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EPSTEIN QUARTERLY
Updated October, 2003
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INTRODUCTION
Over the years I have had several students who did well in high school while on
medication and then stopped the medication as they started college. The results were
disastrous, resulting in failure, probation, and even a 1.8 cumulative average. The
problem came to my attention again when I learned that a student taking a PG (Post
Graduate) year had decided not to continue medication when he entered college. This
student had struggled in school, but did very well after being diagnosed and treated in
his junior year. He took the PG year to compensate for his poor showing in high school
before starting medication. I am very concerned about his future college performance, but
he did start me thinking. Therefore, this issue of the Epstein Quarterly is focused on the
use - and non-use - of medication by ADD students as they begin college.
CASES
Jane:
Jane is a bright girl with many interests. She was diagnosed with ADD in 8th
grade and took medication for school and homework through high school. She was a high B
student, and went to a college that would present a moderate challenge. She had a
difficult time, and completed the year with a 1.8 average, which automatically put her on
academic probation. She had stopped taking the medication shortly after starting college.
I did not see her at Christmas time as scheduled, and her mother told me she knew nothing
about the grades or about the fact that Jane had discontinued her medication.
Charlie:
Charlie had been diagnosed with ADD in 7th grade. He had done well, but
mother had always been his advocate and had a key role in making him successful. When he
left for college Charlie announced that he wanted to be normal, wanted to party without
worrying about medication, and didn’t need it anyway. In fact, not only had
medication helped him focus and do well, but had also helped him control his low
frustration tolerance and reduce his impulsivity. Charlie quickly got into difficulty, not
attending classes, not completing homework assignments, and even getting into a fight with
his roommate. He left school after the first year but hopes to return.
PARENT’S ROLE
I have come to believe that it is essential for parents to continue to work with their
child and the medication as college begins.
Parents have told me that they feel they cannot be involved. They say the student is
now an adult and must take responsibility for his/her actions. Further, they say, they
have no control, and often don’t even see the report cards.
This is not acceptable.
There are many factors that make the ADD student different. Some are immature, even at
college age. Many are poor self-advocates and need help or encouragement to enroll in the
special programs that the college offers.
Also, remember all of the other new experiences facing a first time college student,
from doing laundry to lack of a curfew. Many new challenges must be confronted, all
without the security of home. This makes the first semester a very difficult time for many
students. Parental availability is often needed, though maybe not sought after, as that
would be embarrassing. But parents still have a role!
We’re not inquiring about parties. We need to know about academic functioning,
including successes and difficulties. Most of these difficulties will not be new ones. The
ADD child, now becoming the ADD adult, will continue to be challenged in several areas
that are ongoing problems and not new or college-specific. These areas need to be reviewed
and followed by both the parents and student.
One of these areas is time management. This includes problems with planning and
procrastination. The structure of high school is gone, and mother, the homework prompter,
is not available. Classes may start at 8 AM or 1 PM. Class schedules vary from day to day,
and there may be evening classes, as well as more free time than the student has ever been
used to. The student must learn how to use this free time efficiently, and to handle
assignments so that the requirements are correctly fulfilled.
How is he doing? How is she doing?
Grades reflect the academic functioning. It is important that parents know what marks
the student is receiving. In many schools the grades go to the student and not the parent.
It is important to know when marks come out and to see the report card.
Is that being too pushy or nosy?
I don’t think so. We are talking about keeping an eye on a first year college
student away from home for the first time. With ADD problems can happen. Being on top of a
situation can prevent much grief later on. I suggest that your need to be involved be
discussed before the student leaves for school. Hopefully, your position will be viewed as
caring and concern. In any event, your position will be understood.
OFFICE VISITS AFTER COLLEGE BEGINS
I like to see the student in late October or at Thanksgiving. This gives me a chance to
review performance and the effectiveness of medication in terms of dose and method of use.
This review occurs while there is still time to make corrections if things are not going
well.
Unfortunately, most students do not return until Christmas vacation, which is after the
completion of the first term. When things have gone well it is fine. But when the results
are a 1.8 average and academic probation, it is a problem.
Frequently I find reasons for the difficulties that are directly related to the ADD.
Sometimes we need to review medication, change dosage, etc. Sometimes I have to discuss
feelings about being different. Sometimes I have to discuss the ADD student becoming an
advocate for him/herself, such as requesting extended time on tests or reducing the number
of classes for the second term.
When a student is having trouble, there is much to talk about and many avenues of
approach to help improve the situation.
As you can see, in most cases the treating physician is not kept in the loop during the
first months of college. It is, therefore, essential the parents stay involved, know what
is happening, and offer support or whatever is needed.
CONCLUSION
Change is often difficult for those with Attention Deficit Disorder. One of the most
difficult periods of adjustment occurs when the student leaves home for college. Despite
the significance of change, it is critical that parents stay involved. This means helping
to get special services in place, knowing what grades are being received, and
understanding what problems are occurring.
Please take an active role.
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