(an article from the April 19, 2009 edition of The NY Times)
The transition from high school to college is tough for most students. But for those with attention deficit hyperactivity disorder, university life poses a host of academic, medical and personal challenges. Students with A.D.H.D. struggle to stay focused on their studies and to meet the organizational demands of schoolwork.
Although some children appear to outgrow the disorder as they age, doctors say that as many as two-thirds have symptoms that persist into adulthood.
Medications help, but students need a support system of family, teachers and friends. Last year, The Journal of Pediatric Nursing published a report in which college students with A.D.H.D. recounted the role family members played in their academic success in high school. Mothers made flash cards, gave them books on tape, proofread papers and helped them prioritize. Even school friends would tap them in class if they “zoned out.”
When teenagers leave for college, that personal support system disappears. They move away from parents, trusted teachers and the pediatrician who prescribes their medication.
For a teenager struggling to stay organized, the unusual class schedules, hourlong lectures, late-night study sessions and disrupted sleep routines of college can be a nightmare. Studies suggest that college students with A.D.H.D. are at greater risk for academic and psychological difficulties, and have lower grade-point averages, than peers without the problem. “We have found that there are a lot of significant barriers these students face,” says Dr. Mark H. Thomas, a physician at the University of Alabama student health center, who is part of a campuswide effort to provide additional resources to students with the disorder, including a series of podcasts on how to cope.
“When they come to college without the external supports of parents and teachers to keep them organized and on task, oftentimes they struggle mightily to get everything done that they need to get done,” Dr. Thomas says. “Even those kids who have done relatively well in high school still struggle.”
To ease the transition to college, plan long before arriving on campus.
MEDICATIONS MAY NEED ADJUSTING.
The academic day is extended in college. Most A.D.H.D. medications are prescribed for a school day and homework schedule that starts in the morning and ends before dinnertime. Treatments for high school students typically last at least a school day, to avoid an embarrassing trip to the nurse’s office for another dose. High school students often stop taking medication on weekends and holidays.
But in college, classes can start early and last until late in the evening, and studying and socializing may require taking medications on the weekend.
“One of the things we find is that these kids come in with a prescription that may have worked fairly well for them at home, but their schedules here are longer than what they had in high school,” says Dr. Thomas, who is presenting a paper on the topic at the American College Health Association meeting in May with Dr. Charles F. Caley of the University of Connecticut. The solution may be taking longer-acting treatments twice a day, or a combination of an extended-release and short-acting treatment. Patch treatments, which release medication while on the skin, may also work for the unpredictable day of the college student.
Also, talk to doctors about all-night study sessions and what effect sleep-deprivation can have on ability to cope.
PLAN FOR A PLACE TO GET REFILLS.
College life is consuming. It’s a mistake to assume a teenager will return home for regular visits with the family doctor. Ask the pediatrician for a referral near the university, or find out if doctors at the student medical center have experience treating attention deficit disorder.
In fact, all parents, regardless of whether their child has a learning disorder, should investigate services provided by the medical center. Some offer a wide range, including free flu shots, mental health care and substance abuse counseling.
BEFORE APPLYING, FACTOR IN SERVICES.
When vetting colleges, students may not want to draw attention to their A.D.H.D. needs. But ask about campus services designed to develop study and organizational skills. Every university will have an office of disability services, where a student with a documented problem can apply for academic accommodations. For students with attention deficit, that can include written instead of oral instructions, note-taking help or extra time with a tutor to help keep up with the workload.
But look beyond the disability office and ask about student learning centers. Some give only basic study skill and time-management lessons, while others have specialized services for students with A.D.H.D., dyslexia and other learning disabilities.
A well-known program is the Strategic Alternative Learning Techniques Center at the University of Arizona at Tucson. The center assigns a learning specialist to meet with a student weekly, monitor academic performance and set goals. The center offers counseling, individual tutoring and access to a computer lab, writer’s lab and math and science center. Students with less than 60 credit hours, who may need more support, pay $2,200. Older students pay less.
Small campuses may be especially appealing to a student with attention deficit but they won’t have as many services. Extra research may turn up off-campus tutoring services and learning centers.
Outside the mainstream, Landmark College in Vermont and Beacon College in Florida operate exclusively for students with learning disabilities.
Among guidebooks that list campuses with special programs are “The K&W Guide to Colleges for Students With Learning Disabilities or Attention Deficit Disorder” (Princeton Review) and “Survival Guide for College Students With A.D.H.D. or L.D.” (American Psychological Association). Kathleen G. Nadeau, author of “Survival Guide,” recommends trying to find out about the college’s general attitude toward providing accommodations, and how complicated it is to get them. One way is talking to students who are using the services.
NOT DIAGNOSED? DON’T BE SHY.
Doctors say the transition to college leads to a new crop of students being diagnosed with A.D.H.D. who had previously escaped notice. Symptoms may not have significantly interfered with their schoolwork in high school. “We see a lot of them who may have had symptoms for years but they’ve never been identified because they were smart enough to get by,” Dr. Thomas says. But in the less-structured college environment, where parents aren’t around to wake them and teachers pay less attention to individual students, these once high-achieving students suffer.
“They can’t compensate anymore, so they struggle academically, grades plummet and the parents are wondering if they belong in college at all,” Dr. Thomas says. “We’re able to get them successfully treated, and we see a wonderful improvement in academic performance.”
Considering the academic and social hurdles, Dr. Thomas says, making it to college despite the disorder is, in itself, an achievement.
“These students have great academic potential. It just needs to be unblocked by helping them focus.”
Tara Parker-Pope writes the Well column for The Times.