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College Adjustment as a Mediator Between Attention Deficit/Hyperactivity Disorder Symptoms and Work Self-Efficacy1 1 Paper derived from the first author's master's thesis under supervision of the third author, defended in 2014, at the Graduate Program in Psychology of the Universidade Federal de Santa Maria.

Adaptação Acadêmica Como Mediadora Entre Sintomas do Transtorno do Déficit de Atenção/Hiperatividade e Autoeficácia Profissional

Adaptación Académica Como Mediadora Entre Síntomas del Trastorno por Déficit de Atención con Hiperactividad y Autoeficacia Profesional

Abstract

Studies have addressed features of Attention Deficit/Hyperactivity Disorder (ADHD) in higher education, but the potential relationships between ADHD symptoms, dimensions of college adjustment and students' work self-efficacy remain scarcely explored. The aim of this study was to test a theoretical model in which the dimensions of college adjustment mediate the relationship between ADHD symptoms and work self-efficacy. Participants were 509 college students from two Brazilian public universities. Data were collected using questionnaires and analyzed using a path analysis model. The ADHD symptoms affected work self-efficacy exclusively through college adjustment problems. Improving students' well-being, social support networks, study habits, and feelings regarding their majors and the university may reduce the potential disadvantages in work self-efficacy caused by ADHD symptoms.

Keywords:
attention deficit disorder with hyperactivity; adjustment; self-efficacy

Resumo

Pesquisas têm investigado aspectos do Transtorno do Déficit de Atenção/Hiperatividade (TDAH) no contexto universitário, mas permanecem pouco exploradas as relações entre os sintomas de TDAH, as dimensões da adaptação acadêmica e a autoeficácia profissional dos estudantes. O objetivo desse estudo foi testar um modelo teórico em que dimensões da adaptação acadêmica medeiam a relação entre sintomas do TDAH e autoeficácia profissional. Participaram do estudo 509 estudantes universitários de duas universidades públicas brasileiras. Os dados foram coletados por meio de questionários e analisados por meio de um modelo de path analysis. Os sintomas do TDAH interferiram na autoeficácia profissional exclusivamente por meio de problemas de adaptação acadêmica. O aumento do bem-estar, da rede de apoio social, dos hábitos de estudo e dos sentimentos frente ao curso e à universidade dos estudantes pode reduzir as potenciais desvantagens na autoeficácia profissional causadas pelos sintomas do TDAH.

Palavras-chave:
transtorno da falta de atenção com hiperatividade; ajustamento; autoeficácia

Resumen

Estudios han abordado características del Trastorno por Déficit de Atención con Hiperactividad (TDAH) en el contexto universitario, pero siguen poco exploradas las posibles relaciones entre los síntomas del TDAH, dimensiones de ajuste académico y la autoeficacia profesional de los estudiantes. El objetivo de este estudio fue testar un modelo teórico en que dimensiones de la adaptación académica medían la relación entre síntomas del TDAH y autoeficacia profesional. Participaron del estudio 509 estudiantes universitarios de dos universidades públicas brasileñas. Los datos fueron recolectados a través de cuestionarios y analizados mediante un modelo de path analysis. Los síntomas del TDAH interfirieron en la autoeficacia profesional exclusivamente por medio de problemas de adaptación académica. El aumento del bienestar, la red de apoyo social, los hábitos de estudio y los sentimientos ante la carrera y la universidad de los estudiantes pueden disminuir las potenciales desventajas en la autoeficacia profesional, causadas por los síntomas del TDAH.

Palabras clave:
trastorno por déficit de atención con hiperactividad; ajuste; autoeficacia

Attention Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent, frequent and severe pattern of inattention and/or hyperactivity or impulsivity (American Psychiatric Association, 2013). Evidence suggests that this pattern exists in the form of a continuum or latent dimension, ranging from mild to severe ADHD symptoms that occur among individuals from the general population (Haslam et al., 2006Haslam N, Williams B, Prior M, Haslam R, Graetz B, Sawyer M (2006). The latent structure of attention-deficit/hyperactivity disorder: A taxometric analysis. The Australian and New Zealand Journal of Psychiatry, 40(8), 639-647. doi:10.1111/j.1440-1614.2006.01863.x
https://doi.org/10.1111/j.1440-1614.2006...
; Marcus & Barry, 2011Marcus DK, Barry TD (2011). Does attention-deficit/hyperactivity disorder have a dimensional latent structure? A taxometric analysis. Journal of Abnormal Psychology, 120(2), 427-442. doi:10.1037/a0021405
https://doi.org/10.1037/a0021405...
). Accordingly, it makes sense to focus on the probable negative outcomes of subclinical ADHD symptoms, especially among youth. For instance, 2-8% of students in higher education report some ADHD symptoms (DuPaul, Weyandt, O'Dell, & Varejao, 2009DuPaul GJ, Weyandt LL, O'Dell SM, Varejao M (2009). College students with ADHD: Current status and future directions. Journal of Attention Disorders , 13(3), 234-250. doi:10.1177/1087054709340650
https://doi.org/10.1177/1087054709340650...
; McKee, 2008McKee TE (2008). Comparison of a norm-based versus criterion-based approach to measuring ADHD symptomatology in college students. Journal of Attention Disorders , 11(6), 677-688. doi:10.1177/1087054707308501
https://doi.org/10.1177/1087054707308501...
), but the way these symptoms interfere with the academic functioning of the students is still not entirely understood. In the present study, we expand the investigation concerning the impact of ADHD symptoms among college students by testing a causal model that connects such symptoms to lowered work self-efficacy via poor college adjustment.

