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Key points
- Because of its impact on executive function, ADHD creates unique challenges for college students.
- Creating appropriate supports and expectations ahead of time can help ease the transition into college.
- A student's acceptance of their ADHD—both the diagnosis and the need to develop adaptive habits—is crucial.
Mary Solanto is a professor of Pediatrics and Psychiatry at the Zucker School of Medicine in New York, a Fullbright Scholar, an ADHD researcher, and the author of Cognitive-Behavioral Treatment of Adult ADHD: Targeting Executive Dysfunction. I spoke with her recently about a challenging time for students with ADHD: the transition to college. On the one hand, like most teens, they are often excited about being independent. And on the other, ADHD impacts their executive function –planning and goal-setting skills required for staying healthy and managing college academics in college.
To start, can you say something about the risks of undermanaged ADHD in college?
Students with ADHD face a “perfect storm” of challenges transitioning into college. Although they may have functioned well in high school with the support and scaffolding of parents and teachers, all that falls away precipitously when they begin on campus.
College students are faced with multiple new challenges. These include a heavier workload with more emphasis on working independently, much more unstructured time, and the need to plan and execute papers and prepare for tests over a longer period of time. And yet, many, if not most, have not developed the executive skills needed to manage time, organize and plan.
Furthermore, students face many more temptations to goof off and party. We also know that students with ADHD are more likely to become anxious or depressed (probably as a consequence of their difficulties), as well as to abuse alcohol and substances. It is perhaps not surprising that research clearly documents that college students with ADHD are significantly less likely to graduate than non-ADHD peers, are more likely to drop out or fail out of courses, and attain lower GPAs. Clearly, under-managed ADHD is a major risk factor for an unsatisfactory college experience.
What about ADHD and managing health once at college – sleep, exercise, partying, and all the rest? What does the science say, but also, how do you get a teen to do anything about it?
Pivotal to becoming responsible for self-care – including taking prescribed medication regularly and adhering to healthy routines of sleep, eating, and exercise – is acknowledging the importance of these functions, as well as the difficulty people with ADHD have in implementing them. Thus, acceptance — both of the diagnosis and of the need to develop adaptive habits — is crucial.
Parents can help during the year before the teen goes off to college by allowing and supporting students’ gradually taking over more and more of daily management of these functions (including doing the laundry!), thus demonstrating readiness to transition to college. A therapist practiced in cognitive and behavioral interventions for ADHD may also help the youth to develop and maintain these adaptive habits.
Of course, college kids often don’t want to deal with their ADHD, medically or otherwise. How do you advise parents facing a lot of resistance?
Again, a young adult’s self-awareness and perspective on the disorder are critical. Teens who “don’t believe in” or don’t recognize the impact of ADHD on their functioning are not likely to accept medication or to invest time and effort in learning cognitive-behavioral strategies to manage the condition.
In this context, a health care provider, therapist, or counselor with expertise in ADHD can help the student develop a healthy acceptance of the diagnosis that doesn’t threaten their self-esteem or self-competence. The goal is to impart an attitude of: “It’s not my fault, but it’s my responsibility.” This education should ideally begin at the time of initial diagnosis.
What supports make it more likely a student with ADHD will succeed in college?
College resources that may help students with ADHD include the learning center, for opportunities to build better organizational and study skills (in group or individual sessions); the counseling center, to address emotional issues including anxiety and/or depression; and the health center, to monitor, manage and adjust the medication regimen as needed. The ACCESS program, developed by Arthur Anastopoulos and Joshua Langberg at UNC-Greenberg and Virginia Commonwealth University, respectively, is a comprehensive model program that promotes the academic, emotional, and social development of college students with ADHD.
To make use of resources like these, a student must feel empowered, not ashamed, to seek assistance. It may also be helpful if, after admission to the college, parents accompany them to meet with the appropriate professional(s) at these centers to break the ice.
For students in public schools, IEP or 504 accommodations are available and mandated by Federal law. What about college-age kids?
IEP’s apply only to K-12 students, but colleges are required by law to provide accommodations that ensure all students can access courses and materials. These aren’t necessarily the same as those granted in elementary or high school. Unlike K-12 provisions, colleges are not required to make essential “modifications” to the curriculum, such as alterations in course or graduation requirements, although they may choose to do so.
Examples of typical accommodations available at the college level include:
- Extended time on tests.
- Testing in a location with reduced distractions.
- Permission to use a laptop computer in the classroom.
- Assistance with notetaking, such as recording of lectures or access to another student’s notes.
In order to access these accommodations, students must apply to the college Disability/Accessibility office, and complete forms documenting the disability and justification for the specific accommodations requested. A letter from the diagnosing or treating professional is usually required.
What’s one practical bit of advice for parents you can end with today?
The most important piece of advice to parents and students transitioning to college is, “Plan and prepare.” That checklist might look something like:
- Early in Senior year, meet with your student’s IEP team to identify the executive self-management skills they need to develop, and potential college accommodations. The student should participate in this meeting.
- Set up cognitive behavioral therapy (CBT) to work on executive functions or academic coaching to address those needs.
- Work with the therapist or coach to set up routines at home that include taking medication, other self-care, and managing study time effectively.
- After admission, meet with the college’s Disability/Accessibility office to discuss available accommodations that are appropriate for your student.
- Submit an application for accommodations by the college’s deadline.
