This article was selected by the APA as January’s ‘Member Course of the Month.’
Aaron E. Winkler, MD. University of Maryland / Sheppard Pratt Psychiatry Residency Program. David W. Goodman, MD, FAPA. Assistant Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine; Director of the Adult Attention Deficit Disorder Center of Maryland
ADHD continues to be a significant and difficult challenge in the collegiate world. The symptoms of the disorder directly impact a person’s ability to manage the demands of college. Matriculating students are expected to rapidly obtain and deploy many self-management skills. Increased academic expectations demand a greater capacity for sustained attention. And the evolving social milieu can tax the emotion-regulation and social cognition of those with ADHD.
Having seen our patients struggle, the Association for Collegiate Psychiatry decided to submit a workshop for presentation at the 2019 APA meeting in San Francisco. While developing the presentation we discovered a wealth of recent ‘young adult’ follow-up data from longitudinal studies.1 Without exception, the study’s findings reflected a significant decrease in functional outcomes across multiple domains of adult life. Further, we discovered that the new work coming from the TRAC observational study of college students has found troublesome rates of psychiatric comorbidity after the first year.2
This epidemiologic evidence supports devoting resources to the care of this cohort. But it appears that this has not penetrated the world of campus mental health treatment. At present, most post-secondary schools (to our knowledge, data is quite limited) lean toward policies that make it difficult for students with ADHD to be diagnosed or treated on campus. One obstacle is requiring evidence of a childhood diagnosis, which many children with high-IQ compensated ADHD may not have received. Another can be the demand for expensive and comprehensive neuropsychological testing even though the diagnostic value of that testing remains unclear.3 Some student health centers ask students to obtain prescriptions from the treaters they saw prior to coming to campus, even if those prescribers are out of state. Though these policies may be deployed in an effort to decrease diversion of stimulant medication, such hurdles may be difficult for the 18 year old ADHD student to navigate. The result is that many students with this predictably destructive condition go untreated.
The good news is this subject interests the collegiate community. Among other things, our APA workshop was selected to be the APA’s ‘Member’s Course of the Month’ for January 2020.4
Much work remains in developing and deploying diagnostic policies and treatment strategies that colleges and universities feel comfortable supporting. We mentioned the APSARD community during the workshop as a resource for professionals interested in ADHD. And we hope the wider ADHD research and treatment communities will join us in focusing our energy on this underserved and sometimes maligned group of students who need our help.
1) Gordon CT, Fabiano GA. The Transition of Youth with ADHD into the Workforce: Review and Future Directions. Clinical child and family psychology review. 2019 Feb 6:1-32.
2) Anastopoulos AD, DuPaul GJ, Weyandt LL, Morrissey-Kane E, Sommer JL, Rhoads LH, Murphy KR, Gormley MJ, Gudmundsdottir BG. Rates and patterns of comorbidity among first-year college students with ADHD. Journal of Clinical Child & Adolescent Psychology. 2018 Mar 4;47(2):236-47.
3) Antshel, K. Role of Neuropsychological Assessment in ADHD. APSARD blog post Jan 2, 2020. Accessed Jan 17, 2020. https://apsard.org/role-of-neuropsychological-assessment-in-adhd-2/