ADHD symptoms can impair several facets of college adjustment. With respect to cognitive functioning, students who report ADHD symptoms have poor planning and study skills (Rabiner, Anastopoulos, Costello, Hoyle, & Swartzwelder, 2008Rabiner DL, Anastopoulos AD, Costello J, Hoyle RH, Swartzwelder HS (2008). Adjustment to college in students with ADHD. Journal of Attention Disorders , 11(6), 689-699. doi:10.1177/1087054707305106
https://doi.org/10.1177/1087054707305106...
); they have greater difficulty concentrating and avoiding distractions (Palmini, 2008Palmini A (2008). Professionally successful adults with attention-deficit/hyperactivity disorder (ADHD): Strategies of compensation and subjective effects of pharmacological treatment. Dementia & Neuropsychologia, 2(1), 63-70.; Rohde, Knapp, Lykowski, & Carim, 2004Rohde LA, Knapp P, Lykowski L, Carim D (2004). Crianças e adolescentes com transtorno de déficit de atenção/hiperatividade [Children and adolescents with attention deficit/hyperactivity disorder]. InP Knapp (Org.), Terapia cognitivo-comportamental na prática psiquiátrica [Cognitive Behavior Therapy in psychiatric practice] (pp. 358-373). São Paulo, SP: Artmed.); and they tend to have lower Grade Point Averages (GPA) compared to other students (Advokat, Lane, & Luo, 2011Advokat C, Lane SM, Luo C (2011). College students with and without ADHD: Comparison of self-report of medication usage, study habits, and academic achievement. Journal of Attention Disorders, 15(8), 656-666. doi:10.1177/1087054710371168
https://doi.org/10.1177/1087054710371168...
). Interpersonally, college students with ADHD symptoms are more prone to become involved in arguments with professors and classmates (Souza, Mattos, Pina, & Fortes, 2008Souza I, Mattos P, Pina C, Fortes D (2008). ADHD: The impact when not diagnosed. Jornal Brasileiro de Psiquiatria, 57(2), 139-141. doi:10.1590/S0047-20852008000200010
https://doi.org/10.1590/S0047-2085200800...
), possess fewer social skills and social adjustment strategies (Shaw-Zirt, Popali-Lehane, Chaplin, & Berman, 2005Shaw-Zirt B, Popali-Lehane L, Chaplin W, Berman A (2005). Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. Journal of Attention Disorders , 8(3), 109-120. doi:10.1177/1087054705277775
https://doi.org/10.1177/1087054705277775...
), and receive less support from friends (Wilmshurst, Peele, & Wilmshurst, 2011Wilmshurst L, Peele M, Wilmshurst L (2011). Resilience and well-being in college students with and without a diagnosis of ADHD. Journal of Attention Disorders , 15(1), 11-17. doi:10.1177/1087054709347261
https://doi.org/10.1177/1087054709347261...
). With regard to the relationship with the university, students with ADHD symptoms tend to feel less attached and affiliated to their educational institutions (Shaw-Zirt et al., 2005Shaw-Zirt B, Popali-Lehane L, Chaplin W, Berman A (2005). Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. Journal of Attention Disorders , 8(3), 109-120. doi:10.1177/1087054705277775
https://doi.org/10.1177/1087054705277775...
), and they are more likely to engage in antisocial behavior (Gudjonsson, Sigurdsson, Adalsteinsson, & Young, 2013Gudjonsson GH, Sigurdsson JF, Adalsteinsson TF, Young S (2013). The relationship between ADHD symptoms, mood instability, and self-reported offending. Journal of Attention Disorders , 17(4), 339-346. doi:10.1177/1087054711429791
https://doi.org/10.1177/1087054711429791...
) and experience drinking-related problems (Mesman, 2015Mesman GR (2015). The relation between ADHD symptoms and alcohol use in college students. Journal of Attention Disorders , 19(8), 694-702. doi:10.1177/1087054713498931
https://doi.org/10.1177/1087054713498931...
). Internal correlates of ADHD symptoms among college students include low self-esteem and emotional instability (Blase et al., 2009Blase SL, Gilbert AN, Anastopoulos AD, Costello EJ, Hoyle RH, Swartzwelder HS, Rabiner DL (2009). Self-reported ADHD and adjustment in college: Cross-sectional and longitudinal findings. Journal of Attention Disorders , 13(3), 297-309. doi:10.1177/1087054709334446
https://doi.org/10.1177/1087054709334446...
; Shaw-Zirt et al., 2005Shaw-Zirt B, Popali-Lehane L, Chaplin W, Berman A (2005). Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. Journal of Attention Disorders , 8(3), 109-120. doi:10.1177/1087054705277775
https://doi.org/10.1177/1087054705277775...
), procrastination (Souza et al., 2008Mesman GR (2015). The relation between ADHD symptoms and alcohol use in college students. Journal of Attention Disorders , 19(8), 694-702. doi:10.1177/1087054713498931
https://doi.org/10.1177/1087054713498931...
), and depression (Norwalk, Norvilitis, & MacLean, 2009Norwalk K, Norvilitis JM, MacLean MG (2009). ADHD symptomatology and its relationship to factors associated with college adjustment. Journal of Attention Disorders , 13(3), 251-258. doi:10.1177/1087054708320441
https://doi.org/10.1177/1087054708320441...
).

