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Abstract

The purpose of this study was to assess the association between attention-deficit hyperactivity disorder (ADHD) symptoms and rejection sensitivity in college students, and whether it is mediated or moderated by elements of mental well-being. Using a cross-sectional design, the study examined 304 Hungarian college students who responded online to a set of questionnaires that included the Adult ADHD Self-Report Scale, The Mental Health Test, and the Rejection Sensitivity Questionnaire. Path analysis indicated that well-being, creative/executive proficiency, self-regulation, and resilience partially mediated the relationship between ADHD symptoms and rejection sensitivity, while savoring moderated this link. The model explained up to 50% of the total variance in rejection sensitivity scores. Findings suggest that university students with ADHD symptoms may particularly benefit from acquiring savoring skills to enhance their mental well-being and lower rejection to sensitivity. As such, the results carry significant implications for counseling psychologists, educators, and mental health professionals working in the higher education sector.

Keywords

university students rejection sensitivity ADHD symptoms

Young adulthood is marked by significant changes: individuation from family, development of new social connections, and increased responsibility and autonomy (Duffy et al., 2019). Moreover, this period presents a high risk for maladaptive cognitions, academic struggles, and the onset of mental health conditions, all while self-regulation skills are still under development (Tariq et al., 2021). Due to these unique stressors and vulnerabilities, university students are a population of particular interest to policy makers, mental health professionals, educators, and researchers (Emmerton et al., 2024). For many young adults, the university serves as the hoped-for environment for social and academic flourishing, yet the prevalence and intensity of mental health problems are on the rise (Sanders, 2023). While risk factors are well established, the literature offers little guidance on how to maintain positive mental health.

To help fill this gap in the literature, in this study we focused on the theory of positive psychology introduced by Seligman and Csikszentmihalyi (2000), which boosts research, enabling us to better understand the role of positive personality characteristics in flourishing at both individual and social levels. Flourishing, a relatively new concept in psychology, offers a promising framework to support the ongoing process of self-regulation and achieve emotional and social well-being. Notably, the well-established factors of positive psychology, such as competence, emotional stability, positive emotions, positive relationships, and resilience, significantly overlap with the characteristics needed for successful academic adjustment (Hassan et al., 2023). This is especially important for historically disadvantaged groups in higher education, who often find this transition particularly challenging. For example, diversity factors such as ethnicity, gender, sexuality, culture, socio-economic status, and disability can significantly heighten stress and psychological difficulties during this period (Volstad et al., 2020). Given the rising number of students with disabilities on college campuses (DuPaul et al., 2021), there is an urgent need for a framework that promotes our understanding of health maintenance, helps social adjustment, and empowers them to thrive in this environment.

Incoming first-year university students represent a population with a significant prevalence of attention-deficit hyperactivity disorder (ADHD), with Mak et al. (2022) reporting that 15.9% of university students across nine countries screened positive for ADHD risk and Shaw and Selman (2023) noting a prevalence of 8.4% in the United Kingdom. Despite increasing awareness, a concerning number of individuals remain undiagnosed (Lovett et al., 2015), however. This issue is particularly concerning in Hungary, as national data suggests that ADHD prevalence among adults falls between 2% and 4% (Bitter et al., 2010). However, data on the prevalence of ADHD among university students is still unavailable, and existing resources for diagnosis and intervention are insufficient to meet the significant demand (Kilencz et al., 2024). This disparity likely contributes to a high number of students with ADHD symptoms remaining undiagnosed.

University students with ADHD symptoms face substantial challenges in their education. Such struggles often stem from difficulties with emotion regulation and a heightened vulnerability to internalizing disorders (Farmer et al., 2023). Thus, growing research acknowledges emotional symptoms as intrinsic to ADHD, emphasizing their impact on well-being, educational outcomes, and mental health (Reimherr et al., 2020; Villemonteix et al., 2015). It is important to acknowledge that self-reported ADHD symptoms can overlap with other conditions, including substance use disorders (Bahji, 2024), autism spectrum disorder (Waldren et al., 2024), learning disabilities (Kellens et al., 2024), bipolar disorder (Barden et al., 2023), mood disorders (particularly major depressive disorder), and generalized anxiety disorder (Alarachi et al., 2024). However, the high prevalence of emotional dysregulation alongside ADHD symptoms is independent of comorbidity (Shaw et al., 2014), underscoring the need for a deeper understanding of these connections, especially within the unique population of university students (Lovett et al., 2015).

Highlighting the need for assessment and support for this population, our study investigated the connection between ADHD symptoms and rejection sensitivity (RS) among college students. Specifically, we examined whether constructs of mental well-being, including resilience, self-regulation, general well-being, and creative/executive functioning, mediate or moderate this relationship.

The Link Between RS and ADHD

RS is a cognitive-behavioral construct that refers to the predisposition to anxiously anticipate, quickly identify, and overreact to instances of rejection (Downey et al., 1997). While not recognized as a distinct diagnostic entity, it is understood to be a cognitive-affective bias or personality disposition characterized by an increased sensitivity to social rejection (Gardner et al., 2020). This negative emotional reaction, while widespread, is chronically understudied, especially in the context of adult ADHD symptoms.

The RS model (Downey & Feldman, 1996) suggests that extreme sensitivity to signals of rejection, leading to overreactions, stems from a natural learning process. Such sensitivity can be a product of early, extended, or intense experiences of rejection from caregivers or important individuals in a person's life (Gardner et al., 2020). Through these experiences, children learn to anticipate rejection in situations involving close relationships. Therefore, the anxious anticipation of rejection forms the starting point of the dynamics. This tends to result in a reduced threshold for perceiving negativity, a heightened tendency to take negative cues personally, and intense emotional responses (Pietrzak et al., 2005). This inclination toward oversensitivity, in turn, can alter behavioral patterns in a way that can result in actual rejection (Meehan et al., 2018; Mor & Inbar, 2009; Ng & Johnson, 2013).

Since high RS and the subsequent emotional symptoms are prevalent among individuals with ADHD traits (Babinski et al., 2019; Jaisle et al., 2023), some view them as an intrinsic aspect of the disorder rather than merely an associated characteristic (Faraone et al., 2019). Symptoms of ADHD are generally perceived negatively (Beaton et al., 2022) and often provoke a hostile emotional state and intense interpersonal rejection (Paulson et al., 2005). For example, children with ADHD symptomatology frequently experience peer rejection and negative interactions within their home environment. Further, parents are more inclined to demonstrate greater levels of criticism and lesser warmth towards children exhibiting ADHD traits (Psychogiou et al., 2007). Research has linked childhood ADHD symptoms and the often co-occurring oppositional behavior with negative attachment, implying that rejection by parents can, in some instances, be a persistent issue (Clarke et al., 2002; Gomez & Gomez, 2002).

The challenges that adults with ADHD symptoms encounter in social settings are well documented (Wymbs et al., 2021). Qualitative studies, for example, have revealed that adults with ADHD symptoms struggle with maintaining relationships (Kwon et al., 2018; Matheson et al., 2013) and moderating their behavior to conform to social norms (Schreuer & Dorot, 2017). In experimental research, undergraduate students expressed decreased levels of inclination to engage with individuals exhibiting behaviors characteristic of ADHD (Canu et al., 2008; Paulson et al., 2005). Further, negative perceptions of individuals living with ADHD symptoms are not contingent upon their success or abilities. Even high-functioning adults with ADHD symptomatology report experiencing heightened levels of judgment from others (Sedgwick et al., 2019).

Although adults with ADHD symptoms often encounter challenges in interpersonal relationships, social support can enhance functioning for this population (Ginapp et al., 2023). According to Segrin (2001), when individuals with ADHD symptoms face social rejection, they are more likely to respond by adopting avoidant behaviors. Additionally, they are prone to experience heightened psychological distress (Paulson et al., 2005).

The Mediating Role of Mental Well-Being in the Link Between ADHD and RS

Increased RS is associated with a lower quality of life, diminished social support, and reduced psychological well-being (Ng & Johnson, 2013). Furthermore, it has been found to predict the progression and outcome of depression, exhibiting a positive association with a higher prevalence of depressive symptoms (Ayduk et al., 2000; De Rubeis et al., 2017). While mental disorders have received extensive attention to date, there is a scarcity of published research on factors that promote positive adaptation and well-being in individuals with high RS.

In recent years, there has been a growing interest in well-being research (Rusk & Waters, 2015). Over this period, the concept of mental well-being has evolved from being solely defined as an absence of ill-being, focusing exclusively on positive individual functioning without accounting for emotions (Rose et al., 2017), to encompassing a state of flourishing (Keyes, 2007). Additionally, authors from the field of positive psychology emphasize the importance of assisting individuals in maintaining meaningful lives and achieving satisfaction. However, the mere elimination of negativity does not necessarily usher in positivity (Seligman et al., 2005).

