Need help - ADHD in college student

[whitestavern]

Long story short, S was diagnosed with ADHD late in his sophomore year of hs. He tried meds for a short time but didn't really think they worked and didn't like the way they made him feel. He did "good enough" so we didn't really push it. He just finished his first year in college, and it was a disaster. Between the ADHD and Covid/online classes, he did very poorly. He apparently struggled with anxiety this semester as well, though we did not know that. D told us (afterwards, sadly) that he would call her in a full blown panic attack. He did do a lot of research on ADHD while at school, and when he got home he immediately went back on meds. He is under the impression that these will be a quick fix of all his issues, but I feel like he needs way more support than just the meds. He's got EF issues that I think need to be addressed. I've been doing a lot of research and the options for treatment seem overwhelming. Cognitive behavioral therapy, ADHD coaching, neurofeedback, etc. etc. Would anyone who has a college kid with ADHD and executive function issues who has had success treating both share your story? Where did you start? What did you do? What did your journey look like? I feel like we have about 10 weeks to get this figured out. I will have him take the lead on his treatment, but if it's this overwhelming for me, there's no way he could start from scratch. I'd like to at least gather information and provide him with some choices on what's worked for others so he has a starting point. TIA.

[KSera]

Treating the ADHD may help his anxiety some. My dc wasn’t diagnosed until college either, and medication has been the only (very helpful) intervention. Dc does read on their own various things about managing ADHD sometimes. 

[PeterPan]

Neurofeedback (I'm going to be controversial here) is scammy in my book. For us it was worthless, maybe even a negative. I'll tell you that the other thing you want to think about is auditory processing. One reason it gets worse with college is because the sound dynamics change. That's what happened to my dd. Things she could get by with at home were very hard in big classrooms. So if he has ANY issues understanding speech in background noise, you'd be super smart to add an audiologist to your list. You'd be looking for someone who specializes in APD. It can affect the online classes, masked classes, etc.

Yes he needs back on the meds. No, do not assume the meds for the ADHD will solve the anxiety. Anxiety is multifaceted. The ADHD meds will *help* but that will end up being your biggest challenge. 

Have you checked him for retained reflexes? Has he ever had an OT eval? How is self awareness? Does he have any sensory issues? 

The university should have a disability service, student services, something like that where he can file his paperwork and start getting support. He needs to do that pronto. If the grades were bad, they *might* even be able to help him dig out a big, especially if he was failing to complete projects or something where they could intervene. Don't assume nothing can be done, kwim? He just needs to talk with the, see what they can do going forward, see what they recommend about cleaning up his past.

So some schools will provide a coach who will be adequate or you can pay for an EF coach. You need to see what they offer, but at this point what you might want to do is both get him started with someone private now AND use the school provided services in the fall. A psych who specializes in ADHD or an Educational Therapist, either would work for this. 

The problem with the anxiety is it just freezes everything else. None of the coaching will matter a lick when that anxiety flares up. So that's why I'm encouraging you to put *your* research there, because that's going to be his weak point he struggles to solve. And fwiw, there's a somewhat uncommon genetic cause (NBPF3) that affects B6 and zinc levels. It's the cause of anxiety for me and my peeps and it's amazing when it's treated. We've done prescription meds, but once we found the gene the actual treatment (zinc and P5P=a form a B6) is crazy effective. The rest of my anxiety is situational and I can control that with strategies (breathing, lifting weights, etc.) or take a med, my choice. 

Does he like the way his current ADHD med makes him feel? If he doesn't, that's another thing to work on. So frequent visits to the doc or find a psychiatric nurse practitioner who will spend time and get this sorted out over the summer. 

Whether he does it with an OT, psych, Ed Therapist, or whomever, learning strategies of mindfulness, body scanning, etc. can give him an immediate EF bump. They aren't a replacement for meds and treating the chemistry issues, but they work together. If he has retained reflexes, integrating those may give him some good improvements. Typically 40 days straight of the exercises is enough, so he has time.

If he has self awareness issues, the CBT should be done *after* he works on the self awareness/interoception. CBT assumes the person is aware of what their body is feeling.

