Examining Cognitive Disengagement Syndrome in Relation to Social Problem Solving in Young Adults.

OBJECTIVE: Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo (SCT), is characterized by symptoms such as excessive daydreaming, mental confusion, and hypoactivity. CDS symptoms are associated with emotional, social, and daily life impairments. The way in which one solves problems in their daily life is associated with experiences of further problems, such that maladaptive problem-solving can lead to further physical and psychological problems. However, there is limited information on how CDS symptoms are associated with problem solving. The current study examined CDS symptoms in relation to different social problem solving approaches. METHOD: A total of 280 college students (ages 18-23 years; 77.9% female) completed measures of psychopathology symptoms and social problem solving. RESULTS: Above and beyond ADHD and internalizing symptoms, CDS symptoms were independently associated with negative problem orientation and avoidance style domains of maladaptive problem solving. CONCLUSION: Findings indicate that CDS symptoms are related to specific difficulties with social problem solving. CDS symptoms may lead to difficulties attending to problems or working through relevant steps needed to identify solutions for the problem, which may then lead to avoidance and social withdrawal. Longitudinal research is needed to evaluate maladaptive problem solving as a potential mechanism in the association between CDS, social withdrawal, and internalizing symptoms.

The role of executive functioning on the intention-behaviour relationship of health behaviours: a temporal self-regulatory perspective.

OBJECTIVE: The current study employed the Temporal Self-Regulation theory (TST) to determine if self-regulatory capacity and prepotent behaviour moderate the relationship between intention and health behaviours (i.e., physical activity, and healthy eating) in college students. DESIGN: 220 students were surveyed across two time points to assess past/intended behaviour (Time 1) and follow-up behaviour (Time 2). MAIN OUTCOME MEASURES: To address limitations in previous research, self-regulatory capacity was assessed using an ecologically valid rating scale (Barkley Deficits in Executive Functioning Scale). Multi-item assessment measures were utilised for physical activity (International Physical Activity Questionnaire) and healthy eating (All-Day Screener) behaviours. RESULTS: A link between intention and follow-up behaviour was established and executive functioning (EF) and past behaviours were positively associated with follow-up behaviour. EF had no unique moderation effects on health behaviours, but combinations of Low, Moderate, and High levels of past behaviour and EF demonstrated moderation for physical activity and healthy eating. CONCLUSION: This study demonstrated the utility of the TST in predicting health behaviour and emphasised the mutual necessity of EF and past behaviour in understanding the intention-behaviour relationship. Findings can be used to formulate studies and interventions that reduce barriers to health behaviours, therefore, lessening the need for high self-regulatory abilities.

Barriers to Treatment Adherence Among College Students with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: The current study sought to obtain a longitudinal perspective of and quantitatively assess barriers to medication adherence experienced by college students with attention-deficit/hyperactivity disorder (ADHD). Thus, we examined semester-long trends in barriers to adherence in addition to the relationships between barriers and medication adherence and barriers and quality of life. METHODS: Participants were college students diagnosed with ADHD. Throughout a Fall semester, participants completed 4 sets of online questionnaires and attended 4 in-person visits, which included pill counts and written questionnaires. Participants completed measures assessing barriers to adherence and health-related quality of life, and adherence was measured via pill counts. Mean values of barriers, adherence rate, and quality of life were used for all analyses. RESULTS: Of the 45 students surveyed, mean adherence rate was 56.70%, and 84.45% of participants reported at least 1 barrier. Across the semester, participants reported experiencing an average of 3.07 barriers, and a consistent barrier reported was not realizing when pills run out. Although reported barriers were unrelated to adherence, the results showed that barriers were associated with lowered quality of life, specifically lower overall quality of life in addition to lower emotional functioning, psychosocial health, school functioning, and physical functioning. CONCLUSION: Barriers to adherence appear to be common in college students with ADHD, and certain barriers are consistent with the planning difficulties observed in individuals with ADHD. Because students experiencing more barriers had lower quality of life, interventions are needed to improve students' overall illness management experience.

Subjective Versus Objective Measures of Medication Adherence in Adolescents/Young Adults with Attention-Deficit Hyperactivity Disorder.

