Refinement and Testing of a New Cognitive-Behavioral Intervention to Treat Executive Dysfunction in College Students with ADHD

据估计，美国大学校园中有8%的学生患有多动症，占25%的学生患有多动症。 残疾。患有ADHD的大学生经历了严重的学业障碍，包括低年级 平均绩点（GPA）;增加试用期、病假和要求退学的频率;以及降低 毕业率。这些不良经历可能导致抑郁和焦虑的发生率较高 在患有多动症的大学生中，以及长期的职业障碍。执行力差的自我- 管理越来越被认为是ADHD的一个中心特征，也是功能障碍的一个主要原因。 在学校和工作中的缺陷。ADHD的执行功能障碍通常表现为自我缺陷， 管理方面的时间，组织和规划，并与较差的学术 ADHD儿童的表现，以及成年人更大的职业障碍。虽然认知- 行为疗法（CBT）在治疗ADHD成人的执行功能障碍方面是有效的， 这种针对大学生需求的干预措施一直很少。本申请的具体目的是 因此：（1）调整我们成功的成人团体CBT，以解决执行自我管理受损的问题， 患有ADHD的大学生;（2）培训校园学习障碍专家提供干预（3）， 检查ADHD优化干预的可行性、可接受性和有效性 症状，执行自我管理，学习成绩和情绪结果和（4）检查 执行自我管理的变化是近端行为/认知变化之间的关键中介 以及关注的治疗结果。CBT将交付给严格评估和诊断的学生 在我们的合作网站-温加滕学习资源中心（WLRC）的学生在美国 的PA。该项目的前半部分将是一个发展阶段，在此期间，10周的小组计划（6-8 学生）将进行调整和完善，在此期间，三名WLRC工作人员将接受培训， 干预在试点研究期间，84名符合条件的学生将被随机分配接受CBT或治疗 作为一个整体。最终的手动CBT方案将在6个10周的治疗系列中提供，每个治疗系列 由一名学员独立完成将根据以下指标评估治疗前后的变化：（1） 学习成绩;（2）ADHD DSM-5注意力不集中症状;（3）执行自我管理;以及（4） 抑郁焦虑和自尊关于可接受性、可行性和可扩展性的信息， 大学校园的计划将从3组利益相关者收集：1）学生参与者2） WLRC学员和咨询委员会以及3）调查人员。我们还将调查咨询/残疾中心 关于在资源方面实施干预的潜在可行性和效用， 人员配备和培训。汇编这一资料预计将有助于对可行性进行临时预测 一个全面的多地点试验的干预，其可扩展性，以大学校园普遍。

An estimated 8% of students on US college campuses have ADHD, accounting for 25% of students with disabilities. College students with ADHD experience significant academic impairment, including lower grade point averages (GPA's); increased frequency of probation, medical leave, and required withdrawal; and lower graduation rates. These adverse experiences likely contribute to the higher rates of depression and anxiety among college students with ADHD, as well as long-term occupational impairment. Poor executive self- management is increasingly recognized as a central characteristic of ADHD and a major cause of functional impairment at school and at work. Executive dysfunction in ADHD is typically manifested as deficient self- management with respect to time, organization, and planning, and correlates with worse academic performance in children with ADHD, and greater occupational impairment in adults. Although cognitive- behavioral therapy (CBT) is efficacious in treating executive dysfunction in adults with ADHD, efforts to adapt this intervention for the needs of college students have been sparse. The Specific Aims of this application are therefore: (1) to adapt our successful adult group CBT to address impaired executive self-management in college students with ADHD; (2) to train campus learning disability specialists to deliver the intervention (3) to examine the feasibility, acceptability, and effectiveness of the optimized intervention vis-à-vis ADHD symptoms, executive self-management, academic performance, and emotional outcomes and (4) to examine change in executive self-management as a critical mediator between proximal behavioral/cognitive changes and the therapeutic outcomes of interest. CBT will be delivered to rigorously evaluated and diagnosed students with ADHD at our collaborating site - the Weingarten Learning Resources Center (WLRC) for students at the U of PA. The first half of the project will be a Development phase, during which the 10-week group program (6-8 students) will be adapted and refined and during which three WLRC staff will be trained to deliver the intervention. During the Pilot Study, 84 eligible students will be randomized to receive either CBT or Treatment as Usual. The final manualized CBT protocol will be delivered in six 10-week treatment series, each led independently by one of the trainees. Pre- to post-treatment change will be assessed on measures of: (1) academic performance; (2) ADHD DSM-5 inattentive symptoms (3) executive self-management; and (4) depression, anxiety, and self-esteem. Information concerning the acceptability, feasibility, and scalability of this program on college campuses will be collected from 3 sets of stakeholders: 1) the student-participants 2) the WLRC trainees and Advisory Board and 3) the Investigators. We will also survey counseling/disability centers concerning the potential feasibility and utility of implementing the intervention with respect to resources, staffing, and training. Compiling this information is expected to facilitate interim projections about the feasibility of a full-scale multi-site trial of the intervention, and its scalability to college campuses generally.