Zábó et al. (2022) proposed the Maintainable Positive Mental Health Theory (MPMHT), an innovative framework building upon classical models and contemporary theories of positive psychology, which conceptualizes mental health as a function of personal capabilities such as resilience and creative/executive competencies. These attributes empower individuals to strike a balance with their external environment, thereby promoting personal growth. The components also ensure consistent functioning within an individual (through self-regulation) and facilitate the balance between positive and negative emotions (using coping and savoring strategies). The efficient interplay of these factors culminates in global well-being, a multifaceted construct encompassing personal and social dimensions. Notably, the MPMHT recognizes the critical role of social acceptance, making it potentially valuable for understanding and supporting adults with ADHD symptoms, who often experience heightened sensitivity to rejection.

In relation to RS, resilience acts as a mediator (Sart et al., 2016), enabling individuals to harness their mental resources to preserve their well-being in the face of stress and adversity. Higher resilience correlates with a more rapid recovery from stressful situations, including potential social rejections (Verdolini et al., 2021). Self-regulation strategies like delayed gratification and cognitive-attentional cooling can also help individuals with ADHD symptoms manage their emotional reactions to rejection, particularly in social situations (Ayduk et al., 2000). These strategies allow individuals to pause, assess the situation calmly, and respond more effectively, reducing the negative impact of the perceived rejection. Creative and executive efficiency refers to the ability to effectively generate diverse solutions to problems, both personally and socially (Zábó et al., 2022). By applying creative thinking to social interactions, individuals with ADHD symptoms can develop unique strategies to navigate potential rejections, minimizing their emotional impact (Kraines & Wells, 2017). Finally, global well-being encompasses not just psychological health but also spiritual and social dimensions (Zábó et al., 2022). This includes factors like social acceptance, self-actualization, and positive societal contributions. Individuals with higher levels of global well-being tend to view life and social interactions more positively (Lench & Bench, 2012). This positive outlook can alter the perception of social cues (Hecht, 2013), potentially mediating the perception of rejection.

The Role of Savoring Capacity in the Link Between ADHD and RS

Beyond well-being, resilience, self-regulation, and creative efficiency as potential mediators between ADHD symptoms and social functioning (Zábó et al., 2022), a fifth element may play a unique role in this relationship. Savoring, the ability and capacity to actively seek out, appreciate and hold onto positive experiences and pleasures (Bryant & Veroff, 2007; Bryan et al., 2022) is a prerequisite in the MPMHT framework (Zábó et al., 2022). Savoring is a key process within the broaden-and-build theory of positive emotions, which posits that positive emotions expand one's awareness and inspire a broader range of thoughts and actions. This expansion leads to the acquisition of new experiences, enhanced abilities, and stronger social ties, all of which contribute to greater health and relationship satisfaction. Furthermore, positive emotions can act as a cushion against the impact of negative emotions (Fredrickson, 2001; Smith & Bryant, 2016). This aligns with the Dynamic Model of Affect (DMA), suggesting that individuals have a wider range of emotional experiences in the absence of stress, with positive and negative emotions operating more independently (Walter & Bruch, 2008).

In addition to its direct association with well-being (eg, Bryant, 2003; Wood et al., 2003), savoring is further proposed as a moderator variable (Bryant & Veroff, 2007; Chadwick, 2012; Costa-Ramalho et al., 2015). That is, empirical research suggests that savoring acts as a moderating factor in various situations, from buffering the impact of traumatic experiences (Sytine et al., 2018) and moderating the link between negative emotions and suicidal behaviors (Klibert et al., 2019) to influencing the relationship between activity engagement and aspects of well-being, including life satisfaction, depression, loneliness, and sense of purpose (Smith et al., 2020). In the MPMHT framework, savoring belief refers to people's perceived capacity to savor positive life experiences. Although in the case of ADHD symptoms, sustaining attention to positive experiences often seems challenging (Segal, 2023), savoring could counterbalance the negative emotions associated with RS. While individuals with ADHD symptoms experience more stress and negative emotions during their university years than their peers without ADHD (Sahmurova et al., 2022), we anticipate that their capacity to savor may play a crucial role in experiences of rejection.

A previous study found that ADHD symptoms may directly predict RS (Hussain, 2024). However, given that RS likely stems from prior rejection by peers and parents (Gardner et al., 2020), rather than low capacity to savor, we proposed it would moderate rather than mediate (directly explain) the link between ADHD symptoms and RS. In particular, we expected higher levels of savoring to weaken or eliminate the association between ADHD symptoms and RS, while lower levels of savoring would strengthen this association. By enhancing the frequency and intensity of positive emotions, individuals with ADHD symptoms might experience a more balanced emotional state, potentially weakening the connection between the symptoms and RS.

Based on the related findings from the literature, the aim of our study was to (a) confirm a direct link between college students’ ADHD symptomatology and RS; (b) investigate whether the positive psychological constructs, well-being, creative and executive efficiency, self-regulation, and resilience, mediate the relationship between ADHD symptomatology and RS; and (c) to determine if savoring capacity moderates the relationship between the ADHD symptomatology and RS. Given the absence of a well-established theoretical framework regarding the potential predictive or moderating effects of savoring capacity in this relationship (Costa-Ramalho et al., 2015), the present study remains exploratory.

Method

Study Design and Participants

Between February and May of 2023, we conducted a cross-sectional study using an online Typeform survey. The study targeted all university students in Hungary by disseminating the survey through Neptun, a unified platform adopted by all Hungarian universities. To enhance reach, the questionnaire was also shared in Facebook groups popular among Hungarian students, particularly those focusing on research, psychology, and ADHD. Participation was voluntary, and no compensation was offered. To be included, participants had to (a) be over 18 years of age, (b) be active students at a Hungarian university, (c) give written informed consent, (d) report no difficulties in understanding the questions, and (e) admit to have responded truthfully and carefully. Application of these criteria did not lead to any exclusions. A total of 304 students, 237 (78%) female and 65 (21.4%) males, enrolled in higher education institutions in Hungary, participated in the study. Their ages ranged from 18 to 35 years (M = 24.38, SD = 4.39).

Hungary's universities and colleges award degrees through a well-established three-tier system aligned with the European Qualifications Framework (EQF). Bachelor's programs (EQF Level 6) typically take 6–8 semesters (3-4 years) to complete. Students can then pursue optional master's programs (EQF Level 7) lasting 2–4 semesters (1-2 years). A unique feature of the system is the undivided one-tier master's program, combining bachelor's and master's coursework into a single 5- to 6-year direct program for a master's degree in specific fields like medicine or teacher training. Finally, doctoral degrees (EQF Level 8) are pursued as 4-year postgraduate programs.

In our sample, 56.6% (n = 175) of the participants were in a bachelor's program, 21.7% (n = 66) in an undivided one-tier master's program, 13.8% (n = 42) in doctoral studies, and 6.9% (n = 21) were pursuing a master's degree. Most were full-time students (71.4%, n = 217), while 26.3% (n = 80) were part-time, and a minority were distance learners (2.3%, n = 7).

In the survey, participants could disclose learning disabilities/difficulties or decline disclosure. None of the participants reported having a learning disability (or chose to decline to answer); 11 participants (3.62%) reported a previous diagnosis of ADHD. All participants identified Hungarian as their primary language.

We strictly followed the principles of the Declaration of Helsinki and Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals formulated by the International Committee of Medical Journal Editors (ICMJE). The study procedures received approval from the Institutional Review Board of the University of Szeged, Doctoral School of Education (7/2021). After providing informed consent, participants shared demographic details and completed the survey. Notably, the participants responded to all items on the respective scales; no data were missing. The study materials were administered in the Hungarian language.

Measures

Attention-Deficit Hyperactivity Disorder

ADHD symptoms were screened using the Adult ADHD Self-Report Scale (ASRS-v.1.1), developed by the World Health Organization (WHO) (Kessler et al., 2005). The scale, which can be completed in a self-reported manner, encompasses 18 items (eg, “How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?”), each to be responded to on a five-point Likert scale indicating the frequency of the experienced symptoms from 0 (never) to 4 (very often). The primary goal of the ASRS-v1.1 is to serve as a reliable tool to identify adults who may need further assessment for ADHD. The scale is not intended to diagnose ADHD but to serve as a first step in the screening process. Total scores for the 18 items can range from 0 to 72. Higher scores reflect higher degrees of ADHD symptoms. In line with previous studies (eg, Hawi & Samaha, 2024; Garcia Pimenta et al., 2024), the current study assessed ADHD symptoms using the ASRS total scores, demonstrating good internal consistency (Cronbach's α = .87).

In addition to the total score, the first six items of the ASRS function as an effective screening tool for ADHD risk. While the original dichotomous scoring method (assigning 1 point for exceeding the threshold) has been updated, research suggests the 0–24 scale is more robust and better suited for studying ADHD prevalence and related factors compared to the 0–6 system (Kessler et al., 2007). This revised scale classifies scores into four categories: 0–9 (low negative risk), 10–13 (high negative risk), 14–17 (low positive risk), and 18–24 (high positive risk).