One negative correlate of ADHD symptoms that merits attention among college students is work self-efficacy, i.e., an individual's perception of his/her capacity to perform well in the practice of his/her occupation (Ourique & Teixeira, 2012Ourique LR, Teixeira MAP (2012). Autoeficácia e personalidade no planejamento de carreira de universitários [Self-efficacy and personality on university student's career planning]. Psico-USF, 17(2), 311-321. doi:10.1590/S1413-82712012000200015
https://doi.org/10.1590/S1413-8271201200...
). In contrast with the general concept of self-efficacy as described by Bandura (2001)Bandura A (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26. doi:10.1146/annurev.psych.52.1.1
https://doi.org/10.1146/annurev.psych.52...
, work self-efficacy comprises a specific set of beliefs about one's work and career. Students who sustain such positive beliefs about their work performance have higher levels of positive college adjustment, persistence in university studies, and superior career planning (Ourique & Teixeira, 2012Ourique LR, Teixeira MAP (2012). Autoeficácia e personalidade no planejamento de carreira de universitários [Self-efficacy and personality on university student's career planning]. Psico-USF, 17(2), 311-321. doi:10.1590/S1413-82712012000200015
https://doi.org/10.1590/S1413-8271201200...
). Moreover, they engage more in extracurricular activities and have higher achievement motivation, which influences their aspirations, the transition from college to work, and their professional achievements (Bardagi & Boff, 2010Bardagi MP, Boff RM (2010). Autoconceito, autoeficácia profissional e comportamento exploratório em universitários concluintes [Self-concept, professional self-effectiveness and exploratory behavior in university seniors]. Avaliação (Campinas), 15(1), 41-56. doi:10.1590/S1414-40772010000100003
https://doi.org/10.1590/S1414-4077201000...
). In sharp contrast, college students with ADHD symptoms are more likely to have negative beliefs about their performance (Shifrin, Proctor, & Prevatt, 2010Shifrin JG, Proctor BE, Prevatt FF (2010). Work performance differences between college students with and without ADHD. Journal of Attention Disorders , 13(5), 489-496. doi:10.1177/1087054709332376
https://doi.org/10.1177/1087054709332376...
) and experience high levels of anxiety when taking cognitive tests (Prevatt, Dehili, Taylor, & Marshall, 2015Prevatt F, Dehili V, Taylor N, Marshall D (2015). Anxiety in college students with ADHD: Relationship to cognitive functioning. Journal of Attention Disorders , 19(3), 222-230. doi:10.1177/1087054712457037
https://doi.org/10.1177/1087054712457037...
), even when they perform comparably to other students (Lewandowski, Gathje, Lovett, & Gordon, 2012Lewandowski L, Gathje RA, Lovett BJ, Gordon M (2012). Test-taking skills in college students with and without ADHD. Journal of Psychoeducational Assessment, 31(1), 41-52. doi:10.1177/0734282912446304
https://doi.org/10.1177/0734282912446304...
). The inattentive symptoms of ADHD seem to be particularly associated with an undermined confidence in work and career planning and performance, possibly because these symptoms imply more accentuated executive functioning deficits than hyperactivity alone (Norwalk et al., 2009Norwalk K, Norvilitis JM, MacLean MG (2009). ADHD symptomatology and its relationship to factors associated with college adjustment. Journal of Attention Disorders , 13(3), 251-258. doi:10.1177/1087054708320441
https://doi.org/10.1177/1087054708320441...
).

A hypothesis that we advance in the present study is that poor college adjustment mediates the negative association of ADHD symptoms with work self-efficacy in college students. Although no prior studies seem to have addressed this issue, one investigation reported evidence that adjustment, at least in children, fully mediates the negative relationship between ADHD symptoms and reading and math achievement (Volpe et al., 2006Volpe RJ, DuPaul GJ, DiPerna JC, Jitendra AK, Lutz JG, Tresco K, Junod RV (2006). Attention deficit hyperactivity disorder and scholastic achievement: A model of mediation via academic enablers. School Psychology Review, 35(1), 47-61.). This means that the connection between ADHD symptoms and the variables related to academic success can occur rather indirectly: ADHD symptoms influence college adjustment, which in turn affects career outcomes. As depicted in Figure 1, we similarly hypothesized that there is no direct connection between ADHD symptoms and low work self-efficacy but rather an indirect link in which ADHD symptoms lead to poor college adjustment and in which poor college adjustment causes low work self-efficacy. If true, this may indicate a potential causal mechanism by means of which students with ADHD symptoms come to develop a reduced confidence in their capacity to perform well at work and make decisions about their careers. A clear picture of the way in which the variables connect with one another represents the first step toward more effective interventions with college students (Shaw-Zirt et al., 2005Shaw-Zirt B, Popali-Lehane L, Chaplin W, Berman A (2005). Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. Journal of Attention Disorders , 8(3), 109-120. doi:10.1177/1087054705277775
https://doi.org/10.1177/1087054705277775...
).

