ADHD in College Students - a Guide for Clinicians and Administrators

Abstract

ADHD affects 5-6% of all college students. It is a disorder with profound comorbidities and consequences, including increased mortality. Difficulties and damage accrue synergistically during the college years, directly affecting academic achievement and graduation rate. It can be reasonably extrapolated that these students may be at higher risk for sentinel events involving impulsive behavior, intoxication and self-harm, and that current campus policies aimed at reducing access to stimulant medication contribute to social injustice by disproportionately affecting already disadvantaged students. After exploring the large body of observational data, specific recommendations regarding diagnosis and treatment are made. The gold-standard for diagnosis is a comprehensive clinical interview informed by reports from others who know the patient. While universities often demand neuropsychological testing before offering medication, there is a broad agreement among researchers and clinicians that this is not scientifically justified. The most effective treatments combine pharmacotherapy with individual and group psychotherapy. Stimulants are very effective. So much so that starting all patients on non-stimulants solely to prevent diversion is clinically inappropriate. Rather, effective methods to limit diversion that do not limit access to care for those with the disorder must be developed. Various psychotherapies have been assessed and have shown benefits. A CBTbased, comprehensive, multi-modal and manualized intervention has been specifically created and examined for use with college students. The outcome data are encouraging. By combining appropriate diagnostics, effective pharmacotherapy, and comprehensive, multi-modal psychotherapy, administrators and clinicians may join forces to meaningfully improve retention, academic achievement, graduation rates, and emotional growth for this large and high-risk cohort. Colleges may need to invest in hiring expert clinicians to deploy this care, as most do not have enough of them currently.