College during COVID-19: The pandemic's effect on college adjustment in first year students with ADHD.

Objective: The current study aims to compare college adjustment and the effects of the COVID-19 pandemic on first-year students with and without ADHD. Participants: Two cohorts (pre-pandemic, during the pandemic) of first-year, undergraduate college students (N = 3,006; Mage=18.32) were recruited from a multisite research consortium across several universities. Methods: First-year participants self-reported on ADHD diagnosis and symptoms, functional impairments, and experiences transitioning to college. Results: First-year college students with and without ADHD reported significantly greater academic, daily living, and overall functional impairments during the pandemic compared to pre-pandemic. Compared to college students without ADHD, college students with ADHD reported greater functional impairment, more difficulty adjusting to the academic demands of college, and were less likely to feel valued at their institution. Conclusions: First-year college students with and without ADHD experienced greater difficulties navigating the transition to college during the pandemic. Psychosocial and academic supports to help students transition to college are needed.

Stigma Related to Observable Symptoms, But Not Stimulant Medication Use, in Young Women With ADHD.

OBJECTIVE: ADHD is associated with stigma, but whether stimulant medication use contributes to this is unknown. We examined how perception of a young woman may be influenced by visible ADHD symptoms and/or prescribed stimulant medication use (PSMU). METHOD: Three-hundred-fourteen undergraduates were randomly assigned to watch one of four videos: a woman portraying (a) neither symptoms of ADHD nor PSMU, (b) no ADHD symptoms but disclosing PSMU, (c) ADHD symptoms but no PSMU, or (d) both ADHD symptoms and PSMU. Participants then completed measures of their liking of and desire for affiliation with the woman. RESULTS: Analyses suggest that visible symptoms of ADHD were perceived negatively and are associated with less liking and desire for affiliation. PSMU was associated with negligible additive stigma. CONCLUSION: This supports that noticeable ADHD symptoms may be the primary driver of the stigma associated with the disorder, and specifically that directed at young women with ADHD.

ADHD and Psychological Need Fulfillment in College Students.

OBJECTIVE: Self-determination theory suggests that the satisfaction and frustration of basic psychological needs-autonomy, competence, relatedness-are uniquely associated with overall well-being. Undergraduates with attention-deficit/hyperactivity disorder (ADHD) experience more academic-related impairment and are less likely to graduate. Thus, well-being is important to understand and aim to improve in these students. METHOD: Students at four universities (N = 2,197) completed a survey and reported previous diagnoses, ADHD symptoms, and psychological need satisfaction and frustration. Group differences were explored via t-tests; associations were explored via structural equation modeling. RESULTS: The ADHD group reported lower satisfaction and higher frustration across all psychological needs. Inattention and hyperactivity/impulsivity were uniquely associated with aspects of need fulfillment beyond the impact of comorbid symptoms. Sex differences emerged such that women with ADHD had the lowest overall need satisfaction. CONCLUSIONS: Addressing need fulfillment, both satisfaction and frustration, in interventions with undergraduates with clinical/subclinical levels of ADHD may optimize treatment effectiveness.

The importance of executive functioning for social skills in college students: a relative weights analysis.

STATEMENT OF RELEVANCE: Social interaction is one of the most important things that humans do on a day-to-day basis, impacting both mental and physical wellness. College is a particularly important period where social interaction becomes increasingly important as well as complex. While there is no currently agreed upon cognitive basis of social interaction, the executive function (EF) system is believed to play a central role. The current study provides further evidence of the role of the EF system across different social skills in addition to highlighting the complexity of these relationships.

Feasibility and Acceptability of an Internet-Based Intervention for Young Adults with ADHD.

Internet-based interventions (IBIs) to treat psychological disorders are available, but accessibility to these to treat attention-deficit/hyperactivity disorder (ADHD) in young adult populations is quite limited. The current study examined the feasibility of a proposed IBI for ADHD and participant perceptions regarding treatment acceptability and credibility, and outcome expectancy. Participants (N = 235; aged 18-35) with a prior ADHD diagnosis were recruited through Amazon's Mechanical Turk (MTurk) and were provided with a proposed IBI and explanatory outlines of treatment module content. Participants in the cross-sectional study were randomly assigned to either a tailored (i.e., targeted content modules), minimal (i.e., presented overall fewer and non-targeted modules), or full (i.e., all possible modules) condition. Results demonstrated moderate IBI acceptability among participants in the tailored and full conditions. The majority of participants preferred IBI over face-to-face (F2F) treatment, and most individuals who preferred F2F treatment also considered an IBI to be an acceptable treatment modality. Lack of significant mean differences between the tailored and full conditions on several of the main outcomes of interest (e.g., perceptions of acceptability) suggests that implementation of either method of treatment could prove effective. Differences based on treatment length and relevance, and biological sex were also explored. Implications, limitations, and future directions are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s41347-022-00256-4.