OBJECTIVE: To examine the frequency of medication nonadherence using both objective and subjective data and to compare the differences between these measures in adolescents and young adults (AYAs) with attention-deficit hyperactivity disorder (ADHD). METHOD: Fifty-four participants enrolled. Frequency (mean percent of prescribed doses not taken) of nonadherence was measured using subjective (visual analog scale) and objective (pill count and electronic monitoring) methods. Differences between measures were compared using t tests and analysis of variances. RESULTS: Objective measures showed that participants missed 40% to 43% of their prescribed doses. Contrastingly, subjective measures indicated that participants missed 25% of their prescribed doses. Frequency of nonadherence was significantly higher when relying on objective measures rather than on subjective measures (t[46] = -4.51, p < 0.01 for pill counts, and t[47] = -4.81, p < 0.01 for electronic monitoring). CONCLUSION: Nonadherence is high in AYAs with ADHD. These individuals tend to overestimate their adherence when self-reporting. Physicians should exercise caution when prescribing based on patient report of adherence and use objective measures when possible.

Parent Perceptions of Their College Students' Self-Management of Attention-Deficit/Hyperactivity Disorder.

PURPOSE: The present study examines parents' perspectives of the experiences and challenges surrounding self-management of Attention-Deficit/Hyperactivity Disorder (ADHD) in their college students. METHODS: Participants were parents of emerging young adults with ADHD prescribed daily medication for their condition. Thirteen individual interviews were conducted using a semistructured interview script guided by the Health Belief Model. The qualitative data were analyzed via directed content analysis. RESULTS: Five themes emerged from the interviews: (1) parents are heavily involved in their child's self-management prior to college, and the abrupt transition of responsibilities is difficult for parents; (2) parents' worries about their child's self-management and functioning are exacerbated by privacy laws and poor communication from child and university; (3) volitional nonadherence is high; (4) obtaining academic accommodations is difficult; and (5) parents recommend a gradual transition, desire enhanced communication from the college, and wish for social support resources in the college setting for their children. CONCLUSIONS: Parents of college students with ADHD are distressed and frustrated by the transition to college. They express the desire to remain continually involved in their child's self-management of ADHD, but several barriers hinder their ability to do so, resulting in fear of the potential consequences on their child's functioning. This collateral information from parents regarding the challenges associated with ADHD self-management experiences in college should result in the development of comprehensive interventions to improve the quality of life in college students with ADHD.

Transition to College and Adherence to Prescribed Attention Deficit Hyperactivity Disorder Medication.

OBJECTIVE: As youth with attention deficit hyperactivity disorder (ADHD) transition to adulthood, they must learn how to manage their ADHD treatment independently. This may be challenging because many of the skills necessary to adhere to treatment (e.g., organization, planning) are impaired in those with ADHD. Using electronic monitoring, we examine trajectories of adherence to medication in a cohort of college students with ADHD. Further, we examine the effect of transitioning to college and executive functioning on adherence. METHODS: Electronic monitors tracked adherence for 51 undergraduate students with ADHD across an academic semester. Multilevel modeling examined individual trajectories in monthly adherence and the role of transition status and self-reported executive functioning on these trajectories. RESULTS: Overall, participants adhered to 53.53% of prescribed doses. Transition status predicted the linear slope in adherence (ß = -8.95, standard error [SE] = 3.61, p < .05), with lower initial adherence among undergraduates transitioning to independence (34.17%) compared with post-transition undergraduates (67.63%; ß = 33.46, SE = 8.00, p < .001). Adherence demonstrated a curvilinear change (ß = -7.23, SE = 1.25, p < .001). It increased from the beginning of the semester to midterms before subsequently declining through the rest of the semester, including during final exams. Executive functioning did not predict adherence (ß = -.10, SE = .02, p = .54). CONCLUSION: Only half of all doses were taken as prescribed. Adolescents transitioning to independence demonstrated the lowest levels of adherence, suggesting that the transition to independence is a high-risk period for poor self-management of ADHD.

