Parsing Day-to-Day Dynamics of ADHD and Perceived Stress in College Students: An Ecological Momentary Assessment...

Although ADHD is characterized as a lifelong condition, emerging evidence indicates that symptom severity can fluctuate day-to-day. In this study, we examined whether these fluctuations are directionally associated with fluctuations in perceived stress, using 28 days of ecological momentary assessment data.

Participants were 187 undergraduate students (Mage = 19.7 years; 78% women). We estimated temporal, contemporaneous, and between-subject networks.

At the sum-score level, ADHD and perceived stress were consistently positively associated across all three network types. In analyses of ADHD symptoms and perceived stress, increases in ADHD-related concentration difficulties and procrastination were associated with higher levels of perceived stress on the following day. Conversely, increases in perceived stress, particularly feelings of lacking control, were associated with elevated ADHD symptoms the next day. In the contemporaneous network, ADHD-related procrastination, restlessness, and concentration difficulties showed the strongest associations with perceived stress. These symptoms were also prominent in the between-person network, which additionally identified dependence on others for organization as a key ADHD-related feature unique to this level of analysis. Negative ADHD-perceived stress relations also appeared in both contemporaneous and between-person networks.

Overall, findings highlighted specific dynamics that may underlie the overlap between ADHD and perceived stress, particularly during the demanding period of college adjustment, with key elements serving as potential early warning signals and targets for micro-level interventions to disrupt escalating cycles of co-occurrence.