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.
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"Early intervention for ADHD is forever," says Dr. Margaret D. Weiss. College students with ADHD need to be engaged in treatment before they fail.
The moral of that story is that "with college students, you have to do CBT [cognitive-behavioral therapy] first," she said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. 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 CBT 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. Weiss said. Treatment with medication alone does not seem to diminish ADHD symptoms or improve student adjustment to college, multiple studies have shown. Programs that carry forward the skills-based training that children with ADHD receive are needed for college students to succeed.
"Pills do not build skills," she said.
Typically, children with ADHD are followed in pediatrics and psychiatry until they reach age 18 and then are "abandoned" at a key point in life when they face intense challenges – leaving home, learning to drive, and dealing with peer drug use, the complexities of dating, and the increased demand for executive function in college, Dr. Weiss said.
"Treatment in childhood does not mitigate adult outcomes without ongoing follow-up," she said. "Early intervention for ADHD is forever." College students with ADHD need to be engaged in treatment before they fail.
An estimated 2%-8% of college students have clinically significant levels of ADHD symptoms, studies have shown, and 25% of college students with disabilities are diagnosed with ADHD. There have been few studies of assessment methods, however, and nearly no controlled studies of psychopharmacological, psychosocial, or educational interventions, Dr. Weiss said. Good measures of outcomes have not been developed in these cases, but at least college students can self-report on whether they’re doing well, getting to class on time, and taking notes, for example.
Research also is needed not only on college students with ADHD who are struggling, but on the resiliency of young people with ADHD who make it to college, she added. Studies should investigate the competencies of students with ADHD who have achieved success against the odds.
"If you read the early longitudinal follow-up studies" of students with ADHD, "you wouldn’t think that anybody got to college," she noted. In the modern era of disability services and accommodations, longitudinal outcomes might change. In the future, all colleges and universities will recognize ADHD in their students, and multimodal, multidisciplinary treatment of ADHD in college will be the norm, Dr. Weiss predicted.