College Success for the Student with ADHD
by Ari Tuckman, PsyD., MBA

Every summer I get calls from the parents of ADHD college students who had a rocky year and are now probably on academic probation. They need to get their grades up in the fall or be forced to take time off. Most of these students had already been diagnosed with ADHD, but some of them didn't know they had ADHD until we started meeting. This revelation usually explains a lot.

In the interest of helping other students avoid these struggles, let's talk about how to succeed in college if you have ADHD. Going from high school to college can be a gigantic transition. For most students, the hardest part isn't the work itself (although it does get harder) but rather the sudden need to manage their lives with minimal outside support. The parents and teachers who might have helped keep you on track before aren't around any more.

Here are my top tips for succeeding in college with ADHD:

• Create a full-semester calendar. To avoid suddenly discovering that you have three tests in two days, write all of your big assignments on one calendar that covers the entire semester. Post it on your wall. Then mark off the days as they pass. This will help you see better what you need to do and when you need to do it.
• Use the available support services. Most schools offer at least some sort of support services for students with ADHD and other disabilities. Find out what they offer and what it takes to qualify for those services, then use what you need. Don't wait until the end of the semester (they hate that).
• Go to all your classes. Yes, this is an obvious one, but it works. Don't talk yourself into "just skipping this one class. I'll go to the next one."
• Talk to your professors as soon as you start to struggle. The deeper the hole, the harder it is to dig out of. Professors are much more willing to work with you if the situation hasn't yet become a total disaster.
• Keep taking your medication. It's always amazing to me how many college students stop taking their medication. If it helped you succeed in high school, why would you stop taking it when the demands are that much greater?/li>
• Find the professors who teach the way that you learn. Ask your advisor and all your friends about professors' teaching styles so you can find the ones who will be the best fit for you.

If you are an older student or going back to college after some time off, congratulations! Remember, the most important thing is that you finish, not when.

ADHD Changes From Adolescence to Adulhood
by Richard Rubin, MD

In a Dartmouth Medical College Psychiatry seminar, I described how advancing age produces variations in ADHD and requires individualized treatment approaches. Previously diagnosed children have core symptom "migration" differences, such as hyperactivity becoming internalized, more felt as a problem than observed. Combined emotional disorders occur more frequently, such as anxiety and depression. Behavior problems such as oppositional and conduct disorders may evolve to more serious consequences, such as legal infractions and school/job disruptions. Substance abuse occurs more, and can worsen the ADHD. Adolescents may reject prior medicine out of rebellious pride or stigma fears, leading to more young adult ADHD impairments.

ADHD may also present as a new concern in this age group. Inattentive kids may not be identified until high school or college demands increase. Combined anxiety symptoms may inhibit hyperactive behavior, delaying ADHD recognition. Often sociable, athletic girls are popular and socially promoted, but their overlooked ADHD weaknesses become problems later. Younger kids may be provided much school and home support, but become impaired when independent adolescent or adult competence is required. Some parents and school personnel may reject medicine for children, delaying their presentation for treatment. Sometimes elementary and middle school children receive psychological testing, but milder ADHD problems don't qualify for special education programs, and they are not referred for treatment. These may progress to greater life function difficulties. We also recognize now that some ADHD adults have a "late onset" in adolescence, not childhood as the current Diagnostic Manual requires. In addition, adolescents and young adults may be treated for more prominent anxiety, depression, or trauma problems, but combined ADHD is not recognized until later. ADHD may also present covertly and need recognition when obscured by "stress" problems, excessive use of nicotine and caffeine, impulsive sexual consequences, substance abuse, and driving citations.

Treatment planning differs between adolescence and adulthood depending on the individual's impairments. Some young adults may manage their ADHD symptoms adequately with appropriate activity choices and management skills, but others have significant impairments in work, home, and social life. The three pillars of treatment are 1) understanding one's ADHD characteristics, 2) strengthening brain function with medicine, and 3) practicing the right self-help skills. Medication choices need to cover adequate duration of symptom control. Combined problems such as anxiety, mood, and sleep problems need consideration. Misuse and diversion risks should be addressed. Recent research advances now expand the FDA approved choices to five, in order of approval: atomoxetine (Strattera), mixed amphetamine salts (Adderall XR), dexmethylphenidate (Focalin XR), lisdexamfetamine (Vyvanse), and OROS methylphenidate (Concerta). RL Rubin 2008

Below are some interesting articles on ADHD and related topics:

• Clutter Could Signal a Bigger Problem Disability
• Skepticism Suddenly Disappears When You Read a List of Symptoms
• Attention Deficit-Hyperactivity Disorder Explained

Visit myADHD.com and use the follow tools this month to help children with ADHD establish household routines and to promote responsibility:

• My Daily Jobs
• My Morning Jobs List
• My Bedtime Jobs List
• Using a Home Token Economy Worksheet