Skip to main content

Advertisement

SpringerLink
Log in

The Challenges and Limitations of Diagnosing and Pharmacologically Treating ADHD in University Students

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

The diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) in university students present particular challenges. The lack of quality childhood historical data and limitations of existing neuropsychological instruments can create difficulties, especially when this easily feigned condition presents with numerous incentives for it to be feigned (i.e. access to psychostimulants, academic accommodations). The need for a thorough history in combination with symptom validity test (SVT) use is emphasized. A brief overview of psychostimulant mechanism of action, risks, side effects and long-term effects is provided, followed by suggestions for future research directions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Advokat C., Lane, S. M., & Luo, C. (2011). College students with and without ADHD: Comparison of self-report of medication usage, study habits and academic achievement. Journal of Attention Disorders, 15(8).

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Arlington: American Psychiatric Association.

    Book  Google Scholar 

  • Barkley, R. A., Murphy, K. R., & Fischer, M. (2010). ADHD in adults: What the science says. New York: The Guilford Press.

    Google Scholar 

  • Booksh, R. L., Pella, R. D., Singh, A. N., & Gouvier, W. D. (2010). Ability of college students to simulate ADHD on objective measures of attention. Journal of Attention Disorders, 13(4), 325–338.

    Article  Google Scholar 

  • Boone, K. B. (2013). Clinical practice of forensic neuropsychology: An evidence-based approach (pp. 23–25). New York: The Guilford Press.

    Google Scholar 

  • Bright, G. M. (2008). Abuse of medications employed for the treatment of ADHD: Results from a large scale community survey. Medscape Journal of Medicine, 10(5), 111.

    PubMed  PubMed Central  Google Scholar 

  • Canadian ADHD Resource Alliance (CADDRA). (2011). Canadian ADHD Practice Guidelines (Third ed.). Toronto: CADDRA.

    Google Scholar 

  • Castells, X., Ramos-Quiroga, J. A., Bosch, R., Nogueira, M., & Casa, M. (2011). Amphetamines for ADHD in adults. www.Cochrane.org. Published June 15, 2011. Accessed 26 March 2017.

  • Conners, C. K. (2011). Conners’ continuous performance test (3rd ed.). Toronto: Multi Health Systems, Inc.

    Google Scholar 

  • Conners, C. K., Erhardt, D., & Sparrow, M. A. (1998). Conners’ adult ADHD rating scales (CAARS). Torrance: WPS.

    Google Scholar 

  • DeSantis, A. D., Webb, E. M., & Noar, S. M. (2008). Illicit use of prescription ADHD medications on a college campus: A methodological approach. Journal of American College Health, 57(3), 315–324.

    Article  PubMed  Google Scholar 

  • Diller, L. (2010). ADHD in the college student: Is anyone else worried? Journal of Attention Disorders, 14(1), 3–6.

    Article  PubMed  Google Scholar 

  • Frances, A. (2013). Saving Normal. New York: HarperCollins.

    Google Scholar 

  • Green, A. L., & Rabiner, D. L. (2012). What do we really know about ADHD in college students? Neurotherapeutics, 9(3), 559–568.

    Article  PubMed  PubMed Central  Google Scholar 

  • Groenman, A., Oosterlaan, J., Rommelse, N., Groenman, A. P., Oosterlaan, J., Rommelse, N. N., Franke, B., Greven, C. U., Hoekstra, P. J., Hartman, C. A., Luman, M., Roeyers, H., Oades, R. D., Sergeant, J. A., Buitelaar, J. K., & Faraone, S. V. (2013). Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. The British Journal of Psychiatry, 203, 112–119.

    Article  PubMed  Google Scholar 

  • Gu Y, Xu G, & Zhu Y. (2016). A randomized controlled trial of mindfulness-based cognitive therapy for college students with ADHD. Journal of Attention Disorders, Dec 30, 2016. (Accessed online 4 May 2017).

  • Habel, L. A., Cooper, W. O., Sox, C. M., Habel, L. A., Cooper, W. O., Sox, C. M., Chan, K. A., Fireman, B. H., Arbogast, P. G., Cheetham, T. C., Quinn, V. P., Dublin, S., Boudreau, D. M., Andrade, S. E., Pawloski, P. A., Raebel, M. A., Smith, D. H., Achacoso, N., Uratsu, C., Go, A. S., Sidney, S., Nguyen-Huynh, M. N., Ray, W. A., & Selby, J. V. (2011). ADHD medications and the risk of serious cardiovascular events in young and middle-aged adults. JAMA, 306(24), 2673–2683.

    Article  PubMed  PubMed Central  Google Scholar 

  • Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Conference Participants. (2009). American Academy of Clinical Neuropsychology Consensus Conference Statement on neuropsychological effort, response bias and malingering. The Clinical Neuropsychologist, 23(7), 1093–1129.

    Article  PubMed  Google Scholar 

  • Ilieva, I., Boland, J., & Farah, M. J. (2012). Objective and subjective cognitive enhancing effects of mixed amphetamine salts in healthy people. Neuropharmacology, 64, 496–505.

    Article  PubMed  Google Scholar 

  • Jasinski, L. J. & Ranseen, J. D. (2011). Malingered ADHD evaluations: A further complication for accommodations reviews. The Bar Examiner, December 2011, 6–16

  • Jasinski, L. J., Harp, J. P., Berry, D. T. R., Shandera-Ochsner, A. L., Mason, L. H., & Ranseen, J. D. (2011). Using symptom validity tests to detect malingered ADHD in college students. The Clinical Neuropsychologist, 25(8), 1415–1428.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization adult ADHD self-report scale (ASRS): A short screening scale to use in the general population. Psychological Medicine, 35, 245–256.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the national comorbidity survey replication. The American Journal of Psychiatry, 163(4), 716–723.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kolar, D., Keller, A., Golfinopolous, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(1), 107–121.

