APA Journals Dialogue
May 9, 2017
Effects of ADHD on Executive Functioning in College Students
In this episode of APA Journals Dialogue, Drs. Lisa Weyandt, Arthur Anastopoulos, and George DuPaul discuss the differences in executive functioning in college students with and without ADHD.
- Weyandt, L. L., Oster, D. R., Gudmundsdottir, B. G., DuPaul, G. J., & Anastopoulos, A. D. (2017). Neuropsychological functioning in college students with and without ADHD. Neuropsychology, 31(2), 160–172. http://dx.doi.org/10.1037/neu0000326
About the Guests
Drs. Lisa Weyandt, Arthur Anastopoulos, and George DuPaul are psychologists who specialize in research on and treatment of college students with ADHD at the University of Rhode Island, the University of North Carolina at Greensboro, and Lehigh University, respectively. Together, as part of a five-year study, they investigated the various implications of ADHD diagnosis and treatment in college students.
About the Journal
Visit the Neuropsychology website.
Marla Bonner: Hello, I'm Marla Bonner. Welcome to APA Journals Dialogue, a podcast featuring research from the journals program of the American Psychological Association. In this episode, we look at an article from Neuropsychology.
Drs. Lisa Weyandt, Arthur Anastopoulos, and George DuPaul are all researchers whose work focuses on treatments for individuals with ADHD.
Dr. Weyandt is a professor of psychology at the University of Rhode Island, and she is a faculty member in the George and Anne Ryan Institute for Neuroscience and the Interdisciplinary Neuroscience Program.
Dr. Anastopoulos is a professor of human development and family studies and the director of the ADHD Clinic at the University of North Carolina at Greensboro.
Dr. DuPaul is a professor of school psychology at Lehigh University, and focuses his research on school-based behavioral interventions for students with ADHD.
In their article, "Neuropsychological Functioning in College Students With and Without ADHD," Drs. Weyandt, Anastopoulos, and DuPaul examined the relationship between ADHD diagnosis and performance on executive functioning and intellectual tasks as part of a multiyear and multisite study.
Joining us today are Drs. Weyandt, Anastopoulos, and DuPaul. Thank you all for joining us. We appreciate your time.
Dr. DuPaul: Thank you.
Dr. Anastopoulos: Thank you.
Dr. Weyandt: It's good to be with you.
Marla: Thank you! So, in your article, you mention "TRAC." Could you share with our audience what TRAC is and also provide an overview of the project, and perhaps discuss how the current study relates to the overarching goals of TRAC?
Dr. Anastopoulos: Sure, I can do that. TRAC stands for "Trajectories Related to ADHD in College," and, just to give you the big picture, it is a five-year R01 grant award from the National Institute of Mental Health.
Drs. DuPaul, Weyandt, and myself are the multiple principle investigators on this project, and we've been doing this across three primary sites: the University of North Carolina at Greensboro, Lehigh University, and the University of Rhode Island. We began the project in the fall of 2012, and we're actually in the process of finishing up this spring.
So to give a better sense of what it's about, we were interested in doing this because, in the ADHD literature, there are a fair number (if not a lot) of studies on children and adults, but very few on college students with ADHD, relatively speaking, and most of what we know about college students with ADHD has come to us from studies conducted at a single point in time.
Indirectly, we have some information about college students with ADHD from longitudinal studies that began looking at children and followed them into adulthood, but what was going on in college wasn't really the focus of those studies.
But what we do know from the data that have been collected is that, in general, children with ADHD will go on to four-year colleges at much lower rates and even finish college at much lower rates than the general population. And those who do remain in school tend to perform less well.
But what's unclear is how all this unfolds across the college years and what are the variables that help determine whether someone is successful or not when they're dealing with ADHD.
So TRAC was a project (and it's really the first project) to examine very comprehensively how ADHD and its associated features and its associated impairments unfold across multiple domains of functioning during the college years. And of course, all of this is to help inform assessment and treatment of students in college dealing with ADHD. And beyond the college years, of course, this is important because this has implications for the long-term financial and mental health of this ADHD population and for society at large.