Internalizing and externalizing comorbidity and symptom burden in a VA ADHD specialty evaluation clinic.

The purpose of this study was to evaluate psychiatric diagnosis and symptom comorbidity in veterans diagnosed with attention-deficit/hyperactivity disorder (ADHD). Study design was retrospective chart review from an ADHD evaluation clinic at a Veterans Affairs hospital. Participants were 227 military veterans who completed a standardized ADHD assessment and produced valid Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) profiles. There were no differences in rates of internalizing or externalizing psychiatric conditions diagnosed in inattentive compared to combined ADHD presentations. However, compared to a subsample with no psychiatric diagnoses, individuals diagnosed with ADHD endorsed significantly more internalizing symptom burden, with combined ADHD veterans also endorsing significantly greater levels of negative emotions and neuroticism. Base rates of comorbid classes of psychiatric diagnoses were not increased in individuals with ADHD, though higher rates of trauma disorders were seen in the combined group compared to the inattentive group. Multivariate base rates of MMPI-2-RF Restructured Clinical scales across various subgroups are presented. There was evidence for differential phenotypes of psychiatric symptoms across ADHD presentations in clinically referred veterans, predominantly related to higher rates of internalizing symptoms.

Unique considerations in the assessment of ADHD in college students.

Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment planning. In terms of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), EBPA practices are well-established for children, and more recently for adults, but for college students in particular there are special considerations that warrant attention. College students with symptoms of ADHD have some challenges that are unique, and thus the assessment and diagnosis of ADHD in these students is unique. The aim of this review is not to cover all EBPA strategies for diagnosing ADHD in emerging adult college students; rather, we will focus on the unique considerations at play in college ADHD assessment. These include (a) conceptual matters such as the appropriateness of the DSM-5 criteria for college students, the limitations of our understanding of ADHD this population because of a lack of diversity in research studies, and the issue of late-identified ADHD; and (b) practical matters, such as specific documentation needs, how to gather and interpret self- and other-report of symptoms, how to assess impairment, and alternate explanations for ADHD-like symptoms in college students.

Adult ADHD and romantic relationships: What we know and what we can do to help.

It has been widely maintained that enduring and healthy romantic relationships are critical to quality of life in adulthood, and can buffer the impact of adversity, including psychological disorder. Unfortunately, much research points toward adults with attention-deficit hyperactivity disorder (ADHD) having short-lived and discordant romantic relationships. Despite this ample evidence, relatively little research has focused on identifying specific factors that may strengthen or explain their relational difficulties, which would have obvious relationship distress prevention and intervention implications. The current study reviews the state of the literature on romantic relationships in adults with ADHD, including differences that have been established between ADHD and non-ADHD populations as well as distal and proximal factors that appear to increase risk of relationship distress of adults with ADHD. Finally, notable gaps in the literature are identified and implications are raised with regards to prevention and intervention efforts designed to address functional impairment in adults with ADHD.

College Readiness: Differences Between First-Year Undergraduates With and Without ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentive, hyperactive, and impulsive behaviors. Impairment in individuals diagnosed with ADHD is significant; one such domain of impairment is achieving a college education. College students with ADHD tend to have lower grade point averages, take longer to graduate, and have higher dropout rates than individuals without ADHD. Those with ADHD may be inadequately prepared for college. College readiness can be broken into self-determination, academic skills, and daily living skills, all of which are possible areas of deficit for individuals with ADHD, given their common characteristics. In the current study, we examined differences in college readiness in undergraduates with and without ADHD. In general, students with ADHD were found to be less prepared for college than those without ADHD, and specific areas of unpreparedness were identified. The findings support the need for intervention for students with ADHD before or early in their college careers. Further research on specific skill deficits and ameliorative steps is needed.

Psychometric Properties of the Weiss Functional Impairment Rating Scale: Evidence for Utility in Research, Assessment, and Treatment of ADHD in Emerging Adults.

Objective: The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Method: Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. Results: The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. Conclusion: The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.

DSM-5 and Other Symptom Thresholds for ADHD: Which Is the Best Predictor of Impairment in College Students?

OBJECTIVE: Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were interested in determining whether a threshold of four, five, or six ADHD symptoms would be associated with significantly different levels of functional impairment and be more or less indicative of a potential ADHD diagnosis. METHOD: We examined the relation between functional impairment and these ADHD symptom thresholds in 2,577 college students. RESULTS: Our findings suggest that none of these symptom thresholds are differentially better at predicting functional impairment. CONCLUSION: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) threshold of five symptoms for ages 17 years and older is not necessarily predictive of ADHD-related impairment in college students and may not be preferable to other thresholds. Options for resolving this diagnostic dilemma are discussed.

