Study: Can self-monitoring help promote academic success, and reduce ADHD symptoms, in college students with ADHD

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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