Articles

Journal of Attention Disorders

Resilience and Well-being in College 15(1) 11­–17

© 2011 SAGE Publications
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DOI: 10.1177/1087054709347261

of ADHD http://jad.sagepub.com

Linda Wilmshurst1, Marella Peele,1 and Luke Wilmshurst2

Abstract
Objective: The study examines psychological well-being and self-concept in college students diagnosed with ADHD.
Method: We surveyed 17 undergraduate college students with ADHD and 19 undergraduate controls concerning academic
and emotional support received from family and friends. All students completed the Connor’s Continuous Performance
Test (CPT-II), Connor’s Adult Rating Scale (CAARS), Tennessee Self-Concept Scale (TSCS:2) and Psychological Well-Being
Scale (PWB). Results: Between group differences were significant for the CAARS and CPT-II, but not total self-concept
(TSC) or global PWB. The strongest predictors for TSC were environmental mastery (PWB) for the ADHD group and
positive relations with others (PWB) for the controls. Students with ADHD reported significantly higher paternal support
than controls who reported significantly greater support from friends. Conclusion: College students with a diagnosis of
ADHD may represent an especially resilient group. Future studies should investigate competencies of students with ADHD
who have achieved success against the odds.

Keywords
ADHD; resilience; psychological well-being; self-concept; college students

The concept of risk and resilience was initially introduced
by Werner and Smith (1982) in their longitudinal study
describing a cohort of individuals who demonstrated many
positive outcomes despite living in adverse conditions.
Werner and Smith (2001) concluded that certain environ-
mental factors, such as positive emotional support from
caregivers and mentors, could protect individuals from neg-
ative outcomes. Initially thought of as a trait, resilience is
currently conceptualized as “a process or phenomenon
reflecting positive child adjustment despite conditions of
risk” (Luthar & Zelazo, 2003, p. 510). Although recogniz-
ing the inherent flaws in treating children who share
negative life circumstances as a homogeneous group,
Luthar and Zelazo stressed the importance of conceptual-
izing adversity as a global index of risk that carries high
statistical odds of negative outcomes, and targeting research
efforts at isolating factors that could serve to significantly
reduce those odds.
At its core, the major difference between risk and resil-
ience paradigms is the focus on negative or positive out-
comes. While studies of risk aim to uncover those factors
that contribute to maladaptive behavior, studies of resil-
ience focus on the strengths that contribute to adaptive
behavior, such as, competence and positive well-being, in
spite of adversity. In their research review, Luthar and
Zelazo (2003) emphasized “resilience cannot be measured
directly, but is determined by the measurement of two com-
ponent constructs, risk and positive adaptation”. The
authors provide definitions for both constructs, stating “a
life condition might qualify (as) a risk indicator if it is sig-
nificantly linked with maladjustment in important domains”,
while the term positive adaptation refers to “substantially
better (adjustment) than what would be expected given
exposure to the risk circumstance being studied” (pp. 514-
515). In addition, the authors are clear to distinguish
between risk factors (increase the possibility of adverse
outcomes), protective factors (shield or buffer from adverse
consequences) and what might be termed promotive or
beneficial factors (add an independent benefit, e.g., having
a particular talent in music or sports). Within the above
context, attention deficit hyperactivity disorder (ADHD)
could readily be considered as a risk indicator, since the
disorder places individuals at risk for negative educational,
emotional, and interpersonal outcomes.
The Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR; APA, 2000) currently recognizes
1
Elon University
2
Oxford University
Corresponding Author:
Linda Wilmshurst, 100 Campus Dr. Elon, NC 87244-2010
Email: lwilmshurst@elon.edu.

