Eric Heiligenstein

Psychological and Academic Functioning in College Students With Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) has been increasingly recognized as a valid adult diagnosis. Yet the impairments related to ADHD in college students have received little scholarly attention. Psychological and academic impairments in college students not previously diagnosed with ADHD were assessed in a retrospective chart review, using specifically defined diagnostic criteria, and compared with a control group. Students with ADHD had a significantly lower mean grade point average, were more likely to be on academic probation, and reported significantly more academic problems. Measures of psychological impairment in the ADHD group were not significantly different from those in the control group. College students diagnosed with ADHD had a specific pattern of academic impairment. The problems of these students, compared with other groups of children and adults with ADHD, appeared to be more related to a type of learning disorder than to the conceptualization of ADHD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Preliminary normative data on DSM-IV attention deficit hyperactivity disorder in college students.

Identification of attention deficit hyperactivity disorder (ADHD) in adults presents a number of problems because there is no one specific diagnostic test for the condition. Given this challenge, clinicians often struggle between restrictive and exclusionary diagnostic methods or overinclusive acceptance that ADHD is a prevalent and disabling problem. A modified version of the Attention Deficit Hyperactivity Rating Scale was administered to 468 students at a large midwestern university. Analysis of the results suggested that the degree of ADHD symptoms in college students is modest and indicated that cutoff scores of 4 for current symptoms of inattention and hyperactivity-impulsivity would be sufficient to identify a college student as distinct from the norm. Although it would be premature to accept the calculated thresholds completely, clinicians should be aware of these differences when evaluating college students for ADHD.

Depression and Academic Impairment in College Students

Impairment from depression and its impact on productivity are of profound societal importance. We report the results of an evaluation of depression and academic impairment in university students, using standardized measures. Sixty-three students completed the Beck Depression Inventory and the work role section from the Social Adjustment Scale-Self Report. Academic impairment, manifested as missed time from class, decreased academic productivity, and significant interpersonal problems at school, was seen in 92% of the students. More severe depression was related to a higher level of impairment. At all levels of depression, affective impairment-inadequacy, distress, and disinterest in school-was more prevalent than was academic impairment. The risk of academic impairment became likely at only moderate-to-severe levels of depression. Discussing the implications of depression with students and aggressively pursuing both medication and nonmedication therapies are essential in preventing the high morbidity associated with untreated depression.

Presentation of Unrecognized Attention Deficit Hyperactivity Disorder in College Students

Mental health providers at university counseling and health centers should be alert to the possibility that college students with previously unrecognized attention deficit hyperactivity disorder (ADHD) may present for initial evaluation at their centers. This study was a systematic chart review of 42 students at an Upper Midwest university who were diagnosed with ADHD during calendar year 1993. Diagnoses were made by the treating psychiatrist, who reviewed records for presenting problems; recent associated problems; previous evaluations as a child, adolescent, or adult; and associated problems in childhood. Presenting problems included ADHD symptoms, mood symptoms, nonspecific learning disability, and academic underachievement. Associated problems were depressive disorders, anxiety disorders, drug and alcohol abuse or both, dependency, legal problems, learning disabilities, and eating disorders. Thirty-three percent had been evaluated for academic or behavior problems as children, and 36% had sought previous psychological care for non-ADHD symptoms as adults. Thirty-one percent were presenting at the university health center for their first evaluation. Childhood histories showed educational underachievement, learning disabilities, and behavior problems.

Cigarette smoking and associated health risks among students at five universities

INTRODUCTION While most college students and other young adults who smoke fall into the light and intermittent smoking (LITS) category, they remain at risk for tobacco dependence and other adverse health effects from their smoking. This study examines smoking patterns, tobacco dependence, and other health variables among students at five universities to better understand how to identify and address tobacco use and related risks in a college health clinic setting. METHODS A health screening survey was completed by 2,091 college and graduate student volunteers seeking routine care at their university health centers or participating in a health class. Independent health variables were analyzed descriptively and in regression analyses with three levels of smoking (none, non-daily, and daily) and tobacco dependence to determine predictors and associated risks. RESULTS Nearly a quarter of students reported any current smoking, 41% of whom reported smoking less than 1 cigarette/day (cpd). Of the daily smokers, 80% smoked less than 10 cpd but 45% met criteria for tobacco dependence. Any smoking was associated with high-risk alcohol use, risky driving, relational abuse, depression, less exercise, and utilization of emergency and mental health services. In regression analyses, students who experienced depression had more than double the odds of being dependent smokers (odds ratio [OR] = 2.32), as did those who reported abuse (OR = 2.07) or sought mental health counseling (OR = 2.09). DISCUSSION Student health providers should be alerted to the multiple risks and comorbidities that occur among all smokers, including LITS, and intervene concurrently to help prevent or mitigate adverse outcomes that result from these conditions and behaviors.

Pemoline Therapy in College Students with Attention Deficit Hyperactivity Disorder: A Retrospective Study

Pemoline, a dopamine agonist, is effective in children with attention deficit hyperactivity disorder (ADHD), but its efficacy in adults is unknown. The authors studied the efficacy and safety of pemoline, using retrospective chart review of treated students with ADHD over a 2-year period. Forty students met diagnostic and treatment criteria; pemoline was associated with much improved or very much improved Clinical Global Impression symptoms scores in 70% of the students during a treatment period of 14 or more days. Severity of illness scores dropped from 4.11 to 3.01 between baseline and subsequent evaluation. Nine evaluable patients had adverse events, most commonly headaches, insomnia, and decreased appetite. Five additional students, who failed to meet the treatment-duration criterion, terminated because of severe initial insomnia. The authors concluded that pemoline is effective and safe in students with ADHD and has a lower abuse potential than methylphenidate and dextroamphetamine, the other two widely used, structurally dissimilar compounds, but controlled studies may be necessary before any final conclusions are reached.

Smoking and mental health problems in treatment-seeking university students.

Smoking prevalence and daily cigarette consumption are significantly higher among individuals with mental health problems. Studies performed in the general population report greater levels of functional disability, more psychiatric symptoms, and poorer quality of life in heavy smokers. Less is known about the burden of tobacco in individuals seeking mental health care. A total of 503 treatment-seeking university students were evaluated with a standardized and validated computer assessment tool (PsyberCare-MH, Polaris Health Directions) that assessed subjective well-being; severity of psychiatric symptoms; and vocational, social, and personal functioning. These patients also were categorized as nonsmokers/occasional smokers (n = 384), light smokers (at least weekly use; n = 68), and heavy smokers (daily smoking >10 cigarette/day; n = 51). Compared with nonsmokers, heavy smokers, but not light smokers, reported substantially poorer well-being, greater symptom burden, and more functional disability (all scales p < .008). Smoking status should be assessed in all individuals seeking mental health treatment and appropriate cessation assistance should be provided.

Pemoline in Adult Attention Deficit Hyperactivity Disorder: Predictors of Nonresponse

The psychostimulants are the most widely used treatment modality for attention deficit/hyperactivity disorder (ADHD). Although positive responses to psychostimulants have been demonstrated, 46% of adults with ADHD, on average, are nonresponsive or cannot tolerate the medications because of adverse effects. We reviewed the charts of 43 students treated with pemoline and studied parameters of nonresponse. Sixteen (37%) met the study definition of nonresponse. Of these 5 (12%) were symptom nonresponders and 11 (25%) were nonresponders because of adverse effects. We found a significant relationship between age and nonresponse resulting from adverse effects, yet no other factors predicted nonresponse to pemoline. Clinicians should consider using smaller starting doses of pemoline in adults to minimize adverse effects.