Today, ADHD has been widely accepted to have a neurobiochemical basis, and stimulants remain the drugs of choice for the appropriate pharmacological treatment of this disorder. Research has indicated that a majority of individuals with the disorder continue to display symptoms which affect functioning into early adulthood. However, at this developmental stage, medical management can be a tricky business. In my practice, I usually see three types of reactions to medication in young adults at the post secondary level:
Students in this group feel that no one will know them at college, and therefore, they can abandon all forms of treatment. They seem oblivious to the fact that these treatments played a central role in helping them get to college in the first place.
I DON'T KNOW
Like students in the "Clean Slate" group, these students have been diagnosed prior to college and took medication until early adolescence. They may even be continuing on medication at this time but have no idea about how their ADHD affects them or how the medication can effectively address their symptomatology. They have little self-knowledge and even less awareness about the workings of their medications.
OH MY GOD, SOMETHING IS WRONG!
Students who belong to this group have been able to cope despite their symptoms. They have reached this level of academic achievement with tremendous effort. It is in college, however, that they become overwhelmed by the level of independent functioning that is required and, they suddenly realize that something is amiss.
To ensure their success in a post secondary setting, all of these students will likely need to address their disorder and take charge of an appropriate treatment regime. In the majority of cases, this regime includes medication. Service providers can assist the student in becoming more knowledgeable about campus resources and learning how to access them in a timely manner. To this end, I have developed a Top 10 list. These are the things that I wish all college students with ADHD knew about their medications when they arrived on campus.
1. The name of your medication and how it works.
Ritalin, Concerta, (methylphenidate) and Dexedrine or Adderall (amphetamines) are the most commonly prescribed medications for ADHD. Ritalin and Dexedrine come as either short-acting (usually 4 hours) or long-acting (6-12 hours) preparations, while Concerta and ADDeral are long-acting preparations. The shorter-acting medications take effect in 20 minutes, while the longer-acting ones may take up to an hour to be fully effective. Both of these medications work on correcting the neurobiochemistry of the brain which is thought to be the cause of ADHD symptoms. These medications enhance receptor functioning, inhibit the breakdown of certain neurotransmitters in the brain, and themselves act as neurotransmitters.
2. If you needed stimulant medication to concentrate in high school, you most likely will need medication to concentrate in college.
Stimulants are the treatment of choice for ADHD. They increase concentration and focus while decreasing distractibility and impulsivity. Approximately 70% of individuals with ADHD continue to have problems with attention throughout their lifespan. ADHD does not go away!
3. Stimulants improve cognitive functioning, but you still have to put in time studying and attending classes.
Taking medication before classes can help you concentrate on what is going on around you. In this way, it enhances information-gathering. You can also use your medication dosage times to establish a study schedule that works best for you. You should know how long your medicine will be effective so that you can predict how much focused study time you have available. Stimulants can also help you stay focused while you are reading and, thus, improve your reading comprehension. Students frequently report that they read all of the material but then have no clue about what they have just read; they haven't been able to pay attention. To solve this problem, be sure your stimulant medication is in effect while you are reading.
4. ADHD affects all aspects of life - social, home, sports and employment.
You don't just need to concentrate in class; you also need to focus on what your friends are saying or instructions your boss gives you on the job. Focus and concentration are important in sports, too, whether you are playing tennis or catching a football. Being distracted and/or acting impulsively can lead to serious problems with your friends or even with the law (for example, while driving a car). It is important to assess how much the symptoms of ADHD are affecting your functioning in all of these settings and then take your medication accordingly. Improved concentration may improve the quality of your life in many ways.
5. It is important to take medication as prescribed by your physician.
Don't self-medicate. Many students have a mistaken notion that if one pill works well, two will work even better. While that may be true for other medications, that is not the case with stimulants. For them, there is something called the "window of efficacy." This term refers to the amount of medication that is the most effective for your particular brain chemistry. The amount of medication you need does not depend on body weight or on the severity of your symptoms, but rather, what works for you. That is why you may need to re-assess periodically if your medication is still functioning at optimum effectiveness. Many students come to college on the same dose of medication that worked for them in elementary or high school. That's fine if that determination has been made after a recent, careful review of your needs as well as the continued effectiveness of that particular dosage level.
6. It is illegal to share your prescription medication.
Stimulant medications are controlled substances. Federal law states that all prescription medications should be kept in their original container and labeled with your name and the name/dose of the medication . You should not transfer your stimulant medication to another bottle for any reason. It is against the law for you to distribute a controlled substance. This means sharing your medication with a friend who needs to study for that big test or concentrate in class or on the playing field is illegal. Many students carry their medications with them at all times to avoid leaving them unattended in their rooms, where they may be more accessible to others.
7. Stimulants do not mix with drugs or alcohol.
Your ADHD is caused by a chemical imbalance in your brain. You are taking stimulant medication to try to correct that imbalance. If you use other drugs such as marijuana, which affect brain dopamine, you wreak havoc with an already-imbalanced system. Your medications will not be as effective, and you will be more impaired in your functioning. Taking stimulants also affects the metabolism of alcohol in your body. Mixing the two can result in higher blood alcohol levels and increase the risk of alcohol poisoning. Mixing cocaine and the stimulants can kill!
8. Check-ups are important.
Check in with the Health Center on campus when you arrive and monthly after that. As a controlled substance, stimulant prescriptions need to be refilled monthly. It is important for you to visit the health center on your campus and set up a mechanism for you to receive your medication prescriptions regularly. If you do not do this, you may find out that you run out of your medication at a critical time (for example, during finals) and then have difficulty refilling your prescription quickly. It is also important for the staff to become familiar with you so that, if questions arise about dose or side effects, they can answer them more readily. You can also have your weight checked monthly to make sure you are still eating enough calories and not losing weight because you are not hungry or forget to eat.
9. Report any side effects promptly.
Do not stop your medication on your own. Talk with someone about addressing these side effects. If your stimulant medication is proving to be effective, there is no reason to stop it because of unpleasant side effects. It is important, however, to report these side effects to the health care facility or to your primary physician. They often have techniques for dealing with these side effects that you may not be aware of. Don't stop taking your medication on your own. Do go and talk with someone about them. A change in medication or reduction in dose may be all that you need, but let the professional decide that course of action.
10. See your primary physician at least once a year for an examination and blood tests.
As with all chronic conditions and medications that are taken routinely, it is important to have a regular check-up. Blood tests that assess liver functioning are important. Your physician back home is likely the one who diagnosed your ADHD and knows you the best. Be sure to check in with him or her to assess how things are going from time to time.
Dr. Patricia Quinn is a developmental pediatrician in the Washington, D.C. area. She has worked for over 28 years in the areas of ADHD and learning disabilities. Dr. Quinn is the author of several books on ADHD, including Putting on the Brakes: A Young People's Guide to Understanding Attention Deficit Hyperactivity. She is editor of ADHD and the College Student: A Guide for High School and College Students with ADD and author of Adolescence and ADD: Gaining the Advantage. Dr. Quinn lives in Washington, D.C. with her husband and four children, two of whom have ADHD. She may be contacted by calling or faxing 202-966-1561. All of her books may be ordered through www.addvance.com or by calling (toll free) 1-888-238-8588.