Just very quickly, we began in year one recruiting 456 first-year college students with and without ADHD between 18 and 22 years of age. Approximately half the sample was female; approximately 30% of the sample came from non-Caucasian/Hispanic backgrounds.
Annually, we conducted four comprehensive evaluations addressing executive functioning, educational functioning, psychological functioning, neuropsychological functioning, social functioning, vocational functioning, as well as how often students were using various treatment services. And here we are at the end of our fourth year, and of the original 456 who started the project, 348 of those students have done fourth-year assessments for us, or 76% were retained through four years which is really very pleasing to us.
And then, just very quickly, to kind of put this in context, we have thus far published four papers summarizing findings from our year one database, including the neuropsychological study that's the focus of today's podcast.
But we also have several other year-one papers that are underway or under review, and now that we will be wrapping up our data collection for all four years, in the very near future we're going to start putting out findings about how ADHD and its associated features and impairments unfold and hopefully arrive at some clearer idea about how to assess and how to treat this population more effectively.
Marla: Well thank you, Dr. Anastopoulos, for that, and we look forward to those future findings from those other studies.
So, at the beginning of the article, you explain that relatively little research has been conducted on college students with ADHD, and what research does exist has inconsistent findings. How did this study address the limitations of previous research on college students with ADHD?
Dr. DuPaul: So some of those strengths of our project have been summarized by Dr. Anastopoulos just a minute ago, but let me highlight a few that are of particular focus for this paper.
One is that we recruited students from multiple sites — from universities in Rhode Island, Pennsylvania, and North Carolina — in contrast to most of the prior research on college students with ADHD, which typically involves a sample from one university. So we have geographical diversity in our sample as well as good representation across gender and racial, ethnic, and socioeconomic groups. So, we believe that this is a study that has a much more representative sample of the college population, at least those students who attend four-year universities.
We should also note that this is the largest single study (that we're aware of) of college students with ADHD that involves a systematic comparison of their functioning relative to their peers without ADHD. So that gives us substantially more power to examine differences across groups than has been available in prior studies on college students with ADHD.
The other thing that we've done here with this study, as Dr. Anastopoulos alluded to, is we had a wide scale recruitment process that we used across two years to identify our participants. So in other words, we didn't just go to our disability resource centers or student disabilities offices to find students who have come forward for accommodations and support, but we cast a wider net using social media and other forms of recruitment such that I believe we've been able to obtain a much more representative sample of college students with ADHD since many of them don't come forward to student disabilities offices for accommodations or support. So again, this is in contrast to many prior studies that have concentrated primarily on recruitment through disabilities offices.
Also, we conducted a rigorous multimethod assessment of the extent to which students met criteria for ADHD. We got information not only from the students themselves, but from their parents when that was available, and we collected data in the context of diagnostic interviews, self-report rating scales, and, as I mentioned, parent reports.
And then, all of those diagnostic data were reviewed by a panel that included the three of us as well as another expert on adult ADHD so that we could reach consensus as to whether students met criteria or not for ADHD, as well as considered other disorders that these students may have (anxiety disorder, mood disorders, and so forth), some of which may be comorbid with ADHD and others which may account for ADHD symptoms.
Really, the process that we underwent was very much a state-of-the-art identification process that allowed us to be pretty confident that our sample really represented students who actually have ADHD and those who don't.
In terms of the Neuropsychology paper itself, it's important to note that we collected multiple measures of neuropsychological functioning, including self-report ratings as well as direct performance measures. So we're looking at this area of functioning from multiple viewpoints.
That kind of summarizes the major of advantages of our study relative to the more common, single university, smaller sample, less diverse research that has been done previously.
Marla: So how can your study better prepare school administrators to develop effective supportive services and secure needed resources for students with ADHD?