Figure 1
Diagram of the theoretical model. AEQ-r = Academic Experiences Questionnaire - reduced version, WSES = Work Self-Efficacy Scale.

Accordingly, in the present study, we sought to perform an empirical test of the connection between ADHD symptoms and work self-efficacy via path analysis. We hypothesized that college adjustment mediates the negative linear relationship between ADHD symptoms and work self-efficacy. Specifically, ADHD symptoms should be negatively related to domains of college adjustment (Advokat et al., 2011Advokat C, Lane SM, Luo C (2011). College students with and without ADHD: Comparison of self-report of medication usage, study habits, and academic achievement. Journal of Attention Disorders, 15(8), 656-666. doi:10.1177/1087054710371168
https://doi.org/10.1177/1087054710371168...
; Norwalk et al., 2009Norwalk K, Norvilitis JM, MacLean MG (2009). ADHD symptomatology and its relationship to factors associated with college adjustment. Journal of Attention Disorders , 13(3), 251-258. doi:10.1177/1087054708320441
https://doi.org/10.1177/1087054708320441...
; Shaw-Zirt et al., 2005Shaw-Zirt B, Popali-Lehane L, Chaplin W, Berman A (2005). Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. Journal of Attention Disorders , 8(3), 109-120. doi:10.1177/1087054705277775
https://doi.org/10.1177/1087054705277775...
), and domains of college adjustment should be positively associated with work self-efficacy (Bardagi & Boff, 2010Bardagi MP, Boff RM (2010). Autoconceito, autoeficácia profissional e comportamento exploratório em universitários concluintes [Self-concept, professional self-effectiveness and exploratory behavior in university seniors]. Avaliação (Campinas), 15(1), 41-56. doi:10.1590/S1414-40772010000100003
https://doi.org/10.1590/S1414-4077201000...
; Ourique & Teixeira, 2012Ourique LR, Teixeira MAP (2012). Autoeficácia e personalidade no planejamento de carreira de universitários [Self-efficacy and personality on university student's career planning]. Psico-USF, 17(2), 311-321. doi:10.1590/S1413-82712012000200015
https://doi.org/10.1590/S1413-8271201200...
). However, ADHD symptoms should be unrelated to work self-efficacy when taking college adjustment into account.

Method

Participants

Participants were 509 college students (aged from 18 to 68; M = 23.54; SD = 5.77; 63.70% women, 58.70% freshmen and 41.30% senior) from two public universities in southern Brazil. With regard to their majors, 13.92% studied Veterinary Medicine, 12.94% Special Education, 12.55% Accounting, 10.00% Business Administration, 8.43% Speech Therapy, 6.67% Nursery, 6.67% Grain Production, 6.27% Information Systems, 6.08% Agrobusiness, 6.08% Biological Science, 5.49% Performing Arts, and 4.90% Math.

Instruments

Adult Self-Report Scale - ASRS (Kessler et al., 2005Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Walters EE (2005). The World Health Organization adult ADHD self-report scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245-256. doi:10.1017/S0033291704002892
https://doi.org/10.1017/S003329170400289...
). The ASRS is a brief inventory developed by the World Health Organization with the purpose of assessing ADHD symptoms in adults. It contains 18 self-report items that identify symptoms of inattention (part A, 9 items; e.g., "How often do you make careless mistakes when you have to work on a boring or difficult project?") and hyperactivity (part B, 9 items; e.g., "How often do you have difficulty unwinding and relaxing when you have time to yourself?"), all of which are rated on a five-point Likert scale, 0 = Never to 4 = Very often. The instrument has demonstrated acceptable test-retest reliability (.53 to .78) and internal consistency (Cronbach's alpha range of .63 to .72; Kessler et al., 2007Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52-65. doi:10.1002/mpr.208
https://doi.org/10.1002/mpr.208...
). In the present investigation, we employed the Portuguese version adapted by Mattos et al. (2006)Mattos P, Segenreich D, Saboya E, Louzã M, Dias G, Romano M (2006). Adaptação transcultural para o português da escala Adult Self-Report Scale para avaliação do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos [Transcultural adaptation of the Adult Self-Report Scale into portuguese for evaluation of adult attention-deficit/hyperactivity disorder (ADHD)]. Revista de Psiquiatria Clínica, 33(4), 188-194. doi:10.1590/S0101-60832006000400004
https://doi.org/10.1590/S0101-6083200600...
. The Cronbach's alpha for this scale was .83 in the current study.