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12 Journal of Attention Disorders 15(1)
three types of ADHD: inattentive (requires six of a possible
nine symptoms of inattention); hyperactive-impulsive
(requires six of a possible nine symptoms of hyperactivity
and impulsivity); and combined (meeting criteria for both
the inattentive and hyperactive-impulsive types). Symptoms
are evident before 7 years of age and exist across multiple
situations. The majority of children who are diagnosed with
ADHD (90%) will have the more obvious forms of ADHD
(hyperactive-impulsive or combined type). Children with
the more subtle form of ADHD (inattentive) are identified
later and at a far lesser rate, with many going undiagnosed.
While lack of self control (disinhibition) associated with
hyperactive-impulsive and combined types is likely to
improve with age, inattention remains relatively stable over
time (Hart, Lahey, Loeber, Applegate, & Frick, 1995).
It is estimated that one-third to two-thirds of children
with ADHD will demonstrate ADHD characteristics
throughout their lifetime (Wender, Wolf, & Wasserstein,
2001), with between 2% and 6% of the adult population
meeting criteria for diagnosis (Wender, 1995). Risks asso-
ciated with a diagnosis of ADHD in older adolescents and
adults, include: lower educational achievement, increased
unemployment or underemployment, problematic interper-
sonal relationships, less stability of residence, a higher
incidence of psychiatric disorders, substance use disor-
ders, and antisocial behavior (Grenwald-Mayes, 2002).
Adults with ADHD are more likely to experience more
frequent job changes associated with boredom or interper-
sonal problems in the office (Toner, O’Donoghue, &
Houghton, 2006).
Improvements in legislation and availability of support
services have resulted in increased numbers of students
with “hidden disabilities” (ADHD, learning disabilities)
seeking admission to colleges (Wolf, 2001) and enrollment
of students with ADHD is on the rise (Shaw-Zirt, Popali-
Lehane, Chaplin, & Bergman, 2005). Estimates are that
between 2% and 4% of college students would meet crite-
ria for diagnosis as ADHD (DuPaul et al., 2001; Weyandt,
Linterman, & Rice, 1995) with males accounting for about
58% of this population. Students with ADHD represent
20% of college students who have disabilities and one-
quarter of those receiving support services (Guthrie,
2002). Weyandt and DuPaul (2006) found only 23 peer-
reviewed studies of college students with ADHD (between
1985 and 2004) that examined prevalence or functioning in
one or more domains. Students with high symptoms of
ADHD demonstrated lower grade point averages (GPAs),
experienced academic probation more frequently, reported
more academic problems than those with fewer symptoms
(Heiligenstein, Guenther, Levy, Savino, & Fulwiler, 1999),
and were less likely to graduate or seek admission to
graduate schools (Murphy, Barkley, & Bush, 2002; Wolf,
2001).
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Compared to controls, Kern, Rasmussen, Byrd, and
Wittschen (1999) found that college students with ADHD
encountered more psychosocial problems evident in
increased tendencies to become more independent, and
aggressive under stressful conditions, and demonstrated
problems accepting criticism or accessing social support
from others. Heiligenstein and Keeling (1995) found that
half of their ADHD sample exhibited comorbid disorders,
such as depressive disorders (25%), anxiety issues (5%),
drug and alcohol dependency (26%), and eating disorders
(2%). Relative to nondiagnosed peers, college students
with ADHD reveal lower quality of life, are less successful
on measures of personal growth and indicate significantly
poorer parent–child relations (Grenwald-Mayes, 2002).
However, within the ADHD sample, students who reported
positive family variables (emotional climate, time spent in
recreational activities) obtained higher scores for quality of
life; a finding that was not significant for the controls. The
researcher suggests, for students with ADHD, family vari-
ables may be a protective factor for increased levels of
success both academically and regarding quality of life
issues.
Mannuzza and Klein (2000) found that children diag-
nosed with ADHD carried self esteem issues into adulthood,
while Rucklidge, Brown, Crawford, and Kaplan (2007)
revealed that a diagnosis in adulthood was associated with
significantly lower self esteem than controls. Only two stud-
ies have evaluated self esteem in college students with
ADHD, and both studies used the Rosenberg Self-Esteem
Scale (SES; Rosenberg, 1965), a 10-item scale measuring
global self-concept. Results indicated that higher ADHD
symptoms in college students were associated with greater
depression and lower self esteem (Norvilitis, Ingersoll,
Zhang, & Jia, 2008), and that college students with a history
of ADHD scored lower on ratings of self esteem relative to
controls (Dooling-Litfin & Rosen, 1997). In the latter study,
within group comparisons revealed that students with ADHD
who reported protective factors (better social skills, possess-
ing a special talent and prior positive mentorship experi-
ences) also reported higher levels of self esteem. Given these
results, increased research into protective factors that may
reduce the risk for negative outcomes in college students
with ADHD merits additional investigation.
The application of risk and resilience paradigms to
research on learning disabilities (LD) in children has
increased recognition of LD as a condition with increased
risk for negative outcomes, while at the same time, has inten-