Mental Well-Being

The Mental Health Test (Zábó et al., 2022) was used to assess participants’ comprehensive picture of positive psychological well-being. The questionnaire consists of 18 items with five subscales. Three questionnaire items are suitable for measuring well-being (eg, “Joy is present more than sorrow in my everyday life.”), three assess savoring (eg, “I like to store memories of fun times that I go through so that I can recall them later.”), five items measure creative and executive efficiency (eg, “Others describe me as a problem solver.”). Three items assess self-regulation (eg, “I am impulsive: I act first and think second.”), and the final subscale made up of four items focuses on resilience (eg, “It does not take me long to recover from a stressful event.”). The items are responded to on a six-point Likert scale ranging from 1 (does not agree at all) to 6 (agrees completely). The internal consistency values of the subscales were above .70, more precisely: .89 for well-being, .76 for creative and executive efficiency, .70 for resilience, .71 for self-regulation, and .75 for savoring.

Rejection Sensitivity

The Rejection Sensitivity Questionnaire (A-RSQ; Berenson et al., 2009) assesses participants’ cognitive-emotional disposition to anticipate rejection anxiously. The A-RSQ comprises 18 scenarios presenting potential interpersonal encounters with a likelihood of rejection from an important figure (eg, “You ask your parents or another family member for a loan to help you through a difficult financial time.”). Participants are asked to assess their anxiety levels regarding the probable outcome of each presented situation. Additionally, they evaluate the perceived probability that the person of significance in each scenario would react with rejection. The cumulative RS score is calculated by the RS score for each situation by multiplying the rejection concern by the level of rejection expectancy. Scores can range from 18 to 432. Higher scores indicate a higher level of RS. Cronbach-α value = .84 in the current study.

Data Analysis

First, descriptive and correlational analyses were performed using the IBM Statistical Package for Social Sciences (SPSS, version 26.0.). Second, we conducted multiple mediators with a moderator analysis (Model 5) using Preacher and Hayes (2008) PROCESS macro v4.1 for IBM SPSS. The model used 5000 resamples through bootstrapping confidence intervals (CIs) to determine the significant effects. We followed Hayes’ (2022) recommendations, and the bias-corrected 95% CIs were selected. In this case, the indirect effect is significant if the CIs do not include 0. The conditional indirect effects were evaluated at three levels: one standard deviation above the sample mean, one below the sample mean, and the sample mean itself. Before conducting the path analyses, all continuous variables were standardized.

Results

Descriptive Statistics and Bivariate Relationships

Based on the ASRS screening tool, 23.9% (n = 89) of participants scored in the low negative, 35.9% (n = 109) in the high negative, 22.7% (n = 69) in the low positive, and 12.2% (n = 37) in the high positive category for ADHD risk. Before the mediation and moderation analysis, we examined the correlations between all variables, as detailed in Table 1. The ADHD symptom score demonstrated a positive correlation with RS scores (r = .46, p < .01). This suggests that as ADHD scores increased, RS scores also tended to increase. However, ADHD scores showed a significant negative correlation with measures of well-being (r = -.34, p < .01), indicating that higher ADHD scores were associated with lower well-being. Similarly, there were negative correlations with creative and executive efficiency (r = -.18, p < .01), self-regulation (r = -.23, p < .01), resilience (r = -.32, p < .01), and savoring (r = -.26, p < .01).

Table 1.
Intercorrelation Between Measured Variables for the Full Sample (N = 304).

Variables Min. Max. M SD Skewness Kurtosis 1 2 3 4 5 6

1. ADHD scores 2 63 32.12 11.74 0.388 −0.076 –

2. RS scores 18 363 96.70 53.69 0.872 0.708 .46 –

3. Well-being 3 18 11.47 3.94 −0.277 −0.676 -.34 -.55 –

4. CE efficiency 6 30 20.82 4.62 −0.234 −0.250 –18 –36 .36 –

5. Self-regulation 3 17 9.54 3.48 −0.171 0.791 –23 –25 .16 .08 –

6. Resilience 3 13 7.35 2.67 0.255 −0.665 –32 –43 .45 .29 .27 –

7. Savoring capacity 3 18 12.51 3.69 −0.462 −0.538 –26 –44 .57 .38 .14 .38

Note. CE efficiency = creative and executive efficiency, RS = rejection sensitivity.

**p < .01.

Further, the RS scores showed a significant negative correlation with well-being (r = -.55, p < .01), creative and executive efficiency (r = -.36, p < .01), self-regulation (r = -.25, p < .01), resilience (r = -.43, p < .01), and savoring (r = -.44, p < .01). Well-being, in turn, showed a positive correlation with creative and executive efficiency (r = .36, p < .01), self-regulation (r = .16, p < .01), resilience (r = .45, p < .01), and savoring (r = .57, p < .01). Creative and executive efficiency also positively correlated with resilience (r = .29, p < .01), and savoring (r = .38, p < .01). Lastly, there was a significant positive correlation between resilience and savoring (r = .38, p < .01). Finally, although the data indicated a positive correlation between creative and executive efficiency and self-regulation (r = .08, p > .05), it was not statistically significant.

The skewness and kurtosis values of the measured variables fell within the acceptable range of ± 1.0 (Hair et al., 2022), suggesting that the data distribution was approximately normal. Furthermore, variance inflation factors ranging from 1.07 to 1.66 and tolerance values between 0.60 and 0.71 indicated no substantial multicollinearity among the independent variables. The data also met the assumption of independent errors (Durbin–Watson = 1.93), and homoscedasticity was confirmed by the Breusch–Pagan test (χ² = 6.25, p = 0.09). Based on these results, all the correlated variables were included in the further analysis.

Mediation and Moderation Analyses

We conducted multiple mediators and a moderator analysis to assess the role of positive mental health constructs in the relationships between ADHD scores and RS. The mediator variables included well-being, resilience, self-regulation, and creative and executive efficiency competence. Furthermore, the model explored the direct effect of ADHD symptoms on RS and whether it was mediated or moderated by savoring capacity.

First, we assessed the relationships between ADHD scores and each of the mediators. ADHD scores were significantly associated with each mediator. The analysis revealed that an increase in ADHD scores was associated with a decrease in all four mediators. ADHD scores were negatively associated with well-being (β = -.343, p < .001), creative and executive efficiency competence (β = -.183, p < .01), self-regulation (β = -.230, p < .01), resilience (β = -.321, p < .001), indicating that as ADHD scores increased, scores on these variables tended to decrease.

Next, the direct effect of ADHD scores on RS scores was assessed. The analysis revealed a significant positive association (β = .466, p < .001), suggesting that as ADHD scores rise, there is a similar increase in RS scores. The relationships between the mediator variables and RS scores were also examined. Well-being (β = -.302, p < .001), creative and executive efficiency (β = -.157, p < .01), self-regulation (β = -.157, p < .01), and resilience (β = -.112, p < .05) had a direct effect on the outcome variable. These findings imply that lower scores on these variables were associated with higher RS scores.

Mediation Effect

Finally, we explored the indirect effects of ADHD scores on RS scores through the mediators. These indirect effects, represented by the total of the individual indirect effects via well-being (B = .103), creative and executive efficiency competence (B = .028), self-regulation (B = .023), and resilience (B = .036), indicate that these variables serve as pathways in the link between ADHD symptom severity and RS scores. Savoring capacity did not meet the criteria for mediation as defined by Baron and Kenny (1986) due to a non-significant beta coefficient (β = -.035, p = .526). After controlling for the measured variables, ADHD scores demonstrated a significant effect of .227 (p < .001) on RS scores, indicating partial mediation. Based on 5000 bootstrap samples, all direct and indirect paths were significant (except for savoring capacity as a mediator), as the 95% bias-corrected CIs did not include zero in each case (see Table 2).

Table 2.
Point Estimates and 95% CIs for the Indirect Effect of ASRS Scores on Rejection Sensitivity Through the Mediator Variables.

Mediator Point estimate SE Lower BC 95% CI Upper BC 95% CI p

Total indirect effects .192 .039 .120 .273 < .001

Well-being .103 .029 .051 .164 < .001

Creative and executive efficiency .028 .013 .006 .057 < .001

Self-regulation .024 .012 .003 .051 < .05

Resilience .036 .020 .001 .080 < .05

Savoring .006 .013 –018 .090 .499

Note. BC = bias corrected; CI = confidence intervals; 5000 bootstrap samples.

Moderation Effect

The moderation analysis revealed that savoring capacity significantly moderated the relationship between ADHD and RS (β = −.244, p < .001). The buffering impact was significant at low (−1 SD) and mean levels of savoring, but diminishes at the higher level (+1 SD), as presented in Table 3. For students who reported low and mean levels of savoring, the relationship between ADHD and RS was stronger and significant. For students with high levels of savoring, on the other hand, the relationship between ADHD and RS was weaker and insignificant. The overall model explained 50% of the variance in the RS scores (R²= .508, F = 43.787, p < .001). Figure 1 provides the final model, incorporating both direct and indirect effects.