Academic Experiences Questionnaire - reduced version - AEQ-r (Granado, Santos, Almeida, Soares, & Guisande, 2005Granado JIF, Santos AAA, Almeida LS, Soares AP, Guisande MA (2005). Integração académica de estudantes universitários: Contributos para a adaptação e validação do QVA-r no Brasil [College students academic integration: Contributes for the adaptation and validation of QVA-r in Brazil]. Psicologia e Educação, 4(2), 33-41. Retrieved from http://repositorium.sdum.uminho.pt/handle/1822/12089
http://repositorium.sdum.uminho.pt/handl...
). This questionnaire assesses the process of adjustment and integration of college students into the university context. The items are rated on a five-point Likert scale, 1 = Does not relate to me at all to 5 = Completely relates to me. The questionnaire comprises 55 items that are organized in five dimensions: (a) Personal (physical and psychological well-being, emotional stability, optimism, decision making, and self-confidence); (b) Interpersonal (relationship with classmates, establishing friendships, and asking for help); (c) Career (career perspective, feelings regarding the undergraduate course, and perception of competences); (d) Study (study habits, use of learning resources, test preparation, and time management); and (e) Institutional (feelings regarding the university, knowledge and appreciation of the infrastructure). In the original study, the Cronbach's alpha for Personal subscale was .84, .82 for Interpersonal, .78 for Study, .86 for Career, and .77 for the Institutional subscale (Granado et al., 2005Granado JIF, Santos AAA, Almeida LS, Soares AP, Guisande MA (2005). Integração académica de estudantes universitários: Contributos para a adaptação e validação do QVA-r no Brasil [College students academic integration: Contributes for the adaptation and validation of QVA-r in Brazil]. Psicologia e Educação, 4(2), 33-41. Retrieved from http://repositorium.sdum.uminho.pt/handle/1822/12089
http://repositorium.sdum.uminho.pt/handl...
). The Cronbach's alpha for the Personal and Interpersonal subscales in the current study was .86; for the Career subscale, .89; for the Study subscale, .77; and for Institutional subscale, .68.

Work Self-Efficacy Scale - WSES (Teixeira, 2002Teixeira MAP (2002). A experiência de transição entre a universidadmercado de trabalho na adultez jovem [The university-to-work transition experience in young adulthood] (Doctoral dissertation). Retrieved from http://www.lume.ufrgs.br/bitstream/handle/10183/4007/000346602.pdf
http://www.lume.ufrgs.br/bitstream/handl...
). This brief scale assesses one's perception of competence in performing his or her professional tasks. The instrument contains seven items, such as "I think I might have difficulty performing my professional role". The items were rated on a five-point Likert scale, 1 = Totally agree to 5 = Strongly disagree. The Cronbach's alpha for this scale in the original study was .82, and in the current study, it was .83.

Procedure

Data collection. From March to April 2013, 510 questionnaires were administered collectively in classrooms at scheduled times with professors, after the authorization of the coordinators of the courses, which were selected by convenience for this study. Students were informed about the objectives and procedures of this study and were invited to participate. Data collection began only after the signature of the consent form, which was separated from the questionnaire to guarantee the anonymity of the participants. Participants took approximately 40 minutes to complete the questionnaires.

Data analysis. We estimated the linear correlations (Pearson) between the variables using SPSS 20.0 after averaging the items of each scale to compute the individual scores and recoding the negatively worded items. The path analysis model was tested using Mplus 6.12 (Muthén & Muthén, 2010Muthén LK, Muthén BO (2010). Mplus: Statistical analysis with latent variables. User's guide. Los Angeles, CA: Muthén & Muthén.). We used the Maximum Likelihood estimation method with robust standard errors (MLR) because of the ordinal nature of the variables and their eventual violation of the normality assumption. Mplus inserts missing data using the Full Information Maximum Likelihood procedure when the estimator = MLR. To assess the model, we relied on a chi-squared test (the p-value should be non-significant), the indices of the Root Mean Square Error of Approximation (RMSEA; this should be as close as possible to .0; values below .08 are acceptable); the Confirmatory Fit Index (CFI; this should be as close as possible to 1.00; values above .95 are desirable); and the Tuker-Lewis Index (TLI; this should be as close as possible to 1.00; values above .95 are desirable; Hu & Bentler, 1999Hu L, Bentler PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55. doi:10.1080/10705519909540118
https://doi.org/10.1080/1070551990954011...
).

Ethical Considerations

The research was previously approved by the Research Ethics Committee from Universidade Federal de Santa Maria (CAAE n. 12378213.9.0000.5346).

Results

Table 1 presents the lowest and highest scores, means, and standard deviations. We observed higher means in the personal, career, and interpersonal dimensions of AEQ-r. All instruments presented reasonable internal consistency. The Shapiro-Wilk tests of univariate normality revealed statistically significant departures from a normal distribution in all variables, supporting our preference for a robust estimator in the subsequent path analysis.

Table 1
Descriptive Information of Variables

Next, we estimated bivariate correlations between the variables of this study. As observed in Table 2, the features of ADHD (ASRS) negatively correlated with all variables of college adjustment and with work self-efficacy. All dimensions of college adjustment correlated positively with one other and with work self-efficacy, although they were all small to moderate in size.

