1. ADD & the College Student Issues, Problems, Solutions Dr. Sean P. Barrett, Ph.D

2. Overview What is ADD? ADD in a Community College Context How to make your class ADD friendly Assessment Issues in College Students Treatment Issues in College Students Question/Answer

3. What is ADD? Attention Deficit Disorder Deficit: insufficiency, shortcoming Disorder: disease, dysfunction Brain Malfunction OR Brain Style? Inherited differences in the way brain is ‘wired’ Well suited for some tasks/ environments not others Causes difficulties in many areas but may also have some positive aspects

4. An ADD ‘brain style’ is usually not a good fit for the types of tasks required to do well in college

5. Diagnostic Criteria for ADD Persistent symptoms of inattention and/or impulsivity/hyperactivity Must be evidence of symptoms during early childhood Symptoms cause significant impairment

6. Inattention fails to give attention to details/makes careless mistakes difficulty sustaining attention doesn’t seem to listen when spoken to directly doesn’t follow through on instructions difficulty organizing tasks & activities avoids / dislikes tasks that require sustained mental effort loses things necessary for activities easily distracted by extraneous stimuli forgetful in daily activities Hyperactivity-Impulsivity often fidgets or squirms in seat leaves seat when sitting is expected runs or climbs in inappropriate situations difficulty doing activities quietly is often "on the go" or acts as if "driven by a motor“ talks excessively blurts out answers before questions have been completed has difficulty awaiting turn interrupts or intrudes on others Specific Symptoms 6 of 9 symptoms for either or both clusters are required for diagnosis.

7. Initially conceptualized as childhood disorder that could be outgrown Now recognized to persist across lifetime Many criteria are still defined in terms of childhood symptoms Growing evidence that symptoms may be expressed differently in adulthood

8. Symptoms/Features in ADD in Adults

9. Cut to the chase… Focus on big picture, gist or main point not details Rapid-transit processing Skimming/skipping ahead when reading Impatient when listening/waiting/ interacting

10. Need for stimulation Seeking out stimulation Thrill seeking Accident prone Addiction prone

11. Procrastination Difficulty starting a task in absence of immediate pressure/deadlines Difficulty staying on task –frequent breaks, e-mail checking etc Need to see the big picture before working on details

12. The On/Off Switch Lack of control of “on/off switch” for attention Difficulty getting started Once engaged can’t stop or ‘shift gears’ Hyper-focus ‘Attention variability disorder’ - Hallowell

13. Juggling act Tendency to take on many tasks at once Starting new projects without finishing old ones –procrastination? Seeking novelty or stimulation?

14. What were we talking about again… Going off on tangents Loosing track of original point when speaking Something you see/hear/read sets your mind off in another direction Difficulty focusing on conversations when not actively involved ‘Tuning out’ during conversations Uh-huh phenomenon Often distracted by ‘internal’ world

15. ‘I need to get organized…’ Difficulty getting (staying) organized Messy Organized mess? Loosing things –Put things down without thinking

16. That took HOW long Poor sense of time Late (early) for appointments etc. Missed deadlines (bills, assignments etc.) Misjudging how long it takes to do something

17. Can’t keep that foot out of my mouth… Saying whatever comes to mind when it comes to mind Poor sense of impact on others

18. Low Self-Esteem Feelings of inadequacy for having so much trouble with things that seem to come naturally to others Sense of underachievement –“I just can’t seem to get my act together”

19. Positive attributes of ADD? Creativity Enthusiasm & Energy Spontaneity Liveliness Flexibility Open-minded

20. How does ADD Impact a College Student?

21. Performance usually does not match knowledge/ability in ADD students ADD often impairs an individual’s performance on tasks that typically form the basis for assigning grades

22. Problems Associated with Tests/Exams -Following exam instructions -Instructions often not carefully read (answer 3 of 5) -Multiple choice -Impulsive responding -Misaligned answers -Problems with negative wording

23. Problems Associated with Tests/Exams -Time management -Too much time on some sections -Repeated checking for mistakes -Arriving late -Penmanship -Often illegible -Printing takes longer -Distractibility -Distracted by others in room, noises etc.

