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Arthur D. Anastopoulos 1 , Joshua M. Langberg 2 , Kristen A. King 1 , & Laura D. Eddy 1

ACCESS: An Evidence-Based Treatment Program for Improving the Educational and Social-Emotional Functioning of College Students with ADHD. Arthur D. Anastopoulos 1 , Joshua M. Langberg 2 , Kristen A. King 1 , & Laura D. Eddy 1 1 University of North Carolina Greensboro

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Arthur D. Anastopoulos 1 , Joshua M. Langberg 2 , Kristen A. King 1 , & Laura D. Eddy 1

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  1. ACCESS: An Evidence-Based Treatment Program for Improving the Educational and Social-Emotional Functioning of College Students with ADHD Arthur D. Anastopoulos1, Joshua M. Langberg2, Kristen A. King1, & Laura D. Eddy1 1 University of North Carolina Greensboro 2 Virginia Commonwealth University

  2. Acknowledgements UNC Greensboro • Laura Besecker, Paul Silvia, Jeff Labban, Erin Spence, Kaicee Beal, Rachel Reid, Elizabeth Carter, Jessica Goodman, Michele Stewart, & Lydia Jodrey VCU • Melissa Dvorsky, Stephen Molitor, Liza Bourchtein, Zoe Smith, Lauren Oddo, & Hana-May Eadeh

  3. Disclosures Royalties from Guilford Press: Co-author, ADHD Rating Scale-5 (DuPaul, Power, Anastopoulos, & Reid, 2016)

  4. Conference Inclusion Statement We ask you to join us in creating a culture of • Access • Inclusion • Civility • Respect …this week and in all aspects of our organization.

  5. Why study college students with ADHD? • High functioning ADHD subgroup • Lower GPAs, withdraw from more courses, switch colleges more often, & take longer to finish • 1 of 4 complete college (Barkley et al., 2008)  Institutional concern re: graduation & retention  Public health & economic significance  Possible link to negative adult ADHD outcomes

  6. “Perfect Storm” • 18-25 years of age  Emerging Adulthood (Arnett, 2007) • Demands for self-regulation increase • Bad fit for students with self-regulation deficits • Loss of external supports previously in place • Limited awareness/use of campus resources • Limited understanding of ADHD

  7. Campus Resources, Coaching, & Medication • Disability accommodations (e.g., extended time) available but often not used, produce minimal long-term benefits, & do not address co-occurring difficulties • Coaching less often available, improves some executive functions (e.g., organization, planning) but does not directly address co-occurring psychological problems • Preliminary support for efficacy/safety of Lisdexamfetamine

  8. Psychosocial Treatment • Relatively small number of studies • Psychosocial interventions, primarily emphasizing Cognitive & Behavioral Treatment (CBT) strategies • See He & Antshel (2016) for an excellent review of published CBT studies

  9. Follow us at: ACCESS for ADHD ACCESS Website

  10. Initial ACCESS Project • College STAR grant awarded to East Carolina, UNC Greensboro, & Appalachian State and funded by Oak Foundation, Glaxo-Smith Kline, and consortium of local Greensboro private foundations • From 2011-2015, ACCESS was conceptualized, developed, refined, and pilot tested in an open clinical trial involving 88 undergraduate students at UNC Greensboro

  11. ACCESS Program Overview • Cognitive-Behavioral Therapy (CBT) Program • Incorporates elements of adult CBT programs (Safren et al., 2005; Solanto, 2011) adapted to developmental needs of college population • Two-semester sequence  8-week active phase + semester long maintenance phase • Simultaneous delivery of group CBT & individual mentoring

  12. CBT Group Component • Eight weekly 90-minute sessions during active phase • One 90-minute session during maintenance phase • Increase ADHD knowledge, behavioral strategies, & adaptive thinking • Increase access to campus resource units If goals met improved educational, social, & emotional functioning

  13. CBT Group Session Content

  14. Mentoring Component • Eight weekly 30-minute individual sessions during active phase • Four 30-minute individual sessions during maintenance phase • To monitor and fine tune what is learned in group • To assess need for disability services/other campus resources • To set and monitor attainment of personal goals (coaching)

