Beyond the label: identifying modifiable predictors of ADHD-like adaptation in young adults

Attention Deficit Hiperactivity Disorder (ADHD) diagnoses have risen sharply, but this surge may partly stem from diagnostic oversimplification rather than genuine neurodevelopmental pathology. University students, a population particularly prone to self-attributed cognitive difficulties, often report inattention that prompts hasty clinical conclusions and stimulant-seeking behaviour, despite lacking early developmental indicators. This study aimed to disentangle neurodevelopmental ADHD traits from ADHD-like Adaptation in university students by integrating subjective attention complaints, clinical ADHD symptom profiles, and objective cognitive measures.

A total of 223 university students without formal psychiatric diagnoses were categorized into Possible ADHD (n = 50), ADHD-like Adaptation (n = 36), and No ADHD (n = 137) groups based on current symptoms (according to DSM-5 criteria) and retrospective childhood ADHD traits (assessed using the Wender-Utah Rating Scale). Self-perceived attention deficit (SPAD) was also assessed to capture participants' subjective experiences of attentional difficulties independent of formal diagnosis. Groups were compared in terms of cognitive performance (Stroop Test, Trail Making Test, MOXO-d-CPT), lifestyle factors (digital screen time, sleep quality assessed by the Pittsburgh Sleep Quality Index, and chronotype), and internalizing symptoms (assessed using the Beck Anxiety and Depression Inventories). Single-step and chained mediation analyses explored the relative contributions of neurodevelopmental vulnerability and contextual variables to ADHD symptomatology.

No significant differences were observed in objective measures of attentional accuracy or timing, either across SPAD groups or across clinical ADHD groups. However, individuals with SPAD(+), Possible ADHD, and ADHD-like Adaptation exhibited higher levels of impulsivity and hyperactivity compared with their respective control groups. ADHD symptoms were associated with poor sleep quality, problematic technology use, risky alcohol consumption, elevated stress, anxiety and depression. Importantly, mediation analyses revealed that these lifestyle and psychosocial risk factors accounted for only a modest portion of adult ADHD-like Adaptation (indirect β ranging from 0.140 to 0.241, all p< .001; mediation percentages between 20.41% and 29.93%). The primary determinant remained neurodevelopmental ADHD vulnerability (direct β range: 0.497 - 0.546, all p< .001).

These findings suggest that subjective attention difficulties without clear neurodevelopmental markers may constitute a pathway through which processes of self-labeling and clinical misattribution increase vulnerability to ADHD overdiagnosis.