Managing ADHD in College Students During COVID-19

Managing ADHD in College Students During COVID-19

Afton Kapuscinski, Ph.D. & Kevin Antshel, Ph.D.

Syracuse University

The dynamic and rapidly developing COVID-19 pandemic has affected us all. Rather than focusing on the totality of the impact, we are electing to focus on what we know best: college students with ADHD. Below, we outline ideas to help college students with ADHD cope and function well despite the substantial disruptions caused by COVID-19. Managing ADHD during a global pandemic is, to our knowledge, not a topic that has been previously investigated. Thus, when developing these considerations, we relied upon our knowledge of the science of clinical psychology as well as our combined near 30-years of clinical experience working with college students with ADHD.

College students, especially those who were living away from home, are likely to be experiencing significant disruption to their daily lives. Not only has their primary residence suddenly changed, but they have also lost social supports, as well as the structure provided by academic and extracurricular obligations. Before COVID-19, many studies reported that college students with ADHD were already at increased risk for depression and anxiety. The jarring changes to daily life and uncertainty about when normal life will resume may well increase prevalence rates of depression and anxiety in students with ADHD. While some feelings of fear and loss are normative  (COVID-19 is a legitimate threat), those with pre-existing anxiety and depression may have a more difficult time managing the intensification of these emotions.

When channeled appropriately (e.g., not at panic levels), fear and anxiety can be quite adaptive and help us follow CDC guidelines cautiously to “flatten the curve”. However, very high levels of anxiety often lead to difficulty with concentration and completing tasks. Additionally, a larger, more long-term concern is the potential for depression to set in as weeks of social distancing and restriction of activities likely turns into months. In an effort to help with both proximal anxiety as well as the greater distal threat (depression) in an already vulnerable population, several of the following may be beneficial to consider for college students with ADHD:

1. Be mindful of media consumption levels. Media headlines, news alerts and social media are likely to be rife with the most tragic and dramatic stories (e.g., celebrities who have died from COVID-19). Consuming excess media (probably defined by the extent to which catastrophizing occurs) likely leads to a loss of balanced perspective (Jenness et al., 2016) and the adoption of irrational beliefs (e.g., I won’t be able to graduate college). Consider silencing news alerts or using screen time limits to moderate media exposure.
2. Establish routines. Everyone’s daily routines have been impacted. Rather than getting lost in a cycle of Netflix and gaming, it is important to re-establish routines. If uncertainty is the poison, routines are the antidote. In our experience, the importance of sleep-wake cycles as the first routine to re-establish cannot be overstressed (Lyall et al., 2018). Routines related to medication adherence, physical activity and coursework should be the next ones added to the daily schedules.
3. Establish physical boundaries. Being at home 24/7 increases the risk for a blurring of boundaries between work and recreation. Develop specific places to do school work that are separate from recreation spots. If this is not possible, develop some rules (e.g., I won’t browse YouTube until after 3 PM).
4. Maintain social supports. Stay connected in real time with sources of social support from college through phone calls, Facetime, and Zoom (e.g., virtual throwback dance parties!). It is unfortunate that the public health officials labeled it “social distancing”. In our opinion, “physical distancing” is a better term and belies the importance of not isolating.
5. Maintain sources of reinforcement. COVID-19 has disrupted many of our existing sources of reinforcement (e.g., engaging in Greek life, attending a NCAA basketball game with friends, earning money working at a campus coffee shop). Find creative ways to derive pleasure, especially through activities that bring a sense of meaning and purpose. For example, developing new hobbies (e.g., biking, photography) might serve to reduce the reinforcement void.
6. Limit use of substances. College students with ADHD are at increased risk for substance use problems. The distress caused by the pandemic in combination with reduced opportunities for rewarding activities may make substance use (alcohol and cannabis in particular) more enticing for those who are particularly vulnerable. We recommend being mindful that despite liquor stores being classified as essential services, heavy use can actually impair mood and academic functioning (Meda et al., 2017).
7. Increase physical activity, especially outside. A significant body of research indicates that physical activity is beneficial for reducing inattention and anxiety and improving mood (Neudecker, Mewes, Reimers, & Woll, 2019). A sedentary lifestyle is therefore particularly problematic for college students with ADHD. Aiming for 7000 steps per day is a reasonable place to start. The old maxim, “What gets measured, gets done” suggests smartphone apps to track and plan physical activity may improve adherence.
8. Reduce procrastination. Rather than saying, “I will do that later”, attach a specific time/date target to each important task, and use a planner to indicate when you will work on each task. Divide larger tasks into smaller tasks and connect each task to a specific time/date in your planner. Be mindful of how you “advertise” the task to yourself. A script, “What is in it for me to do this now?” can be useful for framing tasks in a way which increases engagement.

The above represents only a few of many possibilities. Please consider replying to this blog with your own ideas about what might be beneficial to consider for college students with ADHD during the COVID-19 pandemic!

Citations

Jenness, J. L., Jager-Hyman, S., Heleniak, C., Beck, A. T., Sheridan, M. A., & McLaughlin, K. A. (2016). Catastrophizing, rumination, and reappraisal prospectively predict adolescent PTSD symptom onset following a terrorist attack. Depress Anxiety, 33(11), 1039-1047. doi:10.1002/da.22548

Lyall, L. M., Wyse, C. A., Graham, N., Ferguson, A., Lyall, D. M., Cullen, B., . . . Smith, D. J. (2018). Association of disrupted circadian rhythmicity with mood disorders, subjective wellbeing, and cognitive function: a cross-sectional study of 91 105 participants from the UK Biobank. Lancet Psychiatry, 5(6), 507-514. doi:10.1016/S2215-0366(18)30139-1

Meda, S. A., Gueorguieva, R. V., Pittman, B., Rosen, R. R., Aslanzadeh, F., Tennen, H., . . . Pearlson, G. D. (2017). Longitudinal influence of alcohol and marijuana use on academic performance in college students. PLoS One, 12(3), e0172213. doi:10.1371/journal.pone.0172213

Neudecker, C., Mewes, N., Reimers, A. K., & Woll, A. (2019). Exercise Interventions in Children and Adolescents With ADHD: A Systematic Review. J Atten Disord, 23(4), 307-324. doi:10.1177/1087054715584053