24. Test/Exam Preparation Procrastination Last minute crammers Reading difficulties Wavering attention when reading Skimming/jumping around

25. Test/Exam Preparation Knowing what to study Focus on big picture What details are important? Study materials Disorganized or lacking

26. Papers & Assignments -unrealistic goals -poor attention to ‘nit-picky’ details -organizational issues difficulty creating/following outlines failure to follow steps necessary for task completion

27. In Class Behaviors -Note taking Difficulty listening and writing at same time Illegible notes -Disruptive behaviors -Coming to class without necessary materials (paper, pen etc.)

28. Making an ADD friendly classroom

29. Testing: Test preparation –Tell students what they should focus on when studying –In class before test let students know what they can expect Test Instructions –Verbally go over instructions

30. Testing: Timed tests –If possible do not have timed tests –Always provide more time than you think the average student will need –Provide time for students to check over work –Provide guidelines for how long each section should take –Occasionally announce time remaining

31. Testing: Distractibility –Exams should be written in an environment with few distractions (front of class, other room) Multiple choice –Have students circle answers on exam paper as well as on bubble sheet –Avoid use of double negatives in questions

32. Testing: Scheduling –ADD students often become hyper-focused when studying and have great difficulty shifting attention to new topics –Students with ADD should not write more than one exam per day and ideally have one day in between exams. Alternate exam formats –Oral exams, practical demonstrations, take- home exams

33. Classroom: Allocate time for class discussion –Active engagement helps sustain attention Communicate expectations for participation –Set clear limits and rules

34. Classroom: Organize material in 15-20 minute blocks Incorporate hands-on activities –Tend to learn best by ‘doing’ Make lecture notes available –Post on web ct, allow for recordings

35. Assignments: Provide concrete guidelines and limits Vary assignment formats –Oral presentations, debates, group-work etc. Component deadlines –Make individual components of assignments separate end goals of themselves

36. Assignments: Allow for choice/creativity –Focus tends to be better when ADD students are actively involved in creating or deciding what to do Use of Web CT –Reminders about due dates, assignment instructions –Ease of submission of multiple assignment components

37. Students: Take manageable course loads –Consider taking an extra semester to meet requirements Select an appropriate field of study –Find something that interests you! Use medication properly

38. Other Tips for Students: Speak with your instructor Ask for help Utilize available resources If not already done so get a proper assessment

39. How do I know it is ADD? Assessing ADD in College Students

40. A proper assessment is critical to: –Establish the presence or absence of ADD –Distinguish ADD symptoms from symptoms of other disorders

41. Essential components to a valid ADD assessment Life history interview Self-reported symptoms Objective cognitive assessment Collateral reports School report cards Screening for other psychiatric disorders

42. Faking ADD? 20% of college students evaluated for ADD at an Ontario clinic were suspected of faking (Harrison, 2006) Why Fake ADD? –Access to accommodations/resources –Access to drugs –Escape responsibility

43. Be reluctant to accept diagnoses based strictly on self-report checklists Don’t be afraid to ask for additional documentation/clarification But remember the MAJORITY of cases are genuine!

44. Treatment Issues for ADD in College Students

45. Stimulant medications (e.g. Ritalin, Dexedrine) are usually the first line of treatment When used as prescribed medications are typically very effective in treating some (though not all) ADD symptoms Immediate transient improvements Few serious side effects

46. Stimulants have abuse potential High demand from non-ADD students –Study aid, partying Poor compliance and monitoring Stigma of medication use –Diversion/misuse as means of fitting in Non-stimulant medications –Typically less effective –Better at addressing inattention than impulsivity/hyperactivity

47. Non-medication options Coaching –Organizational & study skills Psychotherapy –Especially helpful for self-esteem Support groups –If there aren’t any consider starting your own!

48. Non-medication options Diet –Less junk; more omega 3 Exercise –Regular cardiovascular exercise has been demonstrated to improve symptoms

49. Questions?Questions?