes involved in the etiology and maintenance of AUD among women experiencing IPV-specifically the prominent role of PTSD symptom severity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effectiveness of executive functioning training among heterogeneous adolescent samples: A systematic review.

The aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. A systematic review of the literature was conducted to retrieve and consolidate findings from articles evaluating executive functioning training techniques among adolescents. A total of 26 articles were located that examined the role of executive functioning training techniques among adolescents (age 10-19 years). Articles retrieved enabled comparison across psychiatric and medical diagnoses including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), as well as adolescents with physical health concerns. Results revealed that among typically developing adolescents, executive functioning training was non-significant or yielded small effect size improvements in executive functioning as measured by behavioral and neuroimaging tasks among 62.5% of studies reviewed. In contrast, in those with medical conditions, ASD, ADHD, and conduct disorder, all but two studies reviewed yielded a medium to large effect size, supporting the effectiveness of EF training. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.

Attention-deficit hyperactivity disorder and youth's emotion dysregulation: A systematic review of fMRI studies.

A number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer performance and quality of life among youth. Recent neuroimaging research has observed significant functional differences in youth with ADHD compared to healthy controls. Therefore, the aims of this systematic review were to summarize the literature on functional connectivity of emotion dysregulation in youth with ADHD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed to conduct a systematic review across three databases, and 13 studies were identified for inclusion. Across the studies, 14 primary regions were examined; 12 of the 13 studies identified a significant association between functional connectivity of emotion dysregulation and youth with ADHD. Although studies varied in the structures investigated, the most notable differences appeared in the prefrontal cortex, orbitofrontal cortex, amygdala, and ventral striatum in ADHD participants. Future research concerning this topic may help contribute to the understanding of this association by utilizing longitudinal research designs, controlling for psychiatric comorbidities and emotion dysregulation severity, inclusion of more diverse samples and ensuring that studies are adequately powered.

Prescription opioid misuse among university students: A systematic review.

Misuse of prescription opioids has substantially increased in the past decade among the general population, including among university students. Relative to the literature concerning opioid misuse among the general population, little information is available regarding the college student population. Objective: The purpose of the present study was to conduct a systematic review of the literature concerning the prevalence of prescription opioid misuse among the university student population. Results: The lifetime estimate for prescription opioid misuse among general populations of students ranged from 4% to 19.7%, with higher estimates for special student populations. Students most at risk for misuse of prescription opioids are those who report higher rates of psychological distress, depression, and suicidal thoughts and behaviors, and white, male students who use alcohol and illicit drugs. Conclusions: Findings from this study underscore the need for opioid prevention and intervention programs on university campuses.

Outcomes and Predictors of Stimulant Misuse in College Students with and Without ADHD.

In recent years, rates of prescription stimulant misuse have increased among young adults ages 18 to 25 along with increases in dispensing rates of these medications. Preliminary studies suggest that college students with Attention-Deficit Hyperactivity Disorder (ADHD) may be more likely to misuse their stimulant medication than their non-ADHD peers. Research is needed to further explore possible rates, correlates, and outcomes of prescription stimulant misuse among college students with and without ADHD. Data regarding study strategies, psychological functioning, stimulant misuse, and GPA were collected from students from universities within the US (N = 144), showing significantly higher rates of misuse among college students with ADHD. With depression and anxiety entered into the predictive model, inattentive symptoms were the only significant predictor of misuse in the full sample. The present findings have implications for academic interventions aimed at supporting the success of college students with and without ADHD and inform academic outcomes of prescription stimulant misuse.

Diversity inclusion in United States opioid pharmacological treatment trials: A systematic review.

