O’ROURKE, SARAH R., Ph.D. Anxiety in College Students with ADHD. (2014) Directed by Dr. Arthur D. Anastopoulos. 113 pp. The purpose of this study was to compare rates of anxiety disorders and symptoms in college students with and without ADHD and to identify factors that protect against anxiety in this population. Forty-six college students with ADHD and a matched control group of 46 students without ADHD participated in this study. Participants completed a diagnostic interview to assess for lifetime and current anxiety disorders; they also completed several measures of anxiety symptoms. As expected, participants with ADHD were more likely to have a lifetime history of an anxiety disorder than participants without ADHD, and were also more likely to report having entered college with a previous history of an anxiety disorder. Participants in the two groups were equally likely to meet diagnostic criteria for a current anxiety disorder. Participants in the ADHD group endorsed significantly lower self-efficacy and significantly higher maladaptive beliefs about worry and obsessive-compulsive symptoms compared with the control group, though the between-group differences in maladaptive beliefs about worry and obsessive-compulsive symptoms were no longer significant when depressive symptoms were covaried. The two groups did not differ on symptoms of panic, social anxiety, or worry, which was unexpected. Perceived social support was associated with a lower risk of having a current anxiety disorder in the ADHD group. The findings of this study highlight the substantial comorbidity that students with ADHD display upon college entry. ANXIETY IN COLLEGE STUDENTS WITH ADHD by Sarah R. O’Rourke A Dissertation Submitted to the Faculty of the Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Greensboro 2014 Approved by Arthur D. Anastopoulos Committee Chair APPROVAL PAGE This dissertation written by Sarah R. O’Rourke has been approved by the following committee of the Faculty of The Graduate School at The University of North Carolina at Greensboro. Committee Chair ______________________________________ Arthur D. Anastopoulos Committee Members ______________________________________ Janet J. Boseovski ______________________________________ Kari M. Eddington ______________________________________ Michael J. Kane ____________________________ Date of Acceptance by Committee _________________________ Date of Final Oral Examination ii ACKNOWLEDGMENTS Sincere thanks to my mentor and dissertation chair, Dr. Arthur Anastopoulos, who guided me with wisdom and humor through the process of writing my dissertation. The other members of my committee, Dr. Janet Boseovski, Dr. Kari Eddington, and Dr. Michael Kane, also provided invaluable input regarding the design of the study. Several members of Dr. Anastopoulos’ research team, including Allison Bray, Dr. Jessica Benson, Dr. Kristen King, and Dr. Jennifer Sommer, contributed significantly to the development of this project and to the recruitment of participants. This research was supported by a grant from the UNCG Psychology Department. Finally, I am grateful to my parents, Peter and Sue Rock, and to my husband, Jim O’Rourke, for their endless encouragement and support. iii TABLE OF CONTENTS Page LIST OF TABLES ............................................................................................................. vi LIST OF FIGURES .......................................................................................................... vii CHAPTER I. INTRODUCTION ................................................................................................ 1 ADHD ............................................................................................................ 4 Anxiety Disorders .......................................................................................... 9 College Students with ADHD ...................................................................... 11 A Model for Understanding ADHD and Anxiety in College Students ...................................................................................... 19 The Present Study: Research Questions and Hypotheses ............................ 20 II. METHODS ......................................................................................................... 23 Participants ................................................................................................... 23 Measures ...................................................................................................... 29 Procedure ..................................................................................................... 39 III. RESULTS ........................................................................................................... 44 Preliminary Inspection of Dependent Variables .......................................... 44 Primary Analyses ......................................................................................... 45 Post-hoc Analyses ........................................................................................ 50 IV. DISCUSSION ..................................................................................................... 53 Primary Analyses ......................................................................................... 53 Post-hoc Analyses ........................................................................................ 58 Limitations ................................................................................................... 59 Summary of Findings ................................................................................... 62 Future Research ........................................................................................... 64 Clinical Implications .................................................................................... 66 Conclusion ................................................................................................... 70 REFERENCES ................................................................................................................. 72 iv APPENDIX A. TABLES AND FIGURES ...................................................................... 95 APPENDIX B. COLLEGE LIFE QUESTIONNAIRE .................................................. 105 APPENDIX C. PARTICIPANT INFORMATION FORM ............................................ 108 APPENDIX D. UNIVERSITY OF NORTH CAROLINA AT GREENSBORO CONSENT TO ACT AS A HUMAN PARTICIPANT: LONG FORM .................................................................................. 110 APPENDIX E. AUTHORIZATION TO DISCLOSE PHI ............................................ 112 APPENDIX F. RECRUITMENT FLYER ..................................................................... 113 v LIST OF TABLES Page Table 1. Demographic Characteristics of ADHD and Control Groups ............................ 95 Table 2. Other Background Characteristics of ADHD and Control Groups .................... 96 Table 3. Psychological Characteristics of ADHD and Control Samples .......................... 97 Table 4. Study Measures ................................................................................................... 98 Table 5. Descriptive Statistics for Outcome Variables for Total Sample (N = 92) .......... 99 Table 6. Correlations Among MANOVA Variables for Final Sample (N = 92) ............ 100 Table 7. Lifetime and Current SCID-CV Anxiety Diagnoses by Group ........................ 101 Table 8. Results of Follow-up ANOVAs Comparing ADHD and Control Groups on Measures of Anxiety Symptoms. ................................................ 102 Table 9. 95% Confidence Intervals of Pairwise Differences in Current Impairment .................................................................................................... 103 vi LIST OF FIGURES Page Figure 1. Biopsychosocial Model of the Development of Anxiety in College Students with ADHD.................................................................. 104 vii CHAPTER I INTRODUCTION Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common childhood conditions, and for a majority of affected individuals, symptoms and impairment associated with this disorder persist into adolescence and adulthood. Although rates of college entry and college completion among individuals with ADHD are lower than in peers without ADHD (Weiss & Hechtman, 1993), ADHD is the most common disability reported among first-year college students (Pryor, Hurtado, DeAngelo, Blake, & Tran, 2010). Research on college students with ADHD, however, is extremely limited, and well-established findings on children and adults with ADHD may or may not generalize to college students with ADHD. College students with ADHD are thought to differ from the general population of individuals with ADHD in several important ways, and may have higher intellectual abilities, higher academic achievement prior to college, and better adaptive skills than individuals with ADHD who do not attend college (Frazier, Youngstrom, Glutting, & Watkins, 2007; Glutting, Youngstrom, & Watkins, 2005). Still, college students with ADHD have difficulty in a number of domains, including academics, interpersonal relationships, and adjustment to college and symptoms of other disorders (e.g., Heiligenstein, Guenther, Levy, Savino, & Fulwiler, 1999; Rabiner, Anastopoulos, Costello, Hoyle, & Swartzwelder, 2008; Shaw-Zirt, Popali- Lehane,