ADHD Goes to College (Part 1 and 2)


March 1st, 2012

Why Freshman with ADHD are Most at Risk – Part 1

By Leslie Rouder, LCSW

It has been reported in a recent study that one in 20 college freshman were diagnosed with ADHD in 2010.   If you are faculty member, this means that the likelihood that at least one student with ADHD will be enrolled in each one of your classes every semester.   In addition, and more perplexing, is that there is a good possibility that you may have one or several students attending your classes with undiagnosed ADHD.  

So, what does this mean?  How best can the faculty accommodate this particular disability and how might one identify, or perhaps approach a student who has not disclosed that he or she, in fact, has any disability?  And if we are accommodating these students, why are they most at risk?

When a student provides faculty with an accommodation memo, it is clear what the academic accommodations for that student will be, however the exact nature of the diagnosis is not provided.  It is up to the student and faculty to discuss the accommodations as well as one’s learning style and needs.   Although this conversation is often encouraged by the Disability Services Office at most universities, it is not required.  Therefore, this conversation may never happen and what may seem like a “hidden disability” to many, might actually be an obstacle in excelling academically, socially, and psychologically for these students. 

How might a student with ADHD present in the classroom setting and why are freshman students with this diagnosis at greatest risk for failure?   We first would have to look at the possible ways in which ADHD effects one’s functioning both in and out of the classroom setting.

In reading the latest information on adult ADHD symptoms developed by Russell Barkley, along with Kevin Murphy and Mariellen Fischer, they came up with 91 updated symptoms that would be predictive of an individual having ADHD.  Out of their list of 91, I compiled the following list of symptoms that would be most detrimental in an academic environment. Individuals with ADHD may present with several or any combination of the following symptoms;

  • Is easily distracted by irrelevant thoughts when he or she needs to concentrate on something.
  • Is prone to daydreaming
  • Is easily bored
  • Has difficulty delaying gratification and working on completing goals.
  • Starts a project or task without reading or listening to directions carefully
  • Wastes or mismanages time
  • Fails to meet deadlines for assignments
  • Has difficulty planning for upcoming events
  • Forgets to do things he or she is supposed to do
  • Is not able to comprehend what he or she reads as well as he or she should be able to do; has to reread material to get its meaning
  • Can’t seem to remember what he or she previously heard or read about
  • Has trouble motivating self to start work
  • Has difficulty motivating self to stick with work and get it done
  • Has trouble staying awake or alert in boring situations
  • Not motivated to prepare in advance for things that must be done
  • Has difficulty organizing his or her thoughts
  • Has difficulty explaining things in their proper order or sequence
  • Is easily frustrated
  • Has difficulty prioritizing and has difficulty doing things in their proper order or sequence
  • Can’t seem to get to the point of his or her explanation as quickly as others
  • Has trouble doing what her or she intends to do

One can easily see, given the above list, how this might negatively impact a student’s ability to thrive in an academic environment.  In the best case scenario, a student who is aware of his or her  diagnosis and is being treated with medication, while seeking academic accommodations  and coaching will have the best chance at being successful.  Medication alone, however, although helpful, does not completely mitigate the negative symptoms.  In fact a recent URI and Lehigh University Research study of college students with ADHD, determined that although medication (in this case Vyvance, a widely used psycho-stimulant) was helpful in improving symptoms and executive functioning, the improvements did not reach the levels of their peers.  “This tells us that stimulant medication is an effective treatment that needs to be supplemented by other treatment, including educational support and accommodations,” according to Dr. DePaul, who was involved with this study.

 ADHD Goes to College 

Why Freshman with ADHD are Most at Risk – Part 2

But what happens to those students who are unaware of their diagnosis?  Freshman are the most at risk because while attending high school and living at home with their parents, they may have had a lot more structure and support from both teachers and parents.  If this is their first time living away from home, they will need to self-regulate and structure their time in ways that are far more difficult for them than for other students.   According to Dr. Stephanie Sarkis, “The reality is that young adults with ADHD tend to function at a younger emotional age than their peers.”  Their parents have likely spent years monitoring their child’s academic and social activities and although being away at school may be exciting for these students, being on their own, can also be overwhelming.

The areas of concern to most be aware would be in comorbid disorders that are present in approximately 25 to 50% of people with ADHD. (Fischer et al., 2007; Sarkis et al. 2005) These would include depression, anxiety, eating disorders, sleep problems, and drug alcohol abuse. Sometimes symptoms are missed because of the ADHD and it has been determined that only 36% of students with ADHD who meet the criteria for depression actually sought medication or counseling while on campus.  

Eating disorders among college students with ADHD was the highest of any comorbid disorder. (Mattos et al., 2004.) This is most probably in response to a heightened sense of loss of control over their environment and ability to be successful, which makes this population (particularly in girls) almost 4 times more likely to develop an eating disorder than non –ADHD girls. (Biederman et al, .2007) 

Sleep is another area that is negatively impacted in that freshman students are now in an environment for the first time in which they have no parental authority regulating what time they go to bed.  Handling this new found freedom is not always easy for these individuals. In addition, many individuals with ADHD are not always alert first thing in the morning and may not do well with early classes.

With a tendency to self-medicate, as well as the need for social acceptance, students with ADHD have a greater propensity toward drug alcohol abuse.  In fact, one in five adults with ADHD will experience a drug alcohol abuse problem.   (Wilens & Updhyaya, 2007)

In conclusion, college presents very significant challenges to students with ADHD, especially in their freshman year.  Students need to avail themselves of the resources on campus that can provide support services, such as the Office of Disability Services as well as the Counseling Center.  Seeking support and asking for help when needed is essential to their success.  Although most universities do not provide neuro- psychological batteries on campus, the Office of Disability Services can direct students on where to get the appropriate testing to determine a diagnosis.  Faculty can help in sustaining this vulnerable population by redirecting students to the necessary resources on campus and by further educating themselves about how to identify and support these students. 

 

Leslie Rouder, LCSW is a therapist and ADHD coach, as well as a university consultant and trainer.  To receive her free newsletter or to read additional articles, you may visit her website at www.ADDadults.net