Improving the Performance of College Students with ADHD (Part 2)

Improving the Performance of College Students with ADHD (Part 2)

Posted on: June 25th, 2021 by Neurohealth Associates

(CONTINUED FROM PART 1)

There are exciting innovations for students with ADHD happening at colleges across the US right now. Along with support from family and friends, some of these innovations are yielding very positive results.

College & University ADHD Clinics

The SUCCEEDS ADHD Clinic (Students Understanding College Choices – Encouraging and Executing Decisions for Success), founded at the University of Maryland at College Park in 2018 and with a second location now at the University of Illinois at Chicago, aims to help college students with ADHD with academic and/or mental health difficulties. The program was created to address ADHD-specific deficits (in areas like executive functioning and self-regulation) that have been largely excluded from university services and accommodations.

Students in the program undergo an initial evaluation that identifies domains of focus — be it academics, substance dependency help, anxiety, or another issue — and that informs their individualized treatment plan for the semester. The program also offers organizational skills training — covering areas like prioritizing, goal setting, and routines — as well as weekly group sessions, individualized academic and mental health coaching, and guided study hall sessions. Parental involvement is a factor, but the degree of involvement varies across patients.

SUCCEEDS is first and foremost a clinical service for these students, but the program also serves as an opportunity for research. Findings in a study involving a small portion of the roughly 50 clinic participants show that more than half reported clinically significant changes in organizational skills. All of the participants with moderate levels of mood disorder at baseline reported clinically significant changes in symptoms. And half of the students with elevated levels of alcohol use reported changes in use by the end of the program.

Preliminary evidence suggests that SUCCEEDS and programs like it are an effective method for addressing the distinct and wide-ranging difficulties experienced by college students with ADHD. That said, these programs have also illuminated several important considerations, including the sheer complexity of patient cases. 

For anyone with ADHD, comorbidity tends to be the rule, not the exception. Individualized treatment plans, as well as program content overall, must therefore take into consideration comorbid conditions and challenges. Future directions for the program include, but are not limited to, further expansion across colleges, creating tiered levels of care, and implementing more standardized parental involvement.

ADHD Organization, Time Management, & Planning Interventions

Skill and knowledge-building interventions may also help students with ADHD succeed in college, as demonstrated by a pilot study of a largely behavioral-based intervention program for these students across two public universities.

The 8-week program focuses on OTMP and study skills, as these most directly relate to the executive function deficits associated with ADHD and to the demands of college. Skills covered in the weekly in-person group sessions include planning with calendars, creating task list systems, studying and note-taking, and addressing procrastination. Some of the program’s sessions also focus on psychoeducation, where participants learn more about and discuss ADHD.

At the program’s end, the 30 participants tended to report improvement in inattention, in overall ADHD symptoms, and in OTMP skills compared to baseline measures. Participants also generally reported satisfaction with the intervention and had a very high attendance rate (87 percent rate for weekly sessions). The program thus holds promise for targeting ADHD-specific challenges and improving outcomes in college for students with ADHD.

The Role of Parents of College Students with ADHD

Parenting significantly impacts the trajectory of a child and adolescent with ADHD, even into adulthood. It is well established that, with ADHD, a positive parent-child relationship can lead to adaptive outcomes, whereas the opposite can lead to adverse outcomes.

Children and teens with ADHD are at a greater risk for harsh and inconsistent parenting. Compared to non-ADHD peers, adolescents with ADHD experience less monitoring and supervision from parents and more frequent arguments with them as well. 

These interactions put these teens at higher risk for comorbid difficulties, including oppositional defiant behaviors, substance abuse, anxiety, and mood disorders. On the other hand, parenting that involves more responsiveness, higher levels of warmth, and more knowledge of and involvement in activities has been linked to fewer negative outcomes.

Research also shows that higher levels of authoritarian parenting (a harsher, overly punitive style) and lower levels of authoritative parenting (which is widely accepted as the optimal parenting approach), are associated with negative outcomes, and especially in emerging adulthood. Authoritarian parenting is linked to acute ADHD symptoms and the internalization of symptoms, which include stress and anxiety. 

However, higher levels of parental warmth, involvement, and autonomy-granting may buffer against mood disorders and ADHD symptoms in college. Parents of college students with ADHD, therefore, may be in a unique position to provide particularly valuable support, even from a distance.

Support from Family & Friends for College Students with ADHD

Findings from a recent study on parental support for college students with ADHD and its influence on symptoms and impairments are mostly in line with this existing literature. The study’s “high ADHD” group (those who reported a previous diagnosis of ADHD and/or identify with five or more DSM-5 symptoms) reported lower levels of trust with parents, poor quality of communication, and higher levels of alienation with parents compared to students in the “no ADHD” group. 

The study found that, overall, a low level of parent trust was related to more impairment. Higher levels of alienation, meanwhile, were also related to higher levels of impairment and more anxiety, stress, and negative emotions. A closer, more trusting relationship with parents, it appears, may protect against poor outcomes in college for students with ADHD.

ADHD Medication Misuse on College Campuses

For college students with ADHD, taking prescribed stimulants and other ADHD medications as directed is correlated with success. But the nonmedical use of stimulants is a significant issue on college campuses, with prevalence rates roughly ranging between 5 percent and 10 percent. This trend may be rooted in universal college stressors today.

Over time, college freshmen especially are arriving onto campuses with higher GPAs and more attention (and stress) toward academics, but less attention on emotional health. How does this relate to stimulants? The average college student believes that stimulant medication provides academic benefits. 

Interestingly, research on nonmedical stimulant use among college students without ADHD suggests an expectancy effect — in other words, the data shows no actual link between stimulants and improved neurocognition in students without ADHD. In fact, some research shows that stimulant misuse is associated with a drop in GPA in students who do not have ADHD.

Clearly, not all college students misuse stimulants. Research shows that the individuals at risk for misusing are those who self-report problems with procrastination and/or time management; who use other substances; and who believe that stimulant misuse is rampant on campus.

Preventing Stimulant Misuse at Colleges & Universities

An ongoing project at New York’s Syracuse University has revealed some insights into addressing stimulant misuse on college campuses.

The prevention program involves more than 400 freshmen without ADHD, half of whom are undergoing a brief intervention that targets misuse risk factors like time-management problems, procrastination, and perceived stimulant benefit. Analysis reveals that, compared to controls, the intervention group saw a lower rate of stimulant misuse (about 4 percent prevalence versus 11 percent) during their first semester in college. This group also saw a reduction in positive expectations for stimulants.

Interestingly, procrastination and time management interventions had negligible impact on participants, which raises questions about refocusing the program on successful interventions – namely, motivational interviewing and challenging expectations on stimulants. Ultimately, however, participants positively rated the intervention experience overall.

Current Takeaways for College ADHD Treatments

College students with ADHD are increasingly common, and increasingly navigating stressors that are unique to them. While college disability services are one solution, only a minority of college students with ADHD seek these services. Innovative care models and targeted interventions for these students show promise in increasing the necessary skills for college success and in improving symptoms of ADHD and its comorbidities. Research also shows that a strong parent-child relationship may improve outcomes in college — and beyond.

Neurofeedback Therapy

Here at Neurohealth Associates, we specialize in Neurofeedback treatments. Neurofeedback may be helpful for treating ADHD symptoms, especially if you are unsure about putting yourself or your child on medication. The easy, noninvasive treatments can painlessly improve your mental health condition and outlook on life.

Schedule a consultation with NeuroHealth today and find out how we can help you.

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