[PeterPan]

If you don't mind a suggestion that sounds scammy and might not work, I'll tell that, at least today, if I was throwing $$$ around and wanted to try SOMETHING, anything, I'd do HBOT over neurofeedback. I just did almost 60 sessions of HBOT, and my anxiety, my whole level is so zen right now. And I really don't know if it's that I was taking a lot of P5P (probably 500mg a day) trying to combat the oxidative stress or if it's actually good for anxiety like they say. I'm just saying I'm really zen in a way I've never been. No clue if it will last.

I'm not saying it would help, lol. I'm just saying if you want to blow $3k to say you did, there you go. If you body scan while you're in there, all the better. They also make some claims about it helping ADHD, and I don't know. The logic makes no sense to me. I know for a while midprocess my ADHD went cu-razy, like could hardly drive safely my mind was so distracted. Then it came to a peaceful place.

So if you want to blow money to say you did, at least HBOT is not completely worthless. Has to be hard chamber, 100% oxygen.

[SanDiegoMom]

My daughter was diagnosed after high school - so in the fall of her freshman year at college. She has spent the last 3 1/2 years learning how to manage the ADHD.  Here is what she would say has worked the most for her -- she does not have auditory issues, she probably does have retained reflexes but I don't know what to pursue really for that, and she is super duper smart and able to hang on due to her amazing memory and her people skills (she's able to sweet talk anyone into extending deadlines, asking for extra accommodations, etc) 

First off is the research, which it sounds like he is doing.  She was helped by the How to ADHD series on Youtube (seriously great videos) and then reading books by Dr. Hallowell and Dr. Barkley.  

Second is getting on the RIGHT meds. That took quite awhile.  She found that while short acting meds (ritalin) worked, the side effects were really difficult to manage.  She tried Concerta but it didn't work well. Vyvanse has been a lifesaver. She is on Strattera too, which she says helps boost her working memory (though it doesn't help with task activation). She also got a prescription for Ativan as she got diagnosed with panic disorder (common for people with adhd). She has needed it less and less thankfully.  like down to once every three or four months? 

Working with the right therapist is important. She's got a psych who has adhd and that's been helpful, and doing CBT with a good lcsw or psychologist is very helpful.  She has a lot of stuff to work through having grown up with undiagnosed adhd.  

Through the research she has slowly been building routines to help her through the day.  Key points are - organization of stuff (everything in its place, routines at night so that morning is smooth). She does yoga and running/walking, and tries to remember to eat right, drink water, and sleep enough. :). Those are things she never realized were important, but have a huge effect on how she experiences her adhd.  Meditation helps boost EF. 

Sugar affects her very badly, but she has always used it to offset anxiety. This is an existing struggle.

She still struggles a lot, but she has come very far.  She still turns everything in at the last minute, is late to things, and misses doctor's appointments. She had to cram 600 pages of reading into 3 days last quarter, read salient parts of material right before the exam, watches all the class lectures on 2x speed the day before tests -- it's not pretty.  So "living in the red zone" hasn't changed when it comes to school work, but she's at least healthier and happier, which are huge wins. 

She would be happy to connect if your son wants to hear more -- she has done some peer mentoring through an organization called AllBrains on campus (for adhd and autism). You can just PM me.

[whitestavern]

Wow, thank you all. I never received notification of responses, so I just came on here this morning to double check because I couldn't believe no one had responded. So thank you! 

We are working with a neuropharmacologist on the meds. I wasn't impressed with his GP who only prescribeD one med (Concerta) and just kept increasing the dose because S says it's not working. The new doc has him on Adderall and low dose Lexipro for the anxiety and what she thinks is also depression. We see her in a couple of weeks. He did not want to try the Lexipro (doesn't feel like he's depressed and says the anxiety was only bad when he was at school) but I asked him to give it a couple of weeks just to see. 

To answer a few questions, we sent in his neuropsychologist paperwork to the accommodations office, but he just never took advantage of it. He says he missed some classes and felt like he couldn't catch up and felt frozen. Once he got behind on some assignments, the same thing. He said he'd sit in his room knowing he had to do his work but just didn't do it. He'd call his sister in full blown panic not knowing where to start. It's so foreign to me, I feel like I'm incapable of providing help and support. But I'm working on getting professionals who can hopefully help him. Any idea where I can find a good EF coach? We tried one in hs for a few months but it didn't seem to help at all. Maybe he needs to get the meds figured out before any of that other support will work? Also, as parents, could you tell at all when the meds were working? I don't see any real difference. He has agreed to do some kind of online class this summer, just so he can see how the meds work in an academic setting. He will also reach out to the support services folks at school and try to put a plan together for the fall. It'll be on him to do that though, and I am concerned about sending him back if he's not ready to advocate for himself. I'm wondering if he should take a medical leave or a gap semester, though I know he will be 100% against that. 