Adherence to Attention-Deficit/Hyperactivity Disorder Medication During the Transition to College.

PURPOSE: The present study explores the medication self-management experiences of adolescents with attention-deficit/hyperactivity disorder (ADHD) during their transition to young adulthood in college. METHODS: Participants were college freshmen with ADHD prescribed daily medication for their condition. Ten individual interviews were conducted using a semistructured interview script. Measures related to ADHD medication management were also completed. Qualitative data were analyzed via directed content analysis and quantitative data via descriptive statistics. RESULTS: Five themes emerged from interviews: (1) transitions to independence are often abrupt, and many adolescents lack critical self-management skills; (2) volitional nonadherence is high due to inaccurate disease beliefs, perceived academic demands, and medication side effects; (3) poor self-management negatively impacts school performance; (4) peer pressure to share medication affects social functioning and adherence; and (5) social support is greatly needed. Common barriers to adherence included "don't feel like taking medication" (90%) and "difficulties in sticking to a fixed medication schedule" (80%). CONCLUSIONS: Participants with ADHD were not prepared to manage their chronic illness independently in context of increased demands and newfound freedom, resulting in negative academic consequences. Social factors also play an influential role in ADHD self-management, particularly related to the isolation associated with sharing the medication and its side effects. Intervention programs targeting medication self-management during the transition to independence are greatly needed for young adults with ADHD as high academic performance in college is critical for future success.

Examining the psychometric validity of the Multigroup Ethnic Identity Measure-Revised (MEIM-R) in a community sample of African American and European American adults.

The purpose of this study was to examine the psychometric properties of the Multigroup Ethnic Identity Measure-Revised (MEIM-R), focusing on a sample drawn from a geographic region in the United States that has not been included in previously published research on the MEIM-R. Data were obtained from a community-based sample of 105 African American (AA) and 91 European American (EA) adults located in the state of Alabama. The MEIM-R was best represented by two constructs-exploration and commitment. AA adults reported higher levels of racial/ethnic identity exploration and commitment than EA adults. Differential item functioning was found among 1 of the exploration items. The current study provides additional support for the structural validity of the MEIM-R. Further research on the invariance of responses to the MEIM-R across a variety of sociodemographic factors is still necessary.

Exploring the performance differences on the flicker task and the conners' continuous performance test in adults with ADHD.

OBJECTIVE: To examine the ability of the flicker task to demonstrate greater utility in discriminating performance in young adults with and without ADHD compared to the Conners' CPT (CCPT). METHOD: Flicker task and CCPT performance were compared between an ADHD (n = 28) and control (n = 30) group of college students. RESULTS: This study replicated previous flicker task findings, providing support for using the flicker task to demonstrate the robust nature of change blindness. However, the flicker task did not demonstrate better discriminative utility than the CCPT. Task-dependent measures correlated with ADHD rating scale indices of inattention and hyperactivity/impulsivity, indicating that CPTs lack symptom domain specificity. CONCLUSION: Results support the growing evidence that CPTs currently provide only modest utility for discriminating performance in adults with and without ADHD. Recommendations are provided regarding the future study of CPTs as a valid measure of ADHD performance and the potential utility of the flicker task.

Discriminative and participant-rated effects of methylphenidate in children diagnosed with attention deficit hyperactivity disorder (ADHD).

Despite the demonstrated beneficial effects of methylphenidate and d-amphetamine for the treatment of attention-deficit hyperactivity disorder (ADHD), the discriminative and subjective effects of these compounds in children are not well understood. This study was designed to characterize such effects in children diagnosed with ADHD. In a series of 3 experiments, 17 children were examined to determine whether methylphenidate (n = 12) and d-amphetamine (n = 5) could be reliably discriminated at doses typically used in clinical practice. Under some conditions (e.g., when they were instructed to attend to the drug effects or when a wide range of doses was used), children discriminated methylphenidate (5.0-30.0 mg) from placebo. Children tested under a range of doses of d-amphetamine (2.5-20.0 mg) were unable to discriminate this drug from placebo reliably. Neither methylphenidate nor d-amphetamine produced reliable participant-rated effects.