Available online at www.sciencedirect.

com

ScienceDirect
Cognitive and Behavioral Practice 24 (2017) 152-173
www.elsevier.com/locate/cabp

Media Review

Cognitive Behavioral Therapy for Attention-Deficit/Hyperactivity Disorder in

College Students: A Review of the Literature
J. Allison He, Syracuse University
Kevin M. Antshel, Syracuse University and State University of New York–Upstate Medical University

The current review presents a theory-guided review of the existing cognitive behavioral therapy (CBT) interventions for attention-deficit/
hyperactivity disorder (ADHD) in college students. Across the eight studies that investigated this topic, moderate reductions were shown
in inattentive symptoms but little to no change was reported in hyperactive/impulsive symptoms. Results indicated a moderate treatment
effect on self-reported quality of life and school/work functioning, yet less of an impact on GPA, response inhibition, social functioning,
and executive functioning. Methodological and statistical problems and inconsistencies were noted. Since college students are emerging
adults, it is likely that the optimum CBT intervention for college students with ADHD lies somewhere in between the existing clinic-based
adult ADHD CBT interventions as well as the school-based adolescent ADHD psychosocial interventions. Directions for future research
and recommendations for clinicians in university settings are provided in an attempt to further develop the existing college students
CBT clinical research evidence base.