PeterPan: I don't think he has any auditory processing problems. He was in a brick & mortar school from 8th through 12th grade and did okay. Most of his college classes were online, not in a classroom setting. I think he's very self aware and he doesn't have any sensory issues. Thank you for the info on the zinc and B6. Will a regular GP run that testing? Do you know if he can take those supplements along with his current meds without any contraindication? How did you know it worked? What did you feel or what were the differences before and after? DH tends towards anxiety as well, so it would be interesting to find out if they have that genetic issue. 

So far he does not feel a big difference with the meds. The neuropharmacologist said they sometimes don't make a difference if the anxiety/depression isn't treated as well. I'm taking her word for it and seeing what happens over the next two weeks. I do like that she is reserved in her prescribing and likes to make sure people are at the lowest yet most effective dose. She has also tasked him with getting back to a normal sleep schedule, in bed before 11 and up at 8, which he is trying. 

SanDiegoMom: how did your DD learn what to do and how to do it as far as routine, organization, etc.? I have tried to work with him (as did the EF coach) but none of the things worked. Again, maybe the meds have to be in place and working before any of the other pieces come into play. Thank you for your offer to speak to your DD. I will pass that along to him, though I doubt he will want to reach out (at least yet). But maybe he will surprise me. 

[KSera]

How long has he been on the lexapro and by low dose, are you talking 5mg? Is the adderall extended release or immediate release (XR or IR)? My oldest is on the same combo, and the XR made no noticeable difference, but the IR helps her a lot. If the lexapro dosage is less than 10mg, I wouldn’t be surprised for him to see no effect. A low dose has the advantage of giving an opportunity to see if there are any really unpleasant side effects before increasing. 

[whitestavern]

KSera. He is on the 5 mg dose. So far no side effects. The Adderall is 20 mg/2x daily. So I guess that's the IR. What is your D's dosage, if I may ask?

[SanDiegoMom]

If the Adderall isn't working I would think one of two things -- either Adderall just doesn't work for him, OR the depression/anxiety isn't lowered enough.  My daughter is also on 10 mg of Lexapro and it has helped a lot.  It takes about a month or so to kick in.  She hated Adderall -- she only took it once and it first made her fall asleep and then when she woke up she was horribly anxious and paranoid.  One time was enough for her.  She did Ritalin for a year, but it's still not good to her -- she gets kickback anxiety when it wears off. The Vyvanse is the best.

She knows when it kicks in and she can task activate. However being really behind and feeling like you can't catch up can't just be overcome by meds.  She's always managed through personality as well -- she will contact professors, ask for extensions, make decisions on which papers she can do the least on, what can be studied the least before an exam, etc.  But she also LOVES academics, so she always manages to pull it off even when she's living so close to the edge.  If she didn't love academics, I really don't know what would happen, honestly. She really HAS to be interested in what she's doing to be able to do it.  It's literally an on off switch with her.

She taught herself a ton using the How to ADHD videos and reading books.  She uses a bullet journal to track daily routines, assignments, and her moods and thoughts for the day so she can look back and see when she is most depressed or anxious. She creates a lot of routines so she doesn't get lost in a time warp -- morning routines that include yoga and exercise, sometimes meal prepping on the weekends.  The exercise is hugely important to mood and EF -- alternately running with yoga and throwing in meditation all seem to help. 

But it all still feels to her like she has to do a TON, and if she misses a step it might throw her off completely. And she never does get it perfect of course, she she has had to learn to forgive herself when she does make mistakes.  

And none of the routines really work without the right meds. So that might be where the issue is right now. 

Problems always will crop up too -- she's had a diagnosis for almost four years but it is still very much a work in progress. Things like putting electronics out of her room at night and using her apple watch to listen to podcasts to sleep -- that step took a lot of experimentation to find what worked.  Books don't work -- she will literally finish the book. She has deleted tumblr and reddit off her phone -- she can start making a post and then find herself still sitting in the bathroom with the shower running an hour later finishing writing a post.  Eek. 

