The transition to college is challenging for many students and can be especially difficult for those with ADHD.
Reasons for this include the following:
- Many who have relied on parents to help them with organization and time management struggle when this help is less available.
- Compared to what they were used to in high school, life for most college students is less structured and there are often large gaps between when class assignments are due.
- Many classes have no attendance policy and it is solely up to students to get themselves consistently to class.
These factors place a premium on self-regulation skills, an area where many youth with ADHD often struggle.
For these reasons, it makes sense that students who benefit from regularly taking ADHD medication should continue to use it regularly as they transition to college.
However, this is frequently not the case and one recent study found that college students adhered to only 53% of prescribed doses, with the lowest rates of among first-year students.
Developing a more complete understanding for why many new college students don’t adhere to their prescribed medication regime could helpful promote more consistent adherence.
This was the goal of a study published recently in the Journal of Adolescent Health[Schaefer et al., (2017). Adherence to ADHD medication during the transition to college. Journal of Adolescent Health, 60, 706-713.]
Participants were 10 first-year college students with prescriptions calling for the daily use of ADHD medication. They were interviewed to learn how regularly they took their medication and why they deviated from using it as prescribed.
Although this is a small number of participants, this is not uncommon in qualitative research; in this study, the authors ended recruitment when it became evident that recent interviews yielded little or no new information.
This approach is intended to identify important themes rather than quantitative precision.
Here are the 5 major themes that emerged.
Transitions to independence are often abrupt and many adolescents lack medication self-management skills.
Most participants reported that their parents took a lead role in managing their medication use during high school and they were not prepared to manage this responsibility on their own.
Inaccurate disease beliefs, perceived academic demands,and medication side effects were reported to influence volitional nonadherence.
Deliberate nonadherence, in addition to merely forgetting to take their meds, was common. Many expressed the belief that medication should no longer be necessary, that they could manage their ADHD by self-discipline alone, and that they needed to ‘wean’ themselves.
Many believed they only needed medication to study in the evening and could focus on their own in their classes.
Others felt they could/should adjust when they used medication in response to changes in their academic demands. All these factors contributed to not using it regularly as prescribed.
Poor self-management had perceived negative implications on school performance.
Nearly all participants had regrets about their first-semester and believed that failing to appropriately manage their ADHD contributed to academic struggles.
Pressure from peers to share medication was perceived as frequent and could negatively affect social functioning and adherence.
Nearly every student spontaneously mentioned medication significant pressure to sell or share their meds; they worried about upsetting peers if they did not.
Pressures to share/sell increased around exam times, which is not something students should have to deal with during what is already a stressful time.
Social support was expressed as a perceived need.
Most students felt their ADHD isolated from others and expressed a desire to connect with more advanced students with ADHD. Older students with ADHD could have provided guidance about the importance of using their medication regularly and how they had dealt with pressure from peers to share it.
They also expressed a desire to have an academic counselor who specialized in helping students with ADHD.
Other noteworthy findings
Only 4 of 10 participants had registered for academic accommodations, e.g., receiving extended time on exams, the opportunity to take exams in a distraction-free environment.
Reasons for not registering included not being aware of available accommodations, feeling ashamed, and believing their ADHD was not severe enough to deserve any accommodations.
Summary and implications
This study provide important insights for why so many students don’t take their medication as prescribed as they transition to college. The findings yield clear implications for actions that could be helpful.
First, parents could begin transitioning responsibility for taking meds to students before they leave for college. Many students need practice developing this skill and being on one’s own in college is not the best time to begin developing it.
Second, parents and health providers can speak with students about the importance of medication adherence and discuss the inaccurate beliefs about ADHD that work against this. This would include a discussion of concerns that students have about continuing to use their medication in college and the importance of using it as prescribed.
Third, students need to be coached about how to handle requests from peers to share their medication and the potential serious negative consequences of doing so.
Fourth, schools could develop programs in which new students with ADHD are matched with an older peer mentor. These peer mentors with ADHD would need careful training but could provide important support.
Finally, students need to be made aware of resources on their campus that can assist them and apply/register for academic accommodations that can be helpful.
David Rabiner, Ph.D.