sified focus on strengths that can contribute to adaptive
behavior, such as, competence and positive well-being, in
spite of adversity (Cosden, Brown, & Elliott, 2002). The
majority of research concerning ADHD to date, has focused
on negative educational, personal, and interpersonal out-
comes. Yet, despite the odds, increasing numbers of young
Wilmshurst et al. 13
adults with ADHD are successfully gaining entrance to col-
lege and completing a college education. With the exception
of a few relatively positive statements regarding ADHD in
college students, and a hint of some protective factors that
might buffer negative outcomes for individuals within this
population (Dooling-Litfin & Rosen, 1997; Grenwald-
Mayes, 2002), most studies have focused on hardships and
failures associated with the disorder.
Our goal in the present study was to shift the emphasis
from risk to resilience by investigating the nature of self-
concept and psychological well-being in college students
with a diagnosis of ADHD relative to peers without a diag-
nosis of ADHD. It was our hypothesis that students with
ADHD, who have been accepted to college despite the chal-
lenges, might be, by definition, a very resilient group.
Although resilience has been investigated in children with
LD, to the authors’ knowledge, there are currently no studies
that have investigated the nature of resilience in college stu-
dents with ADHD. Based on previous research and theoreti-
cal perspectives (Luthar & Zelazo, 2003; Werner & Smith,
1982, 2001), we consider a diagnosis of ADHD to place an
individual at risk for negative outcomes in a number of areas.
In this study, we examine the performance of college
students diagnosed with ADHD relative to peers without
the diagnosis on a number of independent measures, includ-
ing academic performance, self-concept and psychological
well-being.
Method
Participants
A total of 36 college students (16 male and 20 female; 18-20
years) enrolled in a small Private University in the mideast-
ern United States were recruited from psychology classes to
participate in the study. The University Insti­tutional Review
Board approved the study and informed consent was obtained
from all participants. Participants included 17 students (10
males, 7 females) with a previous diagnosis of ADHD and 19
students (6 males, 13 females) as the control group.
The male to female population in the study (55.6%
female: 44.4% male) was representative of university demo-
graphics (58.8% female: 41.1% male), with the ADHD
sample consisting of 58.8% males and 41.2% females.
Subjects were primarily White (94.4%) with 5.5% African
American, which was also consistent with University demo-
graphics. Of the total undergraduate population (4,939), 7%
(358) are currently registered for disability services. Students
with a diagnosis of ADHD (85) represent 1.7% of the total
population, and 24.7% of those who are eligible for support
services. Prevalence rates, male to female ratio for ADHD in
college students, and eligibility for support services are all
consistent with rates reported previously (Guthrie, 2002).
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The overall GPA scores for students with ADHD (3.23) was
slightly lower than for the control group (3.34), however,
both scores were superior to scores for all university under-
graduates enrolled at the institution (3.12).
Procedure
Students met individually with the researcher and com-
pleted the measures, in the order they are presented below.
Students voluntarily refrained from taking medication until
after they had completed the CPT-II.
Structured interview The interview accessed information
about ADHD status (age of diagnosis, medication manage-
ment), self-reported GPA scores and perceptions of
academic and emotional support received from mothers,
fathers, and friends. Students rated support on a 4-point
scale from very little to very supportive.
Adult ADHD Rating Scales (CAARS-S:L; Conners, Erhardt,
& Sparrow, 1999). This 66-item self-report scale measures
ADHD-related symptoms on seven subscales, including
DSM-IV scales for: Inattentive, Hyperactive-Impulsive,
Symptoms Total, and ADHD Index. Internal consistency
ranges from .66 to .90. ADHD Index validity is 73%.
Conners’ Continuous Performance Test II (CPT-II; Conners,
2000). This computer generated test measures sustained
attention (vigilance). Test–retest correlation coefficients
over a 3 month interval range from .55 to .84 for the major
outcome measures.
Tennessee Self-Concept Scale (2nd ed., TSCS:2; Fitts &
Warren, 2003). This 82-item self-report scale measures
self-concept in six different areas, as well as, Total Self-
Concept (TSC). Reliability rating (Cronbach’s alpha) for
the Total Self-Concept is .93.
Scales of Psychological Well-Being (PWB; Ryff & Keyes,
1995). The 84 items represent six aspects of wellness (14
items per scale), in a Likert-type self-report scale. Coefficient
alphas range from .87 to .93, with a reliability rating (Cron-
bach’s alpha) for total well-being of .97.
Results
Between Group Differences
A MANOVA was performed with group (diagnosis) and
gender as the independent variables and GPA, student
ratings on three measures, (CAARS [DSM Scales &
ADHD Index], TSCS:2 [Total Self-Concept], PWB [glo-
bal Psychological Well-Being]), and performance on the
CPT-II (Clinical Confidence Index: CCI), as the dependent
measures. There was a significant main effect for group
Wilks’s Lambda = .58, F(8, 25) = 2.31, p < .05, partial eta
squared = .425 and gender Wilks’s Lambda = .45, F(8, 25) =
3.83, p < .005, partial eta squared = .551. There were no
14 Journal of Attention Disorders 15(1)

