Attention Research Update

July 2006

"Helping parents, professionals and educators stay informed about new research on ADHD"

David Rabiner, Ph.D.  Senior Research Scientist, Duke University


Support for Attention Research Update is provided by Landmark College


Landmark College is the nation's leading institution of higher learning for students with ADHD and learning disabilities.  For more than 20 years, Landmark College has been the pioneer in higher education services for young men and women with ADHD, ad offers a wide range of specialized programs for students with these learning challenges.  You can learn more about this outstanding institution at www.Landmark.edu .



Transitions to College in Students with ADHD and/or Learning Disabilities

By: Linda Hecker, Director of Educational Services - National Institute at Landmark College

(NOTE - At the conclusion of this article you will find a brief summary of data that my colleagues and I recently collected on college adjustment in students with ADHD.)


"The road through college was filled with numerous mountains I had to climb. I discovered the average student had bumps in the road but my bumps resembled Mt. Everest." -R. Cary Westbrook "Learning Disabilities and College: Strategies for People that Rock our World"

Troy B and Mike H. are bright, athletic college freshmen at a state university. They were both diagnosed with learning disabilities and ADHD in late elementary school, attended the same public high school where they shared many classes, including time in resource rooms, and graduated with similar GPA's.

At the end of his first college semester Troy is facing academic probation in three of his five classes. Troy has never contacted the university's office of Disability Support Services (DSS): he's vaguely aware it exists, but he decided to make a "fresh start" in college: no one at the university would have to know about his LD - he chose to blend in with his peers.

In contrast, Mike is earning all B's and B+'s in his classes. He's a regular at the DSS office, taking advantage of tutoring, study skills seminars, and support groups. He contacted the office soon after he was accepted at the university, and established a good relationship with a staff member who helped him select courses with professors who are empathetic to students with learning disabilities and provided a letter to Mike's professors suggesting appropriate class accommodations such as extended time on tests, which he can take in a quiet study area free of distractions.

It's no wonder Mike is having a good freshman year while Troy is on the brink of suspension, but let's examine what helped Mike prepare for his positive experience. A successful transition from high school to college can be summed up succinctly:  know yourself; know the law; know your college; (and prepare accordingly)

KNOW YOURSELF

Research on successful outcomes for adults with learning disabilities stresses the importance of well-developed self-awareness and self-advocacy skills, often referred to as metacognition (from Greek "thinking about thinking"). This includes a good understanding of the testing that resulted in a student's diagnosis of LD or ADHD.


* what is the name of the disability?

* what areas of achievement does it affect?

* what are the specific impacts in each area?

* what are the student's strengths?

* what strategies, interventions, and accommodations best support learning?


How can students master this information, especially when test reports are often written in obscure, technical language? Parents should insist that the evaluator meet with their child after the testing to explain the results in language, pictures, and examples appropriate to his/her level of understanding and development   Then parents can reinforce this understanding as their child matures and faces new challenges.

Merely understanding this information isn't enough, however; students must be able to talk about it knowledgeably and comfortably with teachers, advisors, and counselors, not an easy task. One helpful way to build this skill is to have students attend their own IEP meetings as early as they can participate - by late middle school. Ideally, students will take an active role in the meetings, preparing questions beforehand and taking notes to the best of their ability.


KNOW THE LAW

The reason it's so important for college students to be strong self-advocates is that the laws governing treatment of individuals with disabilities change radically when students move from grades K-12 into postsecondary settings.  Students who are not thoroughly familiar with these changes and their implications by the time they apply to college face a difficult transition.

In grades K-12 the Individuals with Disabilities Education Act (IDEA) places the burden on schools to identify students with suspected disabilities, perform evaluations, make specific recommendations for services in cooperation with parental input, provide special services, and monitor students' progress, updating testing as necessary. 

In contrast, postsecondary institutions, governed by Section 504 of the Rehabilitation Act and by the Americans with Disabilities Act (ADA), must ensure that individuals with disabilities have "reasonable accommodations" that provide equal access to programs, courses, and resources, but only when students disclose their disability and present documentation to support their needs. In other words, students in college are responsible for initiating the process. This means they must 1) choose to reveal to school officials and instructors that they have a disability 2) discover the procedures for requesting and implementing accommodations and services and 3) supply testing documents that are current and meet the college's criteria.

Many entering students like Troy fall off track right at Step 1. They do not want to be identified as "different" when they go off to school. When I visit postsecondary schools around the country, talking to DSS staff, their biggest concern is with students with disabilities who never come into their office, or not until they are in crisis, about to flunk out. Often this happens too late to make a successful turn around. On the other hand, successful students like Mike usually connect to the DSS office soon after being admitted and take advantage of the services they offer. They have the maturity to recognize the value of good support systems and to take advantage of what the laws provide.


