In a grainy photo from the early 1970s, two people lean against a white VW Bug. One, a child wearing over-sized glasses, beams enthusiastically at the camera. The other, a teenager with slumped shoulders, appears significantly less energetic.
The teenager is Arthur D. Anastopoulos, exhausted after completing his weekly community service to a club created by his friends. The club matched Big Brothers and Sisters with children receiving therapy at the local mental health clinic, and Arthur’s charge, the child in the picture, exhibited ‘hyperactivity.’ The present-day Anastopoulos laughs and explains: “he’s 7 years old, and he’s had a great two hours while I look like death warmed over. I’ve been through the wringer.”
When you ask Anastopoulos how he chose his career path, the Director of the Attention Deficit/Hyperactivity Disorder (AD/HD) Clinic at UNCG and Psychology Professor will show you this picture. Three years of demanding sessions with his young charge inspired Arthur’s curiosity about hyperactivity, impulsiveness, and short attention spans. Now, with a $3 million grant from the NIH to investigate outcomes for college students with AD/HD, Dr. Anastopoulos has positioned himself and UNCG at the cutting edge of the field.
The Problem. While we have seen a great deal of research around AD/HD in children and adults, we know little about how AD/HD impacts young adults in college.
The college years can represent a perfect storm for those suffering AD/HD. Individuals afflicted with this disorder of self-regulation have trouble stopping to think things through, planning ahead, and regulating themselves as conditions around them change. Thus, they struggle with many everyday activities. To compensate for their limitations, persons with AD/HD often depend on a complex support system.
A successful high school student with AD/HD has almost always benefited from significant parental and educational support mechanisms. Unfortunately, when such students set foot on a college campus, conditions change drastically. First, their support system – almost a kind of treatment – is withdrawn. Simultaneously, demands for self-regulation skyrocket. Not only do self-management needs increase in the realm of school work, they also rise with regard to students’ personal lives – suddenly they must manage money, housing, transportation, social activities, jobs, and the various temptations on college campuses.
In general, 70 of every 100 kids will make it to college. This number drops to 20 for every 100 kids diagnosed with AD/HD. Then thanks to the special set of challenges higher education presents to students with AD/HD, only five of those 20 will actually graduate. Studies also estimate that 2 to 8 percent of college students struggle with undiagnosed AD/HD; their educational outcomes are unknown.
Completing a college degree significantly affects career choices and lifetime earning potential now more than ever, and more and more students with AD/HