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What do these college-bound students have in common?
Jan never did any homework while attending her large public
high school, but she was bright and had an excellent memory. Her teachers and parents often said things to
her like, “You’re so smart. If only you would work harder, you could be the top
student in your class.” Nonetheless, she
was able to get good enough grades to be accepted into a highly ranked large
Norah was an artistic and forgetful girl whose room was always
a disaster. She did her homework with
other classmates or her older sister, who helped her stay on task. She got
excellent grades at her small all-girls religious school. She was accepted into
a prestigious private university.
Ned always turned his homework in late, but the teachers in
his small private school made allowances because he participated so well in class. He had a high grade point average, outstanding
test scores and was accepted into an Ivy League university.
Since [kids with inattentive ADHD] don't themselves realize that they have an actual deficit, they can't explain what's going on.
All of these students had Attention
Deficit Hyperactivity Disorder, and had had it from childhood, although
it was never officially diagnosed. They had mostly inattentive symptoms
rather than the more familiar pattern of hyperactivity and impulsivity.
Students with the hyperactive type of
ADHD are the ones you commonly think about when you hear the diagnosis of
ADHD. They fidget and squirm in their seats, talk nonstop and are in constantly in
motion. They are impulsive and act
without regard for consequences. Thus, these students will cause enough
disruption at home or school to get their condition diagnosed way before
Kids with inattentive ADHD may not be
noticed by teachers. They have difficulty
focusing but also have innate deficits in what's called "executive
functioning," which involves skills such as organizing, planning complex actions
and being able to look forward and anticipate consequences. They might
be easily distracted, miss details and forget things. They also have
difficulty processing information as quickly and accurately as others.
When children with inattentive
symptoms face situations that are difficult and can't figure out a way to manage
it, they tend to shut down and just avoid the situation. They may feel too ashamed to ask for
help. Since they don't themselves realize that
they have an actual deficit, they can¹t explain what's going on.
People are often surprised to hear
that ADHD can be undetected until the college years, but it happens much
more often than you'd think. Elementary and high schools provide
significant structure and support so students with milder types of ADHD can
succeed academically despite their deficits. In contrast,
the college environment provides them with very little structure and
In high school, classes are held
every day. They are small enough so that teachers know each student. The
deadlines for homework assignments are short, and students get constant
feedback about how they are performing. Parents are notified if the student
begins to slip, and remedial action can be taken.
It¹s much easier for students to fall
between the cracks when they get to college. Freshmen frequently take
large lecture courses, where attendance is not taken. They spend much less
time attending classes compared to high school, so they need to be able
to structure their time in between classes more independently
In certain classes, grades may hinge
on just a few exams. In other classes, students may be given weeks
to read large volumes of material and write long papers that will determine
most of their grade. Therefore, students with ADHD can and often do procrastinate to a much greater
degree than they could get away with in high school.
The first information the parent may have about a child¹s school problems often comes when the child arrives home ... with news that he's on academic probation.
Parents of college students are
rarely notified when their children are struggling academically. Privacy laws
prevent colleges from sending grades home to parents without the student's
permission, even though the parents are footing the tuition bills. Thus,
the first information the parent may have about a child¹s school
problems often comes when the child arrives home at the end of the first or
second semester with news that he's on
If you recognize your child in the
above vignettes, the first step is to learn more about ADHD. You can start by checking out the CHADD (Children and Adults with Attention
Deficit Hyperactivity) website. A good book to look at is Driven to
Edward M. Hallowell.
Then consider having your child evaluated
by a psychiatrist or behavioral pediatrician who specializes in the disorder,
before he leaves for school. If he has the diagnosis, you can discuss the
type of supports he needs, including medications, counseling and perhaps extra
support from his school.
When I see such students, I start with
helping them understand the way their brain functions. By the time they get to my office, they and
their parents can be quite demoralized, frustrated and angry with each
other. Understanding that their child is
not “lazy, crazy or stupid,” can go a long way
to ease tensions and build self-esteem.
The next step is to help the student
learn how to manage their disorder in a college setting. They may need to take medications such as
stimulants. They do better with smaller
classes and assistance like tutoring. Many colleges these days have learning centers where they can get help.
But no matter how much you try to
avoid problems, inattentive ADHD often doesn’t show up until after a semester
of failure. This can’t always be
prevented, despite your best efforts.
happens, don’t panic. As I tell my
patients, you are gathering data about yourself, so everything you go through
gives you a better idea about what supports you need in order to function as best you