Kevin Valliere, New York University

Mental health is increasingly on the forefront of the discussion surrounding higher education. According to the Center for Collegiate Mental Health (2019), between 2009 and 2015 U.S. colleges and universities saw a 30% increase in the number of students looking to schedule appointments with their respective counseling center while overall enrollment rose only 5%.

Of those students, an increasing number will be or will have already been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) and deal with its effects through adolescence and adulthood (Murkett, Smart, & Nugent, 2014).

This article will help academic advisors understand what ADHD is, how it impacts today’s college students, and what they can do to help those students.

Understanding ADHD

While exact data on the number of college students with ADHD are limited, reported rates of diagnosis can range anywhere from 2% to 12% (Murkett et al., 2014).

In the current understanding of ADHD, there are three different presentations as identified by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). First, and perhaps most ingrained in the popular mindset, is the predominantly hyperactive presentation. This presentation features such hallmark characteristics as restlessness, disruptive behavior, and aggression. The second presentation, predominantly inattentive, leads to issues with disorganization, inattention, and distractibility. There is a third and final presentation, combined, which has various levels of intermeshed characteristics from the previous two presentations. Boat and Wu (2015) note, however, that “there are no laboratory tests available to identify ADHD in children,” and that clinical interviews pertaining to the child’s academic, social, and family history (in combination with accepted behavior rating scales) are the best way to make a diagnosis.

Gender differences in ADHD are still unclear and range from a disproportionately high percentage of young males to young females on one end to slightly more adult females than adult males on the other (Rucklidge, 2010). In general, caretakers and family members are more likely to identify males as being hyperactive and females as being inattentive. Indeed, reported diagnoses bear this out as young females are more likely to be diagnosed with a predominantly inattentive presentation than males.

In terms of racial differences, while there is “no clear evidence for racial/ethnic differences” in actual rates of ADHD, cultural attitudes may lead to varying interpretations of ADHD-symptomatic behavior, leading parents to choose different outcomes in seeking an ADHD diagnosis or not (Boat & Wu, 2015). For instance, in a 2018 survey the Center for Disease Control found that 12.8% of African American students aged 3–17 had ever been diagnosed with ADHD (compared to a rate of 9.8% overall), while only 3.2% of Asian students had ever been diagnosed (Black & Benson, 2018).

In addition, as many as 70% of those diagnosed with ADHD have a co-occurring affective, learning, or conduct disorder (such as anxiety or dyslexia), and so in many cases students are not just dealing with the symptoms of ADHD but also the compounded symptoms of a number of issues (Boat & Wu, 2015).

Effects of ADHD in College

Murkett et al. (2014) note that because ADHD is a disorder associated with the brain’s biological ability to control executive functions such as attention, motivation, and organization, “postsecondary education can be particularly challenging” for students with ADHD due to rapid changes in “lifestyle, independence, and responsibility.” Traditionally, higher education marks a time where students see a massive increase in independence when structuring their own schedules; ADHD takes the challenges of this increase and dials them up to the nth degree.

Indeed, students with ADHD are more likely to drop out of college than their neurotypical peers (Murkett et al., 2014). In addition, they are likely to have lower grade point averages throughout their college career and are more likely to be on academic probation.

Outside of the classroom, ADHD students are also more likely to misuse substances like the prescription stimulant Adderall, alcohol, and other drugs (Murkett et al., 2014). Other problematic behaviors associated with college students with ADHD include addictive behavior (such as with gaming or the internet), risky sexual behaviors like less-consistent use of contraceptives, and overall higher levels of unnecessary risk-taking.

The high rate of comorbidity with affective disorders can exacerbate already existing issues (Boat & Wu, 2015). A student with both ADHD and depression, for example, faces two significant barriers to succeeding in the classroom: the ability to get oneself out of bed in the first place and the ability to pay attention once they are actually in class.

The news need not all be bad, though: in a qualitative survey, Sedgwick, Merwood, & Asherson (2018) found a number of areas in which adults with ADHD had unique strengths. The adults surveyed were able to use their disorder’s hallmark bouts of “hyper-focus” to further their productivity. They highlighted their creativity and curiosity. And, among many other indicators, they noted their penchant for resilience, given their often lifelong struggles with inattention and compulsivity. So while there are a number of severe risk factors for students with ADHD in college, ADHD can also be a source of inspiration or even pride.

Implications for Academic Advising

As it has been established in previous NACADA publications, unless otherwise certified, “academic advisors are not professional counselors” (Harper & Peterson, 2005). Diagnosis, therapy, and medication management are well outside of the scope of an advisor’s responsibility. However, that does not mean that academic advisors are incapable of assisting students with ADHD in their regular practice.

First and foremost, advisors should be knowledgeable of their institution’s resources for students struggling with or looking to improve their mental wellness.

Campus Resources

When approached by a student who has disclosed they have ADHD, advisors can direct the student to utilize their institution’s relevant disability services office for accommodations. The Attention Deficit Disorder Association (2017) has a list of potential suggestions for students seeking accommodations, breaking the suggestions down into three categories. First, students can ask for assistance with exams and assignments in the form of extended time and a separate and/or quiet location. Second, students can ask for assistance with lectures, including obtaining permissions to record the lectures or receiving a dedicated note-taking service. Finally, students can ask for reduced course loads or priority registration. While advisors may not be an explicit part of this process, they can support students during and after the process with information and advocacy.

