Anthony_Rostain_AIA_15_Bzb6ml.png.jpgGraziano PA, Reid A, Slavec J, Paneto A, McNamara JP, Geffken GR. “ADHD Symptomatology and Risky Health, Driving, and Financial Behaviors in College: The Mediating Role of Sensation Seeking and Effortful Control” Journal of Attention Disorders (2014) Epub ahead of print April. DOI: 10.1177/1087054714527792.

This study explores the relative contributions of “top-down” (i.e. effortful control) and “bottom up” (i.e. sensation seeking) mental processes to maladaptive risky behaviors in college students with ADHD. The authors review these constructs by pointing out that effortful aspects of self-regulation involve intact prefrontal circuits underlying executive functions whereas reactive behaviors not requiring conscious mental resources are influenced by emotional stimuli and are mediated by subcortical brain structures. Given that ADHD involves difficulties in both these domains of psychological functioning, it makes sense to explore which contribute to the onset of maladaptive risk-taking in college students with ADHD.

The authors studied 555 college students attending a southeastern university using an online survey for which they received class credit. Participants filled out standardized rating scales to assess outcomes. Of the total sample, 5.7% reported a history of an ADHD diagnosis and 10.8% reported elevated ADHD symptoms (> 1.5 SD above the mean) on an ADHD rating scale. There were two distinct patterns of risk behaviors: risky driving/financial behaviors and risky health behaviors. ADHD symptoms were highly correlated with these two factors as well as with sensation seeking and effortful control. More ADHD symptoms were associated with risky behaviors ONLY when effortful control was low. Sensation seeking was more highly associated with risky health behaviors but not risky driving/financial behaviors.

The authors note that the study’s reliance on self-report scales and measures limits its validity. ADHD individuals are known to underreport severity of symptoms. Moreover, it was not possible to detect the presence of antisocial behaviors (e.g. Conduct Disorder) that might have a greater impact on risky behaviors than ADHD symptoms. Finally, the fact that the study was conducted on a single campus may limit the generalizability of its findings to the entire population of US college students.

Despite these limitations, this paper reports interesting results suggesting that ADHD symptoms may not be as important as effortful control deficits and as high stimulus seeking in mediating the onset of risk behaviors in this population. These could be important targets for psychological therapies. It also points to the relevance of these two aspects of psychological functioning for preventive health efforts to reduce health, driving and financial risk behaviors, and for clinical approaches to dealing with patients presenting with maladaptive coping mechanisms.

Anthony L. Rostain, MD MA

About Anthony L. Rostain, MD MA

Dr. Rostain is Director of Education, Department of Psychiatry, Professor of Psychiatry and Professor of Pediatrics at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia. He is immediate past President of APSARD, the American Professional Society of ADHD and Related Disorders, and is on the Advisory Board of ADHD in