  15. College STAR Project (2011-2015) Anastopoulos, A.D. & King, K.A. (2015). A cognitive-behavior therapy and mentoring program for college students with ADHD. Cognitive & Behavioral Practice, 22, 141-151. DOI: 10.1016/j.cbpra.2014.01.002 Anastopoulos, A.D. King, K.A., Besecker, L.H., O’Rourke, S.R., Bray, A.C., & Supple, A.J. (2018). Cognitive-behavior therapy for college students with ADHD: Temporal stability of improvements in functioning following active treatment. Journal of Attention Disorders. Advance On-Line Publication: https://doi.org/10.1177/1087054717749932

  16. Study Design • All participants met criteria for ADHD & received ACCESS • Open clinical trial - no comparison group • Outcome assessed across multiple domains of functioning • Collected prior to treatment, after active treatment, and after maintenance phase – no follow-up assessment

  17. Participants • 106 screened  88 eligible (DSM-IV criteria) • 17-27 years of age; 52 females/36 males, • All college levels, mostly 1st year students (38%) • 12% Hispanic; 64% Caucasian,18% African American, 6% multi-racial • 48% Combined, 48% Predominantly Inattentive • 56% with comorbid/co-occurring diagnosis

  18. Results Following active treatment, participants displayed significant improvements in: • Clinical change mechanisms - ADHD knowledge, behavioral strategies, & adaptive thinking • ADHD symptoms (IN/HI) & executive functioning • Co-occurring anxiety and depression symptoms Maintained at the end of maintenance phase, 5-7 months after treatment started

  19. Educational Functioning

  20. Campus Services Use

  21. Limitations • Open clinical trial/no control group • Staff with high level of ADHD expertise • Stability of improvements after treatment ends • Limited scope of assessed outcomes • Sample size

  22. Current ACCESS Project • Funded by a 4-year (2015-2019) $3.2 million Goal 3 Efficacy grant from the Institute of Education Sciences (U.S. Department of Education) • Multi-site randomized controlled trial with Dr. Joshua Langberg (Co-PI) at Virginia Commonwealth University

  23. Randomized Controlled Trial (RCT) • 5 cohorts recruited over consecutive semesters • Randomly assigned to Immediate or Delayed ACCESS • Outcome data: Pre-active treatment Post-active treatment Post-maintenance phase Six-month follow-up

  24. RCT Participants • Screened 361 undergraduates 18-30 years • 280 deemed eligible with rigorously defined ADHD as determined by expert panel • N = 250 (Immediate = 119, Delayed N = 131) • 60% with comorbid conditions • 47.6% first-year in college • 66% female, 6.8% Hispanic/Latino, 33.7% racial minority

  25. Treatment Fidelity • Staff training  Readings, discussion, role plays • Treatment manuals for CBT group and mentoring • Detailed session outlines • Weekly supervision Treatment Fidelity Results: 96.4% CBT Groups 95.6% Mentoring

  26. Mechanisms of Clinical Change • Test of ADHD Knowledge • Strategies for Success • ADHD Cognitions Scale – College Students

  27. ADHD Knowledge

  28. Behavioral Strategies

  29. Maladaptive Cognitions

  30. Campus Resources & Treatment Services

  31. ADHD Symptoms & Executive Functioning Conners Adult ADHD Rating Scale (CAARS) Behavior Rating Inventory of Executive Functioning (BRIEF)

  32. Inattention

  33. Executive Functioning

  34. Depression & Anxiety • Beck Depression Inventory-II • Beck Anxiety Inventory

  35. Depression

  36. Anxiety

  37. Academic FunctioningLearning & Studies Strategies Inventory (LASSI) • Concentration • Attitude • Motivation • Selecting Main Ideas • Time Management • Study Aids • Test Strategies

  38. Attitude

  39. Motivation

  40. Selecting Main Ideas

  41. Test Strategies

  42. General Functioning ADHD Impact Module – Adult (AIM-A) • Performance & Daily Functioning • General Well-Being

  43. Daily Functioning

  44. Summary • Statistically significant improvements in multiple domains – inattention symptoms, executive functioning, mood, academic strategies, daily functioning, disability service use • Improvements persist up to 6 months after ACCESS completed - 18 months after treatment started • Improvements appear conceptually related to mechanisms of clinical change

  45. Conclusions • Results support efficacy • Not a panacea or stand alone treatment; best conceptualized as a tool that can be used in combination with other treatments • Designed specifically to accommodate developmental needs of emerging adults with ADHD  likely can be implemented in many different postsecondary settings • Serves as a protective factor that increases the likelihood that college students with ADHD can be more successful not only during college but also as they begin their developmental transition into the post-college adult world

  46. Session Evaluation Please see session moderator for paper evaluation form or complete the evaluation online.

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