ADHD Does Not Go Away When They Go to College

Long-term studies now show that young adults appropriately treated for ADHD with medication are somewhat more likely to experiment with illegal drugs, but less likely to become addicted to them. Your patients should be accustomed to discussions with you about potential side effects, and this is one of them. The success orientation of most college students should help when counseling them about the potential social as well as physical problems of caffeine, alcohol, and illegal substances. And don’t forget to provide collegiate athletes with a letter about their medicines to avoid problems when they are drug tested.

Prepare your patients with ADHD for a greater need to organize their academic work in college. This can be tricky for them because ADHD interferes with executive functioning. And the older you are, the more of an executive you really need to be. A college student needs to organize his own class schedule, manage homework, and figure out how much time to dedicate to studying. A student with ADHD might be a "man of the moment" and not even consider studying on Monday for an examination for a class he has only on Fridays.

Kids with ADHD are likely to have made it into college with a lot more guidance (or nagging!) from parents or teachers about organization than average.

The good news is that many colleges now offer assistance with organization and study skills for freshmen. You can do a great service by suggesting they research which schools offer these accommodations before they apply and take advantage of these accommodations when they arrive. If formal support is not available, older students can be hired to help a freshman navigate the new challenges of college.

ADHD does not often "travel alone." Learning disabilities and mood disorders are the most common comorbidities.

It is unlikely that a new learning disability will be discovered during college. Most of your patients will already know if they are a slow reader or weak in math and have been helped in earlier parts of their education. College, in many ways, is more forgiving than high school because students have more flexibility to choose classes that align with their strengths.

Students may be unaware, however, that they can request front and center seating in lecture halls or classrooms to help them stay focused as well as extended time, tutoring, and a class scribe, recorded classes, or lecture note transcripts – great resources for kids with ADHD whether they have learning disabilities or not.

Monitor your patients with ADHD for new onset or worsening of the common comorbidities of mood disorders, particularly depression, anxiety, and tic disorders. The likelihood for these conditions to emerge continues to rise throughout adolescence.

Use a standard screening tool at each visit for college-age patients, one that looks for these mood disorders and any suicidality. The stress of college pressure and loneliness is hard on any kid but, combined with the academic weaknesses and predisposition to depression found with ADHD, can be fatal. I prefer an online instrument that patients can complete before coming home from college for a break, such as the CHADIS system.

Teenagers and young adults are more honest about providing potentially negative or sensitive information about themselves to a computer compared with a paper questionnaire, and especially compared with a face-to-face conversation with a doctor. Interestingly, they are more honest and elaborate more on risk behaviors when online, even though they know their physician is going to see the information.

If you are not in a good position to manage your college-aged patients yourself, help them transition to an adult care provider proficient in the management of ADHD. Family physicians often are a better choice than internists because they care for children and are more likely to have experience treating ADHD. But make this decision only if you must, as continuing your long term relationship and support can make a big difference at this delicate transition. Besides, you then get to see them grown up and share in their success!

This column, "Behavioral Consult," regularly appears in Pediatric News, an Elsevier publication. Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University School of Medicine, Baltimore. Dr. Howard’s contribution to this publication was as a paid expert to Elsevier. Dr. Howard disclosed that she is cocreator of CHADIS. E-mail her.