ADHD: Not Just Kidding Around

By Holly VanScoy
From HealthScoutNews

Oct. 28, 2002 — As college students settle into the routine of lectures, tests and papers this fall, a surprising number will learn something shocking: They have attention-deficit/hyperactivity disorder.

Once considered primarily a childhood condition, ADHD, as it is commonly called, is now known to be a lifelong condition for as many as half of those troubled with its hallmark symptoms of inattention, distractibility, impulsivity and emotional instability starting before age 7.

Despite its persistence in as much as 1 percent of the population, the disorder often remains undiagnosed for a decade or more, finally becoming debilitating when academic, social or work pressures mount after high school graduation.

That's why ADHD seems to break out like an epidemic on college campuses every fall.
"The structure of high school is such that students with ADHD can slip through unnoticed," says Robert J. Resnick, a professor of psychology at Randolph-Macon College in Ashland, Va. He's also the author of "The Hidden Disorder: The Clinician's Guide to Attention-Deficit/Hyperactivity Disorder in Adults."

"But college is a different story," Resnick adds. "The stepped-up demands of higher education, coupled with the absence of many familiar external structures and controls, bring these students problems with organization and distractibility to the forefront. They just can't fake academic performance any longer. When referred to the college's support services for help, they find out -- many of them for the first time -- that they have had ADHD for many years."

Female college students are just as likely as male students to be affected, despite the disproportionate number of boys diagnosed with ADHD in the early grades, says Resnick, a former president of the American Psychological Association.

"The condition is no respecter of gender," Resnick explains. "However, the symptoms in young males and females are often different. Boys with ADHD tend to be more active and aggressive, which results in earlier referral for assessment by parents and teachers. In elementary school, the ratio of boys diagnosed with ADHD to girls diagnosed is three- or four-to-one. On the college campus, the ratio is one-to-one."

Beth Howlett, clinical coordinator of the Counseling Center at Widner University in Chester, Pa., is familiar with the phenomenon. She estimates that only about one-third of the ADHD students she works with were diagnosed before they began college.

"Elementary and secondary teachers today are doing a better job spotting the symptoms of this disorder early," Howlett says. "But there are still many students, particularly girls, who slip between the cracks before they start college.?

According to Howlett, students with ADHD tend to have a familiar litany of complaints. These include:

• Inability to concentrate in class or on homework assignments.
• Inability to grasp the meaning of what they've read without repeated re-readings.
• Difficulty following a professor's train of thought, paying attention through long lectures or labs, or taking notes in an organized way.
• Susceptibility to distractions that don't seem to affect their classmates.
• Reliance on stimulants, such as coffee, as a means of focusing on important tasks.
• Abusing substances, such as alcohol, illegal drugs or prescription medications, as a means of managing stress.

"What I call the 'burden of reading' -- the sheer volume of mastery of the written word required in virtually every university course -- is one of the first things that shows up as a problem for the college student with untreated ADHD," Howlett says.

Although the official criteria for diagnosing ADHD later in life is identical to those confirming the disorder in young children, it is increasingly recognized that the condition is often more subtly expressed in adulthood.

As a recent article in American Family Physician notes, the "hyperactivity common in ADHD children is less likely to be overt in adults, and the on-the-go drivenness of the ADHD child is frequently described by ADHD adults as restlessness, difficulty relaxing or feeling ?chronically on edge.?"

"ADHD results in clinically significant impairment," Resnick says. "These are not students that experience difficulty paying attention from time to time in class, or occasionally can't remember something important. These are students who are chronically impulsive, distracted and disorganized. They don't forget where they left their car keys. They forget where they left their cars."

Howlett also says ADHD college students appropriately identified and served often fare better academically and socially than their non-ADHD peers.

"When they are diagnosed early and plugged in to the right resources, students with ADHD do well," she says. "But if the ADHD is left untreated, such students often grow increasingly disorganized, impulsive, frustrated and, ultimately, unsuccessful in this very competitive environment."

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