Although individuals with ADHD are less likely than others to attend college, recent years have seen an increase in the number of college students with ADHD. Because ADHD frequently has an adverse impact on individuals’ academic, social, and psychological functioning, there is a strong basis for expecting that college students with ADHD would also struggle in these areas.

However, some authors have suggested that negative outcomes observed in children and adolescents with ADHD may not apply to college students. This is because college students are likely to have higher ability levels, to have experienced greater success during primary and secondary school, and to possess better compensatory skills than individuals with ADHD from the general population. Thus, the degree to which findings from the general population of individuals with ADHD apply to college students is uncertain, and research on this issue is unfortunately limited. Studying the functioning of college students with ADHD is thus important for learning how ADHD may impact individuals during this key developmental period and the supports that students with ADHD may need to have a successful college experience.

 A web-based survey of students attending a private and public university in the southeastern US was conducted to look at ADHD in college students. This study included over 150 students who reported having ADHD. The focus was to examine how students with ADHD were functioning in academic, social, and emotional domains. Because over 25% of students with ADHD were not receiving medication treatment, the study was also able to examine how medication treatment was related to students' adjustment.

To begin the study, an email invitation to complete a survey was sent out to approximately 10,000 students at the 2 universities during the spring semester of 2007. The primary focus of this survey was to examine the misuse of ADHD medication by college students. In this article, however, the focus is on what was learned about how students with ADHD are adjusting in college.

To protect students’ confidentiality, they were assigned a randomly generated ID number to access the survey and were assured that the researchers would not link survey responses to individual students. Nearly 3,800 students, about 35% of those invited, completed and submitted the survey. Although this response rate is below what was hoped for, it is comparable to what has been obtained in several related web-based surveys of college students.

Survey Content

To identify students with ADHD, participants were asked whether they had a current diagnosis of ADHD from a medical or mental health professional. Students reporting a current diagnosis were asked whether they were currently taking medication to treat their ADHD.

All students were asked a series of questions to assess the severity of their problems with attention and hyperactivity-impulsivity, as well as questions to assess their adjustment in the following areas:

1) Academics - Students were asked to report their current GPA. They were also asked questions pertaining to how concerned they were about being able to succeed academically.

2) Social life - Students were asked to how satisfied they were with their relationships and social life.

3) Depression - Students reported on the frequency and intensity of depressive symptoms.

4) Alcohol, tobacco, and drug use - Students were asked about their use of alcohol, tobacco, and a variety of illicit substances.

Results

One hundred fifty-three students, approximately 4.5% of the respondents, reported a current ADHD diagnosis. One hundred and thirteen of these students were currently being treated with medication.

Overall, students with ADHD were faring worse than their classmates in every are examined. They had significantly lower GPAs, were more concerned about their ability to succeed academically, reported higher levels of depressive symptoms, and were less satisfied with their relationships and social lives. They also drank more often and consumed more alcohol on those occasions when they drank. Finally, they were more than twice as likely as other students to be smokers and to use marijuana.

Little evidence was found that the association between ADHD and these outcomes depended on whether students were male or female. Similarly, little evidence was found that the association between ADHD and students' adjustment varied as a function of students' year were in school. Thus, freshman with ADHD were not likely to be doing any better or worse than seniors with ADHD.

Although the differences reported above were all statistically significant, their actual magnitude was generally not large, suggesting that many students with ADHD were probably doing quite well.  Students were considered to be within the normal range for a area if their score in that area was not more than 1 standard deviation from the mean in the deviant direction, which corresponds to roughly the top 15%. For example, students were considered to be in the normal range for depressive symptoms if their score on this scale did not exceed the 85th percentile. In contrast, students with depression scores that were among the the highest 15% of the sample would be considered struggling in this domain. Similarly, students were considered to be in the normal range for GPA if their GPA was not in the bottom 15% of the sample.

Using this definition of “normal” the data study found that even though students with ADHD were more likely to be struggling than other students, the majority were doing reasonably well. Shown below are the percentage of students with and without ADHD who were functioning in the normal range within each area.

73% of students with ADHD had GPAs in the normal range vs. 90% of students without ADHD;

77% of students with ADHD had worries about academic performance in the normal ranges vs. 85% of students without ADHD;

75% of students with ADHD reported depressive symptoms in the normal ranges vs. 85% of students without ADHD;

79% of students with ADHD had social concerns and worries about academic performance in the normal ranges vs. 85% of students without ADHD;

As can be seen, even though students with ADHD were less likely than other students to be in the normal range, the majority appeared to be adjusting well within each area. Furthermore, the study found that about 35% of the students with ADHD had scores within the normal range for every domain and nearly two-thirds were experiencing difficulty in only a single domain.

What about medication?

The final issue examined was whether students taking medication reported doing better than those who were not.   The study found virtually no evidence for this. In every single area, students with ADHD on and off medication had scores that were very similar. Even when the researchers looked at students' reports of inattentive and hyperactive-impulsive symptoms, the areas where medication would have it's most direct impact,  the difficulties reported by the two groups of students were highly consistent. The only hint of a medication effect found was that at the private university, which was more academically competitive, students on medication had higher GPAs than students not being treated.

Summary and Implications

Data from this study indicate that, on average, students who report having ADHD were faring less well than peers in many of the areas studies. They have lower GPAs, are more concerned about their academic performance, and report higher levels of emotional distress and social concerns. Alcohol use tends to be higher and they are more likely to smoke and use marijuana. Thus, even among individuals with ADHD who have done well enough academically to complete high school and enroll in college, there is evidence of ongoing struggles associated with the disorder.

These average differences, however, can obscure the fact that most students with ADHD were doing quite well. Within each adjustment area, over 70% were functioning in the normal range. Furthermore, nearly two-thirds of students with ADHD were found to be struggling in only a single area and to be within the normal range on all others. This is an important and encouraging finding.

The researchers were surprised by the lack of benefits associated with medication treatment. This could be due to several factors including poor maintenance of treatment regimen during the less-structured atmosphere of college life or limited follow-up by a medical practitioner as a result of the student’s move to a new location. It is also possible that compared to students not on medication, students being treated were more impaired to begin with and were in fact benefiting from its use even though this was not evident in the group comparisons.

However, it may also be the case that medication treatment for ADHD is less effective in college populations because of the unique demands of college life. Relative to what most students would have experienced in high school, the typical college student has substantially increased academic demands and greater amounts of unstructured time, for which self-directed organizational skills are necessary for success. As these abilities are often compromised in people with ADHD, college may present a particular difficulty for these students, especially because they are no longer receiving the structure and support which parents and high school instructors may have previously provided.

The study has several limitations. The most important lmitation is that the researchers relied on students' report of whether they had ADHD and were not able to confirm the accuracy of this directly. It is possible that a number of participants were misdiagnosed, which would introduce error into the results. It is also the case that only students from only 2 universities participated in the study, which is hardly representative of the general population of college students with ADHD.

While recognizing the importance of these limitations, the data add to the growing literature on college students with ADHD. As noted above, it is encouraging that the majority appear to be making adequate adjustments in college. Further research to better understand what how to promote successful outcomes for college students with ADHD, and to better understand the impact of medication treatment in this population, is warranted.