    PubMed  PubMed Central  Google Scholar 

  • Lange, K. W., Reichl, S. R., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 2(4), 241–255.

    Article  PubMed  PubMed Central  Google Scholar 

  • Levin, F. R., & Upadhyaya, H. P. (2007). Diagnosing ADHD in adults with substance use disorder: DSM-IV criteria and differential diagnosis. The Journal of Clinical Psychiatry, 68(Suppl 11), 9–14.

    PubMed  Google Scholar 

  • Lewandowski, L. L., Cohen, J., & Lovett, B. (2013). Effects of extended time allotments on reading comprehension performance of college students with and without learning disabilities. Journal of Psychoeducational Assessment, 31(3), 326–336.

    Article  Google Scholar 

  • McCabe, S. E., Veliz, P., Wilens, T. E., & Schulenberg, J. E. (2017). Adolescents’ prescription stimulant use and adult functional outcomes: A national prospective study. Journal of the American Academy of Child and Adolescent Psychiatry, 56(3), 226–233.

    Article  PubMed  Google Scholar 

  • Miller, L. A., Lewandowski, L. J., & Antshel, K. M. (2015). Effects of extended time for college students with and without ADHD. Journal of Attention Disorders, 19(8), 678–686.

    Article  PubMed  Google Scholar 

  • Olfson, M., Blanco, C., Wang, S., & Greenhill, L. L. (2013). Trends in office based treatment of adults with stimulants in the United States. The Journal of Clinical Psychiatry, 74(1), 34–50.

    Article  Google Scholar 

  • Pelham Jr., W. E., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 449–476.

    Article  PubMed  Google Scholar 

  • Pliszka, S. R. (2007). Pharmacologic treatment of attention-deficit/hyperactivity disorder: Efficacy, safety and mechanisms of action. Neuropsychology Review, 17(1), 61–72.

    Article  PubMed  Google Scholar 

  • Ramos-Quiroga, J. A., Nasillo, V., Fernandez-Aranda, F., & Casas, M. (2014). Addressing the lack of studies in attention-deficit/hyperactivity disorder in adults. Expert Review of Neurotherapeutics, 14(5), 553–567.

    Article  PubMed  Google Scholar 

  • Rasmussen, N. (2008). On speed: The many lives of amphetamine. New York: New York University Press.

    Google Scholar 

  • Sansone, R. A., & Sansone, L. A. (2011). Faking attention deficit hyperactivity disorder. Innovations in Clinical Neuroscience, 8(8), 10–13.

    Google Scholar 

  • Schwarz, A. (2013). Drowned in a stream of prescriptions. The New York Times.

  • Solanto, M. V. (2013). Cognitive-behavioral therapy for adult ADHD. New York: The Guilford Press.

    Google Scholar 

  • Sollman, M. J., Ranseen, J. D., & Berry, D. T. R. (2010). Detection of feigned ADHD in college students. Assessment, 22(2), 325–335.

    Article  Google Scholar 

  • Suhr, J., Hammers, D., Dobbins-Buckland, K., Zimak, E., & Hughes, C. (2008). The relationship of malingering test failure to self-reported symptoms and neuropsychological findings in adults referred for ADHD evaluation. Archives of Clinical Neuropsychology, 23, 521–530.

    Article  PubMed  Google Scholar 

  • Sullivan, B. K., May, K., & Galbally, L. (2007). Symptom exaggeration by college adults in attention-deficit hyperactivity disorder and learning disorder assessments. Applied Neuropsychology, 14(3), 189–207.

    Article  PubMed  Google Scholar 

  • Tucha, L., Fuermaier, A. B. M., Koerts, J., Groen, Y., & Thome, J. (2015). Detection of feigned attention deficit hyperactivity disorder. Journal of Neural Transmission, 122(Suppl 1), 123–134.

    Article  Google Scholar 

  • Virani, A. S., Bezchlibnyk-Butler, K. Z., Jeffries, J. J., & Procyshyn, R. M. (Eds.) (2012). Clinical handbook of psychotropic drugs, 13th Edition, (pp 244–252). Ashland: Hogrefe Publishing.

  • Wilens, T. E., & Morrison, N. R. (2012). Substance-use disorders in adolescents and adults with ADHD: Focus on treatment. Neuropsychiatry, 2(4), 301–312.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S., Pataki, C., & Smalley, S. L. (2008). Mindfulness meditation training in adults and adolescents with attention deficit hyperactivity disorder—A feasibility study. Journal of Attention Disorders, 11(6), 737–746.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, Windsor Campus, London, ON, Canada

    Benjamin Bordoff

  2. Student Health Services, University of Windsor, 242 CAW Student Centre, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada

    Benjamin Bordoff

Authors
  1. Benjamin Bordoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Bordoff.

Ethics declarations

Conflict of Interest

The author declares no conflict of interest.

Additional information

Dr. Bordoff is the Consultant Psychiatrist, Student Health Services, University of Windsor, Windsor, Ontario, Canada

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bordoff, B. The Challenges and Limitations of Diagnosing and Pharmacologically Treating ADHD in University Students. Psychol. Inj. and Law 10, 114–120 (2017). https://doi.org/10.1007/s12207-017-9288-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-017-9288-4

Keywords

Search

Navigation