Elizabeth K. Lefler

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.

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.

Promoting Family and School Success for Children With ADHD: Strengthening Relationships While Building Skills

Children with ADHD typically experience significant impairment at home and school, and their relationships with parents, teachers, and peers often are strained. Psychosocial interventions for ADHD generally focus on behavior change in one environment at a time (i.e., either home or school); however, unisystemic interventions generally are not sufficient. The purpose of this article is to describe a family–school intervention for children with ADHD. In addition, program strategies and theoretical bases are discussed.

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.

ADHD Symptomology and Social Functioning in College Students

Objective: ADHD is no longer considered a disorder that children simply outgrow. Adults experience ADHD at high rates (2.5%-5%) and are impaired in multiple life domains, including social impairment. The purpose of this study was to examine emerging adults with varying degrees of ADHD symptomology in respect to social impairment, state and trait anger, romantic relationship satisfaction, and intimate partner violence (IPV). Method: College students, a subset of emerging adults, were recruited to complete measures online. Results: Data were analyzed using a series of multiple regressions. Higher levels of ADHD symptomology in college students were related to increased social impairment and higher levels of state and trait anger, but not romantic relationship satisfaction or rates of IPV. Conclusion: Anger management and social skills training may be beneficial treatment components for this group.

Preliminary Examination of a New Mental Health Screener in a Pediatric Sample

INTRODUCTION Approximately 80% of children with mental health problems do not receive services. It has been recommended that mental health screening be conducted during pediatric visits (Huffman & Nichols, 2004). METHODS The Primary Care Mental Health Screener (PCMHS) was designed to screen for DSM-IV disorders (APA, 1994) in children. The PCMHS was completed by 328 parents of 3- to 12-year-olds. RESULTS The long-form showed adequate to excellent internal consistency across three age groups and eight subscales with one exception (depression in preschoolers). Next, data were used to shorten the screener without compromising internal consistency, resulting in a 32-item short-form. DISCUSSION The long-form of the PCMHS is a promising mental health screener. The internal consistency of the proposed short-form should be examined with a separate sample. Additional research is needed to improve the reliability of the PCMHS for 3- to 5-year-olds and, in general, to examine the validity of this screener.

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.

Preliminary Examination of a Cartoon-Based Hostile Attributional Bias Measure for Urban African American Boys

The current study illustrates how researchers developed and validated a cartoon-based adaptation of a written hostile attributional bias measure for a sample of urban, low-income, African American boys. A series of studies were conducted to develop cartoon illustrations to accompany a standard written hostile attributional bias vignette measure (Study 1), to determine initial psychometric properties (Study 2) and acceptability (Study 3), and to conduct a test–retest reliability trial of the adapted measure in a separate sample (Study 4). These studies utilize a participatory action research approach to measurement design and adaptation, and suggest that collaborations between researchers and key school stakeholders can lead to measures that are psychometrically strong, developmentally appropriate, and culturally sensitive. In addition, the cartoon-based hostile attributional bias measure appears to have promise as an assessment and/or outcome measure for aggression and bullying prevention programs conducted with urban African American boys.

ADHD in college: A qualitative analysis

Attention-deficit/hyperactivity disorder (ADHD) affects many adults and is particularly impairing for emerging adults enrolled in college. Research has shown substantial academic impairment for these individuals. However, research on ADHD impairment has largely been quantitative and focused on children. Therefore, the current study employed Interpretative Phenomenological Analysis to explore the lived experience of college students with ADHD with the following two research questions: (1) What is it like to be a college student with ADHD? and (2) What resources are utilized by college students with ADHD? Thirty-six college students with ADHD were interviewed in focus group settings. Our participants reported a complex and mixed experience living with ADHD in college and varied use of treatments and other accommodations. Specifically, three Constructs emerged in the current study: Consequences of Diagnosis, Impairment, and Treatment Management. Implications for professionals working with these students and future directions for researchers are discussed.

ADHD stigma among college students.

Abstract The current study examined ADHD stigma within a college-enrolled young adult population, including the debate regarding the cause of stigma: label or behavior. In Phase 1, 135 college students rated stigma toward one of the four fictitious partners described as having either: the label of ADHD alone, the behaviors associated with ADHD alone, the label of ADHD and a set of behaviors associated with ADHD, or neither the label nor behaviors. In Phase 2, 48 college students rated stigma toward one of the two assigned fictitious partners described as having either: the label of ADHD and a set of behaviors associated with ADHD, or the label of Depression and a set of behaviors associated with Depression. It was hypothesized that the interaction between the label and the behaviors would cause the highest levels of ADHD stigma and that ADHD would elicit more stigma than Depression. In Phase 1, stigma was associated with the behaviors of ADHD, but not the label. In Phase 2, ADHD and Depression were found to be equally stigmatized. Implications, limitations, and future directions are discussed.