Treating College Students With ADHD Poses Challenges, UA Researcher Says

Diagnosing and treating college students with ADHD - attention deficit hyperactivity disorder - presents several challenges, a UA expert says.

Dr. Mark Thomas, staff physician at the UA Student Health Center and the University Medical Center, will present a paper on "Optimizing ADHD Medication Therapy in College Health" at the annual meeting of American College Health Association in May in San Francisco with Dr. Charles Caley of the University of Connecticut. Thomas will provide insight on selecting ADHD medications and providing effective coverage for college students. Caley, a neuropharmacologist, will offer background on the basic pharmacology and usage of medications used to treat ADHD, disorder characterized by inattention, hyperactivity or impulsivity.

Thomas, who also is an adjunct clinical professor in UA's College of Community Health Sciences, says doctors prescribing drugs to control ADHD in college students need to make sure the drugs control students' ADHD throughout the day. The drugs need to cover students' active lifestyles.

"After all, a college student's day is typically much longer than most persons and ADHD affects so much more than class and studying," Thomas says.

Doctors can use at least two methods of medicating for extending ADHD mediation coverage throughout the day: Students can take multiple doses of the same medication or combine long- and short-acting medication. There are two limitations, according to Thomas. First, ADHD medication tends to be short-acting unless it is delivered via a specialized, controlled-release product. Also, too much medication at night may keeps students awake. Thomas says students may think staying awake is a symptom of the medication and avoid taking it; however, it also can be a symptom of ADHD itself. Students need to keep taking their ADHD medications every day including weekends and holidays to help them succeed in college and in life.

"Students not taking medication are more forgetful, not as effective with every day tasks, and even drive less safely," Thomas says.

Thomas also notes that skipping medication as prescribed by a physician makes any side effects from the medication stronger than they would be if a student's body was accustomed to taking the drug. He says he hears of students worrying about becoming addicted to the medication, yet the prescribed levels are safe and are non-addictive. Students are more likely to have an addiction to the medication or have other substance abuse problems if they do not take medication as prescribed.

Many college students come to the Student Health Center for testing if they believe they have ADHD. Thomas provides these screenings and then sends those students suspected of having the condition to psychologists for testing to confirm the diagnosis and make sure that there are no other conditions present such as depression, anxiety disorders or a learning disorder. Whereas younger children with ADHD symptoms are often brought to the attention of parents and physicians by schoolteachers, who notice restless behavior and hyperactivity, college students are less likely to be singled out for ADHD-related problems.

"It is more challenging to diagnose college-aged students," Thomas explains, "because there isn't a teacher standing over them all day who can easily identify their symptoms."

Students with ADHD also face challenges beyond regulating medication. Negotiating the campus environment and managing their time wisely without the day to day assistance of their parents can be daunting. Thomas is part of a new campus-wide consortium focusing on helping students with ADHD. Aided by faculty from nine departments across campus and groups of interested UA students, the consortium is seeking to create a compilation of campus resources and a series of podcasts to assist students with ADHD.

Thomas says he received much of his training in treating students with ADHD on the job as a specialist in adolescent medicine in addition to attending numerous conferences.

"There was hardly the same amount of information and research available at the time," Thomas says of his medical education, in contrast to today's established base of ADHD knowledge. "So, through reading and self-training, along with the mentorship I received, I gained experience."

In addition to his work within the Student Health Center, he also has begun an adolescent medicine practice within the Department of Pediatrics at University Medical Center.

Thomas worked in Tuscaloosa for a few years while obtaining his medical degree. He worked in Tennessee following graduation alongside two mentors who specialized in ADHD treatment and filled a much-needed gap in local care. However, he says he was happy to return to The University of Alabama in 2007 to teach family practice and residence students in addition to treating students and researching ADHD.

"It felt like coming home," he says.

The College of Community Health Sciences operates a comprehensive, state-of-the-art medical clinic, University Medical Center, where College faculty members conduct their medical practices and where students and residents receive clinical experience and training. The College's research component supports faculty and student research efforts, including clinical trials.

The University of Alabama, a student-centered research university, is in the midst of a planned, steady enrollment growth with a goal of reaching 28,000 students by 2010. This growth, which is positively impacting the campus and the state's economy, is in keeping with UA's vision to be the university of choice for the best and brightest students. UA, the state's flagship university, is an academic community united in its commitment to enhancing the quality of life for all Alabamians.