Why do university students with a high level of ADHD symptoms also show negative mood symptoms?
In 1968, Attention-Deficit/Hyperactivity Disorder (ADHD) was described for the first time in the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The core symptoms were defined as inattention, impulsiveness, and hyperactivity/motor restlessness and an irresistible urge to move. Since then, the definition of ADHD has been further developed based on research and clinical observations.
One remarkable observation is that the core symptoms hardly ever come alone; patients with ADHD commonly suffer from other comorbid psychiatric disorders such as mood disorders.
In particular, symptoms of depression, anxiety, and psychological distress appear closely related to ADHD. Interestingly, this ADHD-mood symptom relationship is not limited to patients only; they are also found in subclinical and even non-clinical populations. For example, the amount of inattentive symptoms in a sample of nonclinical university students, relates to the amount of depression, anxiety, and stress symptoms.
This finding has triggered researchers to propose different explanations why this relationship exists. From the neurological point of view, ADHD and mood symptoms share in common dysfunctional neurotransmitter systems and similar anomalies in brain activity, more specifically the dopaminergic dysfunction. Another explanation is that mood symptoms are the result of primary deficits in self-regulation (of affect) and emotional lability in ADHD. A third explanation is that negative mood symptoms are triggered by ADHD related functional shortcomings. For example, patients with ADHD often suffer from low academic achievement, driving problems, difficulties in the relationship with individual’s partner, and experiencing other daily shortcomings in different settings such as work-, school-, and family-related problems. Such negative outcomes of having high levels of ADHD symptoms may elicit negative mood.
This association is expected to be most pronounced in stressful environments, for the reason that ADHD may be obstructing the ability to meet demands in high-stress situations. One such example of stressful environments consists of university for first-year students. That is, for first-year students, university may represent a challenging and stressful environment as they try to adhere to the high classwork and social demands. The stresses of university were discussed by Norwalk, Norvilitis, and MacLean (2009): “compared to high schools, university students have much less structured academic environment, which provide more distractions than what students got used to in their high schools”. Consequently, first-year students with a high level of ADHD symptoms are expected to demonstrate elevated levels of inattentive symptoms and consequently having a higher chance of failing academic assignments/tasks. This may, in turn, lead to high levels of negative mood.
In a recently published study, we investigated the exact extent in which severity of ADHD symptoms (i.e. inattentive, impulsive, and hyperactive symptoms combined) and related daily life functional shortcomings contribute to the severity of mood symptoms (depressive, anxious, and stress moods combined) in first-year Psychology students of University of Groningen. My colleagueas an I hypothesised that the more ADHD related functional shortcomings an individual experiences, the higher level of mood symptoms an individual shows (e.g., being depressive, anxious, and/or stressed). Three hundred forty-three students filled out four self-reported scales, measuring ADHD symptoms, ADHD related shortcomings in life settings (such family, work, college, and social life) and executive functions in daily life context (such as daily skills in planning, organization, and controlling impulsive activities).
The study outcomes showed that regardless of the amount of ADHD symptoms, the independent contribution of daily life functional shortcomings (including low executive functioning) to the severity of mood symptoms is 42% to 53%. The amount of ADHD symptoms predicted 20% of mood symptoms; however, after controlling for daily life shortcomings, this predicted percentage dropped from 20 to be 1 %.
This means that daily life functional shortcomings explained 95% of the severity of mood symptoms in students with high levels of ADHD symptoms. We concluded that experiencing difficulties and functional shortcomings related with ADHD are the main causes/predictors of mood symptoms in student population.
Recommendations
The worldwide COVID-19 pandemic may yield an extra level of stress in the student population. Taking this into account, the functional shortcomings in students with high levels of ADHD symptoms may even increase. This can result in a dramatic increase in the level of mood symptoms in university students as we speak.
The university as an institution may be encouraged to provide extra help to those students who suffer from ADHD by providing, for example specialized staff (e.g. study advisors) with a clear goal to diminishing stress in these students. For clinicians, they may be more cautious when giving a diagnosis of mood disorders in students with ADHD as mood disorders could be inflicted by functional shortcomings that need to be solved first.
References
Mohamed, S. M., Börger, N. A., & van der Meere, J. J. (2020). Executive and Daily Life Functioning Influence the Relationship Between ADHD and Mood Symptoms in University Students. Journal of Attention Disorders, https://doi.org/10.1177/1087054719900251.
Norwalk, K., Norvilitis, J. M., & MacLean, M. G. (2009). ADHD symptomatology and its relationship to factors associated with college adjustment. Journal of Attention Disorders, 13(3), 251-258.
Picture credits: featured image downloaded from Flickr.com by Ali West (all creative commons).
In 2011, Saleh M. H. Mohamed obtained his master degree in neuropsychology, from the Psychology Department, Beni-Suef University (Egypt), wherein he was working as an assistant lecturer. In 2017, he got his PhD degree in clinical neuropsychology from University of Groningen, The Netherlands. His research interests are focused on adult ADHD symptoms and related problems (namely, deficits in brain laterality, motivation (effort allocation), error monitoring, and executive functioning).
During his PhD research, he investigated what goes awry in cognitive functioning in individuals with high levels of ADHD symptoms. More specifically, he tested whether adult ADHD symptoms can be better explained by lateral brain dysfunctions, motivational deficits (i.e., problems in effort allocation, also so-called State Regulation deficit), or executive dysfunctions.
His current research represents follow-up studies, testing the role of effort allocation in performing complex executive function tasks in ADHD as well as investigating error- processing, basic and complex cognitive functioning in patients diagnosed with ADHD.
Selected publications:
Mohamed, S. M. H., Borger, N. A., & van der Meere, J. J. (2020). Executive and Daily Life Functioning Influence the Relationship Between ADHD and Mood Symptoms in University Students. Journal of Attention Disorders, [1087054719900251]. https://doi.org/10.1177/1087054719900251
Mohamed, S. M. H., Börger, N. A., Geuze, R. H., & van der Meere, J. J. (2019). Error monitoring and daily life executive functioning. Experimental Brain Research, 237(9), 2217-2229. https://link.springer.com/(…)7/s00221-019-05589-w
Mohamed, S., Geuze, R. H., Borger, N., & van der Meere, J. J. (2017). Toestandregulatie, hersenlateralisatie en ADHD-symptomatologie bij volwassenen. Neuropraxis, 21(3), 49-57.
Mohamed, S. M. H., Börger, N. A., Geuze, R. H., & van der Meere, J. J. (2015). Brain lateralization and self-reported symptoms of ADHD in a population sample of adults: A dimensional approach. Frontiers in Psychology, 6, 1418. DOI: 10.3389/fpsyg.2015.01418