T HE question of whether cognitive behavioral therapy

(CBT) treatments developed for adults with
attention-deficit/hyperactivity disorder (ADHD) is a
developmentally appropriate and efficacious treatment when
applied to college students/emerging adults has never
been critically examined. By applying existing adult CBT
manuals to college students, researchers make the
implicit assumption that college students are more similar
to adults than adolescents, for whom psychosocial
treatments are more intensive and often multimodal
(Young & Amarasinghe, 2010). Yet, an analysis of the
validity of this assumption has not been made.
The purpose of this review is to clarify this problem by
synthesizing and assessing the empirical literature on CBT
for ADHD in college students. The primary aim is to
examine whether CBT produces clinically significant
outcomes as would be predicted by ADHD and CBT
theories. The review begins with a summary of existing
evidence-based interventions for ADHD across the lifespan.
Next, a theoretical overview of CBT for ADHD and relevant
theory on ADHD etiology is presented. Then, the existing
literature on CBT for ADHD in college students is reviewed,
and conceptual gaps and inconsistencies as well as
Keywords: cognitive behavioral therapy; CBT; attention-deficit/
hyperactivity disorder; ADHD; college student
1077-7229/13/© 2016 Association for Behavioral and Cognitive
Therapies. Published by Elsevier Ltd. All rights reserved.
methodological and statistical problems in the literature
are highlighted. Finally, the argument that CBT for ADHD
in adults in its current form needs to be modified for the
college student population is presented, along with
several recommendations on how to advance research on
this clinically significant public health problem (Matza,
Paramore, & Prasad, 2005).
Evidence-based treatment of ADHD across the lifespan
ADHD is defined by the Diagnostic and Statistical
Manual of Mental Disorders (American Psychiatric
Association, 2013) as a disorder with hallmark symptoms
of developmentally inappropriate levels of inattentive
and/or hyperactive-impulsive symptoms in two or more
settings (e.g., school, work, home, etc.) that result in
significant functional impairment and that cannot be
better explained by another condition. Although ADHD
was once considered a disorder of childhood (Hill &
Schoener, 1996), it is now recognized as a chronic and
pervasive developmental disorder that persists into
adolescence and adulthood for 50%–80% of individuals
diagnosed as children (Barkley, Fischer, Smallish, &
Fletcher, 2002, 2006; Biederman, Petty, Evans, Small, &
Faraone, 2010; Klein et al., 2012). Academic and
occupational impairment are especially prevalent in
adolescents and adults with ADHD (Barkley, Murphy, &
Fischer, 2010), and both of these populations achieve
lower levels of educational attainment, lower socioeco-
nomic status (Mannuzza, Klein, Bessler, Malloy, &
LaPadula, 1998), and have poorer occupational, social,
 CBT for ADHD in College Students
and adaptive functioning (Biederman et al., 2012; de
Graaf et al., 2008; Young, Toone, & Tyson, 2003).
In children, adolescents, and adults with ADHD,
stimulant medications are the gold standard and most
efficacious treatment for ADHD (Greenhill et al., 2002;
Pliszka, 2007a,b). Stimulants reduce ADHD symptoms, with
a large mean effect size of d = 0.9 (Faraone, Spencer,
Aleardi, Pagano, & Biederman, 2004). Although pharma-
cotherapy approaches across the lifespan are relatively
consistent in terms of demonstrating the efficacy of
stimulant medications on ADHD symptoms, there is less
consistency on the effect of psychosocial interventions on
symptoms or functioning across the lifespan. Relative to
children with ADHD, there is less knowledge about what
even constitutes effective psychosocial interventions in
adolescents and adults with ADHD. Given the documented
syndromal persistence of ADHD into adolescence and
adulthood and the maintenance of associated functional
impairments, it is surprising that psychosocial ADHD
intervention research remains largely dominated by a
child focus. In the largest child ADHD intervention study to
date (N = 579, across six sites), the NIMH Multimodal
Treatment Algorithm study (MTA Cooperative Group,
1999) included behavioral parent training, teacher training
in contingency management, classroom consultation, and
an intensive all-day, 8-week behavioral therapy summer
camp as the four branches of the psychosocial intervention
strategy. These four intervention components showed
robust effects and are now considered the best-established,
evidence-based treatments for child ADHD (Evans, Owens,
& Bunford, 2014; Fabiano et al., 2009).
Compared to the child literature, the psychosocial
intervention literature is sparser for adolescent ADHD.
However, a recent review cited positive effects for intensive
and integrative multimodal treatment approaches (Sibley,
Kuriyan, Evans, Waxmonsky, & Smith, 2014). These
adolescent ADHD management strategies are similar to
child interventions in that they typically include behavioral
plans at school based on contingency management,
functional behavioral analysis, academic skills training,
social skills training, and parent group training in
behavioral management (Young & Amarasinghe, 2010).
In other words, adolescent ADHD management strategies
retain much of the intensity of the child interventions.
Less has been published on psychosocial interventions for
adult ADHD. Compared to both child and adolescent
ADHD, the adult ADHD psychosocial interventions that have
been studied are somewhat less intensive and less integrative.
In the research literature, cognitive behavioral therapy
(CBT) in a group setting is the predominant treatment
strategy for adult ADHD (Mongia & Hechtman, 2012) and
has shown promise. A meta-analysis (Linderkampa & Lauth,
2011) suggested that psychosocial interventions (i.e., CBT
interventions) are efficacious for adult ADHD with moderate
153
to large effects (d = 0.84). Thus, while less research has been
conducted on psychosocial interventions for adolescent and
adult ADHD, a body of literature supports these approaches.
What constitutes these approaches, however, is starkly
different: psychosocial interventions for adolescents (and
children) with ADHD are intensive, behavior-management
oriented, and often integrated into the school day; on the
other hand, psychosocial interventions for adults with ADHD
are less intensive and typically consist of clinic-based group
CBT.
Recently, researchers have started to implement CBT
for adolescent ADHD and have reported some preliminary
positive outcomes (Boyer, Geurts, Prins, & Van der Oord,
2014; Vidal et al., 2015). Still others (Antshel & Olszewski,
2014) have suggested that the downward extension of
existing adult CBT protocols may hold promise for younger
populations when used as an adjunctive treatment to
pharmacotherapy. Within the past 10 years, researchers
have begun implementing and adapting adult CBT
protocols as a stand-alone treatment for use with college
students as well (e.g., Anastopoulos & King, 2015; Fleming,
McMahon, Moran, Peterson, & Dreessen, 2015). College
students, however, are typically much younger than the
adults in the CBT trials, and college students do not define
themselves as adolescents or adults (Arnett, 2003). Instead,
college students are most often conceptualized as being in
the developmental period of “emerging adulthood,” a
period of time between ages 18 to 25 (Arnett, 2000)
characterized by the following five dimensions: identity
exploration (e.g., trying out different career goals),
feeling-in-between adolescence and adulthood, possibilities
(e.g., setting optimistic life goals), self-focus (e.g., becoming
independent from parents), and instability (e.g., uncertain-
ty and stress from exploring life options) (Arnett, 2000).
CBT for ADHD
Today, CBT remains distinct from other schools of
therapy (e.g., psychoanalytic, psychodynamic or interper-
sonal therapy) in six defining ways that characterize unique
“ingredients” of CBT: (1) use of homework/between-session
activities to promote generalization and maintenance of
skills; (2) direction of session activity; (3) didactic skills
training on how to cope with symptoms; (4) emphasis on the
patient’s future experiences; (5) providing patients with
psychoeducation about their treatment and diagnosis; and
(6) an intrapersonal/cognitive focus (Blagys & Hilsenroth,
2002). In theory, CBT seems poised to address the
psychological and behavioral difficulties associated with
ADHD, since theories on the putative causes of ADHD
(described below) include deficits in response inhibition
(Barkley, 1997), which relates to behaviors, as well as a
cognitive motivational style marked by delay aversion
(Sonuga-Barke, 2002), which relates to cognitions. Indeed,
154 He & Antshel
CBT has shown efficacy in several randomized controlled
trials in adults with ADHD, although the adult CBT
interventions have tended to be more behaviorally focused
than cognitively focused (Safren et al., 2010; Solanto et al.,
2010; Weiss et al., 2012). Yet, CBT has not been found to be
highly efficacious for children with ADHD (Abikoff &
Gittelman, 1985; Durlak, Fuhrman, & Lampman, 1991).
This finding—efficacious for adults, yet not children—
coupled with the large literature suggesting that CBT is
efficacious for conditions other than ADHD in both children
and adults (for a review, see Hofmann, Asnaani, Vonk,
Sawyer, & Fang, 2012), suggests that ADHD-specific devel-
opmental processes may be affecting treatment responsive-
ness. For example, prospective neuroanatomical evidence
points to significant delays in cortical maturation in children
with ADHD compared to typically developing controls in
regions of the prefrontal cortex (Shaw et al., 2007), which
may affect treatment gains. The following section briefly
describes the leading theoretical models underlying ADHD
to provide an overview of other potential ADHD-specific
processes that may be in play.
Theoretical overview of ADHD
Until the late 1990s, research on ADHD was largely
atheoretical. With few exceptions (Oosterlaan & Sergeant,
1996; Quay, 1988; Sergeant, 1995), the majority of
published studies reported descriptive or exploratory
data; similarly, the clinical view of ADHD was descriptive
and rarely theory-driven (Barkley, 1997). Today, two
primary theoretical models of ADHD exist: the response
inhibition model (Barkley, 1997) and the dual-pathway
model (Sonuga-Barke, 2002).
Barkley’s theory argues that behavioral response inhibi-
tion is the single cause and primary deficit of ADHD,
accounting for the associated executive function deficits
(e.g., inability to select, pursue, and attain future goals) and
impairments seen in ADHD (Barkley, 1997). Barkley’s
theory is supported by meta-analytic data (Willcutt, Doyle,
Nigg, Faraone, & Pennington, 2005) indicating that both
children and adults with ADHD (Hervey, Epstein, & Curry,
2004) demonstrate poorer performance on tests of response
inhibition. Conversely, Sonuga-Barke’s model argues that
ADHD is the result of two distinct biological pathways—the
dopaminergic mesocortical and mesolimbic systems. The
mesocortical pathway dysfunction is similar to Barkley’s
model and conceptualizes ADHD as a disorder of
self-regulation of thoughts and actions as a result of
inhibitory dysfunction. Deficient inhibitory mechanisms
then lead to executive dysfunction and behavioral
dysregulation. The mesolimbic pathway dysfunction con-
ceptualizes ADHD as a delay-averse motivational style with
acquired cognitive deficits (Sonuga-Barke, 2002). Both
pathways lead to ADHD symptoms and associated impair-
ments in the quality and quantity of task engagement.
An efficacious treatment for ADHD must be related to a
working theoretical model of the deficits associated with
ADHD. For example, CBT treatments that propose
to address the delay-averse motivational style of ADHD
(i.e., the second pathway of the dual-pathway model)
should involve strategies to mitigate procrastination of less
reinforcing activities as well as a consideration of reinforce-
ment for desired behaviors (e.g., a reinforcement sched-
ule). For example, one commonly employed CBT manual
(Solanto et al., 2010) includes an explicit focus on
visualization of rewards as a means of reducing delay
aversion. In addition to this technique, another CBT
manual (Safren et al., 2005) teaches the use of a
distractibility delay (e.g., writing distracting thoughts in a
notebook rather than acting upon them now) as a means of
reducing impulsivity and delay aversion. As a corollary, CBT
treatments that purport to address the motivational style of
ADHD should also attempt to quantify or qualify that
assertion by demonstrating change in delay aversion from
pre- to posttreatment. With this theoretical background in
mind, the following section provides a brief overview of the
existing evidence-based psychosocial interventions for
ADHD in adolescents and adults and, when applicable,
outcomes will be reviewed. The child literature is not
reviewed since college students are considered emerging
adults, occupying a unique territory between adolescence
and adulthood (Arnett, 2000).
Psychosocial treatments for adolescents with ADHD
The intervention research for ADHD in adolescence
largely consists of pharmacotherapy studies and intensive
behavioral interventions aimed at improving study and social
skills and mitigating disruptive behaviors. Adolescent ADHD
practice guidelines often recommend an integrative or
combined treatment approach of medication and psychoso-
cial interventions (American Academy of Pediatrics, 2011)
and specifically caution providers that adherence to medi-
cation in adolescents may be lower than that in children
(Pliszka, 2007a, b). Several recent reviews suggest that
adolescents are more likely to benefit from an integrative
multimodal treatment strategy that combines behavioral
plans at school, academic skills training, social skills training,
and parent behavioral management group training rather
than a single treatment strategy alone, with effect sizes
ranging considerably (Evans et al., 2014; Sibley et al., 2014;
Young & Amarasinghe, 2010). Mean effect sizes across five
psychosocial interventions for adolescents have been report-
ed to be d = .49 for ADHD symptoms, d = 1.20 for academic
impairment, d = .31 for social impairment, and d = .77 for
family impairment (Sibley et al., 2014). These psychosocial
interventions are often implemented as part of a compre-
hensive education plan and generally include multiple
components that are delivered in school or after school.
 CBT for ADHD in College Students
One such treatment protocol is the Challenging Horizons
Program (Evans, Axelrod, & Langberg, 2004; Evans, Schultz,
Demars, & Davis, 2011). The Challenging Horizons Program
(CHP) is a comprehensive school-based psychosocial
treatment for adolescents with ADHD that emphasizes
both educational (e.g., note taking, academic organization,
and homework completion) and interpersonal (e.g., social
problem solving, goal-setting) components and includes
separate groups to teach and reinforce these skills. Time for
recreation (e.g., 30 minutes games and sports) is also built in
as a way for students to develop peer relationships and
practice social skills. The CHP is time intensive: after-school
sessions are held 2 days per week for 2 hours, 15 minutes
each session for the entire academic year. During the
program, interventionists shape the students' behaviors
using reinforcement. Group parent training and individual
family counseling are also independently held to comple-
ment the academic and social skills groups. Open and
randomized trials of the CHP have yielded moderate-to-large
effect sizes on measures of inattention and school function-
ing, and small-to-moderate effect sizes on grades and
measures of family and peer relations (Evans et al., 2011;
Evans et al., 2015; Langberg, Epstein, Becker, Girio-Herrera,
& Vaughn, 2012; Langberg et al., 2007).
Psychosocial treatments for adults with ADHD
Unlike the intensive, behavioral school-based interven-
tions that are efficacious for adolescents with ADHD,
interventions that have shown promising effects in adults
are somewhat less intensive (i.e., one 2-hour session per
week for 12 weeks for adults compared to 4 hours and
30 minutes per week for 9 months for adolescents).
These typically less intensive approaches include CBT,
structured skills training, and coaching (Young &
Amarasignhe, 2010). Of these approaches, only CBT has
been evaluated using the gold-standard randomized
controlled trial (RTC; Emilsson et al., 2011; Safren
et al., 2010; Solanto et al., 2010; Virta et al., 2010).
One popularly referenced CBT manual for adult
ADHD is Mastering Your Adult ADHD (Safren, Perlman,
Sprich, & Otto, 2005). This manual was tested empirically
in an RCT of adults with ADHD (N = 31) ranging in age
from 25–59 (M age = 45.5) who were randomized to
stabilized medication alone or stabilized medication with
individual CBT. Adults who received CBT reported fewer
symptoms of ADHD, depression, and anxiety at posttreat-
ment compared to the medication-alone group. A
subsequent RCT by Safren and colleagues tested individ-
ual CBT (n = 43, M age = 42.3, SD = 10.3) against
relaxation with psychoeducation (n = 43, M age = 44, SD =
12.2) in a sample of medicated adults with ADHD (Safren
et al., 2010). Again, adults who received individual CBT
had greater ADHD symptom improvement compared to
155
those who received relaxation with psychoeducation at
posttreatment and at 12-month follow-up (Safren et al.,
2010).
Another CBT for ADHD was developed by Solanto and
her colleagues (Solanto, Marks, Mitchell, Wasserstein, &
Kofman, 2008; Solanto et al., 2010). This treatment
sequence includes 12, 2-hour group sessions that cover
material related to contingent self-reward, time- and
task-management, implementation of learned skills,
problem-solving, and planning for future goals. This
intervention was tested in an RCT of adults with ADHD
who were randomized to receive CBT (n = 45, mean age =
41, SD = 11.6) or supportive therapy (n = 43, mean age =
42.4, SD = 12.1). In this RCT, CBT yielded greater ADHD
symptom improvement than supportive therapy across
self, observer, and blinded evaluator ratings (Solanto
et al., 2010). Given the demonstrated efficacy of CBT for
ADHD in adult populations, several researchers have
begun the downward extension of CBT treatments for use
in college student populations. Nonetheless, it is impor-
tant to note that adults who participated in Solanto’s and
Safren’s studies were in their mid-40s—twice the age of
the typical college student.
CBT for ADHD in college students
High school students with ADHD are entering college
at increasingly higher rates—approximately 4% of college
students have an existing diagnosis of ADHD (DuPaul
et al., 2001), and the most recent follow-up survey on
postsecondary trajectories of high school students with
ADHD histories (N = 326) showed that 30% of the ADHD
sample were currently in pursuit of a 4-year degree; this
figure was 9% higher than previously reported data from
a comparable sample in 2006 (Kuriyan et al., 2013).
Despite this increased prevalence of college students with
ADHD, practice parameters do not exist for this
population and few longitudinal studies have followed
adolescents with ADHD as they make their way to college.
This is surprising, since the transition from high school to
college for adolescents being treated for ADHD can be an
abrupt shift, as they move away from a highly structured
environment (e.g., interventions and accommodations
occurring at school, reinforcement schedules in place at
home) to the less structured environment of the college
campus where there are greater demands for functional
independence, for example, needing to manage medica-
tions without the involvement of parents (Fleming &
McMahon, 2012). Thus, there is a pressing need to
develop and test efficacious and feasible treatments on
college campuses to ensure that college students with
ADHD are positioned for success in their new, less
structured environment that requires more functional
independence.
156 He & Antshel
Overview of existing studies
The existing literature on interventions for college
students with ADHD can be broadly divided into three
categories: pharmacological (e.g., stimulants), cognitive
enhancement (e.g., working-memory training), and
psychosocial (e.g., behavioral therapy, CBT) treatments.
The focus of this present review is on psychosocial
treatments, and more specifically, CBT interventions, as
these have shown efficacy in adult and some adolescent
ADHD populations. The following review examines the
body of literature on CBT for ADHD in college students
and aims to address the question of whether CBT, as it is
currently delivered, is a developmentally appropriate and
efficacious treatment for ADHD in college students.
Method
Studies were identified using the following procedure.
First, an electronic database search using the PsycInfo,
PsycArticles, PubMed, and Google Scholar was conducted.
Search terms included: (1) all possible permutations of the
disorder (e.g., ADD, ADHD, Attention Deficit Disorder,
Attention Deficit Hyperactivity Disorder, ADHD-C, ADHD-I,
Attention-Deficit/Hyperactivity Disorder), (2) all possible
permutations of the target sample (e.g., college students,
university students, college sample, college), and (3) all
possible permutations of the target treatment (e.g., inter-
vention, treatment, training, therapy, CBT, cognitive
behavioral therapy, cognitive-behavioral therapy). Next,
the obtained articles were reviewed and the reference list
examined once more to identify any articles that were not
captured by the literature search.
Inclusion/exclusion criteria
Articles were included if the following criteria were met:
(1) published in a peer-reviewed journal any time before
March 2015, (2) written in English, (3) all participants in the
sample were diagnosed with ADHD, (4) all participants in
the sample were college students, (5) interventions were
delivered by a therapist competent to provide CBT (e.g., a
licensed clinical or school psychologist or a doctoral-level
psychologist-in-training), and (6) interventions delivered
had ≥ 5 of the 6 core, distinctive features of CBT (Blagys &
Hilsenroth, 2002). Studies were excluded if the primary
intervention was described as being delivered by someone
other than a mental health professional (e.g., certified life
coach or “ADHD coach”). While several articles described
their intervention as “coaching,” the coaching interventions
that included ≥ 5 of the 6 distinctive features of CBT (Blagys
& Hilsenroth, 2002) were included. The original search
yielded 267 articles and abstracts, 259 of which did not meet
inclusion criteria. See Table 1 for the eight studies retained.
Interrater reliability statistics were calculated by having
each author (a doctoral student in clinical psychology and a
licensed clinical psychologist specializing in CBT) inde-
pendently code each study for inclusion. The intraclass
correlation (ICC) was in the excellent range (ICC = 1.0),
indicating that coders had a high degree of agreement and
suggesting that CBT elements were rated similarly between
coders.
Outcome measures
The present review included several theory-guided
outcome measures from two broad categories: clinical
symptoms and functioning. Specifically, each study was
examined for reports of changes in executive function,
behavior inhibition, functional impairment, and ADHD
symptoms. Below, each of these outcome categories is
discussed in detail, following a description of the study
designs.
Results
Study characteristics
Articles that met study inclusion criteria were all
published between 2005 and 2015, and all interventions
were delivered on a college campus. Studies ranged in
sample size from 1 to 148 and had a mean sample size of 37
participants. See Table 1 for sample characteristics for each
study and Table 2 for a description of the intervention
format, content and delivery, as well as each study’s number
of distinctive CBT elements (Blagys & Hilsenroth, 2002).
Below, the intervention design of each clinical trial is
summarized before presenting clinical outcomes. The only
randomized controlled trial is presented before the open
clinical trials.
Randomized controlled trials
Group dialectical behavior therapy
Fleming et al. (2015) conducted the only RCT of a
psychosocial intervention for college students with
ADHD. In their study, 33 undergraduate students were
randomized to receive the active intervention, which
consisted of 8 weekly, 90-minute sessions of dialectical
behavior therapy (DBT) skills training in a group format
or the control condition, which consisted of 34 pages of
self-guided skills training handouts. The skills handouts
(SH) included publicly available self-help materials for
ADHD, including information about ADHD and execu-
tive dysfunction, organization, planning, time manage-
ment, structuring environments, and stress management.
All students were assessed at pre- and posttreatment as
well as at a 3-month follow-up.
Open clinical trials
Combined group and individual CBT
LaCount, Hartung, Shelton, Clapp, and Clapp (2015)
conducted an open clinical trial of a combined group (10
sessions) and individual CBT (10 sessions) intervention
Table 1
Sample Characteristics of Included Studies
Ascertainment
Prevatt and ■ Large public university
Yelland (2015) in the Southeast
■ 50% self-referred, 50%
referred by parents,
professors, or other
university personnel
Fleming et al. ■ 3 universities in the Pacific
(2015) Northwest
■ Enrolled college students
■ Exclusions: current SUD,
active suicidality, MDD,
history of psychosis, BPD,
or PDD
Scheithaur & ■ Psychology Department
Kelley (2014) Research Pool
■ Enrolled college students
with prior ADHD diagnosis,
current psychotropic
prescription for ADHD
and regular computer
access
Anastopoulos ■ Enrolled college students
and King ■ Recruited from ADHD
(2015) specialty clinic, ODS,
summer orientation,
parents, word of mouth
■ Exclusions: ASD, BPD
Sample Characteristics
■ N = 148
■ 51% Male
■ 73% Caucasian
■ Age: 17-60, M = 24.6, SD = 9.4
■ Mean GPA: 3.08 (SD = .59)
■ N = 33
■ n = 17 in DBT group
■ n = 16 in SH control group
■ 58% Male
■ 58% Caucasian
■ Age: 18-24
■ Control: M = 21.2, SD = 1.67
■ DBT: M = 21.5, SD = 1.12
■ N = 41 completers,
■ n = 22 in SM + group
■ n = 19 in SM- group
■ 76% Female
■ 80% Caucasian
■ Age: 18-32, M = 20.48
■ N = 43 completers
■ 37% Male
■ Age: 17-27, M = 20.3
■ 16% Hispanic, 21%
African American/ multiracial
ADHD Diagnosis Study Design
■ Self-report ■ Uncontrolled 8-session
ADHD coaching program
■ Had to meet all DSM IV ■ RCT of DBT group vs.
CBT for ADHD in College Students
criteria in adulthood, Skills Handout (SH)
including childhood control
onset criteria,
confirmed via
clinician interview
■ Self-report ■ Randomized open trial
with comparison group.
■ All students received goal
setting and study skills
instruction (SM-), but
the treatment group also
received self-monitoring
instruction (SM +)
■ Self-report ■ Open clinical trial
■ CBT groups + individual
mentoring program
(continued on next page)
157
 158
Table 1 (continued)
Ascertainment Sample Characteristics ADHD Diagnosis Study Design
■ Mood/Anxiety
comorbidities included