Table 2
Bivariate Correlations

Afterwards, we tested our theoretical model, in which the college adjustment variables mediate the ADHD symptoms and work self-efficacy. In the first step, we performed a bivariate regression of work self-efficacy on ADHD symptoms. Consistent with the negative correlation between the variables, as observed in Table 2 (r = -.20), the ADHD symptoms significantly and negatively predicted scores for work self-efficacy, F(1, 492) = 20.34, p < .001, R2 = .04, β = -.20, t = -4.51, p < .001. The next question ascertained whether the direct path between these variables remained significant in the full model containing the hypothesized college adjustment mediators.

Because of the positive correlations we found between the college adjustment variables, we specified these endogenous variables in our model to identify the correlated residuals. The first model we tested included a direct path from ADHD symptoms to work self-efficacy. To achieve model identification, we constrained a path coefficient that proved to be non-significant to zero: interpersonal dimension → work self-efficacy (standardized estimate = .01, p = .818). The model yielded a good fit to the data, χ² =.05, df = 1, p = .880, RMSEA = .000, 90% CI [.000, .073], TLI = 1.034, CFI = 1.000. Nevertheless, the standardized coefficient for the direct relationship between ADHD symptoms and work self-efficacy this time was near zero (.04) and was non-significant (p = .439). Therefore, we reran the model constraining this path coefficient to zero. The resulting model fit was excellent as well, χ² =.73, df = 2, p = .693, RMSEA = .000, 90% CI [.000, .063], TLI = 1.023, CFI = 1.000. The Bayesian Information Criterion (BIC) - a measure of model parsimony that penalizes complex models - decreased from 18652.97 to 18647.51 when setting the direct path from ADHD symptoms to work self-efficacy to zero. This particular result confirmed our mediation hypothesis: a constrained model without the direct path from ADHD symptoms to work self-efficacy was deemed as a more adequate, simpler explanation of the data. Final model coefficients are displayed in Figure 2.

Figure 2
Estimated path analysis model. ªParameter constrained to zero. *p < .05. **p <.01.

Discussion

The aim of this study was to test a theoretical model in which ADHD symptoms influence specific dimensions of college adjustment and in which dimensions of college adjustment influence work self-efficacy in turn. Our hypotheses were strongly supported by the results. The main finding was that the relationship between ADHD symptoms and work self-efficacy was fully mediated by personal, study, career, and institutional domains of AEQ-r. This means that the detrimental effect of ADHD symptoms on work self-efficacy occur indirectly by means of a decreased college adjustment. Our results suggest that the potential impact of ADHD symptoms on work self-efficacy may be reduced by targeting an improvement in physical and psychological well-being as well as increasing the quality of study habits and the knowledge and appreciation of the university/faculty infrastructure. Clinical psychology interventions with students with ADHD symptoms may better succeed if they focus on developing skills to manage difficulties such as disorganization, forgetfulness, procrastination, chronic lateness, impulsivity, difficulty in time management, prioritizing tasks and planning for the future (Barkley, 2002Barkley RA (2002). Transtorno de déficit de atenção/hiperatividade (TDAH): Guia completo e autorizado para os pais, professores e profissionais da saúde [Taking charge of ADHD: the complete, authoritative guide for parents] (LS Roizman, Trans.). Porto Alegre, RS: Artmed.; Dipeolu, 2011Dipeolu AO (2011). College students with ADHD: Prescriptive concepts for best practices in career development. Journal of Career Development, 38(5), 408-427. doi:10.1177/0894845310378749
https://doi.org/10.1177/0894845310378749...
). Thus, the intervention should focus on providing structure and understanding of the nature of the symptoms, aside from clarifying coping versus cure options (Anastopoulos & King, 2014Anastopoulos AD, King KA (2014). A cognitive-behavior therapy and mentoring program for college students with ADHD. Cognitive and Behavioral Practice, 22(2), 141-151. doi:10.1016/j.cbpra.2014.01.002
https://doi.org/10.1016/j.cbpra.2014.01....
; Canu & Wymbs, 2015Canu WH, Wymbs BT (2015). Novel approaches to Cognitive-Behavioral Therapy for adult ADHD. Cognitive and Behavioral Practice , 22(2), 111-115. doi:10.1016/j.cbpra.2015.01.002
https://doi.org/10.1016/j.cbpra.2015.01....
; Costello & Stone, 2012Costello CA, Stone SLM (2012). Positive psychology and self-efficacy: Potential benefits for college students with attention deficit hyperactivity disorder and Learning Disabilities. Journal of Postsecondary Education and Disability, 25(2), 119-129.; Dipeolu, 2011Dipeolu AO (2011). College students with ADHD: Prescriptive concepts for best practices in career development. Journal of Career Development, 38(5), 408-427. doi:10.1177/0894845310378749
https://doi.org/10.1177/0894845310378749...
; Eddy, Canu, Broman-Fulks, & Michael, 2015Eddy LD, Canu WH, Broman-Fulks JJ, Michael KD (2015). Brief cognitive behavioral therapy for college students with ADHD: A case series report. Cognitive and Behavioral Practice , 22(2), 127-140. doi:10.1016/j.cbpra.2014.05.005
https://doi.org/10.1016/j.cbpra.2014.05....
; LaCount, Hartung, Shelton, Clapp, & Clapp, 2015LaCount PA, Hartung CM, Shelton CR, Clapp JD, Clapp TKW (2015). Preliminary evaluation of a combined group and individual treatment for college students with attention-deficit/hyperactivity disorder. Cognitive and Behavioral Practice , 22(2), 152-160. doi:10.1016/j.cbpra.2014.07.004
https://doi.org/10.1016/j.cbpra.2014.07....
; Parker, Hoffman, Sawilowsky, & Rolands, 2013Parker DR, Hoffman SF, Sawilowsky S, Rolands L (2013). Self-control in postsecondary settings: Students' perceptions of ADHD college coaching. Journal of Attention Disorders , 17(3), 215-232. doi:10.1177/1087054711427561
https://doi.org/10.1177/1087054711427561...
; Prevatt & Yelland, 2015Prevatt F, Yelland S (2015). An empirical evaluation of ADHD coaching in college students. Journal of Attention Disorders , 19(8), 666-677. doi:10.1177/1087054713480036
https://doi.org/10.1177/1087054713480036...
; Richman, Rademacher, & Maitland, 2014Richman EL, Rademacher KN, Maitland TL (2014). Coaching and college success. Journal of Postsecondary Education and Disability , 27(1), 33-50.).