Table 1. Between Group Differences on Measures of ADHD (CAARS, CPT-II), Total Self-Concept (TSC; TSCS:2), and Total
Psychological Well-Being (PWB)

Controls ADHD
Partial Eta
Variables M SD M SD F(1, 32) Squared

CAARS
  DSM inattentive 55.89 13.55 71.06 12.91 8.967*** .219
  DSM hyper-impulsive 48.26 10.88 55.65 14.09 2.803 .081
  Total DSM 53.05 13.77 67.24 13.81 7.288*** .186
  ADHD index 53.47 8.31 47.26 9.37 6.021** .158
CPT-II
  CCI 51.18 22.26 33.70 15.99 4.887* .132
TSCS:2
  Total self-concept 49.24 6.48 52.74 8.84 1.371 .041
PWB
  Total well-being 123.82 62.55 119.21 33.40 0.197 .006

*p < .05. **p < .025. ***p < .01.

significant interaction effects. Univariate ANOVA results
for the means, standard deviations, and F scores for the
group comparisons are available in Table 1.
Students diagnosed with ADHD scored significantly
higher on the DSM symptom rating scales (CAARS ) for
DSM Inattentive Symptoms, Total DSM Symptoms, and the
ADHD Index compared to controls (See Table 1). Performance
on the CPT-II was also significantly more impaired for stu-
dents with ADHD relative to controls. The overall Clinical
Confidence Index (CCI) for those diagnosed with ADHD
was 51.18 indicating a 51.18 out of 100 chance that signifi-
cant attention problems exist, compared to 33.7 out of 100
chances that those not diagnosed with ADHD experience
significant attention problems. There was a significant main
effect for gender for GPA, with females scoring significantly
higher than males, regardless of whether they were diag-
nosed with ADHD or not (Females: M = 3.48, SD = .42;
Males: M = 3.05, SD = .59, F(1, 32) = 5.83, p < .022, partial
eta squared = .154). There were no significant differences
between students diagnosed with ADHD and their nondiag-
nosed peers on global measures of self-concept, psychologi-
cal well-being, or overall GPA.
Relationship Between PWB Scales
and TSC on the TSC2
Pearson correlations revealed that the total PWB and the
TSC were significantly and positively related for the entire
study sample (r(34) = 3.94, p < .017). A stepwise multiple
regression analysis was conducted to evaluate whether differ-
ent aspects of PWB would predict TSC for students diagnosed
with ADHD compared to controls. The predictors were the six
subscales of the PWB: autonomy, environmental mastery,
personal growth, purpose in life, positive relations with oth-
ers, and self acceptance. For students diagnosed with ADHD,
the subscale of environmental mastery significantly predicted
TSC, F(1, 15) = 8.96, p < .009, while in the control group,
positive relations with others was the significant predictor of
TSC, F(1, 17) = 7.51, p < .014.
Indices of Emotional and Academic Support
A Mann–Whitney U test was conducted to evaluate any
difference in the amount of support college students per-
ceived based on their ADHD status (see Figure 1). Minimal
difference was found between groups in their perceptions
of overall maternal support. However, students diagnosed
with ADHD reported significantly higher levels of support
from their fathers, z = –2.01, p < .04 compared to controls,
whereas controls rated support from friends significantly
higher than that of students diagnosed with ADHD, z =
–2.18, p < .02.
Discussion
The major goal of this study was to apply the risk and
resilience paradigm to a study of college students diag-
nosed with ADHD and investigate possible strengths that
contribute to adaptive behavior, such as, competence and
positive psychological well-being in spite of adversity
(Luthar & Zelazo, 2003; Werner & Smith, 2001). Speci­
fically, we compared evaluations of total self-concept and
psychological well-being in college students with a diagno-
sis of ADHD relative to peers without the disorder.
There are several findings from this study that are of
importance to future investigations of ADHD in college