LaCount, Hartung, ■ Enrolled college students ■ N = 17 (12 completers, ■ Self-report ■ Open clinical trial
Shelton, Clapp ■ Public Midwestern University with 5 noncompleters)
& Clapp (2015) predominantly white student body ■ 53% Male
■ Recruited through ODS, UHS, ■ Age: 18-38, M = 25.41, SD = 5.26
athletics depts., Counseling center,
Psychology clinic
■ Exclusions: SUD
■ Mood/Anxiety comorbidities
included

Eddy, Canu, ■ Enrolled college students ■ N=4 ■ Dx verified: students ■ Case series report
Broman-Fulks ■ Recruited via staff ■ 19 year old Caucasian female asked to bring in

He & Antshel
& Michael referrals / university flyers university freshman assessment reports
(2015) in Southeastern US ■ 25 year old second-semester
Caucasian male at community
college
■ 21 year old Caucasian male
at university (junior)
■ 22 year old Caucasian male
university student (senior)

Swartz, Prevatt ■ Enrolled college students ■ N=1 ■ Self-report ■ Case study

& Proctor ■ Coaching conducted at on-campus ■ Heather, 21 year old Caucasian
(2005) assessment center of large, female senior
Southeastern university
■ Coaches were doctoral students

Prevatt, Lampropoulos, ■ Enrolled college students ■ N = 13 ■ Self-report ■ Open clinical trial

Bowles & ■ Recruited from psychology training ■ 46% Male
Garrett (2011) clinic on large public university ■ 54% Caucasian, 8% African
in Southeast American, 8% Asian, 8%
■ Coaches were doctoral students Hispanic

Note. SUD = Substance Use Disorder. MDD= Major Depressive Disorder. PDD = Pervasive Developmental Disorder. ASD = Autism Spectrum Disorder. DBT = Dialectical Behavior Therapy.
SH = Skills Handout. SM= Self-Monitoring. RCT = Randomized Clinical Trial. GPA = Grade Point Average. Dx = Diagnosis.
Table 2
Intervention Format and Content of Included Studies
Study Intervention Source Interventionist Sessions Intervention Content CBT Score (out of 6)
Prevatt and Yelland ■ Coaching ■ Delivered by doctoral students ■ 8 See Swartz et al. (2005) model ■ Direction of
(2015) principles: in a combined counseling/ activity
Swartz, Prevatt school psychology program ■ Teaching Skills
& Proctor (2005) ■ Supervised by licensed clinical ■ Focus on future
psychologist and licensed ■ Focus on HW
school psychologist ■ Psychoeducation
■ Score = 5

Fleming et al. ■ DBT Principles ■ Delivered by advanced doctoral ■ 8 1. Group orientation, goal-setting ■ Direction of
(2015) ■ CBT: Safren students in child clinical psychoeducation, mindfulness activity
et al., 2010 psychology 2. Daily planner use, chunking ■ Teaching Skills
■ MCT: Solanto ■ Supervised by licensed tasks & prioritization ■ Focus on future

CBT for ADHD in College Students

et al., 2010 psychologist 3. Structuring environment, ■ Focus on HW
using social support ■ Psychoeducation
4. Managing sleep, eating & exercise ■ Intrapersonal/
5. Generalizing & troubleshooting skills cognitive
6. Emotion regulation experience
7. Generalizing & troubleshooting skills ■ Score = 6
8. Review of skills, plan for
high-demand period
9. Review of skills, plan for maintaining
skills use (booster session)

Scheithaur & ■ General Study Skills ■ Delivered by MS level ■ 4 1. Baseline (both groups received ■ Psychoeducation
Kelley (2014) ■ BT Principles clinician (doctoral student) the same GSS training, where two ■ Direction of
■ Supervised by licensed informational handouts were Activity
clinical psychologist reviewed): (a) SQ4R: writing ■ Teaching Skills
questions, reading the text, ■ Focus on future
reciting the answers, reflecting ■ Focus on
on connections, and reviewing Homework
■ Score = 5
the material. (b) GSS: organization,
distraction-free studying, self-testing
2. Check-in Session
3. Check-in Session
4. Exit Interview, outcome measures
assessed

Anastopoulos ■ Licensed psychologists ■ 8 Each session contained (a) psychoeducation ■ Direction of

and King (2015) led 90min groups: mentors about ADHD, (b) behavioral strategies, and activity
■ Teaching Skills

159
(continued on next page)
 160
Table 2 (continued)
Study Intervention Source Interventionist Sessions Intervention Content CBT Score (out of 6)
■ CBT: Safren, Perlman were individuals with (c) cognitive therapy components: ■ Focus on future
Sprich, & Otto, 2005; backgrounds in psych 1. a) What is ADHD; b) Campus resources; ■ Focus on HW
Solanto, 2010 ■ Supervised by doctoral c) What is CBT ■ Psychoeducation
level psychologists 2. a) Etiology of ADHD; b) Choosing tools, ■ Intrapersonal/
e.g., planners; c) Recognizing maladaptive cognitive
thoughts experience
3. a) Assessing ADHD; b) Organization
c) Replacing maladaptive thoughts Score = 6
4. a) How does ADHD affect school?
b) Getting the most from classes;
c) Adaptive thoughts and
improving school work
5. a) Comorbidities of ADHD; b) Studying
effectively; c) Dealing with emotions,
resisting temptations
6. a) ADHD Medications; b) Test-taking,
managing papers and long projects
7. a) Nonpharmacological interventions

He & Antshel
for ADHD; b) lifestyle changes, handling
relationships; c) improving friendships and
family relationships
8. a) Looking ahead; b) setting long-term
goals; c) relapse prevention

LaCount, Hartung, ■ CBT: Safren, ■ Groups + Individual sessions • 20 The intervention included 10 group ■ Direction of
Shelton, Clapp Perlman Sprich, delivered by clinical psychology sessions + 10 individual sessions (*), activity
& Clapp (2015) & Otto, 2005 faculty members and graduate covering 12 topics total. Topics included: ■ Teaching Skills
students Psychoeducation, organization & planning, ■ Focus on future
■ Supervised by licensed ■ Focus on HW
medications
doctoral-level psychologists ■ Psychoeducation
1. Involvement of family member or
■ Intrapersonal/
significant other*
cognitive
2. Prioritizing tasks
3. Managing overwhelming tasks experience
4. Organizing papers Score = 6
5. Gauging attention span & distractibility
delay
6. Modifying the environment
7. Introduction to cognitive model of ADHD
8. Adaptive thinking skills
9. Rehearsal & review of adaptive
Thinking skills*
10. Procrastination
 11. Relapse prevention

Eddy, Canu, ■ CBT: Safren, ■ Delivered by second year graduate ■ 8 1. Psychoeducation, organization & planning ■ Direction of
Broman-Fulks Perlman Sprich, student 2. Organization of multiple tasks activity
& Michael (2015) & Otto, 2005 ■ Conducted at college counseling 3. Problem solving, managing overwhelming tasks ■ Teaching Skills
center 4. Gauging attention span & distractibility delay ■ Focus on future
■ Individual sessions were 5. Modifying environment ■ Focus on HW
videotaped and reviewed by 6. Introduction to cognitive model of ADHD ■ Psychoeducation
clinical psychologist, who 7. Adaptive thinking skills ■ Intrapersonal/
8. Procrastination & Relapse Prevention cognitive
examined 25% sessions for
(collapsed together) experience
treatment fidelity
Score = 6
Swartz, Prevatt ■ BT principles ■ Coaching delivered by doctoral-level ■ 8 Coaching topics that students could choose to work on: ■ Psychoeducation
& Proctor (2005) graduate students in Counseling 1. Information & Psychoeducation ■ Focus on future
and School Psych programs 2. Academic Skills ■ Focus on HW
■ Supervised by licensed psychologists 3. Life management ■ Teaching Skills
■ Conducted at university assessment 4. Goal-setting ■ Direction of

CBT for ADHD in College Students

center 5. Prioritizing activity
6. Motivation Score = 5
7. Organizational skills
8. Planning/Scheduling
9. Problem solving
10. Maintaining attention & reducing distractibility
11. Changing procrastination to persistence
12. Stress management/Relaxation techniques
13. Impulse control / anger management
14. Confidence and self-esteem building
15. Relationship/communication skills
16. Memory improvement
17. Medication mgmt.

Prevatt, Lampropoulo, ■ Coaching ■ Delivered by graduate students ■ 8 See Swartz et al. (2005) model ■ Direction of
Bowles & Garrett principles: ■ Co-supervised by licensed activity
(2011) Swartz, Prevatt doctoral level psychologist ■ Teaching Skills
& Proctor (2005) ■ Focus on future
■ Focus on HW
■ Psychoeducation
■ Score = 5

Note. DBT = Dialectical Behavioral Therapy. CBT = Cognitive Behavioral Therapy. MCT = Metacognitive Therapy. BT = Behavioral Therapy. CBT Score = rating of the number of unique “ingredients” of
CBT present in the study, out of a possible score of 6: (1) use of homework and between-session activities; (2) direction of session activity; (3) didactic skills training on how to cope with symptoms;
(4) emphasis on the patient’s future experiences; (5) providing patients with psychoeducation about their treatment and diagnosis; and (6) an intrapersonal / cognitive focus (Blagys & Hilsenroth, 2002).
Inter-rater reliability for the CBT score coding Intraclass coefficient = 1.0.

