Longitudinal Examination of Sexual Risk Behavior in College Students With and Without Attention-Deficit/Hyperactivity Disorder.

The present study sought to identify differences in the rates and predictors of risky sexual behavior among college students with and without attention-deficit hyperactivity disorder (ADHD). Current ADHD diagnosis, medication status among those with ADHD, executive functioning, substance use, comorbid anxiety, comorbid depression, and gender were identified as potential predictors of increased risky sexual behavior. Multiple group latent growth curve modeling was used to estimate trajectories of risky sexual behavior across four years of college among college students with ADHD (nmedicated = 99, nunmedicated = 105) and a comparison group (n = 217) recruited from colleges throughout the eastern United States (M age = 18.23 years, 53% female, 70% White). First-year college students with ADHD reported significantly higher rates of sexual risk behavior than their peers without ADHD, with no significant differences found based on medication status. Students with ADHD who were taking medication for ADHD reported significant decreases in risky sexual behavior over time. Among college students with ADHD, anxiety was related to increased current risky sexual behavior in the medicated group, while depression was predictive of decreased future risky sexual behavior in the unmedicated group. Alcohol and cannabis use were significantly associated with increased mean levels of risky sexual behavior across all three groups, and cannabis use was associated with decreased future risky sexual behavior within the comparison group. Executive functioning deficits and male gender were predictive of risky sexual behavior within the comparison group. The results demonstrate that college students with ADHD, regardless of medication status, are at an increased likelihood of engaging in risky sexual behavior.

Factor Structure of the Sexual Risk Survey Among U.S. College Students with and without ADHD: Assessing Clinical Utility with a High-Risk Population.

Young adults, particularly college students, report a higher prevalence of risky sexual behavior than the general population, increasing their likelihood for unplanned pregnancy, sexually transmitted infections (STIs), and negative psychological outcomes. Although sexual risk behavior and its consequences are a major public health concern, current prevention literature is insufficient and relies on sexual risk measures with limited psychometric support. The present study, therefore, examined the psychometric properties of a sexual risk survey (SRS; Turchik, Garske, in Arch Sex Behav 38:936-948, 2009), using data from the first year of a longitudinal study following the outcomes of college students with and without attention-deficit/hyperactivity disorder (ADHD; N = 410). Principal components analyses were conducted to assess the factorial structure of the SRS comparing results from a general college population and a college population considered to be high-risk (ADHD). Results revealed four components across both samples. Internal consistency estimates for component scores and total scores ranged from .627 to 918. Implications of the findings are discussed and suggestions for future studies are advanced.

Examining the linkages between marital quality and anxiety: A meta-analytic review.

This study examines the associations between marital quality and anxiety using meta-analytic techniques. A total of k = 151 effects published between the years 2000 and 2019 were analyzed. It was hypothesized that better overall marital quality would be associated with less anxiety. Results showed significant associations between marital quality and anxiety in such a way that higher overall marital quality was associated with lower anxiety. Post hoc analyses revealed that higher levels of positive marital behaviors (e.g., communication and intimacy) and fewer negative marital behaviors (e.g., criticism) were associated with lower anxiety. Additional results examined potential moderators of the association between marital quality and anxiety, including study design, direction of longitudinal associations (i.e., marital quality predicting anxiety or vice versa), gender, assessment of anxiety, and the use of control variables to account for comorbidities and demographic factors. Findings from this study provide a comprehensive review of the associations between marital quality and anxiety, which may be used to inform future research and treatment.

An RCT of a CBT Intervention for Emerging Adults with ADHD Attending College: Functional Outcomes.

