Helping College Students with ADHD to Succeed in School

Learning Objectives: At the completion of this session, participants will be able to

1. Describe common challenges of ADHD college students
2. Review the role of academic accommodations in helping students succeed
3. Discuss the role of medications in treating ADHD college students
4. Describe the benefits of CBT and other psychosocial interventions for this population

Synopsis of presentation:

College students with ADHD are more likely than their peers to encounter problems adjusting to school including utilizing less effective coping skills to meet the academic and social demands of higher education, experiencing more distraction, reporting higher rates of internal restlessness and depressive symptoms, achieving lower GPAs and being more likely to be placed on probation (Blase et al., 2009; Norwalk, Norvilitis, & MacLean, 2009; Rabiner, Anastopoulos, Costello, Hoyle, & Swartzwelder, 2008; Weyandt & DuPaul, 2006). While they are not at greater risk for psychiatric diagnoses and they perform as well on intelligence tests as their age-matched peers, they often report mild mood or anxiety symptoms, substance use and self-esteem issues.

Academic accommodations are recommended for students with ADHD who demonstrate learning impairments. These accommodations include “formal” modifications of the standard teaching and testing approaches environmental adjustments, the use of assistive technology, and focused educational support from learning specialists. Furthermore, there are many “informal” accommodations of coping strategies that can be instituted by students including study groups, tutoring sessions and coaching sessions. ADHD coaching has been shown to be an effective intervention for this population (Prevatt, 2016). These coaches help individuals identify and develop action-oriented approaches for completing personally valued tasks and goals by providing encouragement, frequent reminders, and problem-solving tips for getting through the more difficult aspects of college life.

Relatively little is known regarding the effectiveness of medications for college and university students with ADHD, or about the impact that taking medication has on academic success. Rabiner et al (2008) found no correlation between treatment status and college adjustment including academic concerns, depressive symptoms, social satisfaction, and alcohol/drug use. In a follow-up study with a larger sample, Blasé et al (2009) reported that adjustment to college was unrelated to treatment status. Advokat et al (2011) reported no medication treatment-related differences in the GPA of college students with ADHD. These results may reflect a combination of poor adherence, poor study skills, and the presence of major distractions on campus without concomitant limits. Given reports of stimulant diversion rates of up to 30%, prescribing medications for college students with ADHD is fraught with risk,and great care must be taken to educate about proper usage (including safe storage and prevention of diversion) and to monitor adherence.

Among evidence-based psychosocial interventions for adults with ADHD, CBT approaches have shown the most promise (Safren et al., 2010; Solanto et al., 2010). These treatments emphasize the implementation of coping skills to address common EF deficits, and focus on planning, time management, organization, and dealing with procrastination. They also target rationalizations and motivational deficits that can undo effective coping. While less is known regarding the effectiveness of CBT specifically for college students with ADHD, four recent small N studies found that it is moderately helpful in improving inattentive symptoms and in reducing impairments (see summary in Knouse, 2015).

To summarize, academic accommodations, ADHD coaching and psychosocial interventions have been shown to help improve academic functioning and adjustment to college life. ADHD medication is also recommended, but there is less evidence to support its use. Whatever interventions are used, patients need to take an active role in learning and practicing implementation strategies to daily life.