Figure 1.
Multiple mediators and a moderator model

Table 3.
Point Estimates and 95% CIs for the Moderating Effect of Savoring Capacity on the Relationship Between ADHD and Rejection Sensitivity.

95% CI

Estimate SE LL UL p

Low (−1SD) 0.472 0.057 0.359 0.584 < .001

Mean 0.227 0.045 0.138 0.316 < .001

High (+1 SD) −0.017 0.063 −0.142 0.107 .783

Note. CI = confidence interval; LL = lower limit; UL = upper limit.

Discussion

This study examined the underlying mechanisms in the link between ADHD symptoms and RS among college students, with particular emphasis on their mental well-being. As illustrated, our results indicated a direct positive link between ADHD symptoms and RS. This relationship can be partially explained by inadequate levels of well-being, creative and executive efficiency, self-regulation, and resilience. Additionally, savoring capacity acted as a moderator between these two constructs. Students with low levels of savoring capacity had a stronger connection between ADHD symptoms and RS.

The Mediating Role of Positive Psychological Constructs

The fundamental constructs of the MPMHT mediated the relationship between ADHD symptoms and RS scores and partially explain the observed connection. Previous studies have linked RS and reduced well-being (Efeoglu & Sen, 2022); however, the influence of ADHD symptoms within this context has remained unexplored.

First, well-being had the most substantial mediating effect, suggesting that ADHD symptoms might lead to reduced feelings of well-being (Fuller-Thomson et al., 2022). Individuals with ADHD symptoms often encounter social and emotional challenges that can affect their overall sense of well-being, subsequently heightening their awareness of signs of rejection. Second, creative and executive efficiency plays a pivotal role in this relationship. While individuals with ADHD symptoms may exhibit a rich diversity of creative thoughts (Girard-Joyal & Gauthier, 2022), they may struggle to filter, refine, or execute them efficiently due to executive function challenges. This inefficiency in managing creative thoughts could lead to heightened sensitivity to rejection, as these individuals might perceive their ideas as frequently dismissed or misunderstood. Reduced scores in creative and executive efficiency may lead to perceiving problems as threats, resulting in a tendency to avoid rather than proactively address challenges (Kraines & Wells, 2017). Third, resilience acts as a mediator. Given that individuals with ADHD symptoms frequently face setbacks and challenges that can diminish their capacity to rebound from adverse situations (Freire et al., 2021), individuals may develop a heightened sensitivity to negative feedback, as they may lack the adaptive mechanisms to recover from such experiences. Lastly, self-regulation, often compromised in ADHD (Christiansen et al., 2019), can lead to impulsivity and difficulties in managing emotional responses, further reducing its protective effect on sensitivity to rejection.

Although the proposed mediators provide a comprehensive framework for understanding the interaction between ADHD symptoms and RS, and explained a substantial proportion of the variance in RS scores in the current study, full mediation was not achieved. The partial mediation observed, along with existing literature (Hussain, 2024; Oti et al., 2024), suggests that other factors, such as depression, anxiety, and psychological flexibility, warrant further research in this context.

The Moderating Role of Savoring Capacity

Savoring capacity plays a crucial moderating role in the relationship between ADHD symptoms and RS. While prior research has highlighted the moderating role of savoring capacity on health and life satisfaction (Smith & Bryant, 2016), the specific relationship between ADHD symptoms and savoring capacity, especially concerning RS, has not been explored to the best of our knowledge. Our data indicate that at low savoring levels, the connection between ADHD symptoms and RS was most pronounced. This suggests that individuals with ADHD symptoms may be more prone to feelings of rejection when they have difficulty savoring positive moments. At a medium savoring level, the effect was reduced. Interesting, at high savoring levels, the effect was not significant.

These findings may be understood by examining attention, emotion, cognitive aspects, social behaviors, and self-esteem. One of the hallmark symptoms of ADHD is difficulty with sustained attention (Segal, 2023). Savoring requires one to be present and attentive to the current moment, especially positive moments (Gregory et al., 2023). When individuals with ADHD symptoms struggle with maintaining attention to positive experiences, they might miss out on the emotional benefit of those experiences. This might make negative experiences, like perceived rejections, more salient and impactful. Savoring involves experiencing positive moments and reflecting on them (Gentzler et al., 2016), which can help in the cognitive reframing of negative experiences. An individual with a strong savoring capacity might recall a positive interaction to counterbalance a negative one. If this capacity is diminished, however, as it might be in some individuals with ADHD symptoms, they could struggle with this reframing, leading to a heightened sensitivity to rejection.

Savoring can also contribute to perceived self-esteem and validation (Goodall, 2015). Consistently missing out on the opportunity to savor positive experiences might lead to feelings of low self-worth. This, combined with ADHD symptoms, might make individuals more sensitive to external validation and, consequently, more sensitive to perceived rejections. Our findings point to the protective role of strong savoring abilities against feelings of rejection in college students with ADHD symptoms, emphasizing the potential benefits of interventions focused on enhancing this ability.

Practical Implications

Universities are currently facing a surge in student demand for mental health services, outpacing enrollment growth. This mirrors the rising prevalence of mental health issues among young adults. Consequently, institutions of higher learning have the potential to become the forefront for mental health promotion, prevention, and early intervention (Duffy et al., 2019). This aligns with the recommendations of Solmi et al. (2022), who advocated for integrated models that address mental health needs within the university community, encompassing both at-risk students and those already experiencing mental health challenges.

Cognitive-behavioral therapy (CBT) programs are a common intervention for university students with ADHD symptoms. These programs address such areas as executive functioning, co-occurring conditions like depression and anxiety (Anastropoulos et al., 2021; Solanto & Scheres, 2020), academic skills and coping mechanisms, stress management (Bettis et al., 2017; Van der Oord et al., 2020), and overall ADHD symptoms and life functioning (Eddy et al., 2021). While mindfulness-based and neurofeedback approaches are less common (eg, Harris et al., 2019), most programs emphasize organizational skills and time management (Hartung et al., 2022; LaCount et al., 2018). A systematic review by Álvarez-Godos et al. (2023) examining these interventions found the greatest improvements were in attention, executive functioning, anxiety, and organization. Moderate improvements were seen in study skills, self-concept, and depression, with smaller effects on stress, academic performance, and hyperactivity. Interestingly, behavior regulation showed the least improvement.

Although positive coping programs demonstrably reduce negative emotions, evidence for mindfulness-based and relaxation-based programs improving positive emotional outcomes is mixed (Klibert et al., 2022). The results of the present study are highly promising and shed light on the potential of savoring-based psychosocial interventions. The novel Behavioral Activation plus Savoring (BA + S) intervention (Kumar et al., 2024) represents this approach, supporting Klibert et al.'s (2022) work on savoring exercises as a preventive strategy against social stressors.

It is worth noting that savoring interventions have not been specifically developed for students with ADHD symptoms. We suggest that interventions focusing on cognitive imagery, memorabilia, the Three Good Things, increasing self-awareness of personal achievements, positive imagination, noticing pleasurable features in their environment, structured photography exercises, and reflecting on recent acts of kindness could nurture the capacity for savoring and serve as a first-line intervention for this population (Parks & Schueller, 2014). A starting point in this process would be to incorporate these elements into existing interventions to enhance their effectiveness and improve the modest results currently seen in emotional and behavior regulation.

Strengths and Limitations

This study has several key strengths, including the use of the MPMHT as a novel framework for understanding the connection between ADHD symptoms and RS. It also offers a potential explanation of how factors of mental well-being may play a role in this relationship either as a mediator or a moderator. Moreover, our investigation of these associations within the Hungarian context adds a novel dimension to the research. However, this study is not without limitations.

First, our data are derived from self-reports. Although the ASRS scale has been validated for screening purposes (Farcas et al., 2018; Kessler et al., 2005), it cannot replace clinical diagnoses. While the recruitment materials did not explicitly mention the study's specific purpose to avoid self-selection bias, we distributed the questionnaire in groups frequented by students interested in ADHD and psychology. This approach poses a limitation as it may have resulted in a relatively higher proportion of students with high levels of ADHD symptoms in our sample. In our study, 31.9% of the participants met the criteria for ADHD risk (low and high positive). Our findings align with those of Farcas et al. (2018), who reported similar unweighted prevalence rates of ADHD risk (37.3%) in Hungarian university students using the same ASRS-v1.1 screening tool. Furthermore, the 2–3 years long waiting lists for ADHD screening in Hungarian hospitals (Kilencz et al., 2024) could contribute to a higher prevalence of undiagnosed students (or individuals awaiting diagnosis) within our sample.

