Helping College Students with ADHD Is a Challenge

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EXPERT ANALYSIS FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY

SAN FRANCISCO - Dr. Margaret D. Weiss had hoped that the group psychotherapy program she started for students with attention-deficit/hyperactivity disorder at the University of British Columbia might be more successful than some similar groups she'd heard about elsewhere with disappointing outcomes.

Her hopes were dashed, but some lessons were learned.

Despite a high rate of dropouts from the program, some students showed improvements. For other students, however, the group just confirmed their conviction that they were failures. In one group, for example, participants came to agreement in the very first session that they were all hopeless losers, and that psychiatrists and psychologists were stupid because they kept telling the students to do things that they had been trying to do for 20 years with little success.

The moral of that story is that "with college students, you have to do [cognitive-behavioral therapy] first," she said at the meeting. If the students don't gain some confidence through hands-on CBT-like groups that teach executive function skills, group therapy is not going to work, said Dr. Weiss, head of the ADHD clinic at the university, in Vancouver.

Her program has made some adjustments that could improve chances for success, she said. In Canada, all college students with ADHD are entitled to accommodations and student disability services. However, now students at her institution will be told that in order to get the ADHD accommodations, they must take a required course of cognitive-behavioral therapy and group therapy.

"It's got to be on campus and scheduled so that they'll come," and it must be highly structured, with an emphasis on praising the students' efforts, not their achievements, she said.

Contact with other students who have ADHD might be especially important for college students with the disorder, Dr. Weiss said. Group psychotherapy can be very effective for lonely students. College students with ADHD who live away from home are more likely to have trouble managing activities of daily living, dealing with the distractions of dormitories and partying, falling behind academically and being unable to catch up, and negotiating the world of dating. They are at greater risk of loneliness, emotional dysregulation, self-medication, arguing with teachers, and becoming addicted to computers.

In one survey of 1,638 college students, 68 of whom had ADHD, the students with ADHD reported greater concerns about academic performance and depressive symptoms during the transition to college, Dr. …