For academics, changing the place she does homework frequently, working around other people that are studying, putting readings into some type of app that will read it aloud as an audiobook has helped -- she's tried a lot of different things. She's also had to drop classes, take some pass fail, and just took an incomplete last quarter. So it will never be "fixed", even though it is better!

If it is an EF coach that doesn't know adhd, I would think it wouldn't be helpful.  She has to use a lot of different work arounds that are specific to adhd.  The times she sought out just Neurotypical type help with EF just made her feel worse. 

[PeterPan]

Lexapro is an SSRI so that takes a while, like 6-8 weeks to feel the full effect I think. 

Would the world end if he sat out a year, worked, got himself together, then went back? Might be more successful that way. College is not the only path to a job and fast/furious is not the only way to get college done. He might do better with a lower academic load and the *structure* and daily routine of WORK. 

[KSera]

11 hours ago, whitestavern said:

KSera. He is on the 5 mg dose. So far no side effects. The Adderall is 20 mg/2x daily. So I guess that's the IR. What is your D's dosage, if I may ask?

5mg isn’t into the therapeutic range for most people. My dc’s psych likes to start there as well, but it took 10 to make the difference. While it’s supposed to take 4-6 weeks for full effect, it does seem like one that frequently starts showing some improvement after just a week or two. That was our experience. The adderall dose is way higher than my dc. They take 10mg 1-2x a day (it’s IR, so they have started with the second dose on days they need to be able to study and such later in the day. The first dose covers class time.) He may be a bigger kid than mine, but I think if they’re not feeling anything at 20 mg twice a day, trying something else would be worth it.

[whitestavern]

6 hours ago, KSera said:

5mg isn’t into the therapeutic range for most people. My dc’s psych likes to start there as well, but it took 10 to make the difference. While it’s supposed to take 4-6 weeks for full effect, it does seem like one that frequently starts showing some improvement after just a week or two. That was our experience. The adderall dose is way higher than my dc. They take 10mg 1-2x a day (it’s IR, so they have started with the second dose on days they need to be able to study and such later in the day. The first dose covers class time.) He may be a bigger kid than mine, but I think if they’re not feeling anything at 20 mg twice a day, trying something else would be worth it.

I was wrong - the Adderall is 20 mg, but he splits the pill so he takes half in the morning and half early afternoon. I assume she will up the dose on the Lexapro. He is tall and skinny and unfortunately has lost some weight since he started on the ADHD meds. He's almost 6' and weighs 139 😒 He is trying to force himself to eat more. 

Edited June 1, 2021 by whitestavern

[PeterPan]

He could try eating in the morning before taking the med. My dd would eat 2-3 meals in the evening as her meds wore off. So it would be 8-10pm and she's eating the equivalent of lunch and dinner, lol. Also, getting the anxiety under control can help. 

[prairiewindmomma]

Please don't quote....

Ds(19) doesn't feel any different on his meds, but it's a night and day difference to anyone watching him on the outside. We had him chart his productivity to see the difference between the two.  

Ds has been successful academically this year, but he has been at home. He has needed am reminders to take his meds.  He has needed support in scheduling his doctor followups and in picking up meds to have them available to take.  

I check in once a week to kind of remind him of life stuff he needs to be taking care of: following up with college financial aid office, scheduling a license renewal, etc. I treat it like a coaching session, and keep trying to get him to do some sort of calendaring and reminder system.

I check in to his room daily during peak times (when anxiety is also most high) to make sure he's staying productive. He tends to just totally shut down.

It's not ideal.  He's baby stepping towards independence, but it's where he is at right now. He got straight As, taking 15-18 hours a term, in an engineering major. So, academically--totally can do it. Life skills---still getting there.  We're still improving year-on-year.... I think once he has a job, he can be in apartment with maintenance provided and use tech to put a lot of his life on autopilot, but college is a lot of EF demand and his brain is still very much young-teen like in functioning.  

I don't think this is something you will fix in 10 weeks. I think this is something you can probably scaffold around a bit if he is willing to be scaffolded. I get resistance, but I also expect it. The things I am asking of him in EF aren't easy to do.  He thanks me for the help, and wants me to do it, and that is I think why he's still moving forward generally.  The doctor/meds thing is almost independent now without glitches....we're working on the rest.