KNOW YOUR SCHOOL

Although all postsecondary schools must conform to ADA and most to section 504, schools vary drastically in the levels and kinds of supports and services they provide students with learning disabilities, as well as in the campus culture surrounding disabilities. In some schools, students with learning disabilities-the invisible disabilities-still meet with skepticism and stigma from some professors or departments; in other schools, students with learning disabilities are welcomed for their contributions to campus diversity, and services go well beyond what the law requires.

Community colleges can be especially good initial environments for students whose academic skills are still a little shaky. They often provide developmental or remedial courses and knowledgeable, empathetic support, as well as much lower tuition fees.  In some cases, students may not earn college credit for these skills-based courses, but the extra preparation will pay off in improved GPA's and retention once students are eligible for credit.

Students can get some guidance about which campuses are most LD-friendly from sources such as Peterson's Guide to Colleges for Students with Learning Disabilities, and from online resources, but for authentic, updated information it's best to visit the campus, scheduling an appointment at the office of DSS soon after being admitted. While visiting, take time to talk to other students with LD to hear their views about campus climate.

PREPARING YOURSELF FOR COLLEGE

Students should use their time in high school to develop academic and self-management skills to the highest level possible, taking the most challenging courses that they qualify for. This will encourage them to develop the independent skills they'll need in college, such as organizing and maintaining notebooks. 

For example, students should learn how to take notes efficiently, using note-takers only to supplement their own efforts.  This is because students who actively engage in note-taking and note-revision learn to process and synthesize information, rather than passively digesting someone else's notes, trying to commit the information to rote memory.

Similarly, students need to develop strong active reading, discussion, and math skills.  If your high school doesn't provide support in developing these skills, it may be worthwhile seeking a tutor or academic therapist who can.

While still in high school, students should explore the potential benefits of Assistive Technology. Learn how text-to-speech software like Kurzweil 3000 or voice recognition software like Dragon Naturally Speaking can make academic work less labor intensive.  If possible, select, purchase, and learn to use the appropriate software before going to college, unless you know for sure that the college can provide it when and where it's needed (like at 1 a.m. on Friday when a paper is due at 8 a.m.). If a student hasn't yet learned efficient keyboarding and word processing skills, now is the time.  Don't let your child go off to college disadvantaged relative to other students in these critical areas.

Be aware of the many ways college environments tax executive functioning skills such as managing time and organizing tasks.  The college day is quite unstructured compared to that of high school - students may have only 1 or 2 classes a day, with lots of "free time" in between. There are more long-range assignments, and no study halls or hovering parents making sure students are on track.  Therefore, in high school students must learn how to keep accurate records of assignments, daily and weekly calendars, and how to manage a long-range planning process.  For some students, all these functions can be combined efficiently in a Personal Digital Assistant, like a Palm or Pocket PC, but select one and learn how to use it before leaving home.

Similarly, high school is the best time to investigate whether medication will play a role in regulating a student's ADHD. It can take weeks or months to find the ideal medication and dosage.  Freshmen should start their college experience with a stabilized regime, and not be experimenting with meds while coping with the other challenges of campus life.

Finally, self-management looms large in the life of a college freshman. If students have been relying on parents to awaken them in the morning and make sure they have everything needed for the day, parents should start handing these responsibilities to their children no later than their senior year of high school.  Students should also learn to manage money for themselves, with a bank account, checkbook or credit card for which they are responsible. It may be hard for parents to relinquish their close monitoring of students for fear of having them fall on their face, but it's better to have a few slip ups during high school than to completely fall off track at college, as so many students, with and without ADHD, commonly do.

CONCLUSION

While all this preparation may seem daunting, acquiring these skills, habits, and knowledge can be spread over several years, ideally starting in middle school.  There are many helpful resources (some of them detailed in the references). There's no substitute for actually "doing it", however, so one final recommendation is to take advantage of the many summer programs designed by colleges to help students experience campus life with a little extra support.  Landmark College, for example, offers 3- week summer programs for high school students after their junior year, and 6- week summer courses for students already accepted to college who want to refine their skills. The key to successful transition from high school to college is to prepare well in advance, like Mike H., by knowing yourself, the laws, and your college.

RESOURCES (Note - A brief summary of data that my colleagues and I have collected recently on the adjustment to college in students with ADHD follows this list of resources.)

Brinckerhoff,  Loring C., McGuire, Joan M., Shaw, Stan F. (2002). Postsecondary education and transitions for students with learning disabilities, Austin, TX: Pro-Ed

Frank, K., & Wade, P. (1993). Disabled student services in postsecondary education: Who's responsible for what? Journal of College Student Development, 34 (1), 26-30

Nadeau, Kathleen. (1998).Help4ADD@HighSchool. Silver Spring, MD: Advantage

Reiff, Henry B., Gerber, Paul, Ginsberg, Rick (1997). Exceeding expectations: successful adults with learning disabilities. Austin, TX: Pro-Ed

Westbrook, R.Cary (2003). The journey begins.  Cited in www.ldonline.org/  first_person/westbrook.html



