David Rabiner, Ph.D.
Research Professor, Duke University
College students with ADHD are more likely to drop out than other students, have lower grade point averages, and endorse more academic difficulties overall.Â Even when they receive academic accommodations, e.g., extended time testing, testing in a distraction-reduced environment, copies of lecture notes, many continue to struggle.Â And, there is little evidence that medication treatment alleviates their academic struggles and few receive non-medical interventions to help address their difficulties.
A study published in theÂ Journal of Attention DisordersÂ [Scheithauer & Kelley, (2014) Self-Monitoring by College Students With ADHD: The Impact on Academic Performance., 21, 1030-1039] reports encouraging results from an intervention focused on teaching students 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.Â All had an ADHD diagnosis and a current prescription for stimulant medication.Â Students were randomly assigned to receive study skills training only or study skills training plus instruction in self-monitoring academic behavior.
Study skills training occurred in a single 30-minute session that provided information on organizational skills, studying in a distraction-free environment, and using self-testing to assess mastery of the material being studied.Â Students were also taught a reading method to 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.
After study skills training, students in the self-monitoring group spent an additional 30-40 minutes learning how to self-monitor their academic activity.Â 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 excel form to record whether they completed each behavior each day.Â 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.Â Students who were not completing their daily form received email reminders.
Students in both groups attended 2 follow-up meetings, several weeks later.Â Students in the study skills group discussed their use of the study skills strategies and their general academic progress.Â Those in the study skills + self-monitoring group were praised for the goals/behaviors they regularly completed; they also discussed strategies for the behaviors they were not regularly completing
MeasuresÂ – Measures were completed at baseline and after 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 ChecklistÂ – This checklist was used to assess academic behaviors across 6 categories: inattention, test taking, note taking, reading comprehension and classroom behavior.
GradesÂ – Students recorded their grades for all tests/papers completed during the study period.Â The researchers used students’ report to calculate their average grades while enrolled in the study.
Goal attainmentÂ – All students began the study by identifying 2-3 important academic goals.Â At the conclusion of the study, they rated their progress towards attaining those goals.
ResultsÂ – Students in the self-monitoring intervention reported significant improvement in their ADHD symptoms, academic behaviors. GPA, and goal attainment. In all of these areas, the magnitude of the gains were large and likely to be clinically meaningful.
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.
Students who received study skills training only, in contrast, did not report significant improvements in any area.
Summary and ImplicationsÂ – It is striking that this relatively simple intervention would yield such robust effects. Teaching self-monitoring of academic behavior was the critical factors as receiving study skills alone did not lead to any improvements.
Why was self-monitoring so helpful? Perhaps simply 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. Regularly reviewing whether specific behaviors were performed and goals were met also forces students to confront whether they are likely to be successful.
There are limitations to this study that are important to note.Â First, students were followed for only about 3-4 weeks – whether they would continue to engage in self-monitoring over a longer period is unclear.Â Even if they did, it is not certain that the positive effects would persist.Â Thus, there is a need for a follow-up study that provided a longer test of this intervention.
Furthermore, all measures collected in this study were self-report measures and students’ self-report may not have been entirely accurate.Â In a subsequent study, it would be helpful to obtain other outcome measures such as class attendance as reported by instructors, actual GPA for the semester, etc.
While additional research is needed, results of this initial study are encouraging and the methods seem appropriate to try with younger students as well.
This is a low-cost, low-risk intervention that students, parents and clinicians could readily implement.Â It simply requires developing a core set of academic goals/behaviors that the student commits to pursuing each day
Copyright Â© 2020 by David Rabiner
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