Objective: The current study reports functional outcomes from a multi-site randomized trial of a cognitive-behavioral treatment program for college students diagnosed with ADHD.Methods: A sample of emerging adults (N = 250; ages 18 to 30) currently attending college were comprehensively evaluated and diagnosed with ADHD (M age = 19.7; 66% female, 6.8% Latino, 66.3% Caucasian). Participants were randomized to either a two-semester intervention (Accessing Campus Connections and Empowering Student Success (ACCESS)) or a delayed treatment condition. Participants were assessed with measures of academic, daily life, and relationship functioning prior to treatment, at the end of the first semester, and after the second semester of treatment.Results: Multi-group latent growth curve models revealed moderate effect size improvements on self-report measures of study skills and strategies, as well as on self-report measures of time management, daily functioning, and overall well-being for participants in ACCESS. Importantly, treatment effects were maintained or increased in some cases from the end of the first semester to the end of the second semester. Improvements in self-reported interpersonal functioning were not significantly different across condition and neither condition demonstrated significant change over time in educational record outcomes (GPA and number of credits earned).Conclusions: ACCESS appears to promote improvements in self-reported general well-being and functioning, time management, and study skills and strategies. However, improvements in interpersonal relationships and objective academic outcomes such as GPA were not observed. Clinical implications and future directions for treating ADHD on university and college campuses are discussed.

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.

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.

Multi-Informant Assessment of ADHD Symptom-Related Impairments Among Children and Adolescents.

Existing methods of assessing attention-deficit/hyperactivity disorder (ADHD) are limited because they do not examine impairments in relation to symptoms of ADHD. This study investigated parent and teacher ratings of multiple domains of impairment, assessed in relation to the symptom dimensions of ADHD using the ADHD Rating Scale-5. Nationally representative samples of children rated by parents and teachers were recruited through commercial research firms. One sample included 2,079 parents who rated one of their children of age 5 to 17 years. The second sample included 1,070 teachers in grades K to 12 who rated 2 randomly selected students on their class rosters. Informants rated the extent to which each child displayed the 18 behaviors symptomatic of ADHD over the previous 6 months, as well as symptom-related impairments in the areas of family/teacher relationships, peer relationships, academics, behavior problems, homework, and self-esteem. Respondents were asked to complete the 6 impairment items after rating each of the Inattention and Hyperactivity/Impulsivity symptom items. For both informants a 6-factor model that combined impairment items across source of impairment was adequate and superior to a 2-factor structure based on source of impairment (i.e., impairment due to Inattention vs. Hyperactivity-Impulsivity). Impairment ratings were impacted by child demographic factors, but effect sizes were low. In contrast, impairment ratings were strongly related to ratings on the ADHD symptom dimensions. The study provides support for assessing 6 symptom-related domains of impairment but does not support differentiating whether Inattention or Hyperactivity-Impulsivity is the source of impairment.

Angiogenic, neurotrophic, and inflammatory system SNPs moderate the association between birth weight and ADHD symptom severity.

Low birth weight is associated with increased risk for Attention-Deficit/Hyperactivity Disorder (ADHD); however, the etiological underpinnings of this relationship remain unclear. This study investigated if genetic variants in angiogenic, dopaminergic, neurotrophic, kynurenine, and cytokine-related biological pathways moderate the relationship between birth weight and ADHD symptom severity. A total of 398 youth from two multi-site, family-based studies of ADHD were included in the analysis. The sample consisted of 360 ADHD probands, 21 affected siblings, and 17 unaffected siblings. A set of 164 SNPs from 31 candidate genes, representing five biological pathways, were included in our analyses. Birth weight and gestational age data were collected from a state birth registry, medical records, and parent report. Generalized Estimating Equations tested for main effects and interactions between individual SNPs and birth weight centile in predicting ADHD symptom severity. SNPs within neurotrophic (NTRK3) and cytokine genes (CNTFR) were associated with ADHD inattentive symptom severity. There was no main effect of birth weight centile on ADHD symptom severity. SNPs within angiogenic (NRP1 & NRP2), neurotrophic (NTRK1 & NTRK3), cytokine (IL16 & S100B), and kynurenine (CCBL1 & CCBL2) genes moderate the association between birth weight centile and ADHD symptom severity. The SNP main effects and SNP × birth weight centile interactions remained significant after adjusting for multiple testing. Genetic variability in angiogenic, neurotrophic, and inflammatory systems may moderate the association between restricted prenatal growth, a proxy for an adverse prenatal environment, and risk to develop ADHD.

Assessing attention-deficit/hyperactivity disorder-related impairment: Differential item functioning based on child demographic characteristics.

