Correlations Among Symptoms of ADHD and Peer Relationships, Academic Performance, and Self-Image

Michael W. Firmin
Chi-en Hwang
Cedarville University

Annie Phillips
Regent University

Richard A. Wantz
Wright State University

Abstract

The present study examined relationships between symptoms of ADHD, peer relations, academic performance, and self-image among university-level students. Eighty-three students at a private, Midwestern, comprehensive university participated in the study. None indicated that they had been previously diagnosed with ADHD or were currently receiving any form of ADHD treatment. The students were administered an adapted version of the General Adult ADD Symptom Checklist (Amen, 1995). Particular variables of interest included perceptions of peer relations, academic performance, and self-image. The results showed that 5% of students surveyed met the operational definition criteria for ADHD symptoms. Significant correlations were found with poor peer relations, less satisfactory academic performance, and poor self-image.


CORRELATIONS BETWEEN STATED SYMPTOMS OF ADHD AND PEER
RELATIONSHIPS, ACADEMIC PERFORMANCE, AND SELF-IMAGE

Introduction

Attention-Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed disorder of childhood, prevalent in about 3-7% of school-age children, and occurring more often in boys than girls (APA, 2000). This means, on average, about one child in every classroom has this disorder. While boys outnumber girls by 4:1 to 9:1, some believe that many girls with ADHD are never diagnosed and some studies show that teachers rate girls with ADHD similar to boy counterparts (APA, 2000; Mrug, Hoza & Gerdes, 2001). The etiology for ADHD remains elusive, although the tendency for the disorder to run in families where at least one parent has been previously diagnosed with ADHD is relatively high (Martin, Levy, Pieka, & Hay, 2006; Walker , 2000).

The types of debilitating behaviors and low self-esteem shown by some ADHD children present a significant concern. These may include a sense of underachievement, of not meeting one's goals (regardless of how much one has accomplished), difficulty getting organized, multiple simultaneous projects, trouble with follow-through, a tendency to be easily bored, easy distractibility, trouble focusing attention, impulsive, restlessness, and inaccurate self-observation (Hallowell & Ratey, 1994). ADHD symptoms continue into adolescence for many of the diagnosed children. These adolescents and adults frequently show poor academic performances, poor self-images, and problems with peer relationships (Smith, Dowdy, Polloway, & Blalock, 1997).

The course of the disorder varies by person (Mannuzza, Klein, & Moulton, 2003). During adolescence, symptoms of the disorder tend to be relatively stable. Hyperactive symptoms tend to subside in most individuals by adulthood, although a minority of people continue experiencing the full-range of ADHD symptoms throughout life, and some experience partial symptoms ( Willoughby , 2003). Data suggests that individuals diagnosed with ADHD are susceptible to alcoholism, drug use, and other addictive behaviors (Hays, 2002). Prison research of ADHD adults by Varick (2002) and adolescents Gordon & Moore (2005) indicates that ADHD is disproportionately represented in prison populations, including childhood diagnoses of oppositional defiant disorder and conduct disorder preceding incarceration. Consequently, the connection between childhood ADHD and adulthood ADHD have become the focus of some significant research attention in recent years.

Adler (2002) reports the first formal identification of childhood ADHD dating back to the 19 th century, but formal diagnosis of adult ADHD did not appear in research literature until 1976. Section 504 of the Rehabilitation Act of 1973, the Individuals with Disabilities Education Act of 1975, and the Americans with Disabilities Act of 1990 have brought heightened focus on ADHD diagnoses in college student populations in particular. Wolf (2001) indicates that adults with ADHD who enroll in college face multiple obstacles, some intrinsic and others extrinsic. The present research focuses on this particular population of individuals with ADHD—adults who report symptoms of ADHD.

In particular, the purpose of the study conducted was to examine potential correlations between students at the university-level experiencing symptoms of ADHD with respect to their peer relations, satisfaction with their academic performances, and self-images. The research ultimately will apply to questions of whether students are obtaining the kind of attention and treatment they need in order to function successfully on the multiple of levels required of them by society, and particularly by the higher education milieu. We believe that ascertaining these relationships will make a positive contribution to improving the lives of those with ADHD.

Method

Participants

A sample of 200 students was randomly selected from a student body population of 3000. The university is a private institution located on a rural, Midwest campus. Of the 200 surveys distributed by e-mail, we received 42% responses (n=83). While this was less than desired, the research proceeded as we believed our sample to be an adequate response rate for the present purposes (Monetle, Sullivan, & DeJong, 1998). Each of the participants indicated that they previously had not been diagnosed with any form of ADHD, nor were they prescribed psychotropic medications for hyperactivity. The participant's ages ranged from 19 to 23, with 25 of the participants being males (30%) and 58 being females (70%). The participants in the study were predominately Caucasian due to the nature of the university from which the sample was drawn. In particular, the university possessed only three percent minority population.