161
162 He & Antshel
covering 12 topics over the course of 10 weeks (20,
60-minute sessions total). In this trial, participants were
undergraduate and graduate students with ADHD (n = 12
completers, 5 noncompleters). The study protocol used
the 12-week CBT for ADHD manual published by Safren
et al. (2005) and the study authors stated that they
condensed, but did not exclude, any of the Safren et al.
(2005) manual topics. Group size was not described.
Anastopoulos and King (2015) also conducted an open
clinical trial of a combined group and individual CBT
intervention in undergraduate students with ADHD (N =
43). The intervention comprised 8, 90-minute weekly
group sessions (3–7 students per group) in addition to 8,
30-minute weekly individual mentoring sessions during
which group CBT activities were reviewed. This active
intervention phase was followed by a maintenance phase,
during which participants attended two booster CBT group
sessions as well as five to six individual mentoring sessions
throughout the following semester. (See Table 2 for topics
covered in these meetings.) The study authors’ treatment
approach mimicked the intervention from the empirical
work of Safren et al. (2005) and Solanto et al. (2010),
but deviated from these manuals in that the psychoeduca-
tion, behavioral skills-training, and a cognitive therapy
component was included in each session, rather than being
presented sequentially.
Individual CBT
Eddy, Canu, Broman-Fulks, and Michael (2015)
conducted an open clinical trial of brief CBT for ADHD
with participants (N = 4) who were university or
community college students. The intervention, which
consisted of 8 weekly, 60-minute individual sessions, was
an adaptation of the Safren et al. (2005) manual. To
abbreviate the 12-week protocol to 8 weeks, the study
authors eliminated three sessions (involving a family
member, organizing papers, rehearsal of adaptive think-
ing skills) and collapsed two sessions (procrastination,
relapse prevention) into a single session.
Self-Monitoring
Scheithauer and Kelley (2014) conducted a random-
ized trial of study skills training in college students that
also examined the additive effect of a self-monitoring
intervention. The study authors randomized half of the
participants (n = 22 completers) to self-monitoring
(SM +), during which students were trained to observe
and record their behavior with the goal of altering the
behavior in the future, and half of the participants (n = 19
completers) to a no-self-monitoring (SM-) control, in
which students were given study skills handouts. Both the
SM + and the SM- groups participated in the same baseline
one-on-one interview where the interventionist spent 30
minutes discussing study skills using two handouts; one
handout focused on optimizing reading comprehension
and test performance and the other described general
study skills and goal setting. After this initial intervention
was delivered to all students, the experimenter then
randomly assigned half of the students to the
self-monitoring group (SM +) and half of the students to
no self-monitoring. At this point, the SM- participants
were dismissed, but the SM + participants stayed an
additional 30 to 40 minutes to review principles of
self-monitoring and to orient to an electronic SM
intervention (daily behavioral checklists on predeter-
mined goals such as class attendance and medication
adherence). The interventionist also sent email re-
minders to the SM + group to complete the electronic
SM intervention.
ADHD coaching
Swartz, Prevatt, and Proctor (2005) conducted the first
open clinical trial of an 8-week individual ADHD coaching
intervention and presented the case study of one student.
At baseline, the student completed both the Coaching
Topics Survey (CTS), a survey designed to survey areas of
interest for the participant (e.g., establishing routines,
organizing schoolwork, planning and prioritizing, getting
along with roommates, understanding ADHD, decreasing
negative self-talk, etc.) as well as the Learning and Study
Strategies Inventory (LASSI), an 80-item self-report
inventory designed to assess areas of strength and
weakness across practices and attitudes related to studying
(Weinstein, Zimmerman, & Palmer, 1988). After an initial
meeting to discuss the coaching process as well as
establish treatment goals, 7 more sessions were scheduled,
during which long-term goals and weekly objectives were
discussed. Although the specific treatment protocols were
not included, Swartz et al. (2005) described the coaching
intervention as including “discussions of obstacles,
problem-solving solutions for overcoming areas of diffi-
culty, modifying consequences, and utilizing each week’s
events as a stimulus for future actions” (p. 651).
Prevatt and Yelland (2015) conducted another open
clinical trial of an 8-week individual ADHD coaching
program that was based on the Swartz et al. (2005) model
described above. All of the participants with ADHD (N =
148) were seen on a weekly individual basis and all were
required to complete the aforementioned CTS from which
long- and short-term goals were derived. During weekly
sessions, the coaches monitored progress on these goals
and used cognitive behavioral coaching strategies, psychoe-
ducation and between-session-assignments (BSA’s) to
facilitate goal attainment. Each coaching session included
coaching on weekly objectives related to the college
student’s individualized short- and long-term goals, which
depended on each student’s CTS responses.
Prevatt, Lampropoulos, Bowles, and Garrett (2011)
tested the effectiveness and utility of BSA’s in ADHD
 CBT for ADHD in College Students
coaching with college students with ADHD (N = 13) at a
university training clinic, using the same 8-week Swartz
et al. model (2005). Coaches rated their client’s BSA
performance on a Likert-type 1–7 scale, on several
dimensions, including compliance, quality, attitude, and
perceived usefulness. Coaches also rated their client’s use
of incentives for completing the intervention, including
the use of self-incentives, external incentives, and pleasing
parents as an incentive (1 = not at all to 7 = frequently).
Outcome variables included (1) therapist ratings of
motivation and overall progress at posttreatment and
(2) a pre-post change score calculated by subtracting
therapist rating of initial motivation and functioning from
therapist rating of end of therapy motivation and
functioning.
Study dependent variable: Functional outcomes
Functional impairment and perceived lower quality of
life can be present even at lower levels of ADHD
symptoms. Indeed, a study of four independent large
ADHD research samples demonstrated that ADHD
symptoms alone explain at most 25% of the variance in
functional outcomes and impairment (Gordon et al.,
2006). Thus, researchers who test interventions for ADHD
should not rely solely on ADHD symptoms and instead
incorporate measures of quality of life and functional
impairment at pre- and postintervention (Sibley et al.,
2014). The following section details several objective and
subjective functional outcomes relevant to ADHD in
college students.
Objective functional outcome: Grade Point Average (GPA)
Since college students with ADHD typically report sig-
nificantly more academic concerns than college students
without ADHD (Lewandowski, Lovett, Codding, &
Gordon, 2008), improving GPA is one way by which an
intervention for this population can demonstrate func-
tional impact. Indeed, improving academic performance
is quite often a cardinal goal of intervening with college
students with ADHD. Of the studies reviewed, three out of
eight measured GPA at pre- and posttreatment.
Scheithaur and Kelly (2014) found a significant within-
group increase in GPA in the Self-Monitoring (SM +) group
at the posttreatment, but there were no significant
differences between the SM + group and the (SM-)
study-skill control group. This curious finding is due to
the fact that, despite randomization, there were significant
baseline differences in GPA (SM+ group had a lower mean
GPA than the SM- group). Thus it is difficult to know the
extent to which these results are due to the intervention
effect or represent simple regression toward the mean.
Conversely, Fleming et al. (2015) found no significant
between- or within-group differences in GPA at pre- or
postintervention in their RCT of group DBT. Similarly,
163
Anastopoulos and King (2015) found no significant change
in mean GPA from the semester immediately preceding
treatment to the semester GPA at the end of treatment.
Taken together, these results seem to provide limited
evidence for the efficacy of CBT on improving academic
GPA in college students with ADHD.
However, this lack of an effect must be tempered by
the fact that measuring changes in GPA is accompanied
by many limitations. First, GPA is not a neat construct, due
to the fact that several factors, extraneous to treatment,
may also exert an influence on GPA. For example, a
student may perform better in the semester after an
intervention than the semester preceding intervention,
but if they were also enrolled in more complex classes, this
impact would wash out. Second, any intervention's impact
on GPA may require a longer period of time to manifest
since a student’s GPA may show little improvement after
only one semester of intervention. Third, gains in GPA
may also be contingent on the timing of the intervention:
if the intervention began in the middle of the semester,
rather than the beginning, the effect of the intervention
may be dwarfed by poor test performance or missing
assignments earlier on in the semester. At present, it
remains to be seen whether there are any treatment
effects on GPA as only three trials have assessed this
outcome and none of them were sufficiently powered or
longitudinal enough to assess the impact of an interven-
tion on GPA in subsequent semesters. Extrapolating from
more intensive treatments in adolescents with ADHD
(e.g., CHP), it may be the case that no intervention may
lead to GPA declines (Evans et al., 2011) and thus a lack of
GPA improvement may be viewed differently. Clearly, the
impact of CBT on GPA for college students with ADHD is
an area that needs further research, especially using
longitudinal designs.
Subjective functional outcomes: Functional impairment and
quality of life
Of the eight studies reviewed, four measured changes in
self-reported quality of life and/or functional impairment
as an outcome variable. Fleming et al. (2015) used an
ADHD-specific measure of quality of life—the Adult
ADHD Quality of Life questionnaire (Brod, Johnston,
Able, & Swindle, 2006), a 29-item self-report inventory
assessing four domains of functioning: life productivity,
psychological health, relationships, and life outlook.
Within-group comparisons showed that participants who
received DBT experienced greater improvements in quality
of life (partial η 2 = 0.10) than participants who received the
Skills Handouts (SH) control. Between-group comparisons
also revealed significant differences in self-reported
quality of life at posttreatment (Cohen’s d = .90), but
these differences were not significant at 3-month follow-up
(d = .21).
164 He & Antshel
Prevatt and Yelland (2015) used the Outcome
Questionnaire-45 (Lambert et al., 1996), a 45-item
self-report measure of treatment outcomes that has shown
strong reliability (Cronbach’s α = .80–.94) in measuring
functioning across three domains: symptom distress, inter-
personal functioning, and social role. In their empirical study
of individual ADHD coaching, Prevatt and Yelland (2015)
found significant decreases in total outcome score, symptom
distress, and social role scores. Effects were moderate for total
score and symptom distress (Cohen’s d = .58 and .51
respectively) and large for social role (d = .83). Interpersonal
functioning, however, did not change significantly over time.
LaCount et al. (2015) used the Weiss Functional
Impairment Rating Scale (Weiss, 2000), a self-report
measure of impairments in functioning across seven
domains of functioning—family, work, school, life skills,
self-concept, social, and risky behavior. This scale has
shown strong internal consistency (α = 0.86 to 0.94) in a
sample of college students (Hartung et al., 2013). In
LaCount et al.’s open trial of combined group and
individual CBT, students who completed the intervention
showed significant improvements of moderate size in
self-reported school and work functioning (Cohen’s d =
.51 and .63, respectively).
Lastly, Eddy et al. (2015) also used the WFIRS as well as
the OQ-30 (Lambert et al., 1996), a condensed 30-item
Likert-scale measure of treatment outcomes across the
same three domains of functioning as the OQ-45, in their
case series study (N = 4) of individual CBT. At posttreat-
ment, three out of four participants showed decreases
across WFIRS domains, indicating less self-reported func-
tional impairment. Furthermore, similar results emerged
for self-reported OQ-30 functioning (M pretreatment
score = 38.0; M posttreatment score = 18.8). Taken together,
the results of these four studies suggest that psychosocial
interventions for ADHD may have a moderate effect on
self-reported quality of life and reduction in self-reported
functional impairment in school and work functioning.
However, self-reported improvements in interpersonal
functioning and life skills were not as robust.
Response inhibition
As previously mentioned, Barkley’s theory (1997)
posits that the core deficit of ADHD is essentially a deficit
in response inhibition or impulse control. Of the eight
studies reviewed here, only one included a measure of
behavioral response inhibition. Fleming et al. (2015) used
the Conners’ Continuous Performance Task–2 nd edition
(CCPT-2) as a laboratory-based neuropsychological mea-
sure of response inhibition and inattention and found
that the DBT group did not significantly outperform the
SH control at posttreatment or follow-up in CCPT-2 errors
of commission. Given the prominence that researchers
place on the construct of response inhibition as a central
feature of ADHD, the overall lack of studies incorporating
laboratory-based measures of response inhibition may
come as a somewhat surprising gap. However, research
has shown that laboratory-based neuropsychological tasks
often correlate only modestly with real-world functional
impairment (Stavro, Ettenhofer & Nigg, 2007); this is
potentially due to the low ecological validity of common
executive function tasks purporting to measure response
inhibition (Barkley & Murphy, 2011). More research is