Although numerous studies have examined how child demographic characteristics may impact ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms, there is limited research on how these factors are related to ratings of impairment. This study examined child characteristics (assigned sex, age, race, ethnicity) that may affect parent and teacher ratings of ADHD symptom-related impairments in relationships with family and/or teacher, peer relationships, behavior disruption, academic impairment, homework performance, and self-esteem. The study was conducted using independent U.S. national samples of parents (n = 2,075) and teachers (n = 1,070). Informants rated impairments related to inattention and hyperactivity-impulsivity using the ADHD Rating Scale-5. Rasch analyses were used to examine differential item functioning in relation to child characteristics. Separate analyses were conducted for inattention- and hyperactivity-impulsivity-related impairment for both the parent and teacher samples. For teacher ratings, only two items (behavior disruption, homework impairment) demonstrated differential item functioning with intermediate or large effect sizes (≥ .426 logits) in relation to any child characteristic; whereas for parent ratings, all six items displayed differential item functioning with at least intermediate effect sizes in relation to one or more child characteristics. The findings indicated several areas in which child characteristics may have an impact on ratings of ADHD-related impairment, particularly based on parent ratings, which have potential implications for the diagnostic assessment of ADHD and highlight the need for further research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical Change Mechanisms in the Treatment of College Students With ADHD: Trajectories and Associations With Outcomes.

The purpose of this study was to evaluate trajectories of response for the three theorized mechanisms of clinical change (knowledge, behavioral strategies, and adaptive thinking) associated with the Accessing Campus Connections and Empowering Student Success (ACCESS) intervention for college students with attention-deficit/hyperactivity disorder (ADHD) and their association with treatment outcomes. Participants included 250 college students comprehensively diagnosed with ADHD randomly assigned to ACCESS or to a delayed-treatment control who completed ratings at baseline, end of active treatment, and end of the maintenance phase of treatment (after two semesters). Growth mixture models (GMMs) were used to evaluate trajectories. Participants in ACCESS made significant gains in the use of behavioral strategies and trajectories were associated with large effect size improvements in measures of symptoms and functioning. Participants also made improvements in ADHD knowledge. However, only the knowledge trajectory with rapid improvement displayed significantly better outcomes. Only one trajectory group showed improvement in adaptive thinking with most ACCESS participants remaining stable across time. However, adaptive thinking trajectories were strongly related to both symptom and functional outcomes. ACCESS is associated with large gains in two of the three theorized clinical mechanisms of change, behavioral strategies and ADHD knowledge. Rapid improvement in behavioral strategies was associated with robust improvement in symptoms and functioning. Although improvements in the third mechanism, adaptive thinking, were small, they were strongly associated with outcomes demonstrating the importance of a cognitive-behavioral approach in treating college students with ADHD.

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.

The ATXN1 and TRIM31 genes are related to intelligence in an ADHD background: evidence from a large collaborative study totaling 4,963 subjects.

Intelligence is a highly heritable trait for which it has proven difficult to identify the actual genes. In the past decade, five whole-genome linkage scans have suggested genomic regions important to human intelligence; however, so far none of the responsible genes or variants in those regions have been identified. Apart from these regions, a handful of candidate genes have been identified, although most of these are in need of replication. The recent growth in publicly available data sets that contain both whole genome association data and a wealth of phenotypic data, serves as an excellent resource for fine mapping and candidate gene replication. We used the publicly available data of 947 families participating in the International Multi-Centre ADHD Genetics (IMAGE) study to conduct an in silico fine mapping study of previously associated genomic locations, and to attempt replication of previously reported candidate genes for intelligence. Although this sample was ascertained for attention deficit/hyperactivity disorder (ADHD), intelligence quotient (IQ) scores were distributed normally. We tested 667 single nucleotide polymorphisms (SNPs) within 15 previously reported candidate genes for intelligence and 29451 SNPs in five genomic loci previously identified through whole genome linkage and association analyses. Significant SNPs were tested in four independent samples (4,357 subjects), one ascertained for ADHD, and three population-based samples. Associations between intelligence and SNPs in the ATXN1 and TRIM31 genes and in three genomic locations showed replicated association, but only in the samples ascertained for ADHD, suggesting that these genetic variants become particularly relevant to IQ on the background of a psychiatric disorder.

