Self-reported functional impairment in college students: relationship to noncredible reporting, ADHD, psychological disorders, and other psychological factors

Introduction: Both symptoms and functional impairment should be assessed in college students seeking evaluations for Attention Deficit Hyperactivity Disorder (ADHD). However, impairment is not specific to ADHD. Although it is well documented that self-reported symptoms can be reported noncredibly, there is less research examining credibility of self-reported impairment, and few clinicians rule out alternative causes for impairment. Method: Participants (N = 428) completed self-report measures of functional impairment, sleep, perceived stress, and in an ADHD symptom measure with embedded validity indicators. Results: Noncredible reporters endorsed greater functional impairment than credible reporters in several domains, but impairment was reported at a high rate even in credible responders (N = 323) in several domains. Participants who reported prior ADHD and participants who reported prior psychiatric diagnoses reported greater impairment and higher rates of clinically significant impairment than those who reported no prior diagnoses. Few differences in reported impairment emerged between those who reported ADHD and psychiatric diagnoses. Sleep and stress accounted for significant variance in impairment, and the ADHD group reported greater impairment than the psychiatric diagnosis and no diagnosis groups after controlling for these variables. Conclusions: Results reinforce the importance of considering the validity of, and alternative sources for, self-reported impairment in college students with ADHD concerns.