Feasibility and Acceptability of Group-Based Cognitive-Behavioral Intervention for Executive Self-Management in College Students With ADHD: Replication in a Public Urban Setting

OBJECTIVE: The purpose of this study was to examine the acceptability, feasibility, and replicability of a manualized group cognitive-behavioral intervention designed to enhance executive self-management in college students with ADHD. Whereas the first trial of this intervention was conducted in a private university in a small city in the Netherlands, the current open trial was administered at an urban, public college in the northeast United States. A simultaneous goal of the study was to train PhD-level psychologists to administer the intervention. METHODS: Forty-one students meeting rigorously assessed DSM-5 criteria for ADHD were enrolled in one of six 12-week treatment groups that addressed time-management, organization, and planning, and also targeted procrastination, distractibility, and negative automatic thoughts. Strategies were also included to improve attention to and retention of reading materials and guidance in organizing and writing essays. Each group was co-led by an experienced therapist and one of three clinical psychologists undergoing training. Pre- and post-treatment measures included number and severity of inattentive and hyperactive-impulsive symptoms as assessed on a structured diagnostic interview (AISRS) and via a self-report (CAARS) questionnaire, as well as measures of executive skills (BRIEF-A, LASSI-III). At the end of treatment, students rated the helpfulness of each of the program's components and strategies, and provided a personal narrative of the most important effects of the program on their daily functioning and personal well-being. RESULTS: Thirty-six of the 41 enrollees fully or partially completed the treatment and provided post-treatment data for the analyses. Repeated measures ANOVA yielded significant main effects for decreases in clinician-rated and self-rated number and severity of inattentive symptoms. Change in executive self-management was associated with change in ADHD Inattention severity after controlling for pre-treatment inattention. Significant improvement was also observed on the BRIEF-A Metacognitive Index and LASSI-III composite score. Overall, 67% of students rated the group program as "very helpful" and 30% as "moderately helpful." CONCLUSIONS: The results of this study demonstrate the feasibility and acceptability of the intervention. Pre- to post-treatment reductions in clinician- and self-rated ADHD symptoms and executive self-management skills were observed, although, of course, conclusions regarding efficacy/effectiveness cannot be drawn from uncontrolled trials. This replication of the group CBT intervention in a public, urban setting, with training of interventionists, supports the feasibility of the treatment, and warrants a large-scale randomized controlled trial against an active control group to evaluate efficacy, with potential for dissemination across college campuses generally (ClinicalTrials.gov ID NCT05588505).