ADHD Goes to College

Craig Surman, M.D. Massachusetts General Hospital

Craig Surman, M.D.
Massachusetts General Hospital

We see many individuals who find themselves getting less out of college than they expected, or had to take time off to regroup. Among the many lessons of school, one of the more important ones for people to master is how to learn the best way for them. There are a few things clients with ADHD tell me they wish they had known before they walked into their first dorm room and first large lecture hall, and a lot of it boils down to how to use what is available to make a school fit their needs.

Here is a list of several things that may be useful to cover with students with ADHD who have had to figure out college the hard way. You will have your own to add, and would love to read your responses on the APSARD website members’ forum!!

There is only so much that telling our clients can do to change their behaviour, and each individual will have their own key challenges to address. But here are some of the topics …. in no particular order

1. It is good to know what you don’t do well, and plan accordingly
Some things we do just get done. Others take effort. This goes beyond planning tutors ahead of time for courses that are hard. What makes your client successful as a teammate, as a student, as an employee, or even as a friend? Was it being interested? Was it having other people involved? Did they have good role models? Managing whatever is hard at school can be easier if a person knows the kinds of supports to seek.

2. Never underestimate teamwork
For everything a person does not do well on their own, consider whether it helps them to get other people involved. From helping choose classes, planning study schedules, deciding on a paper topic, or getting steps done towards a long term project – having other brains involved can go a long way. Even just studying where other people are studying – certainly not where people are not studying (!) helps many people.

3. Make a big school smaller
Dropping into office hours, talking with a TA about the best path through a major – the more you engage with others, the less alone you will be in the work.

4. Help them decide how to be an active learner
When you can, get access to subject matter that will be covered and what points are unclear – if you have questions you will engage the material better.

5. Check that things have been moved from short to long-term memory
It may help to educate students on how to make sure things get registered in short term memory, and moved into long-term memory – – suggest they spend study sessions reviewing material and trying to write it out from memory to check whether it got into short term memory. At the next study session, they should check that they can write out all that they previously studied to see if it made it into long term memory.

6. Know how you will be tested
If students are not sure, they should ask about the format of exams – multiple choice, short-essay, etc. Preparation should include self-testing, when possible, in the same format that actual exams will take.

7. Get approval to use, and know how to use, the disability support office before arrival at school,
Each school has different requirements for using disability support services.
Some of them are also more “self-help” than full service – – e.g., “Yes, we will give you class notes, but you will have to find your own note taker and go across campus to use the copy machine”, “Yes, your professors can give you extra time on tests, but it is up to you to get each Professor on board and to figure out where and when you will be taking these exams”. Contacting the disability services coordinator to know how they handle extra time on tests, copies of class notes, and arranging testing in quiet areas will help students with ADHD be informed and make sure supports are in place beforehand.

8. Questions about planning work
Do they use a planner? Does it have a long-view and a short view? Is the screen on a phone enough to see what is coming? Is a wall calendar a better idea?
Do they have a method for breaking down long-term work like projects and papers and studying into discrete steps?
How are their time estimates? Are they better served by doubling the time each step will take? Or does their work seem to fill all available time, and might benefit from more deadlines?
Can they make a habit of knowing priorities for each day and week? Can they stick to a plan of what they will do at different times of the week?

9. Work in the right place
While some people can work in their dorm room with devices and other people around, its often just too tempting for distractions. Help your clients be honest about where you work best. Is it in a quiet corner of the library? Is it at a study center? Is it with other people studying the same material? Having a special spot for a project or intense work can help condition a person to use that area well. Maybe they have to find a spot with no or at least poor Wi-Fi reception while they are at it to reduce distraction – if they can.

9. Help them prioritize self-care in their schedule
It might help to have a clear, written template of what an ideal productive, and enjoyable, week looks like. Should they start by blocking off time for sleep, exercise, classes, and school work – and then find the gaps where they can fit the rest of college life?

10, Planning coursework to spread out the load – and exam periods –
Having 5 papers due in a short period of time, or 4 tests that all require memorizing, can be a real problem. When you can, anticipate these sorts of crunch periods rather than waiting until they swamp you unexpectedly. Choosing courses based on your interest is important, but you must also consider how you will be able to perform at test time and manage multiple deadlines in a brief period.

11. Can students match the class schedule to their natural schedule?
If they are night owls, maybe they should avoid those early morning classes. Can they sit through 4 consecutive classes in one day, or is it better to space them out and have breaks for studying between classes? Where there is a choice, a proactive plan can lead to a more comfortable and successful experience.

12. Are they motivated to make friends with people who are there to get the most out of school?
Helping individuals think about who to align themselves with can lead to better engagement in school. When the friends in their group are letting loose and not studying, it is going to be that much harder for students with ADHDto hit the books. It may help to think about who they might ask to be study partners.

13. Can they learn the art of rewarding themselves for hard work?
What makes them proud of how they spent their time in a day? Do they think about what they will need to get done to really enjoy that study break? What is a payoff they can achieve by keeping to their work goals?

14. How can medication management be optimized?
Lack of local providers, difficulty getting to a pharmacy, new sleep-wake schedules, exacerbation of side effects by poor sleep and compensation with excessive caffeine, requests from peers to share meds – there are many challenges to navigate in optimizing medication management at school. Some of these may not be avoidable, but it may help to talk through with a client their plans for getting, taking, and adjusting medication proactively– as well as to review how it has been going.

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