ACCESS Therapy Shows Promise for College Students with ADHD

Arthur D. Anastopoulos, PhD, Professor, Human Development & Family Studies, Director, ADHD Clinic at UNCG

Arthur D. Anastopoulos, PhD

An open clinical trial published in the Journal for Attention Disorders this month highlights the efficacy of cognitive behavioral interventions in helping high school students with attention deficit/hyperactivity disorder (ADHD) successfully transition to college.

Arthur D. Anastopoulos, Ph., Professor, Human Development & Family Studies, Director, ADHD Clinic at UNCG, was treating mostly child and adolescent ADHD patients when he moved to a college setting, realizing many of these students weren’t receiving the treatment needed.

“These students are good enough to get into college but they often have trouble staying in and doing well,” he told MD Magazine. “The vast majority of the psychosocial interventions really are fairly new… previously, coaching has been used in college settings [and] coaching only scratches the surface of what a student with ADHD needs.”

Treatment changes dramatically when students begin college. When they’re younger, the treatment plans are usually implemented by parents and teachers, but when the students enter the college setting the responsibility of taking medications, as well as making and keeping doctor’s appointments shifts to the student.

“These young adults are very accustomed to having other people be their executive functioning,” Anastopoulos said. “Moms and dads telling them when to do the things.”

Anastopoulos and his team set up a trial to test the efficacy of a cognitive-behavioral therapy intervention called Accessing Campus Connections and Empowering Student Success (ACCESS).

The intervention consisted of 1 semester-long “active phase,” followed by a semester-long “maintenance phase” during which treatment was tapered.

The active phase was designed to increase knowledge of ADHD and awareness of campus resources; improve use of planning, organization, time management, and other behavioral skills affecting executive functioning; and teach cognitive therapy strategies targeting maladaptive thinking patterns related to academic impairment, social impairment, risk of secondary emotional problems, and treatment adherence.

The trial included 88 college students diagnosed with ADHD, ranging from first-years, sophomores, juniors, seniors and post-baccalaureates, aged 17—29. Some students were simultaneously receiving other treatments.

The results included improvements across a variety of areas including decreased severity of ADHD symptoms, improved behavioral regulation, fewer comorbid mood symptoms, increased use of disability service accommodations and medications, as well as an increase in the number of credit hours attempted and earned per semester. Moreover, many improvements were sustained after the maintenance phase.

The study has several limitations, mostly due to the nature of an open trial. The team is currently working on a randomized controlled trial. The next step will be to determine if this type of treatment can be implemented by those who work on college campuses and aren’t experts in ADHD.

“We view college as a critical period to intervene and flip the switch on the track and try to get [ADHD students] heading on a more positive trajectory," added Anastopoulos.

This study was part of the College STAR (Supporting Transition, Access, and Retention: A UNC System Project Supporting Students with Learning Differences) Project, a collaborative project geared to help campuses become welcoming environments for students with learning differences. The project is supported by funding from the Oak Foundation, the North Carolina GlaxoSmithKline Foundation, and a consortium of private foundations in Greensboro, North Carolina.

The study, "Cognitive-Behavioral Therapy for College Students With ADHD: Temporal Stability of Improvements in Functioning Following Active Treatment " was published in the Journal for Attention Disorders in January 2018.

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