A randomized controlled trial examining CBT for college students with ADHD.

OBJECTIVE: College students with attention deficit/hyperactivity disorder (ADHD) are at increased risk for numerous educational and psychosocial difficulties. This study reports findings from a large, multisite randomized controlled trial examining the efficacy of a treatment for this population, known as ACCESS-Accessing Campus Connections and Empowering Student Success. METHOD: ACCESS is a cognitive-behavioral therapy program delivered via group treatment and individual mentoring across two semesters. A total of 250 students (18-30 years of age, 66% female, 6.8% Latino, 66.3% Caucasian) with rigorously defined ADHD and comorbidity status were recruited from two public universities and randomly assigned to receive ACCESS immediately or on a 1-year delayed basis. Treatment response was assessed on three occasions, addressing primary (i.e., ADHD, executive functioning, depression, anxiety) and secondary (i.e., clinical change mechanisms, service utilization) outcomes. RESULTS: Latent growth curve modeling (LGCM) revealed significantly greater improvements among immediate ACCESS participants in terms of ADHD symptoms, executive functioning, clinical change mechanisms, and use of disability accommodations, representing medium to large effects (Cohen's d, .39-1.21). Across these same outcomes, clinical significance analyses using reliable change indices (RCI; Jacobson & Truax, 1992) revealed significantly higher percentages of ACCESS participants showing improvement. Although treatment-induced improvements in depression and anxiety were not evident from LGCM, RCI analyses indicated that immediate ACCESS participants were less likely to report a worsening in depression/anxiety symptoms. CONCLUSIONS: Findings from this RCT provide strong evidence in support of the efficacy and feasibility of ACCESS as a treatment for young adults with ADHD attending college. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Anxiety Symptoms and Disorders in College Students With ADHD.

Objective: This study examined anxiety symptoms and disorders in college students with ADHD. Method: Forty-six college students with ADHD and a matched group of students without ADHD participated. Participants completed self-report measures of anxiety symptoms and associated features, including worry, maladaptive beliefs about worry, panic symptoms, social anxiety, obsessive-compulsive symptoms, and self-efficacy. Participants also completed a diagnostic interview to assess lifetime and current anxiety disorders. Results: Participants with ADHD endorsed more maladaptive beliefs about worry, more obsessive-compulsive symptoms, and poorer self-efficacy compared with comparison participants. There were no group differences in rates of current anxiety disorders. Participants with ADHD were over 2 times more likely than comparison participants to endorse this lifetime history. Conclusion: College students with ADHD are more likely to have a lifetime history of an anxiety disorder and are at greater risk for some anxiety symptoms and associated features.

ADHD Parent and Teacher Symptom Ratings: Differential Item Functioning across Gender, Age, Race, and Ethnicity.

Parent and teacher ratings of the two attention-deficit/hyperactivity disorder (ADHD) symptom dimensions (i.e., inattention, hyperactivity-impulsivity) have been found to differ across child gender, age, race, and ethnicity. Group differences could be due to actual variation in symptomatic behaviors but also could be due to measurement items functioning differently based on child characteristics. This study extended prior investigations establishing measurement invariance at the symptom dimension and item levels, by examining possible measurement variance across child demographic characteristics at the item level (i.e., differential item functioning [DIF]) in two large national samples. Using the Rasch rating scale model (Andrich Psychometrika, 43, 561-73, 1978), we examined DIF of the 18 ADHD symptoms in samples of 2079 children (n = 1037 males) from 5 to 17 years old (M = 10.7; SD = 3.8) rated by parents and 1070 children (n = 535 males) aged from 5 to 17 years old (M = 11.5; SD = 3.5) rated by teachers. All but six ADHD symptom items showed DIF across child age, gender, race (Black vs. White), and ethnicity with more items showing DIF for age than for gender, race, or ethnicity. For child gender and age, more items showed DIF for parent than for teacher ratings. More items showed DIF across racial groups for teacher than for parent ratings. Only two parent- and teacher-rated items showed DIF for ethnicity. Implications of findings for practice, research, and future iterations of ADHD diagnostic criteria are discussed.

