(PS1-76) History of Assessment and Intervention Among Beginning College Students with Attention-Deficit/Hyperactivity Disorder Traits from Urban, Suburban, and Rural Hometowns

This study explored the potential differences in Attention-Deficit/Hyperactivity Disorder (ADHD) for college students from rural, suburban, and urban areas. Rural communities often face unique healthcare challenges, including limited access to services and higher poverty rates (Douthit et al., 2015; Dyk et al., 2018; Lenardson et al., 2010). Despite these challenges, findings from a study in Ohio suggest that rurality does not negatively impact the quality of ADHD care (Epstein et al., 2014). Against this backdrop, this study retrospectively examined the experiences of college students with ADHD, focusing on aspects of diagnosis and treatment.  The study utilized data from a diverse sample from the University Learning, Emotion, and Attention Research Network (ULEARN) consortium, which spans eight universities across the United States. Participants were college students in their first year at their respective institution with a self-reported existing ADHD diagnosis  (N = 776; 63.8% female, 31.6% male, 4.6% other [gender identity]; M age = 18.58 [SD = 1.3] years) and, for analyses related to hypothesis (a) only, those who meet the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) symptomatic threshold for an ADHD diagnosis in childhood (N = 1659; 66.1% female, 27.2% male, 6.7% other [gender identity]; M age = 19.55 [SD = 2.89] years). Hypotheses examined whether college students from rural areas differed from other students in: (a) the ratio of diagnosed to undiagnosed amongst those with elevated ADHD traits and, for those who do have a pre-existing diagnosis, (b) the age at which they received their diagnosis, (c) the type of professional who provided that diagnosis, (d) and whether medication and/or (e) psychosocial treatment were used to address their ADHD. 

The proportion of diagnosed versus undiagnosed individuals differed significantly across rural, suburban, and urban backgrounds χ²(2, N = 1659) = 12.10, p = .002. Standardized residuals revealed that urban students were significantly less likely to endorse an ADHD diagnosis, with a z-score of -2.10 (p < .05). However, no significant differences emerged for the age of diagnosis or the type of professional providing the diagnosis. Students from different geographic areas differed in their likelihood of receiving medication for ADHD χ²(2, N = 776) = 11.506, p = .003, but no significant differences were observed in the use of psychosocial treatment. Findings suggest that rurality influences ADHD diagnosis rates and the likelihood of receiving medication among college students, though other aspects of diagnostic history and treatment appear comparable across backgrounds. These results contribute to a better understanding of how rurality may shape ADHD service utilization in young adults and highlight areas for future research on healthcare accessibility.