ADHD in College Students
Children with Attention Deficit Hyperactivity Disorder (ADHD) graduate from high school and go on to attend college. Some of these children learn to manage their ADHD symptoms effectively without medications, and others need to continue medication throughout their college career. Young adults with ADHD often struggle in learning and maintaining self-management skills that are necessary for every young adult going off to college. People with ADHD tend to struggle most with time management, organizational skills, and procrastination during college.
College students typically lead a disorganized and unstructured life compared to living at home and going to high school. Adolescents who are going to college do not realize how much their family contributes to their daily rhythm that no longer exists in college. There is no daily rhythm in college. A daily rhythm is important in keeping a biological rhythm stable in regards to sleeping and dietary needs. For example, students may have night classes and keep late hours studying. For the ADHD college student, medication may be necessary to help him/her be successful in school; however, these students also need structure and routine to provide them with a necessary stability in college. These students can also utilize educational accommodations to provide additional assistance in college as well. However, psychiatrists need to be wary of some warning signs of medication misuse in college students with ADHD.
How common is stimulant misuse on college campuses?
As a physician, I am concerned about the misuse of stimulants on college campuses. College students use stimulant medications (usually Adderall & Ritalin) to enhance academic performance. In 2010, the National Survey on Drug Use and Health show that 11% of people ages 12 to 25 have used prescription drugs non-medically over the past year. In addition, 30 to 40% of people being prescribed the medication have misused it or diverted it at some point. These numbers are alarming to me as a prescribing physician.
For students with ADHD, they need their medication to function on a day to day basis in school and maintain their academic functioning. For students without ADHD, they are using stimulant medications to stay up all night and enhance their performance on tests. However, recent studies suggest that students without ADHD who abuse stimulant medications do NOT have improved grades.
Stimulant medications also carry a big side effect profile. As a psychiatrist, I have to weigh the risks versus benefits of using this medication in a person with ADHD. Multiple factors such as routine blood work and a physical examination must be done prior to starting this kind of medication due to the cardiac risk warning on all stimulant medications. For the non-ADHD person trying to enhance their grades, this person isn’t aware of the possible adverse side effects and may not be taking a safe dosage. There are some serious side effects about stimulant medications that someone misusing may not be aware of. For example, a person can become psychotic if taking high doses of stimulants and/or not sleeping. Stimulants can also cause depression, irritability, anxiety, or mania. Another important point to mention involves the distribution of stimulant medication among other college students is considered a felony crime.
Red Flags to Watch for in Your College Student with ADHD:
- Needing a prescription refill too soon
- Staying up late, pulling all nighters, and/or not getting 8 hours of sleep at night
- Behavioral and/or mood changes
- Engaging in more risky/impulsive behaviors
- Experimentation with drugs
- Confusion, hallucinations
If your college student is taking ADHD medication while away at school, I strongly encourage parents to be involved in their child’s treatment. Parents are the best advocates for their child even after the child is technically an “adult.” Once your adolescent turns 18, you lose your parental consent in his/her treatment. As a parent, your child can consent to a release of information for you to be a part of their treatment. I also require college students to have an appointment with me around every 1-3 months depending on his/her situation. Students will have an appointment when they are home on school breaks and have the option to have a phone appointment while away at school. Keep in mind, stimulant medications are regulated by the government (DEA) and require careful and frequent monitoring by a physician.
My job as a psychiatrist is to educate families and students going away to college about the dangers and warning signs when taking this kind of medication. My ultimate goal is to help each college student be successful and hopefully not have to rely on medication but learn more self-management skills.