How to Succeed in College with ADHD: Evidence-Based Strategies That Work

The transition to college is both thrilling and nerve-wracking for students with ADHD, who face a unique set of challenges as they progress through higher education. Anticipating these ADHD-related difficulties — from executive dysfunction to procrastination to medication challenges and beyond — is a critical first step to devising solutions that will withstand the college years.

The equally critical second step? Understanding the services, accommodations, and interventions proven to benefit college students with ADHD — and then leveraging them.

How to Succeed in College with ADHD: The Total Support Package

Research suggests that college students with ADHD benefit from a collection of supports — not just a single strategy or service.

1. Academic and Psychosocial Supports

Students with ADHD respond well to both academic and psychosocial supports¹ and they should work to secure these services as a minimum requirement in college.

Academic Supports

Academic and testing accommodations, including extra time and the ability to take tests in quiet, not-distracting environments, can benefit students with ADHD and learning disabilities. Students can secure appropriate accommodations through their college’s office of disability resources after accepting admission. (ADHD need not be part of the student’s college application.)

[Free Guide to Securing ADHD Accommodations in College]

While testing accommodations can make a real difference for students with ADHD, and are requested most often, their impact is amplified when they exist as part of a package of supports that includes the following.

Coaching
Coaching shows great promise as a key service for college students with ADHD.

Coaches help college students achieve personal academic goals. While a service like tutoring is usually based on knowledge-building, coaching is about planning, organizing, and implementing other processes that can help students better absorb material, engage with learning, and keep up with course demands. Coaches may work with students every day or a few times a week, and they often ask them to complete tasks and check in to demonstrate that they are keeping up with their individualized plan.

In a recent study of factors contributing to academic success in college, coaching was associated with a statistically significant increase in GPA for students with ADHD². Researchers found that there’s a 0.04 increase in semester GPA for every hour of coaching.

Furthermore, GPA was not significantly associated with tutoring, hours of advising, and other supports students received during the study. These findings emphasize a truth that clinicians know quite well about ADHD: It’s the “point of performance” supports that are most effective for these individuals, compared to skills-building and knowledge-based supports. In other words, students with ADHD often know what to do — they just do not know what they know.

[Read: Q: How Can My Teen Find an ADHD College Coach?]

Like academic accommodations, coaching is often arranged through the office of disability resources. If coaches are not available through the college, students and families can search for local or virtual ADHD coaches on their own.

Psychosocial Supports

College is a rigorous and challenging academic environment that students are expected to navigate independently. For students with ADHD, a history of academic and social difficulties may lead to dysfunctional cognitions and beliefs⁴. These beliefs can impact mood, coping abilities, functioning, and academic performance in college. Procrastination and avoidance often stem from — and feed — this self-perpetuating cycle.

High rates of co-occurring conditions underscore the importance of psychosocial supports for students with ADHD. In a 2018 study, 55 percent of first-year college students with ADHD exhibited at least one comorbid diagnosis⁴. Female students with ADHD, in particular, exhibited significant rates of comorbid anxiety and mood disorders. Unchecked, these conditions can further impact mood and functioning — in and out of the classroom.

Counseling Programs

College campuses are increasingly adopting Accessing Campus Connections and Empowering Student Success (ACCESS), a cognitive behavioral therapy (CBT) program designed to help students with ADHD achieve academic, personal, and social success. The program is associated with robust positive outcomes for academics and mood⁵.

The program, founded at the University of North Carolina Greensboro, comprises group and individual sessions delivered during two consecutive semesters. Weekly CBT group sessions cover topics like developing adaptive thinking and handling emotions, and offer behavioral strategies for managing long-term projects, social relationships, studying, and organization. Individual sessions reinforce group lessons, track progress toward individual goals, and connect students to campus resources as needed.

ACCESS is becoming a model CBT program for colleges across the country. Students with ADHD should connect with their college’s counseling center to determine if a similar program is in place.

2. Study Strategies

The study strategies that worked in high school rarely pass muster in college. To improve academic performance, students with ADHD must adopt new and effective study and learning strategies.

This begins by adjusting motives. Students with ADHD report greater use of “surface” motives (like fear of failure) and strategies (e.g. rote memorization) when studying^{6 7}. These surface motivators and methods might work in the short-term, but they rarely produce good results in the long run. Deep motives and approaches, on the other hand, are all about intrinsic motivation and real engagement with the material. It’s learning for the sake of understanding, rather than just wanting to pass a test.

Collaborative study is one example of a deeper study strategy that may help students learn course material in engaging and more effective, meaningful ways⁶. Group study, though potentially distracting, also allows for peer-mediated checks on comprehension and understanding.

Students with ADHD also tend to achieve better classroom performance when they are actively engaged in novel tasks like labs and small group activities⁸. Enrolling in courses with hands-on elements like these may boost motivation and grades.

3. Treatment Adherence and Medication Management

Medication management is a common concern among parents of college students with ADHD⁹. In the transition to college, students may falter in adhering to and managing their ADHD medication routine for a variety of reasons, including a loss of structure and external motivators.

Students often continue to work with their primary care provider on medication management¹⁰, but they may be able to work with the college’s student health services office as well. Families must understand, however, that many college healthcare providers are uncomfortable diagnosing and treating ADHD¹¹. If students prefer to work with the college on medication management, they should come prepared with lots of documentation proving their existing ADHD diagnosis and treatment plan.

Stimulant Diversion

Prescription stimulant diversion is a real problem on college campuses — and an illegal practice with penalties including fines and prison time. Still, research shows that more than 60 percent of students who have been prescribed ADHD stimulants have diverted their medication¹². At the same time, 75 to 91 percent of students who misuse a stimulant say they obtained the medication from a peer^{13 14}.

Prescribers play an important part in reducing diversion. The American Academy of Pediatrics (AAP) recommends that prescribers track and monitor prescription requests for signs of misuse or diversion (e.g. a patient requesting an early refill)¹⁵. It also directs prescribers to consider using state-wide prescription drug monitoring programs and/or prescribing non-stimulant medications to patients instead¹⁵.

Parental monitoring, consistent communication, and a positive parent-child relationship are all proven to reduce risky behaviors¹⁶. Understanding who is at risk for stimulant diversion — students who experience frequent peer victimization (i.e. bullying)¹⁷ and those with comorbid conduct disorder and/or substance abuse¹⁸ — may also help caregivers and clinicians anticipate and address this risk before college.

Diversion prevention strategies for students with ADHD include:

• Keep prescriptions private; do not publicize them to peers
• Store medication in a concealed, locked area
• Practice role-playing common diversion scenarios so that you can respond quickly and definitively, shutting down further pressure

Used in tandem, these strategies, services, and interventions — from study skills and coaching to psychosocial support — increase the chances of academic and social success for college students with ADHD.

How to Succeed in College with ADHD: Next Steps

• Free Download: Focus Your ADHD Brain With 5 Helpful Hacks
• Read: How to Prepare Your ADHD Teen for College, According to Research
• Read: The College Survival Guide for Students with ADHD

The content for this article was derived from the ADDitude Expert Webinar “Help for College Students with ADHD: A Parent’s Guide to Improving Outcomes” [Video Replay & Podcast #371] with Kevin Antshel, Ph.D.,which was broadcast live on September 9, 2021.

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