Transcript ADD and the College Student

ADD & the College
Student
Issues, Problems, Solutions
Dr. Sean P. Barrett, Ph.D
Overview
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What is ADD?
ADD in a Community College Context
How to make your class ADD friendly
Assessment Issues in College Students
Treatment Issues in College Students
Question/Answer
What is ADD?
• Attention Deficit Disorder
• Deficit: insufficiency, shortcoming
• Disorder: disease, dysfunction
• Brain Malfunction OR Brain Style?
• Inherited differences in the way brain is ‘wired’
• Well suited for some tasks/ environments not others
• Causes difficulties in many areas but may also have some
positive aspects
An ADD ‘brain style’
is usually not a good
fit for the types of
tasks required to
do well in college
Diagnostic Criteria
for ADD
• Persistent symptoms of inattention
and/or impulsivity/hyperactivity
• Must be evidence of symptoms during
early childhood
• Symptoms cause significant
impairment
Specific Symptoms
Inattention
• fails to give attention to
details/makes careless mistakes
• difficulty sustaining attention
• doesn’t seem to listen when
spoken to directly
• doesn’t follow through on
instructions
• difficulty organizing tasks &
activities
• avoids / dislikes tasks that
require sustained mental effort
• loses things necessary for
activities
• easily distracted by extraneous
stimuli
• forgetful in daily activities
Hyperactivity-Impulsivity
• often fidgets or squirms in seat
• leaves seat when sitting is expected
• runs or climbs in inappropriate
situations
• difficulty doing activities quietly
• is often "on the go" or acts as if
"driven by a motor“
• talks excessively
• blurts out answers before questions
have been completed
• has difficulty awaiting turn
• interrupts or intrudes on others
6 of 9 symptoms for either or both clusters are
required for diagnosis.
• Initially conceptualized as childhood
disorder that could be outgrown
• Now recognized to persist across lifetime
• Many criteria are still defined in terms of
childhood symptoms
• Growing evidence that symptoms may be
expressed differently in adulthood
Symptoms/Features in
ADD in Adults
Cut to the chase…
• Focus on big picture, gist or main
point not details
• Rapid-transit processing
• Skimming/skipping ahead when
reading
• Impatient when listening/waiting/
interacting
Need for stimulation
• Seeking out
stimulation
• Thrill seeking
• Accident prone
• Addiction prone
Procrastination
• Difficulty starting a task in absence
of immediate pressure/deadlines
• Difficulty staying on task
– frequent breaks, e-mail checking etc
• Need to see the big picture before
working on details
The On/Off Switch
• Lack of control of
“on/off switch” for
attention
• Difficulty getting
started
• Once engaged can’t
stop or ‘shift gears’
• Hyper-focus
• ‘Attention variability
disorder’ - Hallowell
Juggling act
• Tendency to take on
many tasks at once
• Starting new
projects without
finishing old ones
– procrastination? Seeking
novelty or stimulation?
What were we talking
about again…
• Going off on tangents
• Loosing track of original point when speaking
• Something you see/hear/read sets your mind off in
another direction
• Difficulty focusing on conversations when
not actively involved
• ‘Tuning out’ during conversations
• Uh-huh phenomenon
• Often distracted by ‘internal’ world
‘I need to get
organized…’
• Difficulty getting
(staying) organized
• Messy
• Organized mess?
• Loosing things
– Put things down
without thinking
That took HOW long
• Poor sense of time
• Late (early) for
appointments etc.
• Missed deadlines (bills,
assignments etc.)
• Misjudging how long it
takes to do something
Can’t keep that foot out of
my mouth…
• Saying whatever
comes to mind when it
comes to mind
• Poor sense of impact
on others
Low Self-Esteem
• Feelings of inadequacy for having so much
trouble with things that seem to come
naturally to others
• Sense of underachievement
– “I just can’t seem to get my act together”
Positive attributes of ADD?
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Creativity
Enthusiasm & Energy
Spontaneity
Liveliness
Flexibility
Open-minded
How does ADD Impact a
College Student?
• Performance usually does not match
knowledge/ability in ADD students
• ADD often impairs an individual’s
performance on tasks that typically
form the basis for assigning grades
Problems Associated with
Tests/Exams
- Following exam instructions
- Instructions often not carefully read (answer 3 of 5)
- Multiple choice
- Impulsive responding
- Misaligned answers
- Problems with negative wording
Problems Associated with
Tests/Exams
- Time management
- Too much time on some sections
- Repeated checking for mistakes
- Arriving late
- Penmanship
- Often illegible
- Printing takes longer
- Distractibility
- Distracted by others in room, noises etc.
