Attention Deficit Hyperactivity Disorder is a psychiatric disorder characterized by hyperactivity as well as difficulty sustaining attention. ADHD is divided into three subtypes. Inattentive: difficulty paying attention to details, difficulty holding attention, difficulty organizing, forgetfulness, etc. Hyperactive: restlessness, constantly moving, fidgeting, trouble waiting their turn, interruptive, etc. Combined: a mix of inattentive symptoms and hyperactive symptoms. ADHD is traditionally thought of as a childhood disorder, as it typically begins in childhood. It is primarily diagnosed in children and can disappear by adulthood in some people (Montano & Weisler, 2011). That has changed over the past decade, as adult ADHD is becoming increasingly diagnosed (whether missed from childhood or emerged in adulthood is a controversial issue), though there is only minimal research regarding this demographic. There is even less research about ADHD for those newest to adulthood – college students – who have taken the first, shaky steps into maturity. This literature review is an inquiry into research about ADHD as it pertains to college students, with a focus on: undiagnosed and misdiagnosed ADHD in college students, substance abuse in college students with ADHD, and functioning of ADHD and non-ADHD college students.
A meta-analysis by Green & Rabiner (2012) gives a basic overview of the (then) current impacts of ADHD on college students and college life. An estimated 2-8% of college students have ADHD, though numbers vary wildly depending on the location of the study, and what questions were asked (present diagnosis vs. suspected case). The GPA of students with diagnosed ADHD tends to be lower than their non-ADHD counterparts, and ADHD students more likely to be on academic probation (Green & Rabiner, 2012). College students with ADHD also struggled with reading comprehension, time management, and procrastination more than their non-ADHD peers. Additionally, they also reported struggling with study and organizational skills (Green & Rabiner, 2012). Finally, Green & Rabiner (2012) examined the social implications ADHD has on college students, and found that they tended to struggle with social skills, social adjustment, and self-esteem issues more than their fellow students. Present research suggests that ADHD college students have a more difficult time academically and socially (Green & Rabiner, 2012), though more research is needed.
Adults with ADHD seldom receive the treatment they need. As Montano & Weisler (2011) examined, adults with ADHD are significantly underdiagnosed. Those that are diagnosed are often under treated, with only about ten percent of diagnosed adults taking medication. Part of the reason for that is because ADHD is often present with other psychiatric disorders like depression and anxiety, whose symptoms can be similar to ADHD. This leads to the ADHD being ignored and misdiagnosed as depression, or anxiety (Montano & Weisler, 2011). The implications for college students are straightforward. If a college student is depressed and anxious, it may be worth investigating the presence of ADHD as a contributing factor to that anxiety and depression.
Finally, college students with ADHD are more likely to abuse tobacco (12.4% more likely), marijuana (4.9% more likely), and various other drugs (15.9% increase) (Busch et al., 2019). The reasons for this are complex. One of the reasons proposed in the study is that people with ADHD are more impulsive. The higher rates of substance abuse also correlate with decreased academic performance (Palmer, McMahon, Moreggi, Rounsaville, & Ball, 2012), which then may drive some students to drink and abuse substances, turning it into a vicious cycle. However, there is very much a “chicken or the egg” discussion regarding whether students who have poor grades are more likely to abuse substances, or students who abuse substances are more likely to have poor grades. It is important to remember that many of the other psychiatric disorders that are often present in individuals with ADHD also have higher rates of substance abuse, so it is difficult to ascribe causation (Montano & Weisler, 2011). It should be noted that many people with ADHD will self-medicate with tobacco. Nicotine has been shown to increase cognitive abilities, including: attention, working-memory, and executive function (Campos, Serebrisky, & Castaldelli-Maia, 2016). The possibility exists that some portion of college students who use tobacco may have undiagnosed ADHD and are using tobacco to self-medicate, as it may ease their symptoms and make them more productive. While the research is interesting, it is also startling, and the question of “what can be done” remains.
The presence of ADHD in college students is a topic that hasn’t received anywhere near the amount of research as childhood ADHD. There is still much to learn about college students and ADHD. Of particular interest is finding out exactly how many college students have ADHD, but have been misdiagnosed with another disorder – such as depression or anxiety; but whose key struggles stem from the ADHD, and the depression and anxiety is a result of not having their attention issues treated properly. The sooner those students can be properly helped, the sooner they can prosper academically and emotionally, as opposed to wondering why they’re lagging behind their peers. The research thus far has certainly been insightful, but the topic is still in desperate need of further inquiry. However, without further research, these students’ struggles will continue to go unnoticed, much to their detriment, and to society as a whole.
References
Busch, Chelsea Z, et al. “First-year college students with ADHD: risk for and correlates of alcohol and substance use.” Journal of Postsecondary Education and Disability, vol. 32(4), 377–393
Campos, M. w, Serebrisky, D., & Castaldelli-Maia, J. (2016). Smoking and cognition. Current Drug Abuse Reviews, 9(2). doi: 10.2174/1874473709666160803101633
Green, A. L., & Rabiner, D. L. (2012). What do we really know about ADHD in college students? Neurotherapeutics: The journal of the American Society for Experimental NeuroTherapeutics, 9(3), 559–568. https://doi.org/10.1007/s13311-012-0127-8
Montano CB, & Weisler R. (2011). Distinguishing symptoms of ADHD from other psychiatric disorders in the adult primary care setting. Postgraduate Medicine, 123(3), 88–98.
Palmer, R. S., McMahon, T. J., Moreggi, D. I., Rounsaville, B. J., & Ball, S. A. (2012). College student drug use: patterns, concerns, consequences, and interest in intervention. Journal of College Student Development, 53(1), 124–132 https://doi.org/10.1353/csd.2012.0014