Pharmacological treatments for opioid use disorders (OUDs) may have mixed efficacy across diverse groups, i.e., sex/gender, race/ethnicity, and socioeconomic status (SES). The present systematic review aims to examine how diverse groups have been included in U.S. randomized clinical trials examining pharmacological treatments (i.e., methadone, buprenorphine, or naltrexone) for OUDs. PubMed was systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The initial search yielded 567 articles. After exclusion of ineligible articles, 50 remained for the present review. Of the included articles, 14.0% (n = 7) reported both full (i.e., accounting for all participants) sex/gender and race/ethnicity information; only two of those articles also included information about any SES indicators. Moreover, only 22.0% (n = 11) reported full sex/gender information, and 42.0% (n = 21) reported full racial/ethnic information. Furthermore, only 10.0% (n = 5) reported that their lack of subgroup analyses or diverse samples was a limitation to their studies. Particularly underrepresented were American Indian/Alaska Native (AI/AN), Asian, Native Hawaiian/Other Pacific Islander (NH/OPI), and multiracial individuals. These results also varied by medication type; Black individuals were underrepresented in buprenorphine randomized controlled trials (RCTs) but were well represented in RCTs for methadone and/or naltrexone. In conclusion, it is critical that all people receive efficacious pharmacological care for OUDs given the ongoing opioid epidemic. Findings from the present review, however, support that participants from diverse or marginalized backgrounds are underrepresented in treatment trials, despite being at increased risk for disparities related to OUDs. Suggestions for future research are advanced. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nonmedical Prescription Opioid Use among a Sample of College Students: Prevalence and Predictors.

Nonmedical use of prescription opioid medication (NMPO) in the United States is a public health crisis, resulting in high rates of emergency room visits, morbidity, and mortality. The purpose of this study was to explore prevalence estimates and correlates of NMPO among a convenience sample of college students in the northeast and southeast regions of the US to help generate directions for future research. Motivations for misuse, age of onset, access, concomitant substance use, and individual factors were investigated among a sample of undergraduate students from two universities. Participants (N = 847) completed a battery of various self-report measures. Findings revealed that 7.7% (Southeastern University) and 12.8% of students (Northeastern University) reported lifetime NMPO, whereas past-month NMPO was reported by 0.8% and 0.9% of participants, respectively. Lifetime history of regularly using alcohol, nonmedical use of benzodiazepine medication, nonmedical use of prescription stimulants, symptoms of depression and anxiety, and executive functioning (i.e., metacognition and behavioral regulation) were significantly related to lifetime history of NMPO in this college sample. These findings offer several potential subsequent lines of investigation regarding the associations between various demographic and psychological factors and NMPO. Future research is needed to help identify college students who are at risk of NMPO.

Academic Trajectories of College Students with and without ADHD: Predictors of Four-Year Outcomes.

Objective: Completing a college degree is associated with success in employment, financial earnings, and life satisfaction. Mental health difficulties, including attention-deficit/hyperactivity disorder (ADHD), can compromise degree completion.Method: We examined 4-year academic performance trajectories of 201 college students with ADHD (97 receiving medication [ADHD-Med], 104 not receiving medication [ADHD-NoMed]) relative to 205 non-ADHD Comparison students. Demographic (e.g., sex, race/ethnicity), psychological (e.g., self-reported depression and anxiety symptoms), and service-related (e.g., receipt of academic support) variables were included as predictors of intercept (i.e., Year 1 performance) and slope (yearly change) of semester GPA, progress toward graduation, and self-reported study skill strategies.Results: College students with ADHD obtained significantly lower GPAs (Hedge's g = -0.46 and -0.63) and reported less frequent use of study skills strategies (Hedge's g range from -1.00 to -2.28) than Comparison students. Significantly more Comparison students (59.1%) persisted through eight semesters relative to ADHD-NoMed students (49%). Multiple variables predicted outcomes with parent education, fewer depressive symptoms, better executive functioning, and receipt of high school Section 504 accommodations and college academic support services among the strongest predictors.Conclusions: Findings suggest support services for students with ADHD should begin prior to college matriculation and focus on improving executive functioning skills and depressive symptoms to increase chances of academic success.

Self-Injurious Thoughts and Behaviors Among College Students: A Latent Class Analysis.

