Analysing the effectiveness of cognitive behavioural therapy in university students with ADHD: A systematic review

Main Article Content

Gabriella Maraschin
Preetee Gokhale

Abstract

Background: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and often persists into adult life. University students with ADHD frequently experience great difficulty with global academic functioning, resulting in higher drop-out rates and, consequently, higher unemployment rates.


Objective: This literature review aims to analyse the effectiveness of cognitive behavioural therapy (CBT) interventions to reduce ADHD-related symptoms in university students with ADHD.


Materials and methods: A literature search was conducted via EBSCO database in October 2023 using key terms: ADHD OR attention deficit hyperactivity disorder AND cogniti* intervention OR cogniti* therapy AND college student* OR university student*. The inclusion criteria were studies using cognitive behavioural therapy as their primary intervention for individuals with ADHD who are enrolled in university or college and are 18 years or above in age.


Results: Seven out of 115 papers were deemed eligible and were included in this review. This review’s studies included four randomized control trials and three before and after open trials. Three key themes were identified through data extraction: intervention design, outcome measures used, and effectiveness of interventions on ADHD-related symptoms. All the studies tailored their CBT intervention toward university students. There was a statistically significant improvement in core domains of ADHD-related impairment, in particular, inattention (N=7), overall executive functions (n=5), and hyperactivity-impulsivity (N=1).


Conclusion: While the current findings suggest positive results of CBT for reducing ADHD-related symptoms in university students with ADHD, further research should explore the sustainability of these gains over the long term. Due to the lack of explicit published study on this topic in the United Kingdom, further research should be conducted in the UK to assess the applicability and effectiveness of tailored CBT interventions within the British university environment.

Article Details

How to Cite
Maraschin, G., & Gokhale, P. (2024). Analysing the effectiveness of cognitive behavioural therapy in university students with ADHD: A systematic review. Journal of Associated Medical Sciences, 58(1), 81–98. Retrieved from https://he01.tci-thaijo.org/index.php/bulletinAMS/article/view/272702
Section
Review Articles

References

Centers for Disease Control and Prevention (CDC). Attention-Deficit/Hyperactivity Disorder (ADHD) [online]. 2023. Available from: https://www.cdc. gov/ncbddd/adhd/facts.html#print [Accessed 23 November 2023].

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Sedgwick-Müller JA, Müller-Sedgwick U, Adamou M, Catani M, Champ R, Gudjónsson G, Hank D, Pitts M, Young S, Asherson P. University students with attention deficit hyperactivity disorder (ADHD): a consensus statement from the UK Adult ADHD Network (UKAAN). BMC Psychiatry. 2022; 22:292. doi: 10.1186/s12888-022-04231-4

DuPaul GJ, Franklin MK, Pollack BL, Stack KS, Jaffe AR, Gormley MJ, Anastopoulos AD, Weyandt LL. Predictors and trajectories of educational functioning in college students with and without attention-deficit/hyperactivity disorder. J Postsecond Educ Disabil. 2018;31(2):161–78. doi: 10.1352/2326- 6988-31.2.161

Fenn K, Byrne M. The key principles of cognitive behavioural therapy. InnovAiT. 2013;6(9):579-585. doi: 10.1177/1757177413506143

National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: How common is it? [Internet]. London: NICE; 2023. Available from: https://cks.nice.org.uk/topics/ attention-deficit-hyperactivity-disorder/backgroundinformation/prevalence/. [Accessed 15 November 2023].

Solanto MV, Scheres A. Feasibility, acceptability, and effectiveness of a new cognitive-behavioral intervention for college students with ADHD. J Atten Disord. 2021;25(14):2068–2082. doi: 10.1177/1087 054720979704

Anastopoulos AD, Langberg JM, Eddy LD, Silvia PJ, Labban JD. A randomized controlled trial examining CBT for college students with ADHD. J Consult Clin Psychol. 2021 Jan;89(1):21. doi: 10.1037/ccp0000545

Holding J. The role of occupational therapy in universities. OT News. December 2023:28-31.

Adamou M, Asherson P, Arif M, Buckenham L, Cubbin S, Dancza K, et al. Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD network. BMC Psychiatry. 2021;21(72). doi:10.1186/ s12888-021-03148-9.

Richardson WS, Wilson MC, Nishikawa J, Hayward RS. A well-built clinical question: A key to evidencebased decisions. ACP J Club. 1995;123

Aveyard H. Doing a Literature Review in Health and Social Care: A Practical Guide. Maidenhead: Open University Press; 2023.

Anastopoulos AD, King KA. A cognitive-behavior therapy and mentoring program for college students with ADHD. Cogn Behav Pract. 2015 May 1;22(2):141- 51. doi: 10.1016/j.cbpra.2014.06.003

BMJ Best Practice. Attention deficit hyperactivity disorder in adults [online]. London: BMJ Publishing Group; 2023. Available from: https://bestpractice.bmj. com/topics/en-gb/814 [Accessed 15 November 2023].