Additionally, several factors may limit the generalizability of our findings. These include the relatively small sample size, the cross-sectional design, the absence of data on participants’ academic majors, and the disproportionately higher representation of female participants. With regard to the latter, our preliminary work did not reveal significant gender differences in the measured variables. While research suggests males are diagnosed with ADHD more frequently during childhood, this disparity appears to narrow by adulthood, with diagnoses becoming more balanced (Babinski, 2024). Although our findings are in line with this statement, the gender disparity in our sample cannot show ample evidence to confirm it; a more equal gender distribution with an exact diagnosis would be necessary for further justification. Anyway, the surplus of female respondents in our survey might be due to the observed tendency of women to participate more frequently in surveys than men (Becker, 2022). Since data are retrospective, reports of emotional intensity may be biased, potentially underestimating or overestimating actual experiences. Additionally, current mood can influence memories (Costa-Ramalho et al., 2015).

Future research on savoring experiences should employ longitudinal approaches with real-time assessments to address these limitations. Despite the extensive research on ADHD and savoring separately, there is a gap in the literature regarding the specific relationship between the two constructs. Future studies could explore how ADHD symptoms may impact an individual's ability to savor positive experiences and how this, in turn, affects their overall well-being and quality of life. While using validated self-report instruments in this study facilitates accessibility and replication with diverse international samples, it is important to acknowledge the limitations of focusing solely on savoring capacity. Further in-depth research is needed to fully understand the role of savoring experiences, processes, and strategies in this relationship. Despite these limitations, our study contributes significantly to our understanding of ADHD symptoms without pathologizing them which is especially relevant for university student populations.

Conclusion

This study contributes to the growing yet still limited body of research focusing on college students with ADHD symptoms. The results have shown that well-being, creative and executive proficiency, self-regulation, and resilience explain a significant portion of the association between ADHD symptoms and RS. Notably, the findings suggest that savoring – the ability to appreciate and amplify positive experiences – significantly moderates this connection, resulting in lower sensitivity to rejection. The primary takeaway of the study is that ADHD symptoms can increase RS due to compromised mental well-being. To counter this, interventions should focus on mental health promotion to support resilience and emotional well-being, and thereby help individuals with ADHD symptoms to navigate social challenges more effectively. The findings underscore the potential of incorporating interventions based on the MPMHT to effectively prevent the negative outcomes ADHD symptoms may spark. Such integration could improve current time management, planning, and CBT initiatives and pave the way for an innovative, strengths-based approach toward the target population.

Variables	Min.	Max.	M	SD	Skewness	Kurtosis	1	2	3	4	5	6
1. ADHD scores	2	63	32.12	11.74	0.388	−0.076	–
2. RS scores	18	363	96.70	53.69	0.872	0.708	.46**	–
3. Well-being	3	18	11.47	3.94	−0.277	−0.676	-.34**	-.55**	–
4. CE efficiency	6	30	20.82	4.62	−0.234	−0.250	–18**	–36**	.36**	–
5. Self-regulation	3	17	9.54	3.48	−0.171	0.791	–23**	–25**	.16**	.08	–
6. Resilience	3	13	7.35	2.67	0.255	−0.665	–32**	–43**	.45**	.29**	.27**	–
7. Savoring capacity	3	18	12.51	3.69	−0.462	−0.538	–26**	–44**	.57**	.38**	.14**	.38**

Mediator	Point estimate	SE	Lower BC 95% CI	Upper BC 95% CI	p
Total indirect effects	.192	.039	.120	.273	< .001
Well-being	.103	.029	.051	.164	< .001
Creative and executive efficiency	.028	.013	.006	.057	< .001
Self-regulation	.024	.012	.003	.051	< .05
Resilience	.036	.020	.001	.080	< .05
Savoring	.006	.013	–018	.090	.499

			95% CI
Low (−1SD)	0.472	0.057	0.359	0.584	< .001
Mean	0.227	0.045	0.138	0.316	< .001
High (+1 SD)	−0.017	0.063	−0.142	0.107	.783

Footnotes

Author Contributions

Vanessa Müller: Methodology, formal analysis, investigation, writing—original draft, and visualization. David Mellor: Writing —review and editing. Bettina Pikó: Conceptualization, validation, resources, supervision, and project administration.

Consent to Publish

Not applicable.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration of Generative AI in Scientific Writing

During the preparation of this work, the authors used Grammarly and Writefull in order to improve the manuscript's language clarity and overall coherence. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Ethical Approval

All procedures performed in the study are in accordance with the ethical standards of the Helsinki Declaration and the Institutional Review Board (7/2021). Informed consent was obtained from all individual participants included in the study.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: When data reported in this study were collected, Vanessa Müller was supported by the New National Excellence Program of the Ministry for Culture and Innovation from the National Research, Development and Innovation Fund, No. ÚNKP-23-3-SZTE-66. The content is solely the responsibility of the authors and does not represent the official views of the Ministry for Culture and Innovation.

ORCID iDs

Vanessa Müller

Bettina F Pikó

References

Alarachi

Merrifield

Rowa

McCabe

R. E.

(2024). Are we measuring ADHD or anxiety? Examining the factor structure and discriminant validity of the adult ADHD self-report scale in an adult anxiety disorder population. Assessment, 10731911231225190. https://doi.org/10.1177/10731911231225190

Álvarez-Godos

Ferreira

Vieira

M.-J.

(2023). A systematic review of actions aimed at university students with ADHD. Frontiers in Psychology, 14, 1216692. https://doi.org/10.3389/fpsyg.2023.1216692

Anastopoulos

A. D.

King

K. A.

Besecker

L. H.

O’Rourke

S. R.

Bray

A. C.

Supple

A. J.

(2020). Cognitive-behavioral therapy for college students with ADHD: Temporal stability of improvements in functioning following active treatment. Journal of Attention Disorders, 24(6), 863–74. https://doi.org/10.1177/1087054717749932

Anastopoulos

A. D.

Langberg

J. M.

Eddy

L. D.

Silvia

P. J.

Labban

J. D.

(2021). A randomized controlled trial examining CBT for college students with ADHD. Journal of Consulting and Clinical Psychology, 89(1), 21–33. https://doi.org/10.1037/ccp0000553

Ayduk

Mendoza-Denton

Mischel

Downey

Peake

P. K.

Rodriguez

(2000). Regulating the interpersonal self: Strategic self-regulation for coping with rejection sensitivity. Journal of Personality and Social Psychology, 79(5), 776–92. https://doi.org/10.1037/0022-3514.79.5.776

Babinski

D. E.

(2024). Sex differences in ADHD: Review and priorities for future research. Current Psychiatry Reports, 26(4), 151–6. https://doi.org/10.1007/s11920-024-01492-6

Babinski

D. E.

Kujawa

Kessel

E. M.

Arfer

K. B.

Klein

D. N.

(2019). Sensitivity to peer feedback in young adolescents with symptoms of ADHD: Examination of neurophysiological and self-report measures. Journal of Abnormal Child Psychology, 47(4), 605–17. https://doi.org/10.1007/s10802-018-0470-2

Bahji

(2024). Navigating the complex intersection of substance use and psychiatric disorders: A comprehensive review. Journal of Clinical Medicine, 13(4), Article 4. https://doi.org/10.3390/jcm13040999

Barden

E. P.

Polizzi

C. P.

Vizgaitis

A. L.

Bottini

Ergas

Krantweiss

A. R.

(2023). Hyperactivity or mania: Examining the overlap of scales measuring attention-deficit/hyperactivity disorder and bipolar spectrum disorders in an assessment context. Practice Innovations, 8(2), 102–15. https://doi.org/10.1037/pri0000202

10.

Baron

R. M.

Kenny

D. A.

(1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–82. https://doi.org/10.1037/0022-3514.51.6.1173

11.

Beaton

D. M.

Sirois

Milne

(2022). Experiences of criticism in adults with ADHD: A qualitative study. PLOS ONE, 17(2), e0263366. https://doi.org/10.1371/journal.pone.0263366

12.

Becker

(2022). Gender and survey participation: An event history analysis of the gender effects of survey participation in a probability-based multi-wave panel study with a sequential mixed-mode design. Methods, Data, Analyses, 16(1), 30. https://doi.org/10.12758/mda.2021.08

13.

Berenson

K. R.

Gyurak

Ayduk

Downey

Garner

M. J.

Mogg

Bradley

B. P.

Pine

D. S.

(2009). Rejection sensitivity and disruption of attention by social threat cues. Journal of Research in Personality, 43(6), 1064–72. https://doi.org/10.1016/j.jrp.2009.07.007

14.

Bettis

A. H.

Coiro

M. J.

England

Murphy

L. K.

Zelkowitz

R. L.

Dejardins

Eskridge

Adery

L. H.

Yarboi

Pardo

Compas

B. E.

(2017). Comparison of two approaches to prevention of mental health problems in college students: Enhancing coping and executive function skills. Journal of American College Health, 65(5), 313–22. https://doi.org/10.1080/07448481.2017.1312411

15.

