Can't study. Can't focus. Can't remember what I was supposed to do next. I've got to do this. No, I've got to do that. What was I doing?
In college, students with attention deficit/hyperactive disorder face an array of challenges—long days and nights of classes, studying and activities, all of which require increasing amounts of concentration.
Dr. Mark Thomas stands ready to help, both at The University of Alabama's Student Health Services and through his research into treating AD/HD on campuses across the country. That treatment includes prescribing drugs that allow students to focus over long periods of time and training in better study habits.
"Medications are, far and away, the most effective treatment for ADHD," says Thomas, a physician in the Student Health Center/University Medical Center, part of UA's College of Community Health Sciences. "They're not the total treatment, but they're the component of treatment that makes the most difference. We do try to advocate to students with AD/HD that the medication is just one part of the overall treatment approach."
A DISRUPTIVE FORCE
Attention Deficit/Hyperactive Disorder has a few categories; some children, for example, are unable to focus but don't exhibit hyperactive symptoms. They are diagnosed with "AD/HD, inattentive type." Those who exhibit both attention problems and hyperactivity are diagnosed with "AD/HD, combined type."
Children with ADHD, according to the Centers for Disease Control and Prevention, "have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be) and in some cases, are overly active." Everybody has periods of distraction or forgetfulness, but for a diagnosis of ADHD, the symptoms need to disrupt the child's life at school and at home.
"The characteristics of inattentiveness would include not only daydreaming, being easily distracted, procrastination, lack of organization, losing things, misplacing things, forgetting appointments, just an overall sense that the world is passing you by, and you're not able to keep up with it," Thomas says. "Patients end up feeling quite overwhelmed."
The Centers for Disease Control and Prevention notes that, as of 2006, 4.5 million children between the ages of 5 and 17 had been diagnosed with ADHD. In 2003, Alabama led the nation with 11 percent of its children diagnosed with ADHD, according to a center report. When these children reach college, they'll need to continue treatment. In addition, some students are being diagnosed with ADHD for the first time in college.
GUIDELINES NEEDED FOR COLLEGE-AGED
So, Thomas and his fellow physicians are responding with research to develop guidelines on treating ADHD on campus. The New York Times recognized his expertise in an April 2009 article on ADHD, and he co-presented a paper in May 2009 at the American College Health Association meeting in San Francisco. At the meeting, he was asked to co-chair an effort to write guidelines for treating ADHD on American college campuses.
"What grew out of that particular meeting was a consensus that we need to establish some guidelines for treatment of AD/HD across campuses," Thomas says. "There are guidelines in place for the pediatric population - children roughly between 6 to 12 - that the American Academy of Pediatrics has come up with. There are also guidelines that psychiatric associations have prescribed for grownups. What are really lacking are guidelines for adolescents and young adults, college age in particular."
Thomas surveyed 124 campus health centers from across the country about how staff members diagnose and treat ADHD. His preliminary findings suggest that about a third of these health centers do not offer prescription treatment for ADHD.
"While students on these campuses could presumably go off campus to receive this service, not having it readily available on-campus may provide a significant barrier to receiving care," Thomas says.
INCONSISTENCIES AMONG CAMPUSES
Campuses also vary widely when it comes to diagnosing ADHD among students.
"Only about half of them handle making a new diagnosis of ADHD," Thomas says. "Who they have handling their prescriptions and making the diagnoses varies widely. The most common providers they have are family-medicine physicians or psychiatrists. As far as making the diagnosis, there's a larger number that use mental health professionals, which also would include psychologists as well as psychiatrists."
Preliminary research also suggests that more than half of the students treated for ADHD in colleges were diagnosed on campus. Students who do not show the hyperactive component of ADHD in their childhood sometimes slip through the diagnosis net because they develop coping mechanisms in elementary or high school. Those coping mechanisms often break down in college.
"Eventually they get to the point where they're no longer able to function adequately either due to the increasing complexity of the school work or because they are now without the aid of parents or teachers looking over their shoulders. That's when they present and become diagnosed."
Students come to Thomas seeking advice usually because a friend or professor notices the symptoms before they do.
Part of the guidelines Thomas is helping develop involves diagnosis. Physicians need to be careful about distinguishing between ADHD and normal problems with concentration. Also, he's looking at who should make the diagnosis and whether the student has other problems that either mimic ADHD or make it worse.
"We don't want to establish the bar for making the diagnosis so high that it presents a significant barrier to care," Thomas says. "At the same time, we don't want to set it so low that it's easy for someone to come off the street and get a prescription they don't really need.
"As part of that diagnostic process, we do want to address the possibility of learning disorders, either co-existing with ADHD or mimicking ADHD. We also look out for other psychiatric diagnoses that mimic ADHD or coexist with ADHD. Why that's important is, with psychiatric diagnoses, we don't want to be treating the wrong thing.
"Sometimes the right medication for ADHD would be the wrong medication for other conditions and make the other conditions worse. On the other hand, if there are some unrecognized psychiatric diagnoses or learning disabilities, then we're losing the opportunity to being able to fully help the patient or the student."
Prescription medicine remains at the forefront of treating ADHD, Thomas says, including dextroamphetamines and methylphenidates. Innovations have refined and improved the way these drugs work on the brains of people with ADHD.
"The stimulant medication helps their brain to get tasks completed without getting distracted and going in other directions. It also helps to filter out extraneous stimuli coming in to their brain," Thomas says. "They're better able to sort out what's important for them to keep in their conscious brain and what bits of information can go into their subconscious."
PODCASTS TO OFFER PEER-TO-PEER SUPPORT
In the "old school" of treating ADHD, physicians perceived that the medication could be harmful, so they prescribed drugs only during school days. Now physicians recognize that the medication is relative very safe and that ADHD affects all aspects of a student's life, including hanging out with friends or studying late into the night. Having untreated ADHD also negatively affects driving safety in young adults. So, medication is needed over an extended period. As a result, physicians are using medicine that's delivered in pills or patches that spread the delivery of the drug over time.
Beyond drugs, Thomas is working to include in the guidelines other avenues of support for students with ADHD. He is working with students from the University Computer-Based Honors program to develop podcasts produced by students with ADHD to offer peer-to-peer support for the condition. He and other University staff members have formed the ADHD Consortium, a group of faculty and staff members interested in students with ADHD. The group is working to coordinate services for these students.
"We try to get them to go to the Office of Disability Services for academic accommodations," Thomas says. "Another leg of their treatment is academic training help, such as training in study skills and time management skills. There are a number of places we can send them to for that, for example the Center for Teaching and Learning at UA. We also are very interested in developing more programs for helping in that area, because that's an area in which students don't have a lot of awareness of what's available."