This study explored emerging typologies of self-injurious thoughts and behaviors and how they relate to known psychological and cognitive correlates. Latent class analysis was employed to identify subgroups of college students (n = 626, mean age = 20, 73% female, and 83% White) based on history of self-injurious thoughts and behaviors. Differences among classes were tested to examine their associations with suicidal ideation, fearlessness of death, depression/hopelessness, thwarted belongingness, problems with alcohol or drugs, behavioral inhibition, and emotional control. Results of the latent class analysis supported a 3-class solution, with students classified as being likely to have (1) no history of any self-injurious thoughts and behaviors (78%); (2) a history of all self-injurious thoughts and behaviors (8%); or (3) a history of suicidal ideation, plan, and non-suicidal self-injurious thoughts and behaviors, but not suicide attempt (13%). Findings examining correlates of self-injurious thoughts and behaviors highlight the importance of fearlessness of death for distinguishing suicide attempters from non-attempters. Attention to mental health and suicide prevention initiatives should remain a critical priority across college campuses.

Brain structure in childhood maltreatment-related PTSD across the lifespan: A systematic review.

Numerous deleterious outcomes are associated with child maltreatment, and PTSD secondary to maltreatment is one of the most commonly cited diagnoses that may follow individuals throughout their lives. Recent neuroimaging research has observed significant structural abnormalities in individuals with maltreatment-related PTSD (m-PTSD) compared to maltreated individuals without PTSD and healthy controls. Therefore, the aims of this systematic review were to summarize the literature on brain structure in m-PTSD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct a systematic search across three databases, and 18 studies were identified for inclusion, including 10 pediatric, 1 adolescent, and 7 adult studies. Across the studies, 19 primary brain structures were examined; 15 of the 18 studies identified a significant association between brain structure and m-PTSD. Although studies varied in the structures investigated, the most notable differences appeared in the corpus callosum, total cerebral volume, cerebellum, hippocampus, and amygdala, which appeared significantly smaller in m-PTSD participants. Future research concerning this topic may contribute to the understanding of this association by using longitudinal designs, controlling for psychiatric comorbidities and maltreatment severity, and ensuring that studies are adequately powered.

Effects of self-injurious thoughts and behaviors and sexual risk-taking behaviors through emotional control.

BACKGROUND: College students are at increased risk for self-injurious thoughts and behaviors (SITB) and sexual risk behaviors (SRB). Although students with a history of SITB appear to be more prone to SRB, the mechanisms linking these risk behaviors remain largely unexplored. Previous research points to emotional control (EC), defined as one's awareness and adaptability of emotions, as a potential mechanism explaining the relationship between SITB and SRB.1 METHODS: Data included 722 college students attending two different universities in the northeast and southeast regions of the United States. Multiple group structural equation models were fit to estimate the direct and indirect effects of history of SITB (suicidal ideation, attempt, and nonsuicidal self-injury) and EC on SRB jointly across men and women. RESULTS: Findings supported indirect relationships between SITB and SRB through dysregulated EC, with type of SITB and patterns of SRB differing between men and women. For women, history of suicidal ideation and nonsuicidal self-injury were indirectly related to increased SRB through dysregulated EC. For men, history of suicidal ideation showed an indirect relationship on SRB through EC. LIMITATIONS: Although this study employed random sampling, limitations include a cross-sectional design, which does not allow for causal inference, and reliance on self-report assessment data. CONCLUSIONS: College students with a history of SITB who experience dysregulated EC may be more likely to engage in risky sexual behavior. Clinicians working with college students should concomitantly consider suicide and self-injury with SRB and consider interventions to improve EC.

Predictors and Moderators of Quality of Life Among College Students With ADHD.

Objective: The current study examines (a) whether ADHD among college students is associated with differences in perceptions of quality of life (QoL); (b) the moderating roles of comorbidity, drug use, psychopharmacological treatment, and psychosocial treatment; and (c) the total impact of these variables on QoL. Method: Participants were college students with and without ADHD (N = 372) in a longitudinal study. Results: College students with ADHD were more likely to assert negative global QoL evaluations relative to non-ADHD peers. The relationship between ADHD and QoL was not altered as a function of medication treatment, comorbid psychopathology, psychosocial treatment, or drug use. Conclusion: College students with ADHD behave similarly to other adults with ADHD in that they make lower subjective global evaluations of their QoL relative to their non-ADHD agemates. Other factors associated with ADHD and QoL do not appear to moderate this relationship.

