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ADHD - Adult

Depression, stress, anxiety, and impairment in college students with positive ADHD screens - DASS-21 Limitations

(PS1-C53) Depression, Stress, Anxiety, and Impairment in College Students with Positive ADHD Screens - DASS-21 Limitations

Friday, November 17, 2023
8:30 AM – 9:30 AM PST
Location: Regency Ballroom, Level 7
Clinicians who assess or treat college students for Attention-Deficit/Hyperactivity Disorder (ADHD) must often consider comorbid symptoms of depression, anxiety, and stress. ADHD symptoms commonly occur with depression and anxiety but measuring the impact of these symptom comorbidities on impairment is challenging. We hypothesized that students screening positive for ADHD would also report more impairment if they reported significant comorbid depression, anxiety, or stress symptoms on the Depression Anxiety Stress Scale – 21 (DASS-21; Lovibond & Lovibond, 1995). A sample of 155 college students, with a mean age of 19.88 years completed the Adult ADHD Self-Report Scale (ASRS-v1.1; Kessler et al., 2005) and the DASS-21, both commonly used screening instruments. Participants also completed the Weiss Functional Impairment Rating Scale – Self-Report (WFIRS-S; Weiss, 2000) which assesses impairment in individuals with ADHD. The initial sample consisted of 107 females (69.0%), 43 males (27.7%), 4 nonbinary (2.6%), and 1 preferred not to answer (0.6%). Positive screens for ADHD were found for n = 77 students. Results confirmed that total impairment was positively correlated with the DASS-21 depression (r = .58, p < .001), anxiety (r = .40, p < .001,) and stress (r = .62, p < .001) scale scores for those who screened positive for ADHD. Additional ANOVA procedures compared impairment scores for positive ADHD screeners scoring within normal versus nonnormal ranges for 1) depressive symptoms, 2) anxiety symptoms; and 3) stress-related symptoms. Mean comparisons showed that individuals with both a positive ADHD screen and a depression score higher than the normal range had higher impairment (M = 65.98, SD = 27.98) than those with depression scores within normal limits (M = 45.41, SD = 21.59, F(1, 68) = 9.82, p = .003). Individuals screening positive for ADHD and who had stress scores outside the normal range had higher rated impairment (M = 68.5, SD = 27.78) than those with stress scores within normal limits (M = 41.80, SD = 17.36, F(1,68) = 18.84, p < .001). However, individuals screening positive for ADHD and who had anxiety scores outside the normal range did not have significantly higher impairment scores than those with anxiety scores within normal limits. This last finding was unexpected as anxiety scores were significantly correlated with impairment for those who screened positive for ADHD. Overall, these analyses suggest greater impairment for students with significant ADHD symptoms who also report depression and stress above the normal range as measured by the DASS-21, but no significantly greater impairment for nonnormal anxiety scores. This last finding may reflect a lack of sensitivity in the DASS-21 anxiety scale to aspects of anxiety associated with impairment. It may instead reflect a constricted “normal” range of anxiety scores. Future research should evaluate this and other anxiety measures for sensitivity to expected additional impairment experienced by persons with ADHD concerns. Clinicians should carefully assess anxiety, depression, and stress responses in clients with ADHD concerns given their additive impact on impairment.