Fleming AP, McMahon RJ, Moran LR, Peterson AP, Dreessen A. Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. J Atten Disord. 2015;19(3):260-271. doi: 10.1177/1087054713507117

Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Sue E Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, McKenzie JE. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;321:160. DOI: 10.1136/bmj.n70

Mhaskar R, Emmanuel P, Mishra S, Patel S, Naik E, Kumar A. Critical appraisal skills are essential to informed decision-making. Indian J Sex Transm Dis AIDS. 2009;30(2):112–119. doi: 10.4103/0253- 7184.59002

Tod D, Booth A, Smith B. Critical appraisal. Int Rev Sport Exerc Psychol. 2022;15(1):52-72. doi: 10.1080/ 1750984X.2021.1950144

Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmorland M. Critical Review Form-Quantitative Studies. Ontario: McMaster University; 1998.

Hewitt-Taylor J. The Essential Guide to Doing a Health and Social Care Literature Review. Oxon: Routledge; 2017.

Hartung CM, Canu WH, Serrano JW, Vasko JM, Stevens AE, Abu-Ramadan TM, Bodalski EA, Neger EN, Bridges RM, Gleason LL, Anzalone C, Flory K. A new organizational and study skills intervention for college students with ADHD. Cogn Behav Pract. 2022;29(2):411–424. doi: 10.1016/j. cbpra.2020.10.004

LaCount PA, Hartung CM, Shelton CR, Clapp JD, Clapp TK. Preliminary evaluation of a combined group and individual treatment for college students with attention-deficit/hyperactivity disorder. Cogn Behav Pract. 2015;22(2):152-160. doi: 10.1016/j. cbpra.2014.09.003

Joy JE, Penhoet EE, Petitti DB. Saving Women’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington: National Academies Press; 2005. Available from: https://www.ncbi.nlm. nih.gov/books/NBK22315/. [Accessed 17 December 2023].

Van der Oord S, Boyer BE, Van Dyck L, Mackay KJ, De Meyer H, Baeyens D. A randomized controlled study of a cognitive behavioral planning intervention for college students with ADHD: An effectiveness study in student counseling services in Flanders. J Atten Disord. 2020;24(6):849–862. doi: 10.1177/10870547 18757711

Conners CK, Erhardt D, Epstein JN, Parker JD, Sitarenios G, Sparrow E. Self-ratings of ADHD symptoms in adults I: Factor structure and normative data. J Atten Disord. 1999 Oct;3(3):141-51. doi: 10.1177/1087054 79900300303

Beck AT, Steer RA, Brown GK. BDI-II, Beck depression inventory: Manual. San Antonio, TX: Psychological Corp.; 1996.

Weiss MD. Weiss Functional Impairment Rating Scale (WFIRS) Self-Report [online]. Vancouver: University of British Columbia; 2000.

Weinstein CE, Palmer DR, Acee TW. Learning and study strategies inventory (LASSI): User’s manual. 3rd ed. H&H Publishing Company, Inc.; 2016.

Barkley RA. Barkley deficits in executive functioning scale (BDEFS). New York: Guilford Press; 2011.

Dumas-Mallet E, Button KS, Boraud T, Gonon F, Munafò MR. Low statistical power in biomedical science: a review of three human research domains. R Soc Open Sci. 2017 Feb 1;4(2):160254. doi: 10.1098/ rsos.160254

Shaw-Zirt B, Popali-Lehane L, Chaplin W, Bergman A. Adjustment, social skills and self-esteem in college students with symptoms of ADHD. J Atten Disord. 2005;8:109–120. doi: 10.1177/1087054705280140

Chew BL, Jensen SA, Rosén LA. College students’ attitudes toward their ADHD peers. J Atten Disord. 2009 Nov;13(3):271-6. doi: 10.1177/1087054708325185

Hammell KW. Dimensions of meaning in the occupations of daily life. Can J Occup Ther. 2004;71:296- 305. doi: 10.1177/000841740407100507

Willcutt EG. The prevalence of DSM-IV attentiondeficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012;9(3):490–499. doi: 10.1007/s13311-012-0135-8

Sedgwick JA. University students with attention deficit hyperactivity disorder (ADHD): a literature review. Ir J Psychol Med. 2018;35(3):221-235. doi: 10.1017/ipm.2018.19

Law M, MacDermid J. Evidence-based rehabilitation. 2nd ed. New Jersey: Slack; 1998.

National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management. London: NICE; 2019. NICE guidelines NG87.

Emmers E, Janssen D, Petry K, Van der Oord S, Baeyens D. Functioning and participation of students with ADHD in higher education according to the ICFframework. J Fur Higher Educ. 2017;41:435-447.

Attention deficit hyperactivity disorder in adults - Symptoms, diagnosis and treatment. BMJ Best Practice [Internet]. Available from: https://bestpractice.bmj. com/topics/en-gb/814.

Aggarwal R, Ranganathan P. Study designs: Part 5– interventional studies (II). Perspect Clin Res. 2019 Oct 1;10(4):183-6. doi: 10.4103/picr.PICR_272_19