Dr. Weyandt: So, based on the results of this study, what we found was that students with ADHD, compared to those without the disorder, perform more poorly on measures of executive function, and what that means is that they perform more poorly in terms of their ability to plan, their organizational skills, impulsivity, their ability to sustain their attention, something we call perseveration.
And, in addition to that, they also demonstrated some working memory deficits. That combination of cognitive abilities are really important for college students to function — to function in the classroom; if they have a job on the side, to function well in that setting.
And, as you know, college students many times, the first year, college students are placed in an environment without teachers checking in on them and parents monitoring them closely, and so these students seem to be at particular risk for not doing as well academically, and then some of our other studies have found that they actually are at greater risk for other types of risk-taking behavior, which you may want to invite us back for another podcast for those studies. But we found that they are at greater risk academically right from the get-go.
So we think that it's really important that services be provided their first semester. And that's a little tricky, because not all students with ADHD register with disability support services, so we think it would behoove universities to reach out to students to continue to inform them of services that are available and what might those services be.
So in addition to disability support services, which can be individually determined for the student, we think it would be useful for students to participate in the academic skills center, develop better study strategies, time management, goal setting, things like exam preparation, note-taking; and if they also have additional comorbid issues, like depression, anxiety, we think it would be beneficial for them to participate in counseling at the health and counseling centers on campuses as well.
Marla: And you found that there were performance differences between students with ADHD who took medication and those who did not. What implications might this have for future research?
Dr. Weyandt: That was an interesting study, one that we're excited about. We found that college students with ADHD taking medication did perform better on some measures of executive functioning, but not all. So that's a fascinating finding — why is that? Why does the medication seem to improve their performance on some (but not all) aspects of executive functioning? So future research really needs to delve into that and piece that apart.
We also think that it's important for future research to look at potential medication effects on other types of executive function tasks in those college students with ADHD.
For example, the real world — our study was conducted in a lab, and as Dr. DuPaul said, we used different types of executive function measures, but what would be great is for us to know in the classroom, how does this translate? How do we see their executive functioning in terms of calling out inappropriately in class or having organizational difficulties while taking notes or on exams or preparing papers; things like that. And then, what might the effects of medication be on those specific skills? We think that would be fascinating to explore.
And also, we found that — and this was an interesting finding — so, college students with ADHD performed poorly on executive function tasks, but so did those students who had comorbid disorders like depression and anxiety. What future research needs to look at is, are there specific types of executive function deficits that are unique to college students with ADHD compared to those with other types of disorders, and do different types of medication affect executive functioning in different ways (such as stimulants, antidepressants, anti-anxiety medications)?
Marla: So it sounds like there were certainly some interesting findings, but were there any that surprised you about the study?
Dr. Weyandt: There were! There were a number that we found surprising. One, I think, was that the number of college students that were not taking medication. So, most college students with ADHD in our study were not taking medication, and we don't know the reason for that. We don't know if they had a prescription, decided not to continue taking it in college; we don't know if these are higher functioning college students with ADHD who may not need the medication compared to students who did not go on from high school and pursue college education, so that was an interesting finding.
I think another one was on the IQ test. So we didn't find that college students with ADHD, compared to those without, differed in intellectual functioning. And that wasn't a surprising finding — that's supported by other research — but there are specific subtests on an IQ test that we did expect that there would be medication-related effects, like Matrix Reasoning and some other subtests. We didn't find those.
I think another finding, as Dr. Anastopoulos alluded to earlier, was the level of commitment to the study. We were really grateful to these students who hung in there year after year, who kept coming back. And when you have executive functioning issues, it's not an easy thing to remember where to show up, what time, and so on, so we really appreciated that.
Marla: Well, this has been a fantastic conversation, and again, we really appreciate your time today, and we will be happy to have you back again in the future. Thank you so much.
Dr. Anastopoulos: Thank you.
Dr. DuPaul: Thank you.
Dr. Weyandt: Thank you.
Marla: To read this article and others from Neuropsychology, please visit our website at www.apa.org/pubs/journals/neu.
Thank you for joining us. I'm Marla Bonner, with APA Journals Dialogue.
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