Cognitive-Behavioral Therapy for College Students With ADHD: Temporal Stability of Improvements in Functioning Following Active Treatment.

Objective: This study examined the extent to which college students with ADHD continued to benefit from a cognitive-behavioral therapy (CBT) program beyond the active phase of treatment. Method: In successive cohorts over a 4-year period, a total of 88 college students with well-defined ADHD received CBT in an open clinical trial format that included active treatment and maintenance phases delivered across two consecutive semesters. Results: Immediately following active treatment, participants displayed statistically significant reductions in ADHD symptoms, improvements in executive functioning, and declines in anxiety and depression symptoms. Although grade point average did not improve significantly, there were statistically significant increases in the number of credit hours that participants attempted and earned across active treatment. Improvements in symptom severity, executive functioning, and educational functioning remained stable 5 to 7 months after active treatment concluded. Conclusion: Findings from this study support the use of CBT interventions for college students with ADHD.

Effects of postnatal parental smoking on parent and teacher ratings of ADHD and oppositional symptoms.

To assess the effects of postnatal parental smoking on subsequent parent and teacher ratings of DSM-IV attention deficit hyperactivity disorder (ADHD) symptoms and oppositional behaviors in children diagnosed with ADHD and their siblings. Children between 5 and 12 years of age with ADHD and their siblings were included. DSM-IV ADHD symptom subscales (Inattentive and hyperactive-impulsive), and oppositionality subscale scores from Conners' Rating Scales were predicted on the basis of parental smoking status in the first 7 years after birth using Generalized Estimating Equations controlling for a range of relevant covariates. Postnatal parental smoking was associated with both parent and teacher ratings of ADHD symptoms and oppositional behavior. After controlling for a number of covariates, several of these relationships were still significant. The risk of maternal smoking for the development of ADHD symptoms does not end during pregnancy. Research on the mechanisms underlying the observed associations is needed.

The misuse and diversion of prescribed ADHD medications by college students.

OBJECTIVE: This study assesses the misuse and diversion of prescribed attention-deficit/hyperactivity disorder (ADHD) medications. METHOD: One hundred fifteen students, attending two universities, with prescriptions for ADHD medications completed a Web survey in spring 2007. RESULTS: Eighty-nine of 115 students (69%) used their ADHD medications as prescribed, whereas 36 (31%) had misused during college by taking larger or more frequent doses than prescribed or by using someone else's medication. Nine students (8%) reported intranasal use during the previous 6 months, and 30 (26%) had diverted medications to peers. Misuse was associated with impulsivity and with other substance use. Enhancing the ability to study outside of class was students' primary motive for misuse, but nonacademic reasons were also reported. Students who misused ADHD medications generally felt that doing so was helpful. CONCLUSIONS: Although most students use their ADHD medication as prescribed, misuse and diversion is not uncommon. Because enhancing academic performance was the primary motive for misuse, the results raise questions about whether undergraduates with ADHD perceive their treatment as adequate and the extent to which physicians and students communicate about issues related to medication adjustments.

Development and Evaluation of the ADHD Cognitions Scale for Adults.

Objective: The clinical literature on ADHD in adults suggests that "overly positive" or optimistic cognitions may contribute to impairment and failure to use self-regulation skills in this population, yet the research literature on this topic is limited. We developed the ADHD Cognitions Scale (ACS), a brief self-report measure of ADHD-related thoughts, and evaluated its psychometric properties. Method: We collected self-report measures, inculding the ACS, from two large community samples (Ns = 262, 304). Results: The measure demonstrated a one-factor solution that replicated in the second sample. Evidence of good internal consistency and also convergent and divergent validity was obtained for both samples. Scores on the ACS correlated with functional impairment, time management problems, and avoidant coping strategies. Conclusion: With additional study, the ACS may be useful to identify and track maladaptive ADHD-related cognitions during cognitive-behavioral treatment, and to further study the role of these thoughts in ADHD-related impairment.

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.