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Wilmshurst et al. 15
Figure 1. Mann–Whitney U Results for Mean Rankings for
Perceived Support From, Mothers, Fathers, Friends, Total Academic,
Total Emotional, and Total Support
T academic = total academic support; T emotional = total emotional sup- with ADHD evidenced more problems accessing social sup-
port; T support = total support.
students. First, we provide support for the use of the Adult
ADHD Rating Scales (CAARS) and Conner’s Continuous
Performance Test II (CPT-II) to successfully screen stu-
dents diagnosed with ADHD from nondiagnosed peers.
Our results provide support for the use of the CPT-II (spe-
cifically the clinical confidence index) and CAARS (spe-
cifically the Total DSM symptoms Scale and the ADHD
Index) in future studies to discriminate individuals with
clinical levels of ADHD symptoms, regardless of whether
they have been diagnosed in the past.
Contrary to previous research of self-concept in college
students with ADHD (Dooling-Litfin & Rosen, 1997;
Norvilitis et al., 2008) current results revealed no signifi-
cant differences between college students with and without
an ADHD diagnosis on measures of academic performance
(GPA), total self-concept (TSC; TSCS:2), or total psycho-
logical well-being (PWB). Although a significant positive
correlation was found between TSC and PWB, self-concept
for the two groups was predicted by different aspects of
well-being. For students diagnosed with ADHD, the envi-
ronmental mastery scale (competence in managing their
environment, making effective use of available opportuni-
ties) of the PWB was predictive of TSC, while in the con-
trol group, positive relations with others (tendency to
engage in satisfying relationships with others, and inti-
macy) was the strongest predictor of TSC. The importance
of environmental mastery in maintaining overall self-con-
cept supports findings by Toner and colleagues (2006) who
reported that adults with ADHD attempt to deal with the
disorder by striving to maintain control and order to coun-
teract an often chaotic and unsettled lifestyle. On the other
hand, college students without the disorder are likely to
follow a more developmentally appropriate path including
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socializing with peers. Alternatively, a less favorable expla-
nation might be that previous difficulty managing social
relationships (Kern et al., 1999) has placed college students
with ADHD in a socially disadvantaged position relative to
their nondiagnosed peers. Further research into priorities
and goals of college students with and without a diagnosis
of ADHD may increase our understanding of complexities
that may be involved.
Finally, college students without a diagnosis of ADHD
perceived emotional and academic support from family and
friends in significantly different ways than their diagnosed
peers. While college students perceived friends as the most
significant avenue of emotional and academic support,
those with a diagnosis of ADHD rated their fathers as the
most supportive of their emotional and academic needs.
Although at least one study has shown that college students
port from others (Kern et al., 1999), it has also been sug-
gested that positive family variables (emotional climate and
time spent in extracurricular activities) may serve as a protec-
tive factor for positive quality of life and increased academic
success for college students with ADHD (Grenwald-Mayes,
2002). Perhaps the success of our sample in gaining entrance
to a highly competitive academic program, against the odds,
may be testimony to the efficacy or protective nature of
perceived paternal support. Given the small sample size, it
was not possible to address the possible interactions between
gender and support relationships which is an interesting
topic for future investigation.
The goal of the present study was to identify positive
characteristics of college students diagnosed with ADHD
who succeed despite the odds. Although overall scores for
self-concept were not statistically different between stu-
dents with and without the diagnosis, results underscored
the concept of equifinality (Cicchetti & Rogosch, 1996).