needed to develop ecologically valid laboratory-based
tests of response inhibition in order to assess whether
CBT reliably affects this important and central outcome
in ADHD.
Executive functioning
Executive functioning (EF) is an umbrella construct
and refers to abilities such as reasoning, planning,
attending, set-shifting, inhibiting goal-irrelevant behav-
iors, and maintaining information in working memory
(Pennington & Ozonoff, 1996). Executive dysfunction has
been implicated as a major source of impairment in
ADHD across the lifespan (Barkley & Murphy, 2011;
Schoemaker et al., 2012) and persists despite pharmaco-
logical treatment (Biederman et al., 2011). Thus, changes
in EF are another way by which researchers and clinicians
can measure the effect of an intervention. Of the eight
studies reviewed, two reported measuring EF. This is
surprising given the centrality that executive dysfunction
has in the two leading ADHD theoretical models.
Moreover, both the Safren and Solanto interventions
conceptualize their CBT as teaching skills that are meant
to compensate for underlying EF deficits.
Fleming et al. (2015) operationalized EF as the total
score on the Brown ADD Rating Scales (BADDS), a 40-item
self-report questionnaire assessing five domains of EF,
including organization / prioritization, focused / sustained
attention, regulation of alertness / effort, affect modula-
tion, and working memory (Brown, 1996). Compared to
the SH control group, the DBT group reported significantly
lower BADDS scores at posttreatment (Cohen’s d = .94)
and at 3-month follow-up (Cohen’s d = .81), indicating
less self-reported EF impairments after treatment.
Likewise, Anastopoulos and King (2015) used the Behavior
Rating Inventory of Executive Function—Adult Version
(BRIEF-A), a self-report questionnaire yielding three
composite scores of EF—Behavior Regulation, Metacogni-
tion, and General Executive Composite as a measure of
self-reported EF (Gioia, Isquith, Guy, & Kenworthy, 2000).
At posttreatment, students in the combined CBT group and
individual mentoring reported significant decreases in all
three executive dysfunction domains, with moderate to
large effects (Cohen’s d = 0.74 – 0.88).
In sum, the two studies that examined self-reported EF
from pre- to posttreatment reported promising results.
 CBT for ADHD in College Students
However, EF in both of these studies was measured via
self-report and did not include collateral report. Given
the validity concerns associated with self-report from
adolescents and adults with ADHD (Jiang & Johnston,
2012; Prevatt, Proctor, Best, Baker, Van Walker & Taylor,
2012), future research should include collateral re-
porters. Likewise, none of the existing studies attempted
a multimethod assessment of EF. Thus, the extent to
which CBT may impart objective changes in EF (e.g.,
improvement on a working memory or organizational
task) also remains unknown.
Study dependent variable: ADHD symptom outcomes
To measure treatment efficacy, symptoms of the
target disorder should be measured at baseline, postin-
tervention, and follow-up. Of the studies reviewed, six
included measures of ADHD symptoms at baseline and
posttreatment/follow-up. Separate results for inattentive
and hyperactive-impulsive (HI) symptoms are presented
below when available.
Two of the studies used the Barkley Current Symptoms
Scale – Self Report Form (CSS-SR), an 18-item DSM-IV-
derived 4-point Likert scale developed to assess for ADHD
(Barkley & Murphy, 2006) which has also been validated
in college students (Fedele, Lefler, Hartung, & Canu,
2012). In LaCount and colleagues’ study of combined
group and individual CBT, completers (n = 12) and
intent-to-treat analysis (n = 17) showed significant
decreases in inattentive symptoms with moderate to
large effects (ITT d = .65, Completer d = .93) but no
effect on HI symptoms (LaCount et al., 2015). In Eddy
and colleagues’ open clinical trial (N = 4) of individual
CBT, descriptive data showed there were no pre- to
posttreatment change in CSS-SR inattentive symptoms in
two students, an increase in one student, and a decrease
in one student. Furthermore, there was no change in
CSS-SR HI symptoms in two students, but a decrease for
the remaining two students (Eddy et al., 2015).
Anastopoulos and King (2015) used the Conners’
Adult ADHD Rating Scales (CAARS), a well-validated
66-item self-report measure of ADHD symptoms in adults
(Conners, Erhardt, & & Sparrow, 2006) that has adequate
internal (α = .80 to .90), and test-retest (r = .80 to .91)
reliability and is aligned with the DSM-IV. In their
combined group and individual CBT intervention,
inattentive symptoms decreased significantly from pre-
to posttreatment (Cohen’s d = .76), but HI symptoms
only improved marginally from pre- to posttreatment
(d = .31).
Scheithaur and Kelley (2014) used the ASRS, another
DSM-IV-derived Likert self-report scale of ADHD symp-
toms in adults (Kessler et al., 2005) that has been used
with college students (Fuller-Killgore, Burlison, & Dwyer,
165
2013). Significant decreases in ADHD symptoms were
seen in the self-monitoring intervention group (SM +) but
not in the skills-handout control (SM-). In the SM + group,
this effect was also clinically significant (d = 1.29).
However, the authors did not separate inattentive versus
HI symptoms in their analysis.
Fleming et al. (2015) used the Barkley Adult ADHD
Rating Scale-IV (BAARS-IV), an 18-item DSM-IV-derived
Likert scale of ADHD symptoms in adults (Barkley, 2011).
Using a between-groups repeated-measures intent-to-treat
ANOVA analysis, the authors found only a trend in
improvement in ADHD symptoms at posttreatment in the
DBT group compared to the SH control group (p = .056),
although DBT did not outperform SH at 3-month
follow-up (p = .14). However, large within-group effect
sizes in BAARS inattentive and hyperactive symptoms
were reported from pre- to posttreatment in both DBT
(Cohen’s d = 1.75) and SH control (Cohen’s d = 1.30).
These large effects were maintained at 3-month follow-up
for both DBT (Cohen’s d = 1.96) and SH control
(Cohen’s d = 1.48). Notably, however, while all partici-
pants were retained for posttreatment ITT analyses, only
64% DBT group members and 25% of SH group
members were retained at 3-month follow-up to calculate
these effects. Thus, interpretation of these effects must be
tempered with caution, since attrition can introduce bias
in estimating treatment effects (Tierney & Stewart, 2005).
Prevatt and Yelland (2015) created their own Client
Symptom Checklist (CSC), which was described as a
DSM-IV-derived self-report symptom inventory of anxiety,
panic, depression and ADHD symptoms. The 12 ADHD
items on the CSC included 8 symptoms of inattention:
difficulty following instructions, difficulty sustaining at-
tention, easily distracted, careless, poor concentration,
forgetful, poor organization skills, fails to finish tasks; and
4 HI symptoms: cannot sit still, driven by a motor, acts
without thinking, and talks excessively. Clients rated each
of these items on a 2-point scale: 1 (yes, generally experience
this symptom) or 2 (no, do not generally experience this
symptom), with lower scores representing more experi-
enced symptoms. Although the study authors included
the CSC in their methods section, they did not present
baseline or postintervention data on the CSC. Also, while
the authors provided Cronbach’s alpha for the ADHD
items on the CSC (α = .83), they did not report any other
psychometric properties for this scale. Finally, the
inclusion of only 12 symptoms of ADHD (rather than
the 18 listed in DSM-IV and DSM-5) also limits conclu-
sions that can be drawn.
To conclude, the existing literature suggests that CBT
for ADHD in college students may have moderate to large
effects for inattentive symptoms; however, HI symptoms
appear to be unaffected or only marginally affected by
CBT. An inconsistency across studies is the wide array of
166 He & Antshel
ADHD symptom checklists that are used to quantify
symptom change. Across six studies, only two used and
presented data from the same checklist (CSS-SR), thereby
allowing direct comparisons. Three studies each selected
a distinct symptom checklist (BAARS-IV, CAARS, ASRS)
and one study created their own checklist (CSC). This
methodological inconsistency confounds comparison
across studies. Furthermore, not all studies differentiated
between reductions in inattentive versus HI symptoms.
Since the CBT treatments for college students appear to
have a greater effect on inattentive symptoms, future
studies should differentiate the category of ADHD
symptoms. While study-specific limitations related to
outcome measures have hitherto been presented, in the
following section, conceptual gaps and inconsistencies as
well as methodological and statistical problems in this
literature will be reviewed.
Conceptual gaps and inconsistencies
Nomenclature inconsistencies
Of the eight studies reviewed, only three explicitly
called their intervention a CBT intervention, yet all of the
studies indicated that they drew upon cognitive and/or
behavioral therapy principles when designing the inter-
vention. Despite the fact that each of the studies had at
least five of the six defining characteristics of CBT (see
Table 3), the researchers were somewhat hesitant to
describe their intervention as CBT. The three ADHD
coaching studies, for example, all reference CBT princi-
ples, but they distinguish themselves from CBT in that
they purport not to focus on challenging negative
cognitions related to ADHD (Prevatt & Yelland, 2015).
Yet a close reading of the ADHD coaching protocols
suggests that this distinction may be spurious. For
example, Swartz et al. (2005) emphasizes that ADHD
coaching uses a cognitive component and “involves
helping students deal with aspects of their disability that
interfere with academic performance and ineffective
self-regulation, poor planning, anxiety, social incompe-
tence, or time management” (p. 648). Kubik (2010)
similarly stated that “[ADHD coaching] focuses on
behavioral, emotional, and cognitive outcomes and builds
life skills to change negative outcomes and beliefs” (p. 1).
Furthermore, topics of ADHD coaching can include:
changing procrastination to persistence, stress manage-
ment and relaxation, impulse control and anger and
frustration management, and confidence and self-esteem
building (Prevatt & Yelland, 2015). These topics seem to
overlap considerably with topics covered in the Safren
et al. (2005) CBT for ADHD module on cognitive
restructuring and procrastination, which focuses on learn-
ing how to think more adaptively in stressful situations.
Furthermore, the methods by which ADHD coaches
conducted the interventions (e.g., psychoeducation, setting
goals, assigning between-session-activities) also have con-
siderable overlap with CBT intervention methods, further
highlighting the nomenclature inconsistency.
Mechanisms of change
In psychotherapy research, mechanisms, or mediators,
refer to the processes or events that lead to therapeutic
change (Kazdin & Nock, 2003). In the present review,
none of the studies included mediational analyses on
mechanisms of change. This omission is very likely due to
the investigators adopting a phased intervention devel-
opment framework as outlined by Rounsaville, Carroll,
and Onken (2001). Nonetheless, moving forward, as
smaller, more exploratory trials are replaced by larger
RCT trials, it will be important to the success of the field to
propose and test mechanisms of change (e.g., improved
response inhibition, reduced inattentive symptoms) using
mediation analysis.
Collateral report of treatment response
While EF is a principal domain of impairment in
ADHD, none of the reviewed studies obtained collateral
report of EF at posttest. Despite their documented
impairments in functioning, college students with
ADHD tend to have a positive illusory bias about their
own performance (Prevatt et al., 2012) and may be overly
optimistic in their self-appraisal (Knouse, Bagwell,
Barkley, & Murphy, 2005). Thus, increasing collateral
contact may be a way to more accurately gauge treatment
response. In a college setting, it may be feasible to gather
collateral data from parents (if living at home), room-
mates, friends, or a class instructor who can evaluate
changes in the student’s functioning.
Methodological and statistical problems in the literature
Validity of ADHD diagnosis
Of the eight studies, five relied solely on self-report of
previous ADHD diagnosis with no further verification of
diagnosis. Only two studies (Anastopoulos & King, 2015;
Fleming et al., 2015) included independent assessments of
ADHD. Anastopoulos and King (2015) reported that 55%
of students in their sample were formally diagnosed with
ADHD in childhood or adolescence, but these students
were not asked to verify these self-reported diagnoses. For
the remaining participants in the Anastopoulos and
King (2015) study, an independent multi-method,
multi-informant strategy (e.g., self-report, collateral report,
clinician-observation of symptoms, and a semistructured
clinical interview) of diagnostic determination was used to
diagnose ADHD. Only one study (Eddy et al., 2015) asked
students to verify their ADHD diagnoses by requiring
them to bring corroborating ADHD assessment reports
to the screening. If the students could not produce
 CBT for ADHD in College Students
documentation, further assessment was done at the clinic to
ensure that all participants met full DSM-IV-TR diagnostic
criteria.
The fact that the majority of studies did not require
students to verify their diagnoses is somewhat concerning,
especially in light of concerns about ADHD overdiagnosis,
which remains a significant controversy in the literature
(Bruchmuller, Margraf, & Schneider, 2012). To ensure that
the interventions clinicians and researchers are developing
are actually targeting the populations that they are meant to
target, validity checks of diagnosis across all participants may
be important to consider. In ADHD, this is an especially
relevant concern, since a significant proportion of children
with ADHD will experience remission of symptoms and
psychosocial impairment by young adulthood (Young &
Gudjonsson, 2008). This underscores the need for re-
searchers and clinicians to complete a comprehensive
baseline assessment of ADHD status prior to enrolling a
student in the intervention. Multimodal assessment, includ-
ing self- and collateral-reports should be used when assessing
ADHD (S. Pliszka, 2007). Undoubtedly, this places greater
burden on researchers, but multimodal assessment has been