Consistent with our predictions, correlational analyses and model parameters showed negative relations between ADHD symptoms and all dimensions of AEQ-r. This means that college students who experience ADHD symptoms tend to present lower physical and psychological well-being, lower skills for establishing friendships, poorer study skills, poorer perception of their competence, and poorer knowledge and appreciation of the university/faculty infrastructure. These findings agree with the results of previous investigations that revealed that college students with ADHD are more likely to have lower social skill levels and low self-esteem, coupled with more depressive symptoms and emotional instability (Blase et al., 2009Blase SL, Gilbert AN, Anastopoulos AD, Costello EJ, Hoyle RH, Swartzwelder HS, Rabiner DL (2009). Self-reported ADHD and adjustment in college: Cross-sectional and longitudinal findings. Journal of Attention Disorders , 13(3), 297-309. doi:10.1177/1087054709334446
https://doi.org/10.1177/1087054709334446...
; Green & Rabiner, 2012Green AL, Rabiner DL (2012). What do we really know about ADHD in college students? Neurotherapeutics, 9(3), 559-568. doi:10.1007/s13311-012-0127-8.
https://doi.org/10.1007/s13311-012-0127-...
; Rabiner et al., 2008Rabiner DL, Anastopoulos AD, Costello J, Hoyle RH, Swartzwelder HS (2008). Adjustment to college in students with ADHD. Journal of Attention Disorders , 11(6), 689-699. doi:10.1177/1087054707305106
https://doi.org/10.1177/1087054707305106...
; Shaw-Zirt et al., 2005Shaw-Zirt B, Popali-Lehane L, Chaplin W, Berman A (2005). Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. Journal of Attention Disorders , 8(3), 109-120. doi:10.1177/1087054705277775
https://doi.org/10.1177/1087054705277775...
; Weyandt et al., 2013Weyandt LL, DuPaul GJ, Verdi G, Rossi JS, Swentosky AJ, Vilardo BS, Carson KS (2013). The performance of college students with and without ADHD: Neuropsychological, academic, and psychological functioning. Journal of Psychopathology and Behavioral Assessment, 35(4), 421-435. doi:10.1007/s10862-013-9351-8
https://doi.org/10.1007/s10862-013-9351-...
).

The negative linear relationship observed between ADHD symptoms and the interpersonal dimension of AEQ-r in the theoretical model of this study may be interpreted as reflecting a possible delay in the development of behavioral inhibition. The inability to inhibit impulsive reactions and consider the future to guide behavior may contribute to delay discounting (Shead & Hodgins, 2009Shead NW, Hodgins DC (2009). Probability discounting of gains and losses: Implications for risk attitudes and impulsivity. Journal of the Experimental Analysis of Behavior, 92(1), 1-16. doi:10.1901/jeab.2009.92-1
https://doi.org/10.1901/jeab.2009.92-1...
). People with ADHD are less likely to inhibit their negative emotions and instead fail to regulate them in the context of interpersonal relationships, which may cause substantial interpersonal problems. Mood lability, disinhibition, and impulsive decision making - frequent features of individuals with ADHD (Conners, 2009Conners CK (2009). Diagnóstico e avaliação do TDAH [Diagnosis and assessment of ADHD]. InCK Conners, Transtorno de déficit de atenção/hiperatividade: As mais recentes estratégias de avaliação e tratamento [Attention deficit hyperactivity disorder: The latest assessment and treatment strategies] (Fodra M Trans., 3rd ed., pp. 15-44). Porto Alegre, RS: Artmed .) - may result in social hostility, punishment, rejection, friendship losses, and even acquiring a poor reputation among professors (Barkley, 2002Barkley RA (2002). Transtorno de déficit de atenção/hiperatividade (TDAH): Guia completo e autorizado para os pais, professores e profissionais da saúde [Taking charge of ADHD: the complete, authoritative guide for parents] (LS Roizman, Trans.). Porto Alegre, RS: Artmed.).

