Teens, ADHD and college planning: Five things to know

The key to navigating the transition is advance planning, said Derenne, a child and adolescent psychiatrist at Stanford Medicine Children’s Health. She shared the advice she offers teens and families as they prepare for the transition to college with ADHD.

1. Factor mental health care into your choice of school

When students plan for life after high school, they should factor in their ADHD treatment from the start, Derenne said. This is especially true for students who plan to move far from home, as they rely more on campus resources — which vary among colleges.

“The thing I say about college mental health services is, ‘Once you’ve seen one system, you’ve seen one system,’” Derenne said. “They’re all completely different.”

Prospective students should ask if a college has an on-campus counseling center and, if so, what it offers. Many college counseling centers treat only short-term problems such as homesickness or roommate trouble, referring students with chronic conditions off campus.

Others may have more providers, perhaps even a psychiatrist on staff. “The staffing is usually not great, though, so there can be waitlists or limited availability for counseling appointments,” Derenne said. Obtaining off-campus mental health care is easier in a large city than a tiny college town, she added. Students should also think through practical considerations like transportation — will they have a car to drive to off-campus appointments? How is the public transportation?

Some, but not all, campuses have a student health center staffed with physicians or nurse practitioners who will manage prescriptions for antidepressants or stimulants given for ADHD. Some campuses have an onsite pharmacy; others do not.

Asking lots of questions about on- and off-campus mental health resources before applying helps clarify which colleges are a good fit, Derenne said.

2. Line up a mental health provider in advance

Once they’ve settled on a college, students with ADHD should start seeking out a psychiatrist or other mental health provider at their new school or city.

“I start by asking my patients if they’ve gone on the college website to see what’s available,” Derenne said. If the on-campus mental health care system isn’t robust, she suggests patients check the Psychology Today website, which includes a national directory of mental health providers, searchable by geographic area and specialty. Other good resources included the CHADD professional directory and the student’s or family’s insurance provider. The teen’s current psychiatrist or therapist may also be able to facilitate referrals to providers near college.

Parents should encourage students to start making their own counseling or medical appointments when they’re still in high school so they can learn the process.

Some college students want to stay with their original caregiver through telehealth appointments, but this isn’t always legally possible. If a student attends college out of state, they’ll need to find a provider licensed in their new state. Many students also continue to check in with their original provider when they are home on breaks or over the summer.

One misconception Derenne sometimes encounters is that students with ADHD think they’ll be OK at college without regular mental health care.

“A lot of people hope that when they go off to college, it will be a fresh start, and they won’t need all the support they used to need,” she said. “Occasionally, someone really thrives in a new environment. But, more often than not, people need more support, not less.”

3. Plan ahead for prescriptions

“A few times, I’ve heard parents say, ‘When it’s time for my college student to get their Adderall refilled, I’ll fill it for them here in California and mail it to them in Massachusetts,’” said Derenne. “You can’t. That’s illegal because it’s a controlled substance.”

Filling prescriptions for stimulants such as Adderall or Ritalin requires planning because stimulants may be abused by students without ADHD who want to use them as study aids. As a result, many student health centers on college campuses have strict protocols for starting these medications.

To document that a student is not attempting to abuse stimulants, but rather is continuing a long-established course of care, “It’s best if you can bring the caregivers at your college an established diagnosis, backed up by medical records and psychological testing, to demonstrate, ‘This is my diagnosis and treatment plan,’” Derenne said.

She suggests that students set recurring alarms on their phones to call their new pharmacy a week before they will run out of medication to ensure they’ll get refills on time.

“You also need to invest in a locker system so your medicine doesn’t disappear,” Derenne said, noting that providers can’t always replace stolen medications. “You might get one pass if you call and say, ‘Someone stole my medicine,’ but if it keeps happening, you won’t be given refills. We know these meds have street value, so we have to protect against diversion.”

College students may also encounter medication shortages. “Sometimes you will have worked really hard to get on a medicine that works for you, and then you go to another area of the country and they don’t have access because there’s a shortage or supply chain issue,” Derenne said. “The bottom line is that you’ve got to start planning way, way sooner than you would think.”

4. Expect responsibility to shift to the student

After years of navigating ADHD, most parents of high schoolers are used to engaging with teachers and support staff about their child’s academic needs.

But college-level educators expect to deal with their young adult students directly. “That can be a really difficult transition for a lot of families,” Derenne said.

To prepare for the shift, it’s useful for every parent of a high schooler to slowly increase the amount of responsibility they give their child — and that’s even truer if the student has ADHD.

“If they frequently go to school and forget a bunch of stuff, it may be good for them to practice” ways to ensure they remember everything, Derenne said. “They need to think, ‘How am I going to get myself out of this mess, instead of just calling Mom or Dad to save me?’ It’s best to let them practice with scaffolding in place, then gradually remove the scaffolding.”

New college students also need to know that academic support is structured differently than in high school.

“The law says all children in K-12 public schools are entitled to a free and appropriate education, so the school has to identify kids with learning challenges and provide accommodations,” Derenne said. “Once they graduate from high school, those protections go away and the Americans with Disabilities Act comes into play. The onus shifts to the student to self-identify and ask for accommodations.”

To do this, students should contact their college’s Office of Accessible Education or Disability Office, bringing documentation of their ADHD diagnosis, how the diagnosis was made, the treatment plan and what reasonable accommodations their care team recommends — such as taking tests in a room alone to minimize distractions, or having flexible deadlines for assignments.

5. What if the transition is difficult?

When students encounter challenges transitioning to college, Derenne encourages them to consider a wide range of solutions.

They might be small, such as gathering the courage to tell your mental health provider you’re struggling with something basic. Derenne has coached patients in college — Stanford University undergrads, very bright students — on how to fill prescriptions and do laundry. “It’s OK to ask for help!” she said.

“I’ve also seen kids show up in my office having a crisis because they haven’t been to class all semester, and no one knew, and now they have to tell their parents that they’re failing out of school.”

Such situations may require a bigger step, such as moving home and taking community college classes while evaluating what to do next.

“I’ve worked with young people who tried to launch, had challenges and had to come home. We came up with a corrective plan so they were able to do it in a more thoughtful way the second time around,” Derenne said. “It may be different from what your friends are doing, but if you can finish your education in five years instead of eight, that might be worth it.”

In some cases, students have decided that their path does not include a college education. “I encourage people to be really thoughtful about that — is college truly something this person wants to be doing, or do they feel like they’re being pressured to do it?”

Whatever the path, considering every option proactively helps, Derenne concluded.

Many students with ADHD navigate the planning and meet the challenges of college with aplomb, she said: “I’ve had lots of experiences where, because we started having the conversation early, something that I predicted might not go well went way better than we thought it would.”