demonstrated to be particularly important when assessing
ADHD in college students (Katz, Petscher, & Welles, 2009)
and should be the gold standard for ADHD treatment
research.
To be fair, what is required in terms of verifying a
diagnosis for most research studies is far more rigorous
than what is needed in actual clinical practice to prompt
treatment. As noted above, this is likely a response to the
critique about overdiagnosis of ADHD. In addition to
verifying more stringent ADHD diagnoses in study partic-
ipants, future research should also consider the extent to
which having a stringent ADHD diagnosis affects the
outcome of CBT. For example, it may be beneficial to
train college students to cope with ADHD symptoms
regardless of whether the symptoms met stringent criteria
for ADHD.
Medication status and adherence
Of the eight studies, only three reported data on
medication status. Fleming et al. (2015) asked students to
have maintained a stable medication regimen for 1 month
prior to enrollment. In this study, approximately 75% of
the students endorsed a current psychotropic prescrip-
tion. Although two students receiving DBT and one
student receiving SH had substantial (i.e., N 25% change
in dose or change in medication type) change in ADHD
medication during the course of treatment, the study
authors reported that all analyses were conducted with
and without these medication changes and that the
pattern of results did not differ. While Scheithaur and
Kelley (2014) reported no effect of self-monitoring on
self-reported medication adherence, neither changes in
167
medication dose nor status at posttreatment were
reported. LaCount et al. (2015) reported that 77% of
their participants endorsed taking psychotropic medica-
tions at the beginning of treatment, and all were asked to
keep their medication regimen consistent. Neither
medication status at posttreatment nor medication
adherence throughout treatment was assessed. Given
that both Safren and Solanto’s CBT protocols were
designed to be used in combination with pharmacother-
apy, the limited attention given to concurrent pharmaco-
therapy is a limitation.
Inconsistency in assessing for ADHD medication status
and medication adherence also limits the strength of
conclusions that can be reached regarding the impact of
the CBT intervention. Future research should include
subjective measures (i.e., self-report) of medication status
and adherence—and as novel technologies continue to
develop, future researchers should take advantage of
more objective measures of medication adherence.
Inadequate comparison groups and sample size
The most recently published study (Fleming et al., 2015)
is, to date, the only RCT design. While Scheithaur and
Kelley (2014) included a study skill and goal-setting control
group (SM-), the study design was intended to evaluate the
additive effect of self-monitoring (SM +) to study skill and
goal-setting instruction. Indeed, while the two groups
experienced the same psychoeducational intervention on
study skills and goal setting, the SM + group invested
significantly more time completing self-monitoring home-
work and also received frequent reminders from the
interventionist to complete their homework. Overall, the
SM- group received far less time with the interventionist
compared to the SM + group. Therefore, the SM- group was
not an adequate control. To move forward, future research
should strive to include both randomization as well as
adequate active control or placebo treatments.
Insufficient statistical power
Relatedly, as the field moves away from Stage IB (pilot
testing) research to Stage II (efficacy) research (Rounsaville
et al., 2001), the recruitment of larger samples will be more
feasible. Even the best randomization cannot overcome the
inherent limitations of small samples—insufficient statisti-
cal power to detect results, nonrepresentativeness, limited
generalizability, and greater probability of spurious find-
ings. Given that half of the studies included in this review
had sample sizes less than N = 15 completers, it was difficult
to interpret analysis of a lack of pre-post treatment effects,
given the lack of statistical power.
Lack of follow-up
Although Anastopoulos and King (2015) included
several booster sessions of CBT a semester after the initial
168 He & Antshel
intervention was complete, they did not report any
follow-up data. Fleming et al. (2015) was the only study
to include a 3-month follow-up. Maintenance of treat-
ment gains is a key component of evaluating treatment
efficacy. Future research should incorporate more fre-
quent and more distal follow-ups (e.g., including 3-, 6-,
and 12- month follow-ups) and use repeated measures
analysis of variance in order to test the differential
durability of treatment effects.
Lack of attention given to the integrity of the independent
variable (CBT)
Given the pilot nature of much of this work, more
attention could have been given to the procedures for
training and certifying therapists, supervising and moni-
toring ongoing therapist interventions, establishing the
feasibility of therapist training, specifying therapist
adherence measures and specifying therapist competency
measures and their reliabilities (Rounsaville et al., 2001).
In general, future CBT research investigating college
students with ADHD will benefit from more attention
being given to the integrity of the independent variable.
Conclusions and Future Directions
Overall conclusions
Just as there are widespread developmental differences
between children and adolescents that necessitate differ-
ences in treatment approaches, there are also critical
developmental differences between adolescence and
adulthood. Treatments developed for adult ADHD are
different in both focus and scope, compared to treat-
ments developed for adolescents. The transition to
adulthood, often referred to as emerging adulthood and
frequently marked by a period of time in postsecondary
education, is yet another developmentally distinct time
point in which unique treatment considerations must be
taken into account. When high school students with
ADHD embark on their college careers, they may face
challenges as they experience abrupt shifts in structures
and expectations.
The present review indicates that the data supporting
CBT for college students with ADHD are nascent but
promising. The moderate to large effect for inattentive
symptoms at posttreatment is particularly encouraging,
yet the data must be interpreted cautiously, since there
has only been one RCT. This paucity of the extant data on
treating college students with ADHD underscores the
need for universities and federal agencies to invest in this
type of research so that these important studies can be
conducted properly, with enough resources to effectively
measure change in outcomes. Only in this way can the
odds of success for college students with ADHD be
multiplied.
Furthermore, changes in ADHD symptoms only
account for approximately 25% of the variance in
impairment (Gordon et al., 2006). Thus, intervention
outcome measurements must go well beyond symptom
reduction alone. In college students with ADHD, CBT
appeared to have a moderate effect on self-reported
quality of life and functional impairment in work/school,
yet less or no impact on GPA, response inhibition,
executive function, or interpersonal functioning. Overall,
there are conceptual and methodological problems
including inadequate verification of ADHD diagnosis,
underpowered samples, lack of randomization, inade-
quate or missing control groups, limited attention paid to
confounding variables such as medication status and
adherence, an overreliance on self-report, little to no
collateral contacts, few objective measures of EF, lack of
follow-up and inadequate attention given to the CBT
integrity. Given the Stage Ib (pilot study) nature of much
of this research, these limitations may be somewhat
unsurprising; however, as a result, the conclusions that
can be reliably drawn from the extant data are limited.
While much of the research reviewed here has
thoughtfully considered executive function theories of
ADHD in treatment development, future research should
strive to include more ADHD theory-driven outcome
measures at pre- and posttreatment using both self- and
collateral-reports as well as more objective functional
assessments (e.g., GPA, job status, driving outcomes,
relational outcomes). It also seems clear that the treatment
development field should come to a consensus on a more
standardized way of measuring treatment outcomes.
Currently, several best practice guidelines exist on diagnos-
ing ADHD, including recommendations on psychometri-
cally sound symptom rating scales; however, no such
guidelines exist for the important task of measuring
treatment response. Given the theoretical importance
placed on executive functioning, delay aversion, and
response inhibition in ADHD, including well-validated
objective and collateral assessments of these constructs in
addition to self-report measures, may be helpful towards
more convincingly demonstrating efficacy.
Future directions
Treatment development
The studies included in this present review have
admirably undertaken the issue of treatment develop-
ment of CBT for college students with ADHD. This is a
still-emerging field where intervention components are
still being piloted and modified. Future research could
strive to more fully incorporate developmental consider-
ations and developmental needs of college students. For
example, since the emerging adulthood years are a period
of identity exploration (Arnett, 2000), researchers and
 CBT for ADHD in College Students
clinicians should consider including a motivational
interviewing component to the intervention (e.g., asking
college students to envision the kind of person that they
would like to be in 5 years). In this way, college students
may be able to focus on goal-oriented behaviors consistent
with the developmental phase of identity exploration.
Similarly, since the experience of college is often one
during which the emerging adult no longer lives at home
and is no longer primarily influenced by parents,
including typically developing college peers and/or
college students with and without ADHD as peer mentors
to confer social norms may also be worthwhile to consider
as part of the intervention program.
Treatment intensity
The evidence-based interventions for adolescents with
ADHD (e.g., CHP) are intensive school-based interven-
tions that include psychoeducation, interpersonal skills
training, structured free time to practice interpersonal
skills, and parental involvement (e.g., parent groups),
spanning 4.5 hours per week for an entire academic year
(Evans et al., 2011). In comparison, the majority of
current models of psychosocial interventions for college
students with ADHD seem less intensive.
For adults, many CBT protocols are also intensive; for
example, group therapy meetings lasting 90 minutes per
week for 15 weeks, supplemented with individual coaching
sessions between group sessions are common (Emilsson
et al., 2011; Young et al., 2015). Likewise, Internet-based
CBT (i-CBT) programs for adults with ADHD have also
been evaluated as potentially efficacious (e.g., Pettersson,
Soderstrom, Edlund-Soderstrom & Nilsson, 2014). In this
specific intervention, participants assigned to the i-CBT
group met weekly for 3 hours per week over 10 weeks and
had the option of engaging with the therapists for extra
support through an online contact function in their
program. Other typical evidence-based CBT treatment
packages include at least 12 sessions (Safren et al., 2010;
Solanto et al., 2010), with each session lasting between 50
minutes and 2 hours. Conversely, out of the eight studies
reviewed here, the college student session length varied
from 20 minutes to 90 minutes and the number of sessions
ranged from 4 (Scheithaur & Kelly, 2014) to 20 (LaCount
et al., 2015), with the majority of studies (N = 5) reporting a
condensed 8-session format over 8 weeks.
At present, adolescents and adults with ADHD are
asked to commit to longer and more intensive treatments,
whereas college students are presumed to be able to
derive the same benefit from a more condensed
intervention. While it may be true that the typical 12- to
16-week academic semester poses some challenges and
constraints for completing an intervention package,
researchers may wish to find ways to move beyond this
obstacle. This seems feasible given that adolescents and
169
adults typically have more structured demands from work
and school, while college students may have more
unstructured time. For example, a recent large survey
(N = 726) showed that, on average each day, college
students spend approximately 3 hours on academics
(including attending classes, studying, and doing home-
work), 31 minutes on paid employment, and 2 hours on
organized activities like clubs (Greene & Maggs, 2015),
leaving a significant portion of the day free for unstruc-
tured activities. Another survey (N = 458) of college
students revealed that the average amount of time using
popular leisure media (e.g., watching online videos, using
social media networks) was approximately 2 hours, 45
minutes per day. Thus, college students may have a
greater surplus of unstructured free time than school-age
children or working adults.
Researchers should take advantage of this unique
opportunity by experimenting with various aspects of
treatment intensity, including session length (e.g., 30
minutes – 1.5 hours), session modality (e.g., individual,
group, phone, video, or in-person sessions), and session
frequency (e.g., 2–3 meetings per week) to determine the
most effective and feasible treatment package for college
students. As noted above, the average age of adults in CBT
ADHD trials is approximately 25 years older than the typical
college student participating in CBT. Conceptually, it
makes little sense to assume that while in high school, the
adolescent with ADHD would need a very intensive
multimodal intervention like CHP to derive any benefit,
yet four months later, once enrolled in college and living
away from home, this same individual with ADHD would
benefit from a less intensive intervention. Thus, varying
treatment intensity for college students with ADHD by
manipulating session length, modality, and frequency is a
logical next step forward. Already, Anastopoulos and King
(2015) and LaCount et al. (2015) have made great strides
by demonstrating that more intense treatments with college
populations are possible: each of their groups implemented
both group and individual modalities and shorter, but more
frequent meetings throughout the academic semester. In
particular, Anastopoulos and King (2015) presented an
impressively integrated treatment protocol that linked
students to other important support mechanisms on the
university campus (e.g., disability services, counseling
center).
Treatment maintenance
Maintenance, or the extent to which behavior change
continues after the intervention has ceased (Cooper,
Heron, & Heward, 2007), has not been systematically
considered in the existing literature. With one exception
(Fleming et al., 2015), none of the studies in this review
included a follow-up with their students after the final
posttreatment assessment session. This gap in the literature
170 He & Antshel
should and could be easily bridged as data collection
methods have improved and become less obtrusive in the
last few years. Currently, it is estimated that 72% of college
students use smartphones (Pearson Education, 2013); thus,
incorporating the use of smartphones to gather assessment
data (particularly follow-up data to capture maintenance of
treatment gains) represents the next methodological step
forward in establishing the effectiveness of a given
intervention. Regardless of how treatment maintenance is
assessed, future CBT for ADHD research should incorpo-
rate explicit means to improve maintenance (e.g., relapse
prevention modules) as well as measure treatment gains
across longer durations (e.g., entire college career).
Stimulant misuse and diversion
Since up to 84% of college students being treated for
ADHD with prescription stimulants have been approached
to divert their medications (Advokat, Guidry, & Martino,
2008; Boyd, McCabe, Cranford, & Young, 2007), prescrip-
tion stimulant misuse and diversion is a growing problem
on college campuses (McCabe, West, Teter, & Boyd, 2014).
It is highly relevant from a clinical and a public health
standpoint to incorporate education about prescription
ADHD medications and skills training on how to handle a
diversion request from peers. Including a treatment session
on this issue within a broader discussion of treatment
adherence (and skills to promote adherence) may be
particularly germane to the college student population.
Community college
Another promising avenue in which ADHD researchers
can make an impact is at community colleges. Many high
school students with ADHD first enter local community
colleges before transitioning to 4-year colleges (Barkley,
Murphy, & Fischer, 2008). A follow-up survey of young
adults with childhood histories of ADHD (N = 326) showed
that 44% of the sample was enrolled in either community
college or vocational college school (Kuriyan et al., 2013),
while 30% was enrolled in traditional 4-year institutions.
While only one participant across the eight studies reviewed
here was a community college student, community colleges
may be a fruitful context within which to develop programs
and interventions for students with ADHD. In this way,
community college students with ADHD may be more likely
to transfer to and succeed at 4-year institutions in the future.
Clinical implications
In the spirit of increased implementation and dissem-
ination, several clinical recommendations for consider-
ation are provided below. First, given the data reviewed
here as well as the adolescent ADHD interventions that
have demonstrated efficacy, clinicians working with
college students with ADHD should consider meeting
with their clients more than once a week. Second, having
both group CBT and individual CBT interventions
operating concurrently also seems prudent to consider.
Third, clinicians working with this population should also
attempt to integrate their services with other providers on
campus (e.g., Office of Disability Services, Counseling
Center, etc.) in an attempt to improve and integrate
service provision. Fourth, efforts to improve treatment
adherence, including discussing how to handle stimulant
diversion requests, are likely to have some benefit for
college students with ADHD. Fifth, given the develop-
mental period of emerging adulthood, clinicians treating
college students with ADHD could incorporate a discus-
sion of emerging adulthood themes (Arnett, 2000) such
as identity exploration, feeling-in-between adolescence
and adulthood, setting realistic and optimistic life goals,
and becoming independent from parents; clinicians
should also attempt to normalize the uncertainty
and stress that may result from exploring life options.
Finally, given the limited carryover observed from
child- and adolescent-focused interventions (Barkley &
Murphy, 2006), as well as the lack of current studies
following college students after CBT intervention, it
may be beneficial to consider adopting more of a
“chronic” model for treating ADHD in college students
(e.g., following students over their entire 4-year experi-
ence rather than treating for only one semester).
References
Abikoff, H., & Gittelman, R. (1985). Hyperactive children treated with
stimulants. Is cognitive training a useful adjunct? Archives of General
Psychiatry, 42, 953–961.
Advokat, C. D., Guidry, D., & Martino, L. (2008). Licit and illicit use of
medications for Attention-Deficit Hyperactivity Disorder in
undergraduate college students. Journal of American College Health,
56, 601–606. http://dx.doi.org/10.3200/JACH.56.6.601-606
American Academy of Pediatrics. (2011). ADHD: Clinical practice
guideline for the diagnosis, evaluation, and treatment of
attention-deficit/hyperactivity disorder in children and adolescents.
Pediatrics, 128(5), 1–16. http://dx.doi.org/10.1542/peds.2011-2654
American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Washington, DC: Author.
Anastopoulos, A. D., & King, K. A. (2015). A cognitive-behavior therapy
and mentoring program for college students with ADHD. Cognitive
and Behavioral Practice, 22, 144–151. http://dx.doi.org/10.1016/
j.cbpra.2014.01.002
Antshel, K. M., & Olszewski, A. K. (2014). Cognitive behavioral therapy
for adolescents with ADHD. Child and Adolescent Psychiatry Clinics of
North America, 23, 825–842. http://dx.doi.org/10.1016/
j.chc.2014.05.001
Arnett, J. J. (2000). Emerging adulthood. A theory of development
from the late teens through the twenties. American Psychologist, 55,
469–480.
Arnett, J. J. (2003). Conceptions of the transition to adulthood among
emerging adults in American ethnic groups. New Directions in Child and
Adolescent Development, 100, 63–75. http://dx.doi.org/10.1002/cd.75
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and
executive functions: Constructing a unifying theory of ADHD.
Psychological Bulletin, 121, 65–94.
Barkley, R. A. (2011). Barkley Adult ADHD Rating Scale-IV. New York:
Guilford Press.
 CBT for ADHD in College Students
Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The
persistence of attention-deficit/hyperactivity disorder into young
adulthood as a function of reporting source and definition of
disorder. Journal of Abnormal Psychology, 111, 279–289.
Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2006). Young adult
outcome of hyperactive children: adaptive functioning in major life
activities. Journal of the American Academy of Child and Adolescent
Psychiatry, 45, 192–202. http://dx.doi.org/10.1097/01.chi.
0000189134.97436.e2
Barkley, R. A., & Murphy, K. R. (2006). Attention-deficit hyperactivity
disorder: A clinical workbook (Vol. 2). New York: Guilford Press.
Barkley, R. A., & Murphy, K. R. (2011). The nature of executive function
(EF) deficits in daily life activities in adults with ADHD and their
relationship to performance on EF tests. Journal of Psychopathology
and Behavioral Assessment, 33, 137–158. http://dx.doi.org/
10.1007/s10862-011-9217-x
Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). What the Science Says.
New York: Guilford Press.
Barkley, R. A., Murphy, K. R., & Fischer, M. (2010). ADHD in adults:
What the Science Says. New York: Guilford Press.
Biederman, J., Mick, E., Fried, R., Wilner, N., Spencer, T. J., & Faraone,
S. V. (2011). Are stimulants effective in the treatment of executive
function deficits? Results from a randomized double blind study
of OROS-methylphenidate in adults with ADHD. European
Neuropsychopharmacology, 21, 508–515. http://dx.doi.org/
10.1016/j.euroneuro.2010.11.005
Biederman, J., Petty, C. R., Evans, M., Small, J., & Faraone, S. V. (2010).
How persistent is ADHD? A controlled 10-year follow-up study of boys
with ADHD. Psychiatry Research, 177, 299–304. http://dx.doi.org/
10.1016/j.psychres.2009.12.010
Biederman, J., Petty, C. R., Woodworth, K. Y., Lomedico, A., Hyder, L. L., &
Faraone, S. V. (2012). Adult outcome of attention-deficit/hyperactivity
disorder: A controlled 16-year follow-up study. Journal of Clinical
Psychiatry, 73, 941–950. http://dx.doi.org/10.4088/JCP.11m07529
Blagys, M. D., & Hilsenroth, M. J. (2002). Distinctive activities of
cognitive-behavioral therapy. A review of the comparative
psychotherapy process literature. Clinical Psychology Review, 22,
671–706.
Boyd, C. J., McCabe, S. E., Cranford, J. A., & Young, A. (2007).
Prescription drug abuse and diversion among adolescents in a
southeast Michigan school district. Archives of Pediatrics & Adolescent
Medicine, 161, 276–281. http://dx.doi.org/10.1001/archpedi.
161.3.276
Boyer, B. E., Geurts, H. M., Prins, P. J. M., & Van der Oord, S. (2014).
Two novel CBTs for adolescents with ADHD: The value of
planning skills. European Child & Adolescent Psychiatry, 24,
1075–1090. http://dx.doi.org/10.1007/s00787-014-0661-5
Brod, M., Johnston, J., Able, S., & Swindle, R. (2006). Validation of the
Adult Attention-Deficit/Hyperactivity Disorder Quality-of-Life
Scale (AAQoL): A Disease-Specific Quality-of-Life Measure. Quality
of Life Research, 15, 117–129. http://dx.doi.org/10.1007/s11136-
005-8325-z
Brown, T. E. (1996). Brown Attention-Deficit Disorder Scales for Adolescents
and Adults. San Antonio, TX: Psychological Corporation.
Bruchmuller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed
in accord with diagnostic criteria? Overdiagnosis and influence of
client gender on diagnosis. Journal of Consulting and Clininical
Psychology, 80, 128–138. http://dx.doi.org/10.1037/a0026582
Conners, C. K., Erhardt, D., & Sparrow, E. (2006). Conners’ Adult ADHD
Rating Scales. Tonawanda, NY: Multi-Health Systems.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior
analysis (2nd ed.). Upper Saddle River, NJ: Merril Education/Prentice
Hall.
de Graaf, R., Kessler, R. C., Fayyad, J., ten Have, M., Alonso, J.,
Angermeyer, M., . . . Posada-Villa, J. (2008). The prevalence
and effects of adult attention-deficit/hyperactivity disorder
(ADHD) on the performance of workers: results from the WHO
world mental health survey initiative. Occupational and Environ-
mental Medicine, 65, 835–842. http://dx.doi.org/10.1136/oem.
2007.038448
DuPaul, G. J., Schaughency, E. A., Weyandt, L. L., Tripp, G., Kiesner, J.,
Ota, K., & Stanish, H. (2001). Self-report of ADHD symptoms in
171
university students: Cross-gender and cross-national prevalence.
Journal of Learning Disabilities, 34, 370–379.
Durlak, J. A., Fuhrman, T., & Lampman, C. (1991). Effectiveness of
cognitive-behavior therapy for maladapting children: A meta-
analysis. Psychological Bulletin, 110, 204–214.
Eddy, L. D., Canu, W. H., Broman-Fulks, J. J., & Michael, K. D. (2015).
Brief cognitive behavioral therapy for college students with
ADHD: A case series report. Cognitive and Behavioral Practice, 22,
127–140. http://dx.doi.org/10.1016/j.cbpra.2014.05.005
Emilsson, B., Gudjonsson, G., Sigurdsson, J. F., Baldursson, G.,
Einarsson, E., Olafsdottir, H., & Young, S. (2011). Cognitive
behaviour therapy in medication-treated adults with ADHD and
persistent symptoms: A randomized controlled trial. BMC
Psychiatry, 11, 116. http://dx.doi.org/10.1186/1471-244X-11-116
Evans, S. W., Axelrod, J., & Langberg, J. M. (2004). Efficacy of a school-
based treatment program for middle school youth with ADHD:
pilot data. Behavior Modification, 28, 528–547. http://dx.doi.org/
10.1177/0145445503259504
Evans, S. W., Langberg, J. M., Schultz, B. K., Vaughn, A., Altaye, M.,
Marshall, S. A., & Zoromski, A. K. (2015). Evaluation of a school-
based treatment program for young adolescents with ADHD. Journal
of Consulting and Clinical Psychology. [Advance online publication.].
http://dx.doi.org/10.1037/ccp0000057
Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based
psychosocial treatments for children and adolescents with
attention-deficit/hyperactivity disorder. Journal of Clinical Adolescent
Ps ychology, 43, 527 –551. http://dx.doi.org/10.1080/
15374416.2013.850700
Evans, S. W., Schultz, B. K., Demars, C. E., & Davis, H. (2011).
Effectiveness of the Challenging Horizons After-School Program
for young adolescents with ADHD. Behavior Therapy, 42, 462–474.
http://dx.doi.org/10.1016/j.beth.2010.11.008
Fabiano, G. A., Pelham, W. E., Jr., Coles, E. K., Gnagy, E. M.,
Chronis-Tuscano, A., & O’Connor, B. C. (2009). A meta-analysis
of behavioral treatments for attention-deficit/hyperactivity disorder.
Clinical Psychology Review, 29, 129–140. http://dx.doi.org/
10.1016/j.cpr.2008.11.001
Faraone, S. V., Spencer, T., Aleardi, M., Pagano, C., & Biederman, J.
(2004). Meta-analysis of the efficacy of methylphenidate for
treating adult Attention-Deficit/Hyperactivity Disorder. Journal of
Clinical Psychopharmacology, 24, 24–29.
Fedele, D. A., Lefler, E. K., Hartung, C. M., & Canu, W. H. (2012). Sex
differences in the manifestation of ADHD in emerging adults.
Journal of Attention Disorders, 16, 109–117. http://dx.doi.org/
10.1177/1087054710374596
Fleming, A. P., & McMahon, R. J. (2012). Developmental context and
treatment principles for ADHD among college students. Clinical
Child and Family Psychology Review, 15, 303–329. http://dx.doi.org/
10.1007/s10567-012-0121-z
Fleming, A. P., McMahon, R. J., Moran, L. R., Peterson, A. P., &
Dreessen, A. (2015). Pilot randomized controlled trial of
dialectical behavior therapy group skills training for ADHD
among college students. Journal of Attention Disorders, 19,
260–271. http://dx.doi.org/10.1177/1087054714535951
Fuller-Killgore, M. D., Burlison, J., & Dwyer, W. (2013). Comparison
of three ADHD screening instruments in college students of
varying cognitive ability. Journal of Attention Disorders, 17, 449–454.
http://dx.doi.org/10.1177/1087054712438136
Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Test
review behavior rating inventory of executive function. Child
Neuropsychology, 6, 235–238.
Gordon, M., Antshel, K., Faraone, S., Barkley, R., Lewandowski, L.,
Hudziak, J. J., . . . Cunningham, C. (2006). Symptoms versus
