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

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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.