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College students with ADHD are more likely to drop out than other students, have lower grade point averages, and endorse more academic difficulties overall. Approximately 25% of college students with ADHD receive academic accommodations, e.g., extended time testing, testing in a distraction-reduced environment, copies of lecture notes, but many continue to struggle regardless. To date, there is little evidence that medication treatment alleviates the academic struggles of college students with ADHD and few receive non-medical interventions to help address their difficulties.
The study
A study published online recently in the Journal of Attention Disorders [Scheithauer & Kelley, Self-Monitoring by College Students With ADHD: The Impact on Academic Performance. Journal of Attention Disorders] reports encouraging results of an intervention based on teaching college students with ADHD to monitor their academic behavior and goals. As you will see below, this is a relatively simple intervention and one that could be readily implemented by many students.
Participants were 53 college students attending a large public university in the Southeastern US. All had an ADHD diagnosis and a current prescription for stimulant medication. These students were randomly assigned to receive study skills training or study skills training plus instruction in self-monitoring academic behavior.
Study skills training occurred in a single 30-minute session during which students were given information on organizational skills, studying in a distraction-free environment, and the use of self-testing to assess mastery of the material being studied. Students were also taught a method for text book reading text that can enhance retention and learning; the method includes previewing the chapter to be read, writing questions about the material, finding the answers to those questions in the text, and reciting the answers.
Following the study skills training, students in the self-monitoring group spent an additional 30–40 minutes learning how to self-monitor their academic activity. This began by having each student identify important academic goals and behaviors, e.g., “I will attend all my classes each day”, “I will complete assigned work before each class”, “I will stay off social media sites during class”. Participants then created an electronic form using excel to be used to record each day whether they completed each behavior. The spread sheet included a progress report tab that made it easy to calculate and graphically display the percentage of academic goals/behaviors completed each day.
The researchers could access students’ forms remotely to confirm that they were being regularly completed. Students who were not completing their form each day were sent email reminders.
Following this initial session, students in both groups attended 2 follow-up meetings, scheduled for 2 and 3 weeks later. Students in the study skills group discussed their use of the study skills strategies and their general academic progress. Those in the study skills + self-monitoring group were praised for the goals/behaviors they were regularly completing; they also discussed strategies for the behaviors they were regularly marking as not completed.
Measures
Measures completed at the beginning and end of the brief intervention were selected so that change in students’ ADHD symptoms, academic behaviors, and academic performance could be assessed. These included the following:
- Adult ADHD Self-Report Scale (ASRS)- This is an 18-item measure in which students rated the severity of each DSM symptom of ADHD.
- School Success Checklist — This checklist was used to assess academic behaviors across 6 categories: inattention, test taking, note taking, reading comprehension and classroom behavior.
- Grades — Students recorded their grades for all tests/papers completed during the study period. The researchers used students’ report to calculate their average grades while enrolled in the study.
- Goal attainment — All students began the study by identifying 2–3 important academic goals. At the conclusion of the study, they rated their progress towards attaining those goals.
Results
Students who participated in the self-monitoring intervention reported significant improvements in all areas. At the conclusion of the study, they reported significant declines in ADHD symptoms, more positive academic behaviors, greater progress towards attaining their goals, and significant improvement in their GPA. In all of these areas, the magnitude of the gains were large and likely to be clinically meaningful.
Students who received study skills training only, in contrast, did not report significant improvements in any of these areas.
Although there was considerable variability in how frequently students completed their daily monitoring form, students had generally positive feelings towards the intervention and rated it as highly acceptable.
Summary and Implications
It is striking that such a relatively simple intervention would lead to the robust effects reported here. Simply by having students identify specific academic behaviors that they were to regularly engage in, and monitor each day whether they had, significant gains were reported in multiple areas where students with ADHD tend to struggle. Providing information and instruction on effective study skills in the absence of teaching this self-monitoring approach, had no comparable effect.
The reason for the positive impact of self-monitoring is not clear. It may be that the simple act of having to decide each day whether one has attained a particular goal, e.g., completed all assigned reading, attended all classes, motivates individuals to attain those goals. Certainly, reviewing a sheet each night where specific goals and behaviors related to academic success are listed provides a regular reminder of what one needs to do. It would also make it more difficult to ‘deceive’ oneself about whether one is acting in ways that are likely to promote successful academic outcomes.
There are, of course, limitations to this study that are important to note. First, students were followed for only about 3–4 weeks — whether they would continue to engage in self-monitoring over a longer period, say an entire semester, is unclear. Even if they did, whether the positive effects would persist is also unknown. Thus, there
is a need for a follow-up study that provided a longer test of this intervention.
It is also the case that all measures collected in this study were self-report measures. Thus, students indicated themselves whether they were meeting their academic goals and these self-reports may not have been entirely accurate. In a subsequent study, it would be helpful to obtain other outcome measures as well, e.g., actual class attendance as reported by instructors, actual GPA for the semester, etc.
While additional research on the use and impact of self-monitoring on the academic success of college students with ADHD needs to be conducted, results of this initial study are encouraging. This is a low-cost, low-risk intervention that students and clinicians could readily implement. It simply requires developing a core set of academic goals/behaviors that the student commits to pursuing each day, developing a simple sheet to track this, and checking each day whether one has completed the behavior.
With programs like google docs, these tracking sheets can be shared between a students, clinicians, and parents. Thus, clinicians or parents could monitor whether the student is regularly completing the form and send email reminders to do so, just as was done in this study. Ideally, of course, students would take responsibility to handling this themselves and doing so would represent an important move towards greater self-regulation for many students.
– Dr. David Rabiner is a child clinical psychologist and Director of Undergraduate Studies in the Department of Psychology and Neuroscience at Duke University. He publishes Attention Research Update, an online newsletter that helps parents, professionals, and educators keep up with the latest research on ADHD, and teaches the online course How to Navigate Conventional and Complementary ADHD Treatments for Healthy Brain Development.
To learn more:
- Physical exercise as ADHD treatment: Necessary but not sufficient
- ADHD Study: Reducing the Need for High Medication Doses with Behavior Therapy