Anxiety sensitivity mediates the relationship between exercise frequency and anxiety and depression symptomology.

The anxiolytic and antidepressant effects of regular physical exercise have been well documented, though the mechanisms through which exercise alleviates symptoms of emotion disorders require further investigation. Mounting research indicates that exercise reduces anxiety sensitivity, a known vulnerability factor for the development and maintenance of psychological disorders, presumably via repeated exposure to feared somatic sensations. The purpose of the present study was to examine whether anxiety sensitivity mediates the relation between exercise frequency and symptoms of anxiety and depression. A large community sample of 955 volunteers completed a demographic questionnaire, the Anxiety Sensitivity Index-3, and the Brief Symptom Inventory-18. Exercise frequency significantly predicted anxiety sensitivity, anxiety, depression, and somatization scores. Mediation analyses indicated that anxiety sensitivity mediated the association between exercise frequency and anxiety, depression, and somatization symptoms. The findings provide further support for the association between exercise and negative affective states and suggest that anxiety sensitivity may be one mechanism through which exercise reduces emotional disorder symptomology. The implications of these findings and recommendations for future research are discussed.

Mountaintop Removal Coal Mining and Emergent Cases of Psychological Disorder in Kentucky.

Although mountaintop removal (MTR) coal extraction techniques have been employed in Appalachia for decades, relatively little research has examined its potential psychological impact on people living in close proximity to MTR activity. The current study taps the State Emergency Department Database (Healthcare Cost and Utilization Project, Kentucky State Emergency Department Database, 2008) to examine the relative risk for diagnoses of depressive, substance use, and anxiety disorders originating in areas with and without MTR activity. Logistical regression analyses, controlling for ethnicity, rurality, mean income, and gender, indicated that MTR independently predicts greater risk for depressive (OR 1.37) and substance use disorders (OR 1.41), but not anxiety disorders. Overall, these findings have public health policy implications, build on other evidence of increased risk of negative mental health outcomes related to MTR, and lend some support to the validity of solastalgia related to environmental change.

Sex differences in claimed and behavioral self-handicapping and ADHD symptomatology in emerging adults.

Although the research is clear that boys with ADHD have higher symptomatology and impairment than girls with ADHD, for adults the research is mixed. Some studies suggest no sex differences, whereas others suggest that women might have higher symptomatology and impairment. The present study examined sex differences in ADHD symptomatology and impairment, and the possible role of claimed and behavioral self-handicapping as an explanation for any differences. Claimed self-handicapping (CSH) involves reports of performance-inhibiting conditions, whereas behavioral self-handicapping (BSH) involves reporting more objective, intentional acts that could undermine performance. College students (N = 699) completed an online study. Sex differences were found for hyperactivity such that women reported higher levels, but not for inattention or impairment. The test of the indirect effect of sex through CSH was significant, suggesting that higher levels of CSH in women were associated with elevated ADHD symptoms and impairment. The test of the indirect effect of sex through BSH was also significant, suggesting that higher levels of BSH in men are associated with elevated symptoms of ADHD and impairment. These data extend the literature by suggesting that self-handicapping might at least partially explain differential self-reporting of ADHD symptoms and impairment in emerging adults across the sexes.

Perceived stress and ADHD symptoms in adults.

OBJECTIVE: Given that ADHD has been linked to dysfunction across development and in many life domains, it is likely that individuals experiencing these symptoms are at increased risk for experiencing stress. The current study examines the association between ADHD and other psychiatric symptoms and perceived stress in a community sample of adults. METHOD: Perceived stress data collected from 983 participants (M(age) = 45.6 years) were analyzed primarily via hierarchical multiple regression using ADHD symptom clusters, demographic variables, and anxiety and depression scale variables as predictors. RESULTS AND CONCLUSION: ADHD symptoms positively associated with perceived stress. Inattention and sluggish cognitive tempo (SCT), as opposed to hyperactivity-impulsivity and newly proposed executive dysfunction symptoms, were the most consistent predictors. These findings reinforce that the experience of ADHD symptoms in adulthood is associated with stress and suggest that SCT could play an important role in assessing risk for negative adult outcomes.

Young adult romantic couples' conflict resolution and satisfaction varies with partner's attention-deficit/hyperactivity disorder type.

