A Psychosocial Treatment Program for College Students (ACCESS)
Condition: Attention Deficit Hyperactivity Disorder
MeSH terms: Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      The results of this study are expected to provide important and new information regarding the
      treatment of academic impairment among college students with ADHD. The present study should
      provide a substantial addition to the existing knowledge base concerning interventions for
      college students with ADHD. In addition, because the intervention is being implemented during
      college, potential benefits include the prevention of the severe academic and psychosocial
      functioning difficulties associated with ADHD, including school dropout.
    

Detailed description: 
      This proposal, "Improving the Educational and Social-Emotional Functioning of College
      Students with ADHD," was submitted in response to CFDA-84.305A Postsecondary and Adult
      Education Research, Goal 3 - Efficacy and Replication.

      The number of young adults with Attention-Deficit/Hyperactivity Disorder (ADHD) pursuing
      college degrees has increased dramatically over the past 30 years. Students with ADHD
      currently represent one of the largest disability groups on college campuses, with at least
      25% of all college students who receive disability services identified with ADHD. The need
      for such services is clearly warranted, given that college students with ADHD are at
      increased risk for having low and failing grades, being placed on academic probation, and
      ultimately dropping out of college. Currently, many colleges and universities offer students
      with ADHD extended time and other accommodations. Unfortunately, use of these accommodations
      is not empirically supported, presumably because they do not address the core difficulties -
      deficits in executive and psychological functioning - shown to lead to educational impairment
      in college students with ADHD. Further complicating matters is that systematic investigation
      of potentially useful psychosocial interventions for college students with ADHD has been
      lacking.

      The investigators set out to address this gap by working with stakeholders to develop a
      psychosocial intervention for college students with ADHD, known as ACCESS - Accessing Campus
      Connections and Empowering Student Success. Development of ACCESS was guided by careful
      consideration of conceptual and empirical factors thought to contribute to the difficulties
      experienced by college students with ADHD, thus resulting in an intervention that
      specifically targets executive functioning, other core ADHD features, and psychological
      functioning. To date, a detailed treatment manual has been developed and revised through an
      iterative process. A large open trial of ACCESS was recently completed by one of the PIs and
      a second open trial of a similar intervention was independently completed by the other PI.
      These trials demonstrate the feasibility of delivering ACCESS on college campuses with
      fidelity and establish preliminary efficacy. In both trials, college students with ADHD made
      significant improvements in ADHD symptom severity, executive functioning, educational
      performance, and emotional functioning. Although promising, such findings are limited by the
      absence of control groups, thereby preventing firm conclusions about efficacy. Accordingly,
      the primary goal of this Goal 3 study is to conduct a multi-site randomized controlled trial
      to evaluate the efficacy of the ACCESS intervention and to assess moderators and mediators of
      intervention response.

      College students with ADHD (N=240) from two large, diverse public universities were randomly
      assigned either to ACCESS or to a delayed treatment condition. Five cohorts of students were
      recruited, with each cohort consisting of 24 students from each site. Educational, executive,
      psychological, and social functioning, as well as service utilization, were assessed at
      pre-treatment, at the end of active intervention, at the end of the maintenance phase, and
      during a 6-month follow-up. An intent-to-treat analysis was used to assess the efficacy of
      ACCESS. Moderator and mediator analyses will also be conducted to address the types of
      students most likely to benefit from ACCESS and to evaluate key mechanisms of change that
      lead to improved academic and social-emotional functioning.

      This study has significant potential to improve the performance of college students with ADHD
      because the intervention was specifically designed to address deficits in executive and
      psychological functioning, factors shown to predict the educational outcomes of college
      students with ADHD. Further, the ACCESS intervention was designed with stakeholder input and
      thus has clear potential for dissemination upon proof of efficacy.
    

Intervention name(s): ACCESS - Accessing Campus Connections & Empowering Student Success
Intervention type(s): Behavioral
Intervention description(s): Cognitive-Behavioral Treatment delivered across 2 semesters via group and individual mentoring sessions
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized Controlled Trial comparing Immediate versus Delayed Treatment
Primary purpose: Treatment