When and How Should We Adjust Treatment?

Half of College Kids Stop Taking Their ADHD Medication. Make Sure Your Teen Isn’t One of Them.

Here are two harsh and critical facts: ADHD medication adherence drops to just 53% when teens with ADHD enter college; and nearly a third of teens with ADHD end up dropping out of school. Though it’s tough to prove causality, a connection between consistent ADHD treatment and graduation rates is likely. Here, learn how to help your teen avoid this trap.

By Sharon Saline, Psy.D. Verified Updated on April 3, 2024

The conversation around ADHD treatment in college often centers on medication diversion — that is, illegally sharing or selling stimulants with non-ADHD peers who hope that taking Ritalin or Adderall will help them focus longer and stronger when studying. Medication diversion is a serious and growing problem, but it is only one piece of a larger story: The transition to college severely stresses the executive-function and self-management skills of students with ADHD, who adhere to only 53% of prescribed ADHD medication doses.

This is the finding of a small research report titled “Adherence to Attention-Deficit/Hyperactivity Disorder Medication During the Transition to College” published in the Journal of Adolescent Health. The study, which included just 10 college students with attention deficit disorder (ADHD or ADD), found five persistent and prevailing reasons for ADHD medication disruption in college:

“Transitions to independence are often abrupt, and many adolescents lack critical self-management skills.” Because their parents managed their medication through middle and high school, the teens didn’t have strategies for refilling and taking their medications regularly.
“Volitional nonadherence is high due to inaccurate disease beliefs, perceived academic demands, and medication side effects.” Many students stopped taking medication regularly because they wrongly believed they would outgrow their ADHD or they thought they only needed stimulants to study, not to manage their day-to-day lives.
“Poor self-management negatively impacts school performance.” All 10 subjects expressed regret about their first-semester academic performance and blamed mismanaged ADHD symptoms for their problems.
“Peer pressure to share medication affects social functioning and adherence.” All 10 subjects reported being pressured by peers to share or sell their ADHD medication, which made them more like to hide their diagnosis and treatment.
“Social support is greatly needed.” Most students felt isolated from their peers and without significant support from their university, though only 4 out of 10 had registered for academic accommodations.

[Free Download: What Are Your Teen’s Weakest Executive Functions?]

How to Help Your Teen Avoid the ADHD Treatment Trap in College

No one goes to college to do poorly. Young adults are hopeful and excited about this next stage of their lives. They want to do well but many teens with ADHD flounder when trying to manage scenarios they’ve never faced alone: remembering to take medication, seeking out help when problems arise, and seeking social acceptance with a new group. College students (with and without ADHD) naturally share less about school and grades. Since confidentiality rules apply at college and most students are legally adults, you cannot access their school information without their explicit permission. This makes for complicated and frustrating parenting. You may not find out there’s a problem until you see a problematic post on Instagram.

College students with ADHD often succumb to a negative snowball effect. They miss a class because they overslept, then do poorly on one quiz or fall behind on turning in an assignment, then start to jump ship instead of seeking support to get back on track. Unlike in high school, no one is monitoring things or notices the imminent slide, which is only exacerbated when ADHD mediation is taken inconsistently — or not at all. Sometimes students genuinely forget to take their pills; or they don’t know how or where to renew their prescription. They may not like going to health services or to their new prescriber. Others secretly decide to stop taking medication that helps them because they want to “do it on their own.” Teens may hide their struggles from their parents because they don’t want to admit their mistakes or their inability to handle the independence they so desperately desired.

To avoid this scenario, start by collaborating with your son or daughter on a plan for communication, accountability, and trouble-shooting before the semester starts. It’s much harder to troubleshoot once you are in the midst of a crisis. Ask yourself if your teen is an accurate, forthcoming reporter. Can you regularly rely on what they tell you about their lives? Beyond poor grades and not going to classes, typical signs that things are amiss include:

constantly feeling overwhelmed
excessive or inadequate sleep
inconsistency in medication refills (if they are still getting them from home prescriber)
social isolation
lack of motivation
poor eating habits
increased anxiety or depression
an unwillingness to talk to you on the phone or have you visit

[Free Webinar Replay: The College Transition Guide for Teens with ADHD]

Talk to your teen about these warning signs, focus on being an ally, define your shared goals, and set up necessary scaffolding. Predict that there will be bumps in the road, but assure your child that you will weather them together, without judgment. The goal is building executive functioning skills to support your teen’s developing brain and growing independence. Engaging in clear and compassionate conversations now will set the tone for dealing with unexpected setbacks later on. This reduces shame and blame and orients everyone toward working together on a concrete plan for college success.

6 Steps to Ensure Consistent ADHD Treatment in College

1. Reflect on and accurately assess your child’s strengths and identify their challenges. It’s typical for a young adult to be strong in something like personal hygiene and setting up social plans, but weaker in organizing their room or remembering to set up (or attend) an appointment. Development is uneven. Consider what challenges they had last year in school and how those might reappear this year. Write down your ideas.

2. Pick a calm time (maybe after dinner) to talk with your teen about this coming year. Talk generally about what went well last year, what responsibilities they can now manage on their own, and what challenges they foresee. Share your observations neutrally by using language such as “I notice…” and “It seems like…” Write these down, too.

3. Make a master list of college life responsibilities, dividing things into categories such as medication (appointments, prescription renewals, usage), academic support services (appointments, meeting with professors, study periods), self-care (laundry, counseling, eating, exercise, etc.). Ask them what they would like to be responsible for and what you (or another specific person) can help them manage. Teach them about setting useful alerts on their phone.

4. Create agreements about how and when you will be in contact with each other. Talk about how you can check in weekly and schedule these times. Don’t barrage them with emails, texts, or phone calls outside of these times. Texting alone does not suffice as a check-in, so opt for FaceTime or a phone conversation. You can get a lot of information from tone of voice, but real-time words and images are even better.

5. Set up a back-up plan. Together, describe possible signs that would indicate he or she is struggling. Brainstorm options of what to do if things aren’t going well and strategize a course of action. Write this down too and email it to each other for easy reference.

6. Go with your college student to the academic support center and to the health center for initial appointments. Ask your son or daughter to sign releases and specify situations when you will make contact with these offices. You want to respect his or her privacy while also being available for emergencies.

Working together to think about concrete steps for living successfully with ADHD in college before the semester begins paves the way for building essential executive functioning skills, resilience and independence. When your son or daughter sees you as an ally, not a critic, they’ll feel less ashamed of their stumbles and more likely to ask for help to regain their footing.

[Good to Go (to College)]