Students with Attention Deficit Disorder (ADD)

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The HEATH Resource Center has recently received a number of requests for information on issues associated with postsecondary education for individuals with Attention Deficit Disorder (ADD). In order to collect information on this emerging topic, the HEATH staff contacted Chesapeake Psychological Services, one of several Washington, DC metropolitan area resources offering comprehensive testing and follow-up support to individuals with varying types of disabilities. Chesapeake Psychological Services has an Attention Deficit/Hyperactivity Disorder Clinic, which offers a full range of treatment services - from educational recommendations to consultation with physicians. As a result of that contact, Dr. Susan Biggs and Dr. Kathleen Nadeau on staff at Chesapeake Psychological Services accepted the invitation to present a professional development program to the members of the Nation's Capital Area Disability Support Services Coalition. What follows is a summary of the Biggs-Nadeau presentation in December 1992.

Defining ADD

The basic characteristics of adults with ADD include inattention and impulsivity. Adults with ADD may be disorganized, may lose things frequently, and may be easily distracted from the task-at-hand. Impulsiveness may include a perceived need to move on immediately to a new task, thus leaving another unfinished (they may be enthusiastic beginners but poor completers); impatience in waiting situations, such as in stalled traffic or standing in a slow-moving line; a short temper; or the tendency to respond poorly to stress and thus become easily hassled.

The education community divides ADD, by definition, into two similar yet slightly different groups. Individuals may be defined as having either ADD - Attention Deficit Disorder, or ADHD - Attention Deficit Hyperactivity Disorder, or attention deficit disorder with hyperactivity. Adults with ADD or ADHD may be either slow and lethargic, or restless and fidgety. Medical researchers now believe that differences in chemistry in the parts of the brain which control inhibition may cause ADD, and may be inherited.

Historical Trends

Medical and educational researchers over the past century have addressed various aspects of attention-related disability. In the early 1900's, attention- related patterns and behavior problems following brain injury were the focus of research. During the 1930's and 1940's, attention-related characteristics among individuals who had not sustained brain injury or brain damage were recognized and studied. Our knowledge became much more defined in the 1960's, with the awareness of some of the components that play a part in an attention-related disability, such as learning disabilities, neurologic dysfunction, or behavioral symptoms. More precision regarding the definition of behavioral characteristics became possible in the 1970's. Finally, in the 1980's, the definition of ADD was included in the Diagnostic and Statistical Manual of the Mental Disorders (DSM-III). The DSM-III is the official glossary of descriptions of mental health diagnosis. The addition of ADD to the DSM-III led to wide recognition of it as a specific disorder.

ADD and Adults

It is becoming clear that ADD is not a disability limited to childhood or adolescence. More and more adults are discovering that they have ADD; current estimates are that between eight and 15 million American adults have the disability. It is a high frequency and low visibility disability, meaning that many individuals have the disability, but its characteristics are not readily apparent.

Some report that between one-third and one-half of children with ADD grow up to be adults with ADD. While adults may be more likely to have an attention deficit disorder without hyperactivity, the adult will likely continue to experience difficulties with concentration; achieving his or her potential; impulsivity; behavior problems at home, school, or work; or will use poor judgment or have self-destructive tendencies. Adults with ADD often present additional diagnoses as well, such as mild chronic depression, mood and energy swings, nervousness, sleep disorders, muscular tension, and/or learning disabilities.

The presence within a person of an ADD is pervasive. It is more likely to affect many, or all, of an individual's life areas, rather than just one isolated area. As a result, adults with ADD may experience difficulties with most life issues. Some adults may be unable to complete formal education or may do so only with overwhelming drive. Others may have trouble with interpersonal relationships. Career problems may be present for others with ADD. Career-related problems may stem from frequent job terminations because of poor job performance, attention and/or organization problems, interpersonal problems with supervisors and/or co-workers, or becoming easily bored and quitting a job. Regardless of the life area in which an adult with ADD is experiencing difficulties, each is likely to feel that he or she is not living up to his or her potential. For relief, some may turn to intense physical or mental activity; others may use drugs or alcohol for self- medication.

Diagnosis

Psycho-educational diagnosticians use a system similar to the six steps described below when evaluating for ADD or ADHD.

1. Understanding Current Concerns and History

   Diagnosticians interview the student, and possibly his or her family in order to garner as much information as possible. Given the field's emerging knowledge about heredity and ADD, a diagnostician may look for clues to indicate if characteristics were present early in an individual's life, regardless of whether or not the individual and/or his or her family were identified as having any of the characteristics of this disability.

   Some diagnosticians develop a questionnaire, such as one described by Biggs and Nadeau, during this phase of the evaluation process to elicit information about ADD or ADHD. Such questions as "Do you feel that you are organized?", or "Would you describe for me your method of organization?" begin to provide diagnosticians with useful insights. Throughout the individual's responses, the diagnostician looks for evidence that ADD characteristics seem to be present in situations both in and out of the school or campus environment. Questions are asked to discover the areas affected by ADD including reading and writing skills, mathematics, attention and concentration abilities, language processing, visual and spatial abilities, memory, processing speed, social skills, and general concerns.