In addition, campus counseling centers can provide students with pharmacological or therapy-based treatment for ADHD or refer students out to local providers. As part of a regular accommodations process, students may already be seeing a psychiatrist or psychologist to show that not only do they have ADHD, but that there is also “evidence of impairment” (Murkett et al., 2014). Helping students navigate the campus counseling framework is still well within the purview of an advisor’s role, while letting certified professionals handle the issues which are outside that purview (such as the social and emotional risk-factors associated with students with ADHD).

Advising Strategies to Address Specific Skills

But since counseling may not be an option (or may not be enough) for a student with ADHD, there are some common-sense actions advisors can take to assist these students. These can be focused into two additional categories based on the unique challenges students with ADHD face.

Organizational Skills. Since organizational skills can be a struggle for students with ADHD, an emphasis should be placed on assisting the student in creating a structure around which they can organize their personal and academic lives. This may take the form of a desk calendar, with the advisor assisting the student in noting important academic deadlines (such as withdrawing from courses or applying for financial aid). It could also lead to helping student find an organizational system that speaks to them, such as using sticky notes, folders, or keeping only digital files.

Frequent and personalized reminders of upcoming deadlines or meetings—in the model of intrusive advising, as discussed by Schwebel et al. (2008)—can also be a way advisors support their students with ADHD.

Academic Skills. Advisors should also be ready to help students with ADHD learn or re-learn how to appropriately take notes and study in college. Since students with ADHD are more likely to be on academic probation, it follows that familiarizing oneself with learning strategies for students on probation is a useful place to start. According to Renzulli (2015), these strategies include initiating specific conversations around the number of hours students study each week and how they study or using “active engagement strategies” like retyping notes and creating individual note cards for various classes.

Encouraging students to utilize campus academic support resources (such as a writing center or tutoring center) is also an option if the advisor feels uncomfortable giving specific advice.

Similarly, there are some catchall suggestions that advisors can give to students who have self-identified as having ADHD. Writing for the advocacy-focused ADDitude Magazine, Klein and Sandler (2019) provide a number of these simple tips. They include building in rewards during study sessions and arranging work and study groups with fellow students to help keep them accountable for their coursework.

Conclusion

When I presented a poster at the 2019 NACADA annual conference in Louisville, KY, I was struck by a common thread of many of the professionals who came up to speak with me. For them, and for many others at the conference, ADHD was not merely a hypothetical professional consideration. Their brother or daughter or partner had ADHD, or perhaps they even had it themselves.

Advising students with any mental health issue is likely to be a deeply personal experience. It can be daunting to try and help a student who is struggling with or working through something that the advisor may or may not understand intuitively.

No student’s experience will be similar, and while an advisor can support a student with ADHD, it will always ultimately be up to the student to follow through on the accommodations and support given at their institution. But through utilizing campus resources, staying up to date on research, and following relevant advice, advisors can have a profound, positive influence on students with ADHD.

Kevin Valliere
Assistant Director of Advising
New York University
Stern School of Business
[email protected]

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Attention Deficit Disorder Association. (2017). Recommended accommodations for college students with ADHD. https://add.org/recommended-accommodations-college-students-adhd/

Boat, T. F., & Wu, J. T. (Eds.). (2015). Mental disorders and disabilities among low-income children. National Academies Press.

Black, L. I., & Benson, V. (2018). Tables of summary health statistics for U.S. children: 2017 national health interview survey, table C-3. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhis/SHS/tables.htm

Center for Collegiate Mental Health. (2019, January). 2018 Annual Report (Publication No. STA 19-180). https://sites.psu.edu/ccmh/files/2019/01/2018-Annual-Report-1.30.19-ziytkb.pdf

Harper, R., & Peterson, M. (2005). Mental health issues and college students. NACADA Clearinghouse of Academic Advising Resources. http://www.nacada.ksu.edu/Resources/Clearinghouse/View-Articles/Mental-health-issues-in-advising.aspx

Klein, A., & Sandler, M.. (2019). Conquering college. Additude Magazine. http://www.additudemag.com/conquering-college/

Murkett, K., Smart, W., & Nugent, K. (2014). Attention-deficit/hyperactivity disorder in postsecondary students. Neuropsychiatric Disease and Treatment, 10, 1781–1791. https://doi.org/ 10.2147/ndt.s64136

Rucklidge, J. J. (2010). Gender differences in Attention-Deficit/Hyperactivity Disorder. Psychiatric Clinics of North America, 33(2), 357–373. https://doi.org/10.1016/j.psc.2010.01.006

Renzulli, S. J. (2015) Using learning strategies to improve the academic performance of university students on academic probation. NACADA Journal, 35(1), 29–41. https://doi.org/10.12930/NACADA-13-043

Schwebel, D. C., Walburn, N. C., Jacobsen, S. H., Jerrolds, K. L., Klyce, K. (2008). Efficacy of intrusively advising first-year students via frequent reminders for advising appointments. NACADA Journal, 28(2), 28–32. https://doi.org/10.12930%2F0271-9517-28.2.28

Sedgwick, J. A., Merwood, A., & Asherson, P. (2018). The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 11(3), 241–253. https://doi.org/10.1007/s12402-018-0277-6

Cite this article using APA style as: Valliere, K. (2020, March). On advising students with ADHD. Academic Advising Today, 43(1). [insert url here]