impairment: The case for respecting DSM-IV’s Criterion D. Journal of
Attention Disorders, 9, 465–475. http://dx.doi.org/10.1177/
1087054705283881
Greene, K. M., & Maggs, J. L. (2015). Revisiting the time trade-off
hypothesis: Work, organized activities, and academics during college.
Journal of Youth and Adolescence, 44, 1623–1637. http://dx.doi.org/
10.1007/s10964-014-0215-7
Greenhill, L. L., Pliszka, S., Dulcan, M. K., Bernet, W., Arnold, V.,
Beitchman, J., . . . Adolescent, P. (2002). Practice parameter for
172 He & Antshel
the use of stimulant medications in the treatment of children,
adolescents, and adults. Journal of the American Academy of Child and
Adolescent Psychiatry, 41, 26S–49S.
Hartung, C. M., Canu, W. H., Cleveland, C. S., Lefler, E. K., Mignogna,
M. J., Fedele, D. A., . . . Clapp, J. D. (2013). Stimulant medication
use in college students: Comparison of appropriate users,
misusers, and nonusers. Psychology of Addictive Behaviors, 27,
832–840. http://dx.doi.org/10.1037/a0033822
Hervey, A. S., Epstein, J. N., & Curry, J. F. (2004). Neuropsychology of
adults with attention-deficit/hyperactivity disorder: A meta-analytic
review. Neuropsychology, 18, 485–503. http://dx.doi.org/10.1037/
0894-4105.18.3.485
Hill, J. C., & Schoener, E. P. (1996). Age-dependent decline of
attention deficit hyperactivity disorder. American Journal of
Psychiatry, 153, 1143–1146.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012).
The efficacy of cognitive behavioral therapy: a review of meta-analyses.
Cognitive Therapy and Research, 36, 427–440. http://dx.doi.org/
10.1007/s10608-012-9476-1
Jiang, Y., & Johnston, C. (2012). The relationship between ADHD
symptoms and competence as reported by both self and others.
Journal of Attention Disorders, 16, 418–426. http://dx.doi.org/
10.1177/1087054710392541
Katz, N., Petscher, Y., & Welles, T. (2009). Diagnosing attention-deficit
hyperactivity disorder in college students: an investigation of the
impact of informant ratings on diagnosis and subjective impairment.
Journal of Attention Disorders, 13, 277–283. http://dx.doi.org/
10.1177/1087054708326112
Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of
change in child and adolescent therapy: Methodological issues
and research recommendations. Journal of Child Psychology and
Psychiatry, 44, 1116–1129.
Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., . . .
Walters, E. E. (2005). The World Health Organization Adult
ADHD Self-Report Scale (ASRS): A short screening scale for
use in the general population. Psychological Medicine, 35,
245–256.
Klein, R. G., Mannuzza, S., Olazagasti, M. A. R., Roizen, E., Hutchison, J. A.,
Lashua, E. C., & Castellanos, F. X. (2012). Clinical and functional
outcome of childhood attention-deficit/hyperactivity disorder
33 years later. Archives of General Psychiatry, 69, 1295–1303.
http://dx.doi.org/10.1001/archgenpsychiatry.2012.271
Knouse, L. E., Bagwell, C. L., Barkley, R. A., & Murphy, K. R. (2005).
Accuracy of self-evaluation in adults with ADHD evidence
from a driving study. Journal of Attention Disorders, 8, 221–234.
http://dx.doi.org/10.1177/1087054705280159
Kubik, J. A. (2010). Efficacy of ADHD coaching for adults with ADHD.
Journal of Attention Disorders, 13, 442–453. http://dx.doi.org/
10.1177/1087054708329960
Kuriyan, A. B., Pelham, W. E., Jr., Molina, B. S., Waschbusch, D. A.,
Gnagy, E. M., Sibley, M. H., . . . Kent, K. M. (2013). Young adult
educational and vocational outcomes of children diagnosed with
ADHD. Journal of Abnormal Child Psychology, 41, 27–41.
LaCount, P. A., Hartung, C. M., Shelton, C. R., Clapp, J. D., & Clapp,
T. K. W. (2015). Preliminary evaluation of a combined group and
individual treatment for college students with attention-deficit/
hyperactivity disorder. Cognitive and Behavioral Practice, 22, 152–160.
http://dx.doi.org/10.1016/j.cbpra.2014.07.004
Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B.,
Vermeersch, D. A., Clouse, G. C., & Yanchar, S. C. (1996). The
reliability and validity of the outcome questionnaire. Clinical
Psychology & Psychotherapy, 3, 249–258. http://dx.doi.org/
10.1002/(SICI)1099-0879(199612)3:4b249::AID-CPP106N
3.0.CO;2-S
Langberg, J. M., Epstein, J. N., Becker, S. P., Girio-Herrera, E., &
Vaughn, A. J. (2012). Evaluation of the Homework, Organization,
and Planning Skills (HOPS) intervention for middle school
students with ADHD as implemented by school mental health
providers. School Psychology Review, 41, 342–364.
Langberg, J. M., Smith, B. H., Bogle, K. E., Schmidt, J. D., Cole, W. R., &
Pender, C. A. S. (2007). A pilot evaluation of small group
Challenging Horizons Program (CHP). Journal of Applied School
Psychology, 23, 31–58. http://dx.doi.org/10.1300/J370v23n01_02
Lewandowski, L. J., Lovett, B. J., Codding, R. S., & Gordon, M. (2008).
Symptoms of ADHD and academic concerns in college students
with and without ADHD diagnoses. Journal of Attention Disorders, 12,
156–161. http://dx.doi.org/10.1177/1087054707310882
Linderkampa, F., & Lauth, G. (2011). The efficacy of pharmacological
versus psychotherapeutic therapies in adults with Attention Deficit/
Hyperactivity Disorder (ADHD): An empirical meta-analysis.
Verhaltenstherapie, 21, 229–238.
Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M.
(1998). Adult psychiatric status of hyperactive boys grown up.
American Journal of Psychiatry, 155, 493–498. http://dx.doi.org/
10.1176/ajp.155.4.493
Matza, L. S., Paramore, C., & Prasad, M. (2005). A review of the
economic burden of ADHD. Cost Effectiveness and Resource
Allocation, 3, 5. http://dx.doi.org/10.1186/1478-7547-3-5
McCabe, S. E., West, B. T., Teter, C. J., & Boyd, C. J. (2014). Trends in
medical use, diversion, and nonmedical use of prescription
medications among college students from 2003 to 2013: Connect-
ing the dots. Addictive Behaviors, 39, 1176–1182.
Mongia, M., & Hechtman, L. (2012). Cognitive behavior therapy for
adults with attention-deficit/hyperactivity disorder: A review of
recent randomized controlled trials. Current Psychiatry Reports, 14,
561–567. http://dx.doi.org/10.1007/s11920-012-0303-x
MTA Cooperative Group (1999). A 14-month randomized clinical trial
of treatment strategies for attention-deficit/hyperactivity disorder.
Archives of General Psychiatry, 56, 1073–1086.
Oosterlaan, J., & Sergeant, J. A. (1996). Inhibition in ADHD, aggressive,
and anxious children: A biologically based model of child
psychopathology. Journal of Abnormal Child Psychology, 24, 19–36.
Pearson Education. (2013). Pearson Student Mobile Device Survey 2013
National Report: College Students. Retrieved from http://www.
pearsoned.com/wp-content/uploads/Pearson-Student-Mobile-
Device-Survey-2013-National-Report-on-College-Students-public-
release.pdf
Pennington, B. F., & Ozonoff, S. (1996). Executive functions and
developmental psychopathology. Journal of Child Psychology and
Psychiatry, 37, 51–87.
Pettersson, R., Söderström, S., Edlund-Söderström, K., & Nilsson, K. W.
(2014). Internet-based cognitive behavioral therapy for adults
with ADHD in outpatient psychiatric care: A randomized trial.
Journal of Attention Disorders. Advance online publication.
1087054714539998.
Pliszka, S. (2007a). Practice parameter for the assessment and treatment
of children and adolescents with attention-deficit/hyperactivity
disorder. Journal of the American Academy of Child and Adolescent
Psychiatry, 46, 894–921. http://dx.doi.org/10.1097/chi.
0b013e318054e724
Pliszka, S. R. (2007b). Pharmacologic treatment of attention-deficit/
hyperactivity disorder: Efficacy, safety and mechanisms of action.
Neuropsychology Review, 17, 61–72. http://dx.doi.org/10.1007/
s11065-006-9017-3
Prevatt, F., Lampropoulos, G. K., Bowles, V., & Garrett, L. (2011). The use
of between session assignments in ADHD coaching with college
students. Journal of Attention Disorders, 15, 18–27. http://dx.doi.org/
10.1177/1087054709356181
Prevatt, F., Proctor, B., Best, L., Baker, L., Van Walker, J., & Taylor, N. W.
(2012). The positive illusory bias: Does it explain self-evaluations in
college students with ADHD? Journal of Attention Disorders, 16,
235–243. http://dx.doi.org/10.1177/1087054710392538
Prevatt, F., & Yelland, S. (2015). An empirical evaluation of ADHD
coaching in college students. Journal of Attention Disorders, 19,
666–677. http://dx.doi.org/10.1177/1087054713480036
Quay, H. C. (1988). Theories of ADDH. Journal of the American Acadeny
of Child and Adolescent Psychiatry, 27, 262–263. http://dx.doi.org/
10.1097/00004583-198803000-00030
Rounsaville, B. J., Carroll, K. M., & Onken, L. S. (2001). A stage
model of behavioral therapies research: Getting started and
moving on from stage I. Clinical Psychology: Science and Practice, 8,
133–142.
 CBT for ADHD in College Students
Safren, S. A., Perlman, C. A., Sprich, S., & Otto, M. W. (2005). Mastering
your adult ADHD: A cognitive-behavioral treatment program — Therapist
guide. Oxford, UK: Oxford University Press.
Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L.,
Groves, M., & Otto, M. W. (2010). Cognitive behavioral therapy vs
relaxation with educational support for medication-treated
adults with ADHD and persistent symptoms: A randomized
controlled trial. JAMA, 304, 875–880. http://dx.doi.org/
10.1001/jama.2010.1192
Scheithauer, M. C., & Kelley, M. L. (2014). Self-monitoring by
college students with ADHD: The impact on academic perfor-
mance. Journal of Attention Disorders. [Advance online publication.].
http://dx.doi.org/10.1177/1087054714553050
Schoemaker, K., Bunte, T., Wiebe, S. A., Espy, K. A., Dekovic, M., &
Matthys, W. (2012). Executive function deficits in preschool
children with ADHD and DBD. Journal of Child Psychology and
Psychiatry, 53(2), 111–119. http://dx.doi.org/10.1111/j.1469-
7610.2011.02468.x
Sergeant, J. A. (1995). A theory of attention: An information processing
perspective. Baltimore: Paul H. Brookes.
Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J., Greenstein,
D., . . . Rapoport, J. (2007). Attention-deficit/hyperactivity disorder
is characterized by a delay in cortical maturation. Proceedings of the
National Academy of Sciences, 104, 19649–19654. http://dx.doi.org/
10.1073/pnas.0707741104
Sibley, M. H., Kuriyan, A. B., Evans, S. W., Waxmonsky, J. G., & Smith, B. H.
(2014). Pharmacological and psychosocial treatments for
adolescents with ADHD: An updated systematic review of the
literature. Clinical Psychology Review, 34, 218–232. http://dx.doi.org/
10.1016/j.cpr.2014.02.001
Solanto, M. V., Marks, D. J., Mitchell, K. J., Wasserstein, J., & Kofman, M. D.
(2008). Development of a new psychosocial treatment for adult
ADHD. Journal of Attention Disorders, 11, 728–736. http://dx.doi.org/
10.1177/1087054707305100
Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H.,
Alvir, J. M., & Kofman, M. D. (2010). Efficacy of meta-cognitive
therapy for adult ADHD. American Journal of Psychiatry, 167,
958–968. http://dx.doi.org/10.1176/appi.ajp.2009.09081123
Sonuga-Barke, E. J. (2002). Psychological heterogeneity in AD/HD—A
dual pathway model of behaviour and cognition. Behavioural Brain
Research, 130, 29–36.
Stavro, G. M., Ettenhofer, M. L., & Nigg, J. T. (2007). Executive functions
and adaptive functioning in young adult attention-deficit/
hyperactivity disorder. Journal of the International Neuropsychological
Society, 13, 324–334. http://dx.doi.org/10.1017/S1355617707070348
Swartz, S. L., Prevatt, F., & Proctor, B. E. (2005). A coaching intervention
for college students with attention deficit/hyperactivity disorder.
Psychology in the Schools, 42, 647–656. http://dx.doi.org/10.1002/
pits.20101
Tierney, J. F., & Stewart, L. A. (2005). Investigating patient exclusion bias
in meta-analysis. International Journal of Epidemiology, 34, 79–87.
Vidal, R., Castells, J., Richarte, V., Palomar, G., García, M., Nicolau, . . .
Ramos-Quiroga, J. A. (2015). Group therapy for adolescents with
173
attention-deficit/hyperactivity disorder: A randomized controlled
trial. Journal of the American Academy of Child & Adolescent Psychiatry,
54, 275–282. http://dx.doi.org/10.1016/j.jaac.2014
Virta, M., Salakari, A., Antila, M., Chydenius, E., Partinen, M., Kaski, M., . . .
Iivanainen, M. (2010). Short cognitive behavioral therapy and
cognitive training for adults with ADHD: A randomized controlled
pilot study. Neuropsychiatric Disease and Treatment, 6, 443–453.
Weinstein, C. E., Zimmerman, S. A., & Palmer, D. R. (1988). Assessing
learning strategies: The design and development of the LASSI. In
Weinstein, C.E., Goetz, E.T., & Alexander, P.A. (Eds.) Learning
and study strategies: Issues in assessment, instruction, and evaluation,
(25–40). San Diego, CA: Academic Press Inc.
Weiss, M. (2000). Weiss Functional Impairment Rating Scale Self-Report
(WFIRS-S) Vancouver, Brittish Columbia: University of British
Columbia.
Weiss, M., Murray, C., Wasdell, M., Greenfield, B., Giles, L., &
Hechtman, L. (2012). A randomized controlled trial of CBT
therapy for adults with ADHD with and without medication. BMC
Psychiatry, 12, 30. http://dx.doi.org/10.1186/1471-244X-12-30
Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F.
(2005). Validity of the executive function theory of attention-
deficit/hyperactivity disorder: A meta-analytic review. Biological
Psychiatry, 57(11), 1336–1346. http://dx.doi.org/10.1016/
j.biopsych.2005.02.006
Young, S., & Amarasinghe, J. M. (2010). Practitioner review:
Non-pharmacological treatments for ADHD: A lifespan ap-
proach. Journal of Child Psychology and Psychiatry, 51, 116–133.
http://dx.doi.org/10.1111/j.1469-7610.2009.02191.x
Young, S., & Gudjonsson, G. H. (2008). Growing out of ADHD: The
relationship between functioning and symptoms. Journal of Attention
Disorders, 12, 162–169. http://dx.doi.org/10.1177/1087054707299598
Young, S., Khondoker, M., Emilsson, B., Sigurdsson, J. F.,
Philipp-Wiegmann, F., Baldursson, G., . . . Gudjonsson, G. (2015).
Cognitive–behavioural therapy in medication-treated adults with
attention-deficit/hyperactivity disorder and co-morbid psychopa-
thology: A randomized controlled trial using multi-level analysis.
Psychological Medicine, 45, 2793–2804. http://dx.doi.org/
10.1017/S0033291715000756
Young, S., Toone, B., & Tyson, C. (2003). Comorbidity and
psychosocial profile of adults with attention deficit hyperactivity
disorder. Personality and Individual Differences, 35, 743–755.
http://dx.doi.org/10.1016/S0191-8869(02)00267-2
Address correspondence to Kevin M. Antshel, Ph.D., 415 Huntington
Hall, Syracuse University, Syracuse, NY 13210; e-mail: kmantshe@syr.edu.
Continuing Education Quiz located on p. xx.
Received: July 14, 2015
Accepted: March 28, 2016
Available online 6 May 2016