2. Selecting Appropriate Measures to Address Concerns

   Diagnosticians select tests from a large inventory of assessment tools. The selection is based on questions raised from the client's history. For example, during the evaluation process, a diagnostician may administer tests which will produce information about the possibilities of ADD or ADHD, learning disabilities, emotional problems, and/or neurological issues.

3. Testing

   Since each individual is unique, there is no pre-determined number of tests that a psychlogist or psychiatrist may administer in order to assess for ADD or ADHD. The assessments usually cover the following areas: intelligence, cognitive/information processing, personality, and educational - if learning disability is suspected.

4. Analysis

   During this stage of the evaluation process, the diagnosticians "play detective" and "put clues together."

5. Treatment Planning Conference

   The treatment planning conference always includes the diagnostician and the student, but may also include parents, spouse, and/or an educational specialist. In the conference, test results are shared and interpreted and recommendations are discussed. These may include specific recommendations to the student regarding study skills, and recommendations to the college regarding needed supports and accommodations. It may include recommendations for a medication evaluation, for psychological counseling, and/or for tutoring. School placement issues may be discussed if the student is not satisfied with his or her current school. For a working adult, both school and career issues may be discussed.

6. Written Report

   The diagnostician completes a full written report, including sections that list the tests which were given and the scores obtained, the interpretation of those scores, and individualized educational recommendations based on the students strengths and weaknesses. Students should review the report thoroughly and ask any questions that they may have, or ask for the diagnostician to go over the report with them. Most diagnosticians will schedule a follow-up appointment with the student, after he or she has received the written report and has had a chance to review it. It is extremely important that the student understand the full contents of the report, as such an understanding will help the student advocate for his or her future needs. In addition, students should always keep a copy of the report, as well as any other relevant information, for their personal reference or future need.

Costs of thorough evaluations, such as the six-step process described above, do vary and students are encouraged to become familiar with all options available to them before making a final choice. Students should also check with their health insurance companies to see if such an evaluation is covered under their policy.

Relevance to Campus Disability Support Services

College Offices for Disability Support Services are likely to see an increase in requests for services for students with ADD or ADHD. The disability is now recognized in the K-12 school system and public awareness about it has been raised by popular media. Accommodations commonly provided by colleges and universities, based on the student's functional limitations, include extending time to complete exams or papers; using notetakers, tutors, or organizational supports; carrying reduced courseloads; and preferential registration for smaller classes.

[Specific questions about any of the information presented here may be addressed to Dr. Susan Biggs and/or Dr. Kathleen Nadeau, Chesapeake Psychological Services, 5041-A Backlick Road, Annandale, VA 22003. (703) 642-6697.]

Selected Publications

• Latham, Peter S. and Latham, Patricia H. Attention Deficit Disorder and the Law - A Guide for Advocates. Washington, DC: JKL Communications, 1992. Weiss, Lynn. Attention Deficit Disorder in Adults. Dallas, TX: Taylor Publishing Company, 1992.
• Wender, Paul H. Hyperactive Child, Adolescent and Adult: Attention Deficit Disorder Through the Life Span. New York: Oxford University Press, 1987.

Recommended Resources

• The ADDult Support Network is a project of the Attention Deficit Disorder Association (ADDA) which publishes a quarterly newsletter entitled ADDult News. It contains personal stories, suggestions, and tips on living with ADD, and other pertinent information on adults with ADD. The subscription fee is $8.00 per year. An ADDult Information Packet is also available for $3, which includes personal accounts of living with ADD and reprints or articles from newspapers. Checks for either or both can be made out to Mary Jane Johnson and sent to ADDult Support Network , 2620 Ivy Place, Toledo, Ohio 43613. (419) 472-1286.

• Chesapeake Psychological Services publishes ADDendum, a quarterly newsletter for adults who have ADD. It contains first-person accounts of ADD and its consequences, summaries of medical and scientific research, coverage of legal issues and developments, listings of support groups, and other resources. Subscriptions within the United States are $12.00 for 1 year (4 issues). To subscribe or obtain additional information, contact Chesapeake Psychological Services, 5041-A Backlick Road, Annandale, VA 22003. (703) 642-6697.

• ADD and the College Student -A Guide for High School and College Students with Attention Deficit Disorder (1994), by Patricia O. Quinn, M.D. (editor), is a 113-page compilation of user-friendly information. While ADD and the College Student begins by stating that it has been written for high school juniors and seniors and college students with attention deficit disorder (ADD), a diverse audience can benefit from the collection of easy-to-read practical advice, including adults who suspect that they may have ADD, family members of individuals with ADD, postsecondary service providers, psychologists, diagnosticians, vocational rehabilitation workers, as well as high school teachers and college counselors.
  