First-Year GPA and Academic Service Use Among College Students With and Without ADHD.

Objective: ADHD is a chronic neurodevelopmental disorder that typically results in persistent academic difficulties over time. Although most colleges offer support services, students often do not use the available services or those to which they are entitled. The present study examined predictors of academic performance among college students with and without ADHD. In addition, the rate, predictors, and outcomes of academic service use were explored. Methods: A series of multivariate analyses of variance (MANOVAs) and regression analyses were conducted using SPSS v. 21 ® software. Results: First year college students with ADHD earned significantly lower grade point averages (GPAs) relative to students without ADHD. Additionally, ADHD combined with other disorders, but not ADHD alone, predicted higher rates of service use relative to students without ADHD. Finally, the findings suggest that typically available academic services are not independently related to GPA among first-year college students with or without ADHD. Conclusion: This study replicates previous work demonstrating significantly lower GPAs among a rigorously defined sample of students with ADHD relative to students without ADHD. Second, this study indicates that traditional predictors of college success may be less meaningful for students with ADHD relative to those without ADHD. Finally, additional research needs to be conducted regarding the use and effectiveness of academic services on college campuses.

Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students.

Prescription stimulant medications are considered a safe and long-term effective treatment for Attention Deficit Hyperactivity Disorder (ADHD). Studies support that stimulants enhance attention, memory, self-regulation and executive function in individuals with ADHD. Recent research, however, has found that many college students without ADHD report misusing prescription stimulants, primarily to enhance their cognitive abilities. This practice raises the question whether stimulants actually enhance cognitive functioning in college students without ADHD. We investigated the effects of mixed-salts amphetamine (i.e., Adderall, 30 mg) on cognitive, autonomic and emotional functioning in a pilot sample of healthy college students without ADHD (n = 13), using a double-blind, placebo-controlled, within-subjects design. The present study was the first to explore cognitive effects in conjunction with mood, autonomic effects, and self-perceptions of cognitive enhancement. Results revealed that Adderall had minimal, but mixed, effects on cognitive processes relevant to neurocognitive enhancement (small effects), and substantial effects on autonomic responses, subjective drug experiences, and positive states of activated emotion (large effects). Overall, the present findings indicate dissociation between the effects of Adderall on activation and neurocognition, and more importantly, contrary to common belief, Adderall had little impact on neurocognitive performance in healthy college students. Given the pilot design of the study and small sample size these findings should be interpreted cautiously. The results have implications for future studies and the education of healthy college students and adults who commonly use Adderall to enhance neurocognition.

Instructor and peer bullying in college students: Distinct typologies based on Latent Class Analysis.

OBJECTIVE: Although bullying is traditionally considered within the context of primary and secondary school, recent evidence suggests that bullying continues into college and workplace settings. Participants/Method: Latent class analysis (LCA) was employed to classify college bullying involvement typologies among 325 college students attending a northeastern university. RESULTS: Four classes concerning bullying involvement were revealed: Non-involved (36%); Instructor victim (30%); Peer bully-victim (22%); and Peer bully-victim/ Instructor victim (12%). CONCLUSIONS: Findings from this study, which classified college bullying experiences by incorporating both peer and instructor (teacher and professor) bullying, add substantially to the literature by providing insight into patterns of relatively unexplored bullying behaviors.

Physiological substrates of executive functioning: a systematic review of the literature.

