Executive dysfunction in ADHD involves deficits in cognitive processes like working memory, planning, organization, andself-motivation. These difficulties can lead toprocrastination, inefficiency, underachievement, andemotional distressin students, fueling a cycle of frustration and impaired academic performance.
Notably, executive deficits often persist even when core ADHD symptoms are managed with medication, underscoring the need for targeted interventions to build compensatory skills and coping strategies to support academic success and well-being.
Key Points
Rationale
ADHD has a pronounced negative impact on academic performance and emotional well-being in college students (Ramsay & Rostain, 2015b; Thomas et al., 2013).
Studies indicate college students with ADHD have higher rates of course withdrawal (Advokat et al., 2011), lower GPAs (Blase et al., 2009), increased likelihood of academic probation (Heiligenstein et al., 1999), and lower graduation rates (Barkley et al., 2006).
Executive dysfunction, especially in time management, organization, and planning, strongly predicts academic impairment in those with ADHD (Biederman et al., 2004; Dvorsky & Langberg, 2014; Weyandt et al., 2013).
While medication can reduce core symptoms, research on its effects and adherence in college students is limited (Blase et al., 2009; Rabiner et al., 2008).
CBT interventions targeting executive dysfunction have proven effective in adults with ADHD (Safren et al., 2010; Solanto et al., 2010), but tailoring to the specific needs of college students is still at an early stage.
This study aimed to adapt an established adult CBT program to address the executive functioning deficits of college students in the specific contexts and demands of the academic environment.
Method
Open trial assessing feasibility, acceptability and effectiveness of a 12-session weekly group CBT intervention targeting executive functioning in college students with rigorously diagnosed DSM-5 ADHD.
Treatment response was assessed pre- and post-treatment with structured interviews of ADHD symptoms, self-report questionnaires of symptoms and executive functioning, and GPA.
Procedure
Two groups of 9 students received 12 weekly 2-hour group CBT sessions including in-session exercises and weekly home practice. Sessions focused on behavioral and cognitive strategies to improve time-management, organization, planning, and application to academic work.
Sample
18 college students (56% female, mean age 23.61) meeting DSM-5 criteria for ADHD-predominantly inattentive (56%) or combined type.
Most had prior ADHD diagnoses and psychiatric comorbidities. 28% took ADHD medication during study.
Measures
Analysis
Repeated measures ANOVA and MANOVA assessed pre-post changes on outcome measures.Effect sizescalculated as partial eta squared.
Results
84% attended ≥9/12 sessions. Significant reductions found in inattentive symptoms on AISRS (ES=0.65) and CAARS-S (ES=0.64). 39% no longer met symptom criteria post-treatment.
Significant improvements seen in time-management, organization and total executive functioning on BDEFS and LASSI. No change in GPA.
Insight
This study provides preliminary evidence that a CBT intervention tailored to the specific executive functioning deficits and academic demands of college students with ADHD is feasible, acceptable, and effective in reducing inattention and enhancing EF in key domains.
Participants found time-management strategies, “chunking” overwhelming tasks, and cognitive restructuring most helpful.
While no GPA change was seen, improved EF and reduced inattention, as found here, have predicted better academic and occupational outcomes in previous studies. Future controlled trials should evaluate the maintenance of gains and elucidate mechanisms of change.
Strengths
Below are some of the strengths of this study:
Limitations
Below are some of the limitations of this study:
Implications
May help improve critical academic and occupational outcomes. Suggests specific EF domains and skills to prioritize. Colleges should consider screening for ADHD and offering such support.
References
Advokat, C., Lane, S. M., & Luo, C. (2011). College students with and without ADHD: Comparison of self-report of medication usage, study habits, and academic achievement.Journal of Attention Disorders, 15(8), 656-666.https://doi.org/10.1177/1087054710371168
Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2006). Young adult outcome of hyperactive children: Adaptive functioning in major life areas.Journal of the American Academy of Child & Adolescent Psychiatry, 45(2), 192-202.
Biederman, J., Monuteaux, M. C., Doyle, A. E., Seidman, L. J., Wilens, T. E., Ferrero, F., Morgan, C. L., & Faraone, S. V. (2004). Impact of executive function deficits and attentiondeficit/hyperactivity disorder (ADHD) on academic outcomes in children.Journal of Consulting and Clinical Psychology, 72, 757–766
Blase, S. L., Gilbert, A. N., Anastopoulos, A. D., Costello, E. J., Hoyle, R. H., Swartzwelder, H. S., & Rabiner, D. L. (2009). Self-reported ADHD and adjustment in college: Cross-sectional and longitudinal findings.Journal of Attention Disorders, 13(3), 297-309.https://doi.org/10.1177/108705470933444
Dvorsky, M. R., & Langberg, J. M. (2014). Predicting impairment in college students with ADHD: The role of executive functions.Journal of Attention Disorders.https://doi.org/10.1177/1087054714548037
Heiligenstein, E., Guenther, G., Levy, A., Savino, F., & Fulwiler, J. (1999). Psychological and academic functioning in college students with attention deficit hyperactivity disorder.Journal of American College Health, 47(4), 181-185.
Rabiner, D. L., Anastopoulos, A. D., Costello, J., Hoyle, R. H., & Swartzwelder, H. S. (2008). Adjustment to college in students with ADHD.Journal of Attention Disorders, 11(6), 689–699.https://doi.org/10.1177/1087054707305106
Ramsay, J. R., & Rostain, A. L. (2015). College students with ADHD. In L. Adler, T. Spencer, & T. Wilens (Eds.),Attention-deficit hyperactivity disorder in adults and children. Cambridge University Press.
Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010). Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial.Journal of the American Medical Association, 304(8), 875-880.
Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. M. J., & Kofman, M. D. (2010). Efficacy of meta-cognitive therapy for adult ADHD. American Journal of Psychiatry, 167(8), 958-968.https://doi.org/10.1176/appi.ajp.2009.09081123
Thomas, M., Rostain, A., & Prevatt, F. (2013). ADHD diagnosis and treatment in college students and young adults.Adolescent medicine: state of the art reviews, 24(3), 659.
Weyandt, L. L., DuPaul, G. J., Verdi, G., Rossi, J. S., Swentosky, A. J., Vilardo, B. S., … & Carson, K. S. (2013). The performance of college students with and without ADHD: Neuropsychological, academic, and psychosocial functioning.Journal of Psychopathology and Behavioral Assessment, 35(4), 421-435.https://doi.org/10.1007/s10862-013-9351-8
Keep Learning
Some Socratic questions for a college class to discuss based on this review paper could include:
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