STUDY SKILLS

Mooney, Jonathan & Cole, David. (2000). Learning outside the lines: two Ivy League students with learning disabilities and ADHD give you the tools for academic success and educational revolution. New York, NY: Fireside (Simon & Schuster)

Williams, Jamie, ed. (2003) Perspectives: special issue on study and organization skills: practical suggestions and sensible plans. International Dyslexia Association. 29 (4), 4 - 35

Strothman, Stuart, ed. (2001) Promoting academic success for students with learning disabilities: a Landmark College guide. Putney, VT: Landmark College

Guides to Colleges and Summer Programs (websites offer the most up to date information)
Kravets, Marybeth. (1999) K & W guide to colleges for the learning disabled. Princeton, NJ: Princeton Review

Mangrum, Charles T. & Strichart, Stephen S., eds. (1992) Peterson's colleges with programs for students with learning disabilities.  Princeton, NJ: Peterson's Guides


Useful web sites:

http://www.ldanatl.org/facts/shhet/summer.html

http://www.ldonline.org/ld_indepth/summer/

http://www.ldonline.org/ld_indepth/postsecondary

http://www.petersons.com



New Data on the Adjustment to College in Students with ADHD

Recently, my colleagues and I have collected survey data from freshmen at Duke University and UNC Greensboro to examine adjustment to college in students with ADHD.  Surprisingly, there are relatively few published studies on this topic, results from prior studies are mixed, and prior work with college students dealt with non-traditional students, e.g., older students, commuter students, students with ADHD who did not have any comorbid disorders, that may not be representative of the general population of college students with ADHD. 

In our study, students were invited to complete an anonymous survey via the Internet in which the focus was on the misuse and abuse of ADHD medications by college students.  We also asked students about their academic concerns, social satisfaction, and depressive symptoms so that we could examine how students who reported an ADHD diagnosis were handling the transition to college in relation to their peers.  This was the first wave of an ongoing longitudinal study, and all students were about 10 weeks into their first semester when the data were collected.

We were not really sure what to expect.  On the one hand, it would not be surprising if students with ADHD were experiencing a more difficult transition, which would be evident in concerns about academic performance, depressive symptoms, and higher rates of social dissatisfication. 

On the other hand, students with ADHD who enroll in college - especially in a   highly competitive college like Duke - have a history of solid achievement behind them and are likely to be a better functioning group overall than the general population of older adolescents with ADHD.  For this reason, it is possible that their college transition would be less problematic than one might first expect.

Survey responses were received from 1648 students, which represented a 46% response rate.  Although lower than desired, this response rate is consistent with what has been reported in other web-based survey studies of college students.  Sixty-seven of these students - about 4% - reported that they were currently diagnosed with ADHD. 

Compared to students without ADHD, those with a current ADHD diagnosis:

* reported significantly concerns about their ability to succeed academically;

* reported significantly higher rates of depressive symptoms at UNC-Greensboro but not at Duke.  The reasons for this difference are unclear.

On a positive note, students with ADHD did not differ from peers in their satisfaction with social relationships in college, nor were they more likely to be using alcohol or marijuana.


Is Medication Treatment Associated with Better Adjustment?

Of the 67 students reporting an ADHD diagnosis, 46 were receiving medication treatment and 21 were not.  We wondered whether those on medication were doing better.  Comparing students in these groups revealed the following:

* There was no difference in self-reported attention problems.

* There was no difference in self-reported hyperactive-impulsive symptoms.

* There was no difference in academic concerns, depressive symptoms, or social satisfaction.

On all these variables, the average scores for students in the treated and non-treated groups were remarkably similar.  Thus, there was essentially no indication that medication treatment was being helpful.  Given that a number of controlled trials have documented the benefits of ADHD medication treatment in adolescents and young adults, how could this be?

It is possible that students treated with medication had more severe ADHD to begin with, which could explain why they were not doing better than non-treated students. 

It is also worth noting, however, that the transition to college may be an especially difficult one for students with ADHD.  Relative to what most students would have experienced in high school, the typical college freshman has substantially increased amounts of unstructured time and confronts a new set of academic demands where the steps to success are likely to be less straightforward. 

This places a premium on executive and organizational skills that may pose particular challenges for students with ADHD who are confronting this new set of challenges without the structure and support that parents and teachers who knew them well may have provided.  In this environment, it is not surprising that benefits provided by medication treatment might be reduced, and that particularly careful treatment monitoring may be needed in order for students to derive significant benefit.  These results point to the need for controlled studies to determine the efficacy of medication treatment in college student populations specifically.  To date, I am not aware of any such studies having been conducted.

We will be collecting a second wave of data on these students towards the end of their sophomore year and it will be interesting to see how they are faring.  I will share these results with you when they become available.

Thanks again to Landmark College for supporting Attention Research Update

Information presented in Attention Research Update is for informational purposes only, and is not a substitute for professional medical advice.  Although newsletter sponsors offer products and services that I believe will be of interest to subscribers, sponsorship of Attention Research Update does not constitute a specific endorsement or guarantee of any company's product or services.