Namely, that self-concept in college students diagnosed
with ADHD may be comprised of a different set of values
and priorities based on life lessons learned, relative to peers
without the disorder. No doubt, within the population of
college students with ADHD, it may also be possible to
identify various different paths to success based on indi-
vidual talents and capabilities (Dooling-Litfin & Rosen,
1997). Our results underline the importance of remember-
ing there can be moderators to risks operative at different
life transitions, such as risks and protective factors for stu-
dents attending college with a diagnosis of ADHD.
There are several limitations to the current study.
Although our sample of college students with a diagnosis
of ADHD matched prevalence rates found in other reports
(Guthrie, 2002), our sample was limited in size and loca-
tion. The lack of between group differences on measures of
self-concept and well-being may have been an artifact of
size, although significant differences were noted on ADHD
16 Journal of Attention Disorders 15(1)
indicators. In addition, size inhibited investigation of poten-
tial gender differences (age of onset, inattentive versus
hyperactive-impulsive symptoms). Our results are correla-
tional in nature, however, longitudinal studies could follow
the trajectory and outcomes of ADHD diagnosed children
who are successful (both academically and in quality of
life) to further increase our understanding of contributing
factors and underlying dynamic processes. Self-report
measures can be biased, and future studies may benefit
from the inclusion of additional ratings from either family
members or from personal friends. Finally, the study did
not include measures of possible maladaptive outcomes,
such as internalizing problems (depression and anxiety)
that might plague those who weather the storm and over-
come adverse circumstances (Luthar, 1993). Future research
should also consider how college students with ADHD
compare to young adults with the disorder who do not
attend college, or how interventions, such a employing an
ADHD coach (see EDGE, 2009 for a large scale study
recently launched to evaluate effectiveness), might further
improve performance in young adults with ADHD.
Despite the study limitations, it is our goal to inspire
other researchers to investigate the implications of having
a diagnosis of ADHD for students in their college years, in
a population that has demonstrated resilience in the face of
significant odds.
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Bios
Linda Wilmshurst, PhD, ABPP, is an associate professor at
Elon University in the Psychology Department where she teaches
Downloaded from jad.sagepub.com at QUEENS UNIV LIBRARIES on February 3, 2015
courses in clinical psychology and mentors undergraduate
research. She received her BA and MA in Psychology from the
University of Windsor and her PhD from the University of
Toronto. Wilmshurst is a Diplomate in Clinical Psychology
(ABPP) and a licensed School Psychologist. She has authored
four textbooks, including: Abnormal Child Psychology: A Devel-
opmental Perspective (2009; Routledge), A Parent’s Guide to
Special Education (2005; AMACOM), Essentials of Child Psy-
chopathology (2005; Wiley), and Child and Adolescent
Psychopathology: A Casebook (2003; Sage). While in clinical
practice, Wilmshurst conducted and published results of an out-
come study comparing two community based treatment
alternatives for youth with severe emotional and behavioral dis-
orders (2002). She is currently on the editorial board of
Counseling and Psychotherapy Transcripts, Client Narratives,
and Reference Works, a searchable web-based collection con-
taining real transcripts of therapy and counseling sessions and
first-person narratives (Sage Publications).
Marella Peele, BA, is a recent graduate of Elon University
(2008) with a major in Psychology. She is pursuing a career as a
Physician Assistant specializing in Pediatrics and Child­hood
Obesity.
Luke Wilmshurst, MSc, received his Masters degree from
Oxford University, and a combined Honors BA in Psychology and
English Literature from the University of Western Ontario
(Canada). He is a regular contributor to IESE Insight (Spain).