Executive function (EF) is a multifaceted construct that has been defined as a set of higher-order cognitive processes that allow for flexibility, self-regulation, strategic planning, and goal-directed behaviors. EFs have been studied in numerous clinical disorders using a variety of neuropsychological tasks and, more recently, neuroimaging techniques. The underlying physiological substrates of EF were historically attributed to the frontal lobes; however, recent studies suggest more widespread involvement of additional brain regions. The purpose of the present study was to conduct a systematic review (using PRISMA 2009 guidelines) of neuroimaging studies employing functional magnetic resonance imaging and diffusion tensor imaging methods investigating the physiological substrates of EFs in attention-deficit/hyperactivity disorder compared to other clinical groups and non-clinical participants. Research articles were retrieved using PsycINFO, PsycARTICLES, MEDLINE, and ScienceDirect, beginning February 2015 through May 2016. A total of 42 studies met eligibility. Of those 42 studies, 22 studies included clinical participants and 20 studies included non-clinical participants. Results revealed increased activation of the frontal brain region in the majority of non-clinical studies and approximately 50% of the clinical studies, albeit with some inconsistencies across subregions, tasks, and age groups. Implications, methodological limitations, and suggestions for future research are discussed.

Rates and Patterns of Comorbidity Among First-Year College Students With ADHD.

The purpose of this study was to examine rates and patterns of non-attention-deficit/hyperactivity disorder (non-ADHD) psychiatric diagnoses among a large group of 1st-year college students with and without ADHD. A total of 443 participants, including 214 men and 229 women ranging in age from 18 to 22 years of age (M = 18.2), were recruited from 9 colleges involved in a large-scale, multisite longitudinal investigation. Non-Hispanic Caucasian students represented 67.5% of the total sample. A comprehensive multimethod assessment approach was used in conjunction with expert panel review to determine both ADHD and comorbidity status. Significantly higher rates of overall comorbidity were found among college students with well-defined ADHD, with 55.0% exhibiting at least one comorbid diagnosis and 31.8% displaying two or more, relative to the corresponding rates of non-ADHD diagnoses among Comparison students, which were 11.2% and 4.0%, respectively. These differences in overall comorbidity rates were, in large part, attributable to the increased presence of depressive and anxiety disorders, especially major depressive disorder (active or in partial remission) and generalized anxiety disorder, among the students with ADHD. Within the ADHD group, differential comorbidity rates were observed as a function of ADHD presentation type and gender but not ethnic/racial diversity status. The current findings fill a gap in the literature and shed new light on the rates and patterns of comorbidity among emerging adults with ADHD in their 1st year of college. Implications for providing clinical and support services to college students with ADHD are discussed.

Impact of Study Skills and Parent Education on First-Year GPA Among College Students With and Without ADHD: A Moderated Mediation Model.

OBJECTIVE: To test if the relationship between ADHD and academic achievement is mediated by service utilization and/or study skills, and if these mediation effects are moderated by parental education level. METHOD: A bootstrapping method within structural equation modeling was used with data from 355 first year college students meeting strict criteria for ADHD or clearly without ADHD to test the mediation and moderation effects. RESULTS: Study skills, but not service utilization, significantly mediated the relationship between ADHD status and GPA; however, this relationship was not significant among students with at least one parent holding a master's degree or higher. CONCLUSION: Among first year college students study skills may be a more salient predictor of educational outcomes relative to ADHD status. Additional research into support services for college students with ADHD is needed, however, results suggest interventions targeting study skills may hold particular promise for these students.

Predictors and Trajectories of Educational Functioning in College Students With and Without Attention-Deficit/Hyperactivity Disorder.

College students with attention-deficit/hyperactivity disorder (ADHD) are at greater risk than peers for im-paired educational functioning; however, little is known regarding their longitudinal academic outcomes. This study examined: (a) differences between ADHD and control participants in academic outcomes (i.e., semester GPA, credits attempted, credits earned) over the first two years of college, and (b) factors that predict second year outcomes. A sample of 456 students (50% with ADHD; 51.8% female; 71.7% Caucasian) from 10 universities completed two annual assessments. Compared to students without ADHD, students with ADHD experience more academic difficulties that persist over two years. Motivation to study reported in year one was a significant predictor of year two GPA, suggesting the importance of providing services as early as possible to support students before they struggle.