Instrument

Amen's (1995) General Adult ADD Symptom Checklist was adapted for use in the present study, with the questions being selected for their appropriateness to the college student population, and one additional question added concerning self-perception of academic performance. In particular, we added “History or feeling of not living up to potential in school work” (report cards with comments such as not living up to potential)” as number 65 to the survey. This was done for the purpose of the present research assessment in ascertaining potential correlations among symptoms of ADHD and pee r relationships, academic performances, and self-images. The content validity of the checklist used in the present study was appraised via expert review. The instrument was examined by three practicing psychologists who each attested to its clinical utility. The internal consistency reliability of the instrument as measured by Cronbach's alpha was .97. Test-retest reliability using Pearson Product Moment Correlation Coefficient was shown to be .90.

The participants responded to all questions on five-point Likert scales and the questionnaire took approximately 20 minutes for the students to complete. In accordance with Amen's findings, persons who scored three (3) or higher on the Likert-scale for more than 20 items were operationally defined as showing strong tendencies toward ADHD. In addition, according to Amen (1995) three questions are essential for making any type of preliminary diagnosis, i.e., # 1 (History of ADD symptoms in childhood, such as distractibility, short attention span, impulsivity or restlessness), # 4 (Short attention span, unless very interested in something), and # 5 (Easily distracted, tendency to drift away, although at times can be hyper focused) By using these criteria, four of the students (5%) surveyed were identified as having a sufficient number of ADHD symptoms for classification as ADHD (as operationally defined for purposes of the present research only). Of all respondents, 6% had a history of ADHD symptoms in childhood, 24% indicated having a short attention span unless very interested in something, 25% indicated being easily distracted with a tendency to drift away, and 13% had a history or feeling of not living up to potential in school or work.

 

Results

Among the checklist items, Amen (1995) indicated that three possessed particular clinical diagnostic utility. Consequently, we focused on these specific items in the present study. Future research may be devoted to the additional checklist items from the data set.

Statistically significant correlations were found between the three diagnostic questions delineated above, addressing not fulfilling the potential in school or work. This suggests that if a respondent reported major symptoms of ADHD, then he/she also was likely to report a sense of underachievement. The results of the correlation analysis are presented in Table 1. Significance was shown between question number 64 and 65 with a correlation of .585** (p<.01), number 4 and 1 with a correlation of .523** (p<.01), number 5 and 1 with a correlation of .543** (p<.01) and number 5 and 4 with a correlation of .644** (p<.01).

Table 1

Statistically significant correlations of diagnostic questions

 

 

Question 1

 

Question 4

 

Question 64

 

Question 4

 

.523**

 

 

 

Question 5

 

.543**

 

.644**

 

 

Question 65

 

 

 

 

.585**

Questions

1. History of ADHD symptoms in childhood

4. Short attention span, unless very interested in something

5. Easily distracted, tendency to drift away

64. Chronic sense of underachievement, feeling you should be much further in your life than you are.

65. History or feeling of not living up to potential in school or work.

** (p<.01)

 

Discussion

The results of the present study are congruent with findings from the research literature. That is, the present data suggests that adults showing ADHD symptomology are likely to suffer from failing to complete projects and to experience a general lack of fulfilling their perceived potentials. In identifying 5% of adult students in our sample as having a significant number of ADHD symptoms, this study also reflects the consistent data reported in the literature that about 3 to 7 percent of the population suffers from ADHD. Obviously, the present results were drawn from a college student sample and external validity is affected by this fact. That is, the generalization of the results should be limited to college student population.

We interpret the results found in light of Seligman's classic learned helplessness theory (1990). In short, it states that when people are reinforced, over time, with lack of success in given domains of life functioning, they come to develop a state of hopelessness and pessimism about their situation. We believe that ADHD children need interventions such that they do not come to simply accept a negative self-belief system regarding their abilities and their potentials. If this occurs, then the present data suggests a potential for long-term or chronic underachievement by adults with ADHD. College students in our sample brought with them a life-time of experiences and self-perceptions when answering the questions posed.

 

Limitations and Future Study

A serious limitation to our study involves the response rate of only 42% by respondents. That is, we do not know how 58% of the sample subjects would have responded to the survey, if they would have returned it. Moreover, we do not know if the responders and non-responders differed in any systematic manner. The present survey study should be replicated, using waves of second and third requests for information, in an attempt to increase participation from subjects. Incentives were not used in the present survey in attempting to increase compliance, although doing so might also increase the overall response rate without negatively affecting the validity of results, if the reinforcement for responding is token or minimal (Monetle, Sullivan, & DeJong, 1998). In addition, increasing our sample size ultimately would have likely increased the number of ADHD students in our sample—boosting the statistical power available in our data analysis.

Future studies may wish to include assessing the degree to which programs intended for the improvement of academic performance and peer relations might help improve self-concepts among ADHD populations. In light of the success they have shown across a wide variety of domains, we suggest that programs aimed at cognitive restructuring may show particular promise (Meichenbaum, 1977). Treating one or more of such symptoms could potentially affect the others, leading to improvements in the daily worlds of persons diagnosed with ADHD.

 

References

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Authors

Michael W. Firmin and Chi-en Hwang, Cedarville University ; Annie Phillips, Regent University ; and Richard A. Wantz, Wright State University .

Correspondence concerning this article should be addressed to Richard A. Wantz, Department of Human Services, College of Education and Human Services, 3640 Colonel Glenn Highway , M052 CA, Wright State University , Dayton , OH 45435-0001 . (937) 775-3481, E-mail: rick.wantz@wright.ed