Attention-deficit/hyperactivity disorder (ADHD) has previously been associated with less satisfaction and success in romantic relationships. This study compares conflict resolution and problem-solving behaviors in young adult romantic couples either having one partner with ADHD combined type (C-couples), having one partner identified with ADHD inattentive type (IA-couples), or in which neither partner has an ADHD diagnosis (nondiagnosed [ND] couples). Self-reports of current and childhood ADHD symptoms corroborated diagnostic status and speaker and listener behaviors, coded via the Rapid Couples Interaction Scoring System (Gottman, 1996), were the primary dependent variables. Analyses revealed greater negativity and less positivity in C-couples' behavior during a conflict resolution task, relative to IA and ND couples, and this corresponded with couples' relational satisfaction. IA-couples emitted relational behavior that was largely similar to ND couples. Findings support that relational impairment exists in C-couples, and to some degree, contrast with previous research suggesting that individuals with predominant inattention experience greater social impairment in adulthood than those with other types of ADHD.

Stimulant medication use in college students: comparison of appropriate users, misusers, and nonusers.

While stimulant medication is commonly prescribed to treat Attention-Deficit/Hyperactivity Disorder in children and adolescents (Merikangas, He, Rapoport, Vitiello, & Olfson, 2013; Zuvekas & Vitiello, 2012) and is considered an empirically supported intervention for those groups (Barkley, Murphy, & Fischer, 2008; Pelham & Fabiano, 2008; Safren et al., 2005) surprisingly little is known about the efficacy of stimulants in the slightly older emerging adult population. A focus has emerged, however, on illicit stimulant use among undergraduates, with studies suggesting such behavior is not uncommon (e.g., Arria et al., 2013). Unfortunately, details are lacking regarding outcomes and personal characteristics associated with different patterns of stimulant misuse. The current study compares the characteristics of four groups of college students, including those with stimulant prescriptions who use them appropriately (i.e., appropriate users), those who misuse their prescription stimulants (i.e., medical misusers), those who obtain and use stimulants without a prescription (i.e., nonmedical misusers), and those who do not use stimulant medications at all (i.e., nonusers). Undergraduates (N = 1,153) from the Southeastern, Midwest, and Rocky Mountain regions completed online measures evaluating patterns of use, associated motives, side effects, ADHD symptomatology, and other substance use. Both types of misusers (i.e., students who abused their prescriptions and those who obtained stimulants illegally) reported concerning patterns of other and combined substance use, as well as higher prevalence of debilitating side effects such as insomnia and restlessness. Research and practical implications are discussed.

Distinct ADHD symptom clusters differentially associated with personality traits.

OBJECTIVE: ADHD has been linked to various constructs, yet there is a lack of focus on how its symptom clusters differentially associate with personality, which this study addresses. METHOD: The current study examines the relationship between impulsive and inattentive ADHD traits and personality, indexed by the Revised NEO Personality Inventory (NEO-PI-R) and the Millon Clinical Multiaxial Inventory (MCMI-III), in a sample of undergraduates. RESULTS: Impulsivity was associated with NEO-PI-R and MCMI-III traits characterized by emotional distress, interpersonal problems, and disruptive behavior, whereas inattention was associated only with focus-oriented constructs. CONCLUSION: ADHD-related inattention is a relatively modest predictor of personality traits, as compared with hyperactivity-impulsivity. These findings have implications regarding the distinctiveness and etiology of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) ADHD types.

Sex differences in the manifestation of ADHD in emerging adults.

OBJECTIVE: Given the mixed literature in the area, the aim of the current study was to determine whether sex differences exist in inattention, hyperactivity, and impairment in college adults with ADHD. METHOD: Individuals from three universities were recruited for the study. Participants with (n = 164) and without ADHD (n = 710) completed on-line measures of symptoms and impairment. RESULTS: College women with ADHD were shown to have higher rates of inattention, hyperactivity, and impairment than college women without ADHD and college men with ADHD. Analyses revealed that women in college who have ADHD experience higher levels of impairment in the following domains: home life, social life, education, money management, and daily life activities. CONCLUSION: Overall, clear differences emerged between men and women with ADHD. Implications and future directions are discussed.

The effects of quercetin supplementation on cognitive functioning in a community sample: a randomized, placebo-controlled trial.

BACKGROUND: The purpose of the present study was to examine the effects of quercetin supplementation on neurocognitive functioning. METHODS: A large community sample (n = 941) completed a 12-week supplementation protocol, and participants were randomly assigned to receive 500 mg/day or 1000 mg/day quercetin, or placebo. RESULTS: Results failed to indicate significant effects of quercetin on memory, psychomotor speed, reaction time, attention, or cognitive flexibility, despite large increases in plasma quercetin levels among the quercetin treatment groups. DISCUSSION: Consistent with recent research, this study raises concerns regarding the generalizability of positive findings of in vitro and animal quercetin research, and provides evidence that quercetin may not have an ergogenic effect on neurocognitive functioning in humans.