Definitions and Characteristics

Attention Deficit Hyperactivity Disorder (ADHD)

An attention problem can occur for many reasons: distraction by a more favored activity, worry, depression, anxiety and a range of problems with learning. An Attention Deficit Hyperactivity Disorder, however, is a neurologically based persistent pattern of inattention, hyperactivity and impulsivity that is more severe and frequent than in others of the same age and comparable level of development.

There are three distinct types of Attention Deficit Hyperactivity Disorder as set forth in the Diagnostic and Statistical Manual- IV (DSM-IV): Predominantly Inattentive , Predominantly Hyperactive-Impulsive and Combined. For diagnosis, some of the hyperactive-impulsive features must be present before the age of 7. The symptoms must be observable in two or more settings and there must be "clear evidence of clinically significant impairment in social, academic, or occupational functioning." In addition, the symptoms must not be better accounted for by another disorder, such as depression, anxiety or pervasive developmental disorder.

Whereas previously it was thought that the symptoms of ADHD alleviated or disappeared during adolescence, Michael Gordon and Russell Barkley, leading researchers in this area, indicate that there is a significant body of information that 50% to 80% of those who are diagnosed during their early years continue to experience symptoms that affect them as adults. The symptoms may change throughout the lifespan with fewer signs of hyperactivity and less evidence of poor planning and inadequate self-regulatory behaviors.

Diagnosis of ADHD in adults requires clear evidence of long-standing problems during childhood and the elimination of other causative factors as well as the examination of associated behaviors. This makes the diagnosis problematic, because often a comprehensive and objective history is not available. Because many of the students entering college presently were in school when the field was first being defined, proper diagnosis might have occurred during elementary or middle school. It is also possible that the ADHD behaviors were explained in other ways, such as "He's unmotivated," "There is an adjustment problem" or "He's not as bright as his sister!" These alternatives hypotheses are quite common, especially for bright students whose performance varies from subject to subject and teacher to teacher. Currently, procedures for diagnosis are becoming more objective and the newer diagnostic tools and measures have better psychometric properties than previously. We are doing a better job of defining what is and what is not ADHD, but it's far from perfect.

Clinical practice for intervention and management lags behind in treatment of adults. It is not uncommon for college students to self-diagnose accurately based on their histories and present symptomology, but it is often difficult to find appropriate services other than medication. A new field of ADHD "coaching" is arising that combines counseling, tutoring and building organization and management skills, but this is often not available in the community or on campuses.

Adults with ADHD are susceptible to severe disruptions in a variety of basic life activities including learning, social relationships, employment and daily adaptive functioning, such as paying bills and turning in assignments on time, remembering appointments and organizing work space. Because these individuals demonstrate characteristics of individuals who are unmotivated, disorganized or just immature, it is often easy to dismiss the symptoms as a lack of caring or "laziness," the labels often pinned on them as children. In addition, as the child with ADHD becomes the adult with ADHD, a number of other problem behaviors may emerge, such as alcoholism, smoking, drug addiction, disruptions in intimate relationships and violations of rules or laws.

Diagnosis of ADHD in adults is a complex process. More and more frequently, instructors are aware of attention problems of students and students are aware of their own difficulties regulating their attention capabilities. Because this is a recognized category of disability, it is important for those who exhibit problems related to attention to be diagnosed so that proper support and therapies can be provided.

Instructing students with ADHD is similar to instructing most other students. They depend on the organization of the instructor, clear presentation of materials, structure for assignments and ample opportunity for feedback. In addition, they may request extended time on tests, separate setting accommodations and support for longer assignments, such as research papers. Because these students may be procrastinators (not by volition, though), it is wise to check in with them regularly and let them know where and how to seek support.