ADHD on College Campuses

(RxWiki News) Can't study. Can't focus. Can't remember what I was supposed to do next. I've got to do this. No, I've got to do that. What was I doing?

In college, students with attention deficit hyperactive disorder (ADHD) face an array of challenges: long days and nights of classes, studying and activities, all of which require increasing amounts of concentration.

Dr. Mark Thomas stands ready to help, both at The University of Alabama's Student Health Services and through his research in treating AD/HD on campuses across the country. That treatment includes prescribing drugs that allow students to focus over long periods of time and training in better study habits.

"Medications are, far and away, the most effective treatment for ADHD," says Dr. Thomas. "They're not the total treatment, but they're the component of treatment that makes the most difference. We do try to advocate to students with ADHD that the medication is just one part of the overall treatment approach."

A Disruptive Force

ADHD has a few categories. Some children, for example, are unable to focus but don't exhibit hyperactive symptoms. They are diagnosed with ADHD predominantly inattentive (ADHD-PI or ADHD-I). Children who do exhibit hyperactive symptoms or impulse control problems are often diagnosed with ADHD predominantly hyperactive-impulsive (ADHD-PHI). Those patients who exhibit both attention problems and hyperactivity are diagnosed with ADHD combined (ADHD-C).

Children with ADHD, according to the Centers for Disease Control and Prevention, "have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be) and, in some cases, are overly active." Everybody has periods of distraction or forgetfulness, but for a diagnosis of ADHD, the symptoms need to disrupt the child's life at school and at home.

"The characteristics of inattentiveness would include...daydreaming, being easily distracted, procrastination, lack of organization, losing things, misplacing things, forgetting appointments--just an overall sense that the world is passing you by and you're not able to keep up with it," says Dr. Thomas say. "Patients end up feeling quite overwhelmed."

Guidelines Needed for College-age ADHD Patients

The CDC notes that as of 2006, 4.5 million children between ages 5 and 17 had been diagnosed with ADHD. When these children reach college, they'll need to continue treatment. In addition, some students are being diagnosed with ADHD for the first time in college.

Recognizing this growing patient population, Dr. Thomas and his fellow physicians are responding with research to develop guidelines for treating ADHD on campus. At the American College Health Association meeting in May 2009, Dr. Thomas was asked to cochair an effort to write guidelines for treating ADHD on American college campuses.

"What grew out of that particular meeting was a consensus that we need to establish some guidelines for treatment of ADHD across campuses," Dr. Thomas explains. "There are guidelines in place for the pediatric population--children roughly between [ages] 6 to 12--that the American Academy of Pediatrics has come up with. There are also guidelines that psychiatric associations have prescribed for grown-ups. What are really lacking are guidelines for adolescents and young adults, college age in particular."

The doctor surveyed 124 campus health centers across the country about how staff members diagnose and treat ADHD. His preliminary findings suggest about a third of these health centers don't offer prescription medication treatment for ADHD.

"While students on these campuses could presumably go off campus to receive this service, not having it readily available on campus may provide a significant barrier to receiving care," Dr. Thomas notes.

Inconsistencies Among Campuses in Treating ADHD

In his research, Dr. Thomas has also found that campuses vary widely in diagnosing ADHD among students.

"Only about half of them handle making a new diagnosis of ADHD," he says. "Who they have handling their prescriptions and making the diagnoses varies widely. The most common providers [college campuses] have are family-medicine physicians or psychiatrists. As far as making the diagnosis, there's a larger number that use mental health professionals, which also would include psychologists as well as psychiatrists."

Preliminary research also suggests more than half of the students treated for ADHD in colleges were diagnosed on campus. Students who don't exhibit the hyperactive component of ADHD in childhood sometimes slip through the diagnosis net because they develop coping mechanisms in school. However, those coping mechanisms often break down in college.

"Eventually they get to the point where they're no longer able to function adequately either due to the increasing complexity of the school work or because they are now without the aid of parents or teachers looking over their shoulders. That's when they present and become diagnosed."

Part of the guidelines Dr. Thomas is helping develop involves diagnosis. Physicians need to be careful about distinguishing between ADHD and normal concentration problems. He's also considering who should make the diagnosis and whether the student has other problems that either mimic ADHD or make it worse.

"We don't want to establish the bar for making the diagnosis so high that it presents a significant barrier to care," the doctor explains. "At the same time, we don't want to set it so low that it's easy for someone to come off the street and get a prescription they don't really need.

"As part of that diagnostic process, we do want to address the possibility of learning disorders, either coexisting with ADHD or mimicking ADHD." Dr. Thomas adds. "We also look out for other psychiatric diagnoses that mimic ADHD or coexist with ADHD. Why that's important is, with psychiatric diagnoses, we don't want to be treating the wrong thing. Sometimes the right medication for ADHD would be the wrong medication for other conditions and make the other conditions worse.

"On the other hand, if there are some unrecognized psychiatric diagnoses or learning disabilities, then we're losing the opportunity to being able to fully help the patient or the student."

Prescription medication remains at the forefront of treating ADHD, Dr. Thomas states. These medications include dextroamphetamines, such as Adderall, and methylphenidates, such as Ritalin, Concerta and Daytrana. Innovations have refined and improved the way these drugs work on the brains of people with ADHD.

"The stimulant medication helps their brain to get tasks completed without getting distracted and going in other directions. It also helps to filter out extraneous stimuli coming in to their brain," explains Dr. Thomas. "They're better able to sort out what's important for them to keep in their conscious brain and what bits of information can go into their subconscious."

Once, some physicians perceived that medication for ADHD could be harmful, so they prescribed for the medication to be taken only during school days. Now, though, physicians recognize that the medication is relative safe and that ADHD affects all aspects of a student's life, including hanging out with friends and studying late into the night--even driving. Therefore, medication is needed over an extended period. As a result, physicians are using medicine delivered in pills or patches that spread the delivery of the drug over time.

Peer-to-peer Support

Beyond drug therapy, Dr. Thomas is working to include in the guidelines other avenues of support for students with ADHD. He's working with students from The University of Alabama's computer-based honors program to develop podcasts produced by students with ADHD that offer peer-to-peer support for the condition.

Additionally, he and other staff members have formed the ADHD Consortium, a group of faculty and staff interested in assisting students with ADHD. The group is working to coordinate services for these students.

"We try to get them to go to the Office of Disability Services for academic accommodations," says Dr. Thomas. "Another leg of their treatment is academic training help, such as training in study skills and time management skills." He adds, "We also are very interested in developing more programs for helping in that area because that's an area in which students don't have a lot of awareness of what's available."

College life can be difficult enough as students transition into adulthood, often juggling studies, jobs, social lives, personal interests and independent living for the first time. For students living with untreated ADHD, this time of their lives can become nightmarish. If treatment and learning assistance aren't readily available on campus, students can often find help from community resources. Ignoring the difficulties is not the solution for a disorder that announces itself even louder the more a sufferer tries to hide it.

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Review Date: 
September 16, 2010