Test/Exam Preparation
Procrastination
• Last minute crammers
Reading difficulties
• Wavering attention when reading
• Skimming/jumping around
Test/Exam Preparation
Knowing what to study
• Focus on big picture
• What details are important?
Study materials
• Disorganized or lacking
Papers & Assignments
-unrealistic goals
-poor attention to ‘nit-picky’ details
-organizational issues
• difficulty creating/following outlines
• failure to follow steps necessary for task
completion
In Class Behaviors
-Note taking
• Difficulty listening and writing at same time
• Illegible notes
-Disruptive behaviors
-Coming to class without necessary
materials (paper, pen etc.)
Making an ADD friendly
classroom
Testing:
• Test preparation
– Tell students what they should focus on when
studying
– In class before test let students know what
they can expect
• Test Instructions
– Verbally go over instructions
Testing:
• Timed tests
– If possible do not have timed tests
– Always provide more time than you think the
average student will need
– Provide time for students to check over work
– Provide guidelines for how long each section
should take
– Occasionally announce time remaining
Testing:
• Distractibility
– Exams should be written in an environment with
few distractions (front of class, other room)
• Multiple choice
– Have students circle answers on exam paper as
well as on bubble sheet
– Avoid use of double negatives in questions
Testing:
• Scheduling
– ADD students often become hyper-focused
when studying and have great difficulty
shifting attention to new topics
– Students with ADD should not write more than
one exam per day and ideally have one day in
between exams.
• Alternate exam formats
– Oral exams, practical demonstrations, takehome exams
Classroom:
• Allocate time for class discussion
– Active engagement helps sustain attention
• Communicate expectations for
participation
– Set clear limits and rules
Classroom:
• Organize material in 15-20 minute
blocks
• Incorporate hands-on activities
– Tend to learn best by ‘doing’
• Make lecture notes available
– Post on web ct, allow for recordings
Assignments:
• Provide concrete guidelines and limits
• Vary assignment formats
– Oral presentations, debates, group-work etc.
• Component deadlines
– Make individual components of assignments
separate end goals of themselves
Assignments:
• Allow for choice/creativity
– Focus tends to be better when ADD students
are actively involved in creating or deciding
what to do
• Use of Web CT
– Reminders about due dates, assignment
instructions
– Ease of submission of multiple assignment
components
Students:
• Take manageable course loads
– Consider taking an extra semester to meet
requirements
• Select an appropriate field of study
– Find something that interests you!
• Use medication properly
Other Tips for Students:
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Speak with your instructor
Ask for help
Utilize available resources
If not already done so get a proper
assessment
How do I know it is ADD?
Assessing ADD in College Students
• A proper assessment is critical to:
– Establish the presence or absence of ADD
– Distinguish ADD symptoms from symptoms of
other disorders
Essential components to
a valid ADD assessment
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Life history interview
Self-reported symptoms
Objective cognitive assessment
Collateral reports
School report cards
Screening for other psychiatric
disorders
Faking ADD?
• 20% of college students evaluated
for ADD at an Ontario clinic were
suspected of faking (Harrison, 2006)
• Why Fake ADD?
– Access to accommodations/resources
– Access to drugs
– Escape responsibility
• Be reluctant to accept diagnoses based
strictly on self-report checklists
• Don’t be afraid to ask for additional
documentation/clarification
• But remember the MAJORITY of
cases are genuine!
Treatment Issues for
ADD in College Students
• Stimulant medications (e.g. Ritalin,
Dexedrine) are usually the first line of
treatment
• When used as prescribed medications are
typically very effective in treating some
(though not all) ADD symptoms
• Immediate transient improvements
• Few serious side effects
• Stimulants have abuse potential
• High demand from non-ADD students
– Study aid, partying
• Poor compliance and monitoring
• Stigma of medication use
– Diversion/misuse as means of fitting in
• Non-stimulant medications
– Typically less effective
– Better at addressing inattention than
impulsivity/hyperactivity
Non-medication options
• Coaching
– Organizational & study skills
• Psychotherapy
– Especially helpful for self-esteem
• Support groups
– If there aren’t any consider starting your own!
Non-medication options
• Diet
– Less junk; more omega 3
• Exercise
– Regular cardiovascular exercise has been
demonstrated to improve symptoms
Questions?