  The first half of this 12-chapter book answers commonly asked quesitons, lists the major symptoms of ADD, and contains a checklist that can be used to help evaluate various symptoms, gain self-awareness, and provide guidance regarding the necessity of seeking a professional assessment. The biochemistry of ADD, medication, and other treatments for ADD also are covered. While Dr. Quinn states that she cannot endorse any of the alternative therapies at this point in time, she explains the basics of biofeedback therapy, self-control or cognitive therapy, and diet and megavitamin therapy. How ADD Affects You focuses on the most common issues faced by adolescents with ADD, both academic and social, and ends with personal commentaries from two college students with ADD.
  
  The second half of ADD and the College Student begins with Preparing for College: A Mother's Perspective. This personal story concludes with helpful hints for college students with ADD and for their parents. The remainder of the book leads readers through senior year at high school, college programs, and accommodations for students with ADD. The support services that postsecondary students with ADD may find helpful are described. Dr. Quinn points out that students can best understand which support services may be most helpful to them only after they understand their own learning strengths and weaknesses. She discusses common academic and emotional difficulties and then goes on to offer suggested accommodations. Quinn explains the three major sources from which the rights of college students with ADD stem: the Constitution, statues and regulations that prohibit discrimination, and cases decided by the courts. ADD and the College Student concludes with Commonly Asked Questions, which cover medicaiton, treatment programs, college admission and SAT's, parent involvement, learning accommodations, and legal issues. References to other relevant publications and organizations also are provided, as are the definitions of ADHD (Attention-Deficit/ Hyperactivity Disorder) used by both the American Psychiatric Association and the American Academy of Pediatrics. ADD and the College Student is available from MAGINATION PRESS, 19 Union Square West, New York, NY 10003. (800) 825-3089. The cost is $13.95, plus a shipping and handling fee of $2.75.

• Approaching College for the Student with ADD is one in a series of videos that seeks to inform students with ADD and their parents about the paths to success in college. In Approaching College for the Student with ADD, Dr. Patricia Quinn dispels the myth that ADD students could do better in school if only they tried harder. Quinn argues that many of these students already are putting considerable effort into their studies, and that for student with ADD, they key to success lies in developing and putting into practice strategies for time management, considering medication options, and continuing to seek supportive services. In the video, Quinn cautions students that the transition from high school and home to college involves enough major changes without making a clean break from medication or deciding to "turn over a new leaf" by attempting to handle course work without support services. Comments from Quinn are augmented by the remarks of several students with ADD, whose advice lends a "front lines" pragmatism to the video. These students recount experiences with teachers and administrators and offer suggestions for effectively discussing the need for special accommodations.

• In ADD and the College Student, another video in the series, Quinn provides a comprehensive list of personality traits associated with attention deficit disorder. For someone recently diagnosed with ADD, or for someone who suspects the presence of ADD, Quinn's overview of the disability is particularly informative. Her description of the disability emphasizes the increased tasks and responsibilities of personal care and academic workload that are associated with college life. Quinn's assessment provides a positive framework for understanding the disability and for developing strategies for the college student with ADD.
  
  Ann McCormick, an advisor at the American University (Washington, DC), follows Dr. Quinn's discussion of symptoms with examples of accommodations that her office commonly employs in providing for the needs of students with ADD. McCormick provides practical advice on choosing a college, and her presentation on accommodations is helpful in that it prepares a student with ADD for the kind of dialogue that must take place for an effective accommodation program to be developed. This discussion includes pragmatic strategies that a student with ADD can employ to improve his or her chances of succeeding in a college environment. The cost of each video is $29.95. To order, prepay the Pediatric Development Center, 3262 Arcadia Place, NW, Washington, D.C. 20015. (202) 966-1561.

• The ABC's of ADD (1993) is a 30-minute videotape that contains basic information for adults with ADD, those who suspect they have ADD, family members of individuals with ADD, or any of the many professionals who may be interested in the issues associated with adults with ADD. The adult focus of the video is conveyed from the start of the tape, which begins with snippets of personal stories told by three young adults with ADD and segments from various professionals speaking to an audience at an earlier conference.
  
  Each section is brief, conveying basic information. First, the primary symptoms of ADD, including some of the most characteristic symptoms of both children and adults with ADD, are discussed. The video expands upon this discussion by presenting characteristic secondary symptoms of individuals with ADD. Each of the medications most commonly prescribed to individuals with ADD is discussed briefly and some of the common side- effects of the various medications are mentioned. The young adults with ADD who appeared at the beginning of the video tell longer versions of their own personal stories, touching on issues associated with postsecondary education and employment. Common characteristics of adults with ADD also are presented in a personal story format. A section on legal rights concludes the tape, briefly laying a foundation for understanding the legislation that has helped prevent discrimination against individuals with disabilities. The ABC's of ADD is available from JKL Communications, P.O. Box 41057, Washington, DC 20016. The cost is $29.

Readers with information to add to HEATH resources on ADD may contact Vickie M. Barr at HEATH.