Bitter

Simon

Bálint

Udvardy-Meszaros

Czobor

(2010). How do different diagnostic criteria, age and gender affect the prevalence of attention deficit hyperactivity disorder in adults? An epidemiological study in a Hungarian community sample. European Archives of Psychiatry and Clinical Neuroscience, 260(4), 287–96. https://doi.org/10.1007/s00406-009-0076-3

16.

Bryan

M. A.

Mallik

Cochran

Lundahl

(2022). Mindfulness and savoring: A commentary on savoring strategies and their implications for addiction treatment. Substance Use and Misuse, 57(5), 822–826. https://doi.org/10.1080/10826084.2022.2046090

17.

Bryant

(2003). Savoring beliefs inventory (SBI): A scale for measuring beliefs about savouring. Journal of Mental Health, 12(2), 175–96. https://doi.org/10.1080/0963823031000103489

18.

Bryant

F. B.

Veroff

(2007). Savoring: A new model of positive experience. Lawrence Erlbaum Associates.

19.

Canu

W. H.

Newman

M. L.

Morrow

T. L.

Pope

D. L. W.

(2008). Social appraisal of adult ADHD: Stigma and influences of the beholder’s big five personality traits. Journal of Attention Disorders, 11(6), 700–10. https://doi.org/10.1177/1087054707305090

20.

Chadwich

E. D.

(2012). The structure of adolescent and adult savoring and its relationship to feeling good and functioning well [Doctoral dissertation], Victoria University of Wellington.

21.

Christiansen

Hirsch

Albrecht

Chavanon

M.-L.

(2019). Attention-deficit/hyperactivity disorder (ADHD) and emotion regulation over the life span. Current Psychiatry Reports, 21(3), 17. https://doi.org/10.1007/s11920-019-1003-6

22.

Clarke

Ungerer

Chahoud

Johnson

Stiefel

(2002). Attention deficit hyperactivity disorder is associated with attachment insecurity. Clinical Child Psychology and Psychiatry, 7(2), 179–98. https://doi.org/10.1177/1359104502007002006

23.

Costa-Ramalho

Marques-Pinto

Ribeiro

M. T.

Pereira

C. R.

(2015). Savoring positive events in couple life: Impacts on relationship quality and dyadic adjustment. Family Science, 6(1), 170–80. https://doi.org/10.1080/19424620.2015.1082047

24.

De Rubeis

Lugo

R. G.

Witthöft

Sütterlin

Pawelzik

M. R.

Vögele

(2017). Rejection sensitivity as a vulnerability marker for depressive symptom deterioration in men. PLOS ONE, 12(10), e0185802. https://doi.org/10.1371/journal.pone.0185802

25.

Downey

Feldman

S. I.

(1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327–43. https://doi.org/10.1037/0022-3514.70.6.1327

26.

Downey

Khouri

Feldman

S. I.

(1997). Early interpersonal trauma and later adjustment: The mediational role of rejection sensitivity. In Cicchetti

Toth

S. L.

(Eds.), Developmental perspectives on trauma: Theory, research, and intervention (pp. 85–114). University of Rochester Press.

27.

Duffy

Saunders

K. E. A.

Malhi

G. S.

Patten

Cipriani

McNevin

S. H.

MacDonald

Geddes

(2019). Mental health care for university students: A way forward? The Lancet Psychiatry, 6(11), 885–7. https://doi.org/10.1016/S2215-0366(19)30275-5

28.

DuPaul

G. J.

Gormley

M. J.

Anastopoulos

A. D.

Weyandt

L. L.

Labban

Sass

A. J.

Busch

C. Z.

Franklin

M. K.

Postler

K. B.

(2021). Academic trajectories of college students with and without ADHD: Predictors of four-year outcomes. Journal of Clinical Child & Adolescent Psychology, 50(6), 828–43. https://doi.org/10.1080/15374416.2020.1867990

29.

Eddy

L. D.

Anastopoulos

A. D.

Dvorsky

M. R.

Silvia

P. J.

Labban

J. D.

Langberg

J. M.

(2021). An RCT of a CBT intervention for emerging adults with ADHD attending college: Functional outcomes. Journal of Clinical Child & Adolescent Psychology, 50(6), 844–57. https://doi.org/10.1080/15374416.2020.1867989

30.

Efeoglu

Sen

C. K. N.

(2022). Rejection sensitivity and mental well-being: The positive role of friendship quality. Personal Relationships, 29(1), 4–23. https://doi.org/10.1111/pere.12403

31.

Emmerton

R. W.

Camilleri

Sammut

(2024). Continued deterioration in university student mental health: Inevitable decline or skirting around the deeper problems? Journal of Affective Disorders Reports, 15(5), 100691. https://doi.org/10.1016/j.jadr.2023.100691

32.

Faraone

S. V.

Rostain

A. L.

Blader

Busch

Childress

A. C.

Connor

D. F.

Newcorn

J. H.

(2019). Practitioner review: Emotional dysregulation in attention-deficit/hyperactivity disorder – Implications for clinical recognition and intervention. Journal of Child Psychology and Psychiatry, 60(2), 133–50. https://doi.org/10.1111/jcpp.12899

33.

Farcas

Kálczai-Jánosi

Kotta

Szabó

János

(2018). Psychometric properties of the Hungarian version of the adult ADHD self-report scale (asrs-v1.1) screener and symptom checklist. Proceedings of the 3rd International Conference on New Findings in Humanities and Social Sciences. https://doi.org/10.33422/3hsconf.2018.09.10

34.

Farmer

G. M.

Ohan

J. L.

Finlay-Jones

A. L.

Bayliss

D. M.

(2023). Well-being and distress in university students with ADHD traits: The mediating roles of self-compassion and emotion regulation difficulties. Mindfulness, 14(2), 448–59. https://doi.org/10.1007/s12671-022-02051-x

35.

Fredrickson

B. L.

(2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56(3), 218–26. https://doi.org/10.1037/0003-066X.56.3.218

36.

Freire

J. V. C.

Cerqueira

R. A.

Sousa

D. F.

Novaes

J.F.A.

Farias

T. M.

Cal

S.F.M.

(2021). Resilience and ADHD: What is new? In Sharma

D. C.

(Ed.), Research trends and challenges in medical science Vol. 9 (pp. 1–15). Book Publisher International. https://doi.org/10.9734/bpi/rtcms/v9/7765D

37.

Fuller-Thomson

B. K. D.

Carrique

MacNeil

(2022). Flourishing despite attention-deficit hyperactivity disorder (ADHD): A population based study of mental well-being. International Journal of Applied Positive Psychology, 7(2), 227–50. https://doi.org/10.1007/s41042-022-00062-6

38.

Garcia Pimenta

Gruhnert

R. K.

Fuermaier

A. B. M.

Groen

(2024). The role of executive functions in mediating the relationship between adult ADHD symptoms and hyperfocus in university students. Research in Developmental Disabilities, 144, 104639. https://doi.org/10.1016/j.ridd.2023.104639

39.

Gardner

A. A.

Zimmer-Gembeck

M. J.

Modecki

(2020). A longitudinal model of rejection sensitivity and internalizing symptoms: Testing emotion regulation deficits as a mechanism and outcome of symptoms. Journal of Personality, 88(6), 1045–57. https://doi.org/10.1111/jopy.12549

40.

Gentzler

A. L.

Palmer

C. A.

Ramsey

M. A.

(2016). Savoring with intent: Investigating types of and motives for responses to positive events. Journal of Happiness Studies, 17(3), 937–58. https://doi.org/10.1007/s10902-015-9625-9

41.

Ginapp

C. M.

Greenberg

N. R.

Macdonald-Gagnon

Angarita

G. A.

Bold

K. W.

Potenza

M. N.

(2023). The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study. SSM - Qualitative Research in Health, 3, 100223. https://doi.org/10.1016/j.ssmqr.2023.100223

42.

Girard-Joyal

Gauthier

(2022). Creativity in the predominantly inattentive and combined presentations of ADHD in adults. Journal of Attention Disorders, 26(9), 1187–98. https://doi.org/10.1177/10870547211060547

43.

Gomez

(2002). The effects of perceived maternal parenting styles on the disruptive behaviors of children with attention deficit hyperactivity disorder/oppositional defiant disorder: Mediation by hostile social biased cognitions. In Shohoy

(Ed.), Advances in psychology research (pp. 37–55). Nova Sciences Publishers, Inc.

44.

Goodall

(2015). Individual differences in the regulation of positive emotion: The role of attachment and self-esteem. Personality and Individual Differences, 74, 208–13. https://doi.org/10.1016/j.paid.2014.10.033

45.