The ASRS scores were negatively related to the study dimension of AEQ-r in our student sample. In other words, ADHD symptoms may interfere with the study habits and time management skills of the participants. These findings disagree with results of a study performed with ADHD-afflicted college students, in which no differences were observed between students with or without ADHD with regard to the number of hours of study per week, the quality of the notes taken during classes, and the performance of assignments ahead of time (Advokat et al., 2011Advokat C, Lane SM, Luo C (2011). College students with and without ADHD: Comparison of self-report of medication usage, study habits, and academic achievement. Journal of Attention Disorders, 15(8), 656-666. doi:10.1177/1087054710371168
https://doi.org/10.1177/1087054710371168...
). Nevertheless, ADHD students need to be constantly vigilant to control inappropriate behavioral tendencies (Palmini, 2008Palmini A (2008). Professionally successful adults with attention-deficit/hyperactivity disorder (ADHD): Strategies of compensation and subjective effects of pharmacological treatment. Dementia & Neuropsychologia, 2(1), 63-70.) and restrain energy outbursts to finish assignments (Conners, 2009Conners CK (2009). Diagnóstico e avaliação do TDAH [Diagnosis and assessment of ADHD]. InCK Conners, Transtorno de déficit de atenção/hiperatividade: As mais recentes estratégias de avaliação e tratamento [Attention deficit hyperactivity disorder: The latest assessment and treatment strategies] (Fodra M Trans., 3rd ed., pp. 15-44). Porto Alegre, RS: Artmed .).

In this study, ADHD symptoms were not significantly related to the career dimension of AEQ-r. Satisfaction with their undergraduate studies, the perception of the competence to perform professional tasks, and career planning perspectives appear to be similar between students with and without frequent ADHD symptoms. Inattention/hyperactivity may not influence career perspectives and the perception of competences due to the strategies that students use to overcome the obstacles of these symptoms, such as taking notes, using alarm clocks, and obtaining assistance from friends and family to remember commitments (Palmini, 2008Palmini A (2008). Professionally successful adults with attention-deficit/hyperactivity disorder (ADHD): Strategies of compensation and subjective effects of pharmacological treatment. Dementia & Neuropsychologia, 2(1), 63-70.). New investigations should still address the implications of this particular finding.

All dimensions of AEQ-r were significantly related to PSES. This association has already been found in a previous study (Brady-Amoon & Fuertes, 2011Brady-Amoon P, Fuertes JN (2011). Self-efficacy, self-rated abilities, adjustment, and academic performance. Journal of Counseling & Development, 89(4), 431-438. doi:10.1002/j.1556-6676.2011.tb02840.x
https://doi.org/10.1002/j.1556-6676.2011...
). Feeling good physically and emotionally may help students perceive themselves as able to perform professional tasks. In turn, study habits and time management may contribute to increased knowledge and improvements in meeting deadlines. Appreciating what the course and university have to offer may also influence students' academic engagement (Cole & Korkmaz, 2013Cole JS, Korkmaz A (2013). First-year students' psychological well-being and need for cognition: Are they important predictors of academic engagement? Journal of College Student Development, 54(6), 557-569. doi:10.1353/csd.2013.0082
https://doi.org/10.1353/csd.2013.0082...
) and add to their perception of obtaining a good education. Having friends on whom students can depend may make them confident in facing obstacles.

One limitation of this study must be acknowledged. First, we chose to perform this study based on the presence of symptoms instead of ADHD diagnoses. This choice was due to the impossibility of investigating all the diagnostic criteria recommended (the presence of symptoms at the moment and before the age of 12, strong impairment in two or more contexts, a differential diagnosis, and contact with other people) and the collection of data from more sources to define a more accurate diagnosis in the period in which we conducted this research. Our findings were based on the presence of inattention/hyperactivity symptoms in college students, regardless of the source of the symptoms. Notwithstanding, our study may be the first to suggest that a relationship between ADHD symptoms and work self-efficacy is caused by adjustment to college.

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  • 1
    Paper derived from the first author's master's thesis under supervision of the third author, defended in 2014, at the Graduate Program in Psychology of the Universidade Federal de Santa Maria.
  • Support: Coordination for the Improvement of Higher Education Personnel (CAPES) and Research Support Foundation of the State of Rio Grande do Sul (Grant # 1878-2551/13-3).

Publication Dates

  • Publication in this collection
    Sep-Dec 2016

History

  • Received
    09 Mar 2015
  • Reviewed
    07 Dec 2015
  • Reviewed
    04 Mar 2016
  • Accepted
    09 Mar 2016
Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 Ribeirão Preto - São Paulo - Brasil, Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
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