College students with attention-deficit/hyperactivity disorder (ADHD) have a harder time making it to graduation than their peers do, a new study suggests.
Researchers found that of 400 students they followed, those with ADHD had a lower grade-point average (GPA) -- about half a grade lower -- than students without the disorder. The gap emerged freshman year, and persisted throughout college.
And in the end, students with ADHD were less likely to make it through four years.
The findings start to fill in a knowledge gap, the researchers said.
Even though the college years are a critical time for young people with ADHD, fairly little has been known about how they fare.
"The transition to college is difficult, even for students without ADHD," said Christopher La Lima, a child and adolescent psychologist who was not involved in the study.
That's partly because college involves more than academics, according to La Lima, who is based at NYU Langone Health's Hassenfeld Children's Hospital, in New York City.
In sharp contrast to their high school days, he said, college students are on their own in managing their time and staying organized, without parents or teachers keeping close watch.
Then there are the many distractions that come with new independence, new living conditions and making new friends.
Even the academic part is different from high school, La Lima noted. Deadlines, for example, may stretch out over long periods, which can easily lead to procrastination and last-minute "cramming."
A disorder of self-regulation
George DuPaul, a professor of school psychology at Lehigh University in Bethlehem, Penn., is the lead researcher on the study.
He, too, said that even when kids with ADHD do well academically -- well enough to get into a four-year college -- they can still struggle with the distractions of college life.
"ADHD is a disorder of self-regulation," DuPaul said. And when the support system of parents and teachers is no longer there, it's challenging, he added.
For the study, DuPaul and colleagues at the University of North Carolina-Greensboro, University of Nebraska-Lincoln and University of Rhode Island followed 406 students across eight semesters. As freshman, 97 had ADHD and were taking medication, while another 104 had the disorder but were not on medication. The rest (205) did not have ADHD.
On average, students with ADHD maintained a lower GPA over all four years. Those on medication were particularly behind, with a GPA hovering around 2.5 in their final two years. In contrast, students without ADHD generally maintained a GPA above 3.0.
The reasons are not clear. But, DuPaul said, students who needed medication might have had more severe symptoms.
When it came to completing four years, students with ADHD again lagged. Of those not taking medication, 49% either graduated or finished eight semesters, versus 59% of the students without ADHD.
That figure was somewhat higher -- 54% -- among students who were on ADHD medication.
It's not that colleges offer no support to students with ADHD. DuPaul said campuses do have services, including academic help and accommodations such as written instructions (rather than just verbal), permission to record lectures, or extra time for test-taking.
Will they ask for help?
But since college students are adults, they have to seek the services.
One of the striking findings in this study, DuPaul said, was how few students with ADHD participated.
"More than half did not receive any academic support," he said.
It's not clear why, but DuPaul said some students may have been unaware the services existed, while others may have passed.
Sometimes, he noted, students resist help because they want to be "independent" or don't want to appear "weak."
But both DuPaul and La Lima encouraged students to get the services they need. Parents can do their part, they said, by talking to their kids -- before they leave for college -- about the challenges that may come up, and how to get help.
It's also important that kids with ADHD not beat themselves up over lackluster performance, La Lima said.
"At some point, you're going to drop the ball," he said. "Nobody's perfect."
DuPaul noted that students' overall mental health is critical. People with ADHD commonly have co-existing conditions, he said, including depression. And in this study, students with depression symptoms generally had more difficulty with studying.
Getting psychological services to those students is also key, DuPaul said.
The study findings were published online Feb. 2 in the Journal of Clinical Child & Adolescent Psychology.
The Attention Deficit Disorder Association has more on ADHD and college services.
SOURCES: George DuPaul, PhD, professor, school psychology, College of Education, Lehigh University, Bethlehem, Penn.; Christopher La Lima, PhD, child and adolescent psychologist, Hassenfeld Children's Hospital, NYU Langone Health, New York City; Journal of Clinical Child & Adolescent Psychology, Feb. 2, 2021, online