Gregory

A. L.

Quoidbach

Haase

C. M.

Piff

P. K.

(2023). Be here now: Perceptions of uncertainty enhance savoring. Emotion, 23(1), 30–40. https://doi.org/10.1037/emo0000961

46.

Hair

J. F.

Hult

G. T. M.

Ringle

C. M.

Sarstedt

(2022). A primer on partial least squares structural equation modeling (PLS-SEM) (3 ed.). Sage Publishing.

47.

Harris

., Lambie

G. W

., & Hundley

. (2019). The effects of neurofeedback training on college students’ attention deficit hyperactivity disorder symptoms. Counseling Outcome Research and Evaluation, 10(2), 64–77. https://doi.org/10.1080/21501378.2018.1442679

48.

Hartung

C. M.

Canu

W. H.

Serrano

J. W.

Vasko

J. M.

Stevens

A. E.

Abu-Ramadan

T. M.

Bodalski

E. A.

Neger

E. N.

Bridges

R. M.

Gleason

L. L.

Anzalone

Flory

(2022). A new organizational and study skills intervention for college students with ADHD. Cognitive and Behavioral Practice, 29(2), 411–24. https://doi.org/10.1016/j.cbpra.2020.09.005

49.

Hassan

Fang

Malik

A. A.

Lak

T. A.

Rizwan

(2023). Impact of perceived social support and psychological capital on university students’ academic success: Testing the role of academic adjustment as a moderator. BMC Psychology, 11(1), 340. https://doi.org/10.1186/s40359-023-01385-y

50.

Hawi

Samaha

(2024). Relationships of gaming disorder, ADHD, and academic performance in university students: A mediation analysis. PLOS ONE, 19(4), e0300680. https://doi.org/10.1371/journal.pone.0300680

51.

Hayes

A. F.

(2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). The Guilford Press.

52.

Hecht

(2013). The neural basis of optimism and pessimism. Experimental Neurobiology, 22(3), 173–99. https://doi.org/10.5607/en.2013.22.3.173

53.

Hussain

(2024). Social-emotional outcomes in emerging adults with ADHD: The influence of self-compassion on peer rejection, rejection sensitivity, and psychological distress . Theses and Dissertations (Comprehensive). https://scholars.wlu.ca/etd/2628

54.

Jaisle

E. M.

Groves

N. B.

Black

K. E.

Kofler

M. J.

(2023). Linking ADHD and ASD symptomatology with social impairment: The role of emotion dysregulation. Research on Child and Adolescent Psychopathology, 51(1), 3–16. https://doi.org/10.1007/s10802-022-00982-6

55.

Kellens

Baeyens

Ghesquière

(2024). Cognitive profiles in preschool children at risk for co-occurring dyslexia and ADHD. Education Sciences, 14(4), Article 4. https://doi.org/10.3390/educsci14040435

56.

Kessler

R. C.

Adler

Ames

Demler

Faraone

Hiripi

Howes

M. J.

Jin

Secnik

Spencer

Ustun

T. B.

Walters

E. E.

(2005). The world health organization adult ADHD self-report scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–56. https://doi.org/10.1017/S0033291704002892

57.

Kessler

R. C.

Adler

L. A.

Gruber

M. J.

Sarawate

C. A.

Spencer

Van Brunt

D. L.

(2007). Validity of the world health organization adult ADHD self-report scale (ASRS) screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52–65. https://doi.org/10.1002/mpr.208

58.

Keyes

C. L. M.

(2007). Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist, 62(2), 95–108. https://doi.org/10.1037/0003-066X.62.2.95

59.

Kilencz

Bálint

Mersich

Papp

Ferencz

Á.

Balogh

Pulay

Farkas

Réthelyi

(2024). What is adult ADHD after all? Psychiatria Hungarica, 39(1), 80–95.

60.

Klibert

J. J.

Luna

Miceli

(2019). Savoring” buffers the association between negative emotions and suicidal behaviors in the GSM community. Journal of Gay & Lesbian Mental Health, 23(1), 27–44. https://doi.org/10.1080/19359705.2018.1518795

61.

Klibert

J. J.

Sturz

B. R.

LeLeux-LaBarge

Hatton

Smalley

K. B.

Warren

J. C.

(2022). Savoring interventions increase positive emotions after a social-evaluative hassle. Frontiers in Psychology, 13, 791040. https://doi.org/10.3389/fpsyg.2022.791040

62.

Kraines

M. A.

Wells

T. T.

(2017). Rejection sensitivity and depression: Indirect effects through problem solving. Psychiatry, 80(1), 55–63. https://doi.org/10.1080/00332747.2016.1185891

63.

Kumar

Corner

Kim

Meuret

(2024). A randomized controlled trial of brief behavioral activation plus savoring for positive affect dysregulation in university students. Behaviour Research and Therapy, 177, 104525. https://doi.org/10.1016/j.brat.2024.104525

64.

Kwon

S. J.

Kim

Kwak

(2018). Difficulties faced by university students with self-reported symptoms of attention-deficit hyperactivity disorder: A qualitative study. Child and Adolescent Psychiatry and Mental Health, 12(1), 12. https://doi.org/10.1186/s13034-018-0218-3

65.

LaCount

P. A.

Hartung

C. M.

Shelton

C. R.

Stevens

A. E.

(2018). Efficacy of an organizational skills intervention for college students with ADHD symptomatology and academic difficulties. Journal of Attention Disorders, 22(4), 356–67. https://doi.org/10.1177/1087054715594423

66.

Lench

H. C.

Bench

S. W.

(2012). Automatic optimism: Why people assume their futures will be bright. Social and Personality Psychology Compass, 6(4), 347–60. https://doi.org/10.1111/j.1751-9004.2012.00430.x

67.

Lovett

B. J.

Nelson

J. M.

Lindstrom

(2015). Documenting hidden disabilities in higher education: Analysis of recent guidance from the association on higher education and disability (AHEAD). Journal of Disability Policy Studies, 26(1), 44–53. https://doi.org/10.1177/1044207314533383

68.

Mak

A. D. P.

Lee

Sampson

N. A.

Albor

Alonso

Auerbach

R. P.

Baumeister

Benjet

Bruffaerts

Cuijpers

Ebert

D. D.

Gutierrez-Garcia

R. A.

Hasking

Lapsley

Lochner

Kessler

R. C.

(2022). ADHD Comorbidity structure and impairment: Results of the WHO world mental health surveys international college student project (WMH-ICS). Journal of Attention Disorders, 26(8), 1078–96. https://doi.org/10.1177/10870547211057275

69.

Matheson

Asherson

Wong

I. C. K.

Hodgkins

Setyawan

Sasane

Clifford

(2013). Adult ADHD patient experiences of impairment, service provision and clinical management in England: A qualitative study. BMC Health Services Research, 13(1), 184. https://doi.org/10.1186/1472-6963-13-184

70.

Meehan

K. B.

Cain

N. M.

Roche

M. J.

Clarkin

J. F.

De Panfilis

(2018). Rejection sensitivity and interpersonal behavior in daily life. Personality and Individual Differences, 126, 109–15. https://doi.org/10.1016/j.paid.2018.01.029

71.

Mor

Inbar

(2009). Rejection sensitivity and schema-congruent information processing biases. Journal of Research in Personality, 43(3), 392–8. https://doi.org/10.1016/j.jrp.2009.01.001

72.

T. H.

Johnson

S. L.

(2013). Rejection sensitivity is associated with quality of life, psychosocial outcome, and the course of depression in euthymic patients with bipolar I disorder. Cognitive Therapy and Research, 37(6), 1169–78. https://doi.org/10.1007/s10608-013-9552-1

73.

Oti

P. O.

Anozie

E. U.

Chinweuba

D. C.

(2024). Rejection sensitivity, psychological flexibility and quality of life among people living with HIV/AIDS. Journal of Psychology and Allied Disciplines, 3(1), 48–60. https://www.jpadfunai.com/index.php/JPAD/article/view/32

74.

Parks

A. C.

Schueller

S. M.

(Eds.). (2014). The Wiley Blackwell handbook of positive psychological interventions (1st ed.). Wiley. https://doi.org/10.1002/9781118315927

75.

Paulson

J. F.

Buermeyer

Nelson-Gray

R. O.

(2005). Social rejection and ADHD in young adults: An analogue experiment. Journal of Attention Disorders, 8(3), 127–35. https://doi.org/10.1177/1087054705277203

76.

Pietrzak

Downey

Ayduk

(2005). Rejection sensitivity as an interpersonal vulnerability. In Baldwin

M. W.

(Ed.), Interpersonal cognition (pp. 62–84). The Guilford Press.

77.

Preacher

K. J.

Hayes

A. F.

(2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–91. https://doi.org/10.3758/BRM.40.3.879

78.

Psychogiou

Daley

D. M.

Thompson

M. J.

Sonuga-Barke

E. J. S.

(2007). Mothers’ expressed emotion toward their school-aged sons: Associations with child and maternal symptoms of psychopathology. European Child & Adolescent Psychiatry, 16(7), 458–64. https://doi.org/10.1007/s00787-007-0619-y

79.

Reimherr

F. W.

Roesler

Marchant

B. K.

Gift

T. E.

Retz

Philipp-Wiegmann

Reimherr

M. L.

(2020). Types of adult attention-deficit/hyperactivity disorder: A replication analysis. Journal of Clinical Psychiatry, 81(2), 19m13077. https://doi.org/10.4088/JCP.19m13077

80.

Rose

Joe

Williams

Harris

Betz

Stewart-Brown

(2017). Measuring mental wellbeing among adolescents: A systematic review of instruments. Journal of Child and Family Studies, 26(9), 2349–62. https://doi.org/10.1007/s10826-017-0754-0

81.

Rusk

R. D.

Waters

(2015). A psycho-social system approach to well-being: Empirically deriving the five domains of positive functioning. The Journal of Positive Psychology, 10(2), 141–52. https://doi.org/10.1080/17439760.2014.920409

82.

Sahmurova

Arikan

Gursesli

M. C.

Duradoni

(2022). ADHD Symptoms as a stressor leading to depressive symptoms among university students: The mediating role of perceived stress between ADHD and depression. International Journal of Environmental Research and Public Health, 19(17), 11091. https://doi.org/10.3390/ijerph191711091

83.

Sanders

(2023). Student mental health in 2023. King’s College.

84.

Sart

Z. H.

Börkan

Erkman

Serbest

(2016). Resilience as a mediator between parental acceptance-rejection and depressive symptoms among university students in Turkey. Journal of Counseling & Development, 94(2), 195–209. https://doi.org/10.1002/jcad.12076

85.

Schreuer

Dorot

(2017). Experiences of employed women with attention deficit hyperactive disorder: A phenomenological study. Work, 56(3), 429–41. https://doi.org/10.3233/WOR-172509

86.

Sedgwick

J. A.

Merwood

Asherson

(2019). The positive aspects of attention deficit hyperactivity disorder: A qualitative investigation of successful adults with ADHD. Attention Deficit and Hyperactivity Disorders, 11(3), 241–53. https://doi.org/10.1007/s12402-018-0277-6

87.

Segal

(2023). Sustained attention plays a critical role in reading comprehension of adults with and without ADHD. Learning and Individual Differences, 105, 102300. https://doi.org/10.1016/j.lindif.2023.102300

88.

Segrin

(2001). Interpersonal processes in psychological problems. Guilford Press.

89.

Seligman

M. E. P.

Csíkszentmihályi

(2000). Positive psychology. An introduction. American Psychologist, 55(1), 5–14. https://doi.org/10.1037/0003-066X.55.1.5

90.

Seligman

M. E. P.

Steen

T. A.

Park

Peterson

(2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410–21. https://doi.org/10.1037/0003-066X.60.5.410

91.

Shaw

Selman

(2023). An asset, not a problem: Meeting the needs of neurodivergent students. Unite Students.

92.

Shaw

Stringaris

Nigg

Leibenluft

(2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–93. https://doi.org/10.1176/appi.ajp.2013.13070966

93.

Smith

J. L.

Bihary

J. G.

O’Connor

Basic

O’Brien

C. J.

(2020). Impact of savoring ability on the relationship between older adults’ activity engagement and well-being. Journal of Applied Gerontology, 39(3), 323–31. https://doi.org/10.1177/0733464819871876

94.

Smith

J. L.

Bryant

F. B.

(2016). The benefits of savoring life: Savoring as a moderator of the relationship between health and life satisfaction in older adults. The International Journal of Aging and Human Development, 84(1), 3–23. https://doi.org/10.1177/0091415016669146

95.

Solanto

M. V.

Scheres

(2021). Feasibility, acceptability, and effectiveness of a new cognitive-behavioral intervention for college students with ADHD. Journal of Attention Disorders, 25(14), 2068–82. https://doi.org/10.1177/1087054720951865

96.

Solmi

Radua

Olivola

Croce

Soardo

Salazar de Pablo

Il Shin

Kirkbride

J. B.

Jones

Kim

J. H.

Kim

J. Y.

Carvalho

A. F.

Seeman

M. V.

Correll

C. U.

Fusar-Poli

(2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–95. https://doi.org/10.1038/s41380-021-01161-7

97.

Sytine

A. I.

Britt

T. W.

Pury

C. L. S.

Rosopa

P. J.

(2018). Savouring as a moderator of the combat exposure–mental health symptoms relationship. Stress and Health, 34(4), 582–8. https://doi.org/10.1002/smi.2822

98.

Tariq

Reid

Chan

S. W. Y.

(2021). A meta-analysis of the relationship between early maladaptive schemas and depression in adolescence and young adulthood. Psychological Medicine, 51(8), 1233–48. https://doi.org/10.1017/S0033291721001458

99.

Van Der Oord

Boyer

B. E.

Van Dyck

Mackay

K. J.

De Meyer

Baeyens

(2020). A randomized controlled study of a cognitive behavioral planning intervention for college students with ADHD: An effectiveness study in student counseling services in flanders. Journal of Attention Disorders, 24(6), 849–62. https://doi.org/10.1177/1087054718787033

100.

Verdolini

Amoretti

Montejo

García-Rizo

Hogg

Mezquida

Rabelo-da-Ponte

F. D.

Vallespir

Radua

Martinez-Aran

Pacchiarotti

Rosa

A. R.

Bernardo

Vieta

Torrent

Solé

(2021). Resilience and mental health during the COVID-19 pandemic. Journal of Affective Disorders, 283, 156–64. https://doi.org/10.1016/j.jad.2021.01.055

101.

Villemonteix

Purper-Ouakil

Romo

(2015). Is emotional dysregulation a component of attention-deficit/hyperactivity disorder (ADHD)? Encephale, 41(2), 108–14. https://doi.org/10.1016/j.encep.2013.12.004

102.

Volstad

Hughes

Jakubec

S. L.

Flessati

Jackson

Martin-Misener

(2020). You have to be okay with okay”: Experiences of flourishing among university students transitioning directly from high school. International Journal of Qualitative Studies on Health and Well-Being, 15(1), 1834259. https://doi.org/10.1080/17482631.2020.1834259

103.

Waldren

L. H.

Leung

F. Y. N.

Hargitai

L. D.

Burgoyne

A. P.

Liceralde

V. R. T.

Livingston

L. A.

Shah

(2024). Unpacking the overlap between autism and ADHD in adults: A multi-method approach. Cortex, 173, 120–37. https://doi.org/10.1016/j.cortex.2023.12.016

104.

Walter

Bruch

(2008). The positive group affect spiral: A dynamic model of the emergence of positive affective similarity in work groups. Journal of Organizational Behavior, 29(2), 239–61. https://doi.org/10.1002/job.505

105.

Wood

J. V.

Heimpel

S. A.

Michela

J. L.

(2003). Savoring versus dampening: Self-esteem differences in regulating positive affect. Journal of Personality and Social Psychology, 85(3), 566–80. https://doi.org/10.1037/0022-3514.85.3.566

106.

Wymbs

B. T.

Canu

W. H.

Sacchetti

G. M.

Ranson

L. M.

(2021). Adult ADHD and romantic relationships: What we know and what we can do to help. Journal of Marital and Family Therapy, 47(3), 664–81. https://doi.org/10.1111/jmft.12475

107.

Zábó

Oláh

Vargha

(2022). A new complex mental health test in a positive psychological framework. Frontiers in Psychology, 13, 775622. https://doi.org/10.3389/fpsyg.2022.775622

			95% CI
	Estimate	SE	LL	UL	p
Low (−1SD)	0.472	0.057	0.359	0.584	< .001
Mean	0.227	0.045	0.138	0.316	< .001
High (+1 SD)	−0.017	0.063	−0.142	0.107	.783

Associations Between ADHD Symptoms and Rejection Sensitivity in College Students: Exploring a Path Model With Indicators of Mental Well-Being

Abstract

Keywords

The Link Between RS and ADHD

The Mediating Role of Mental Well-Being in the Link Between ADHD and RS

The Role of Savoring Capacity in the Link Between ADHD and RS

Method

Study Design and Participants

Measures

Attention-Deficit Hyperactivity Disorder

Mental Well-Being

Rejection Sensitivity

Data Analysis

Results

Descriptive Statistics and Bivariate Relationships

Mediation and Moderation Analyses

Mediation Effect

Moderation Effect

Discussion

The Mediating Role of Positive Psychological Constructs

The Moderating Role of Savoring Capacity

Practical Implications

Strengths and Limitations

Conclusion

Footnotes

Author Contributions

Consent to Publish

Data Availability Statement

Declaration of Conflicting Interests

Declaration of Generative AI in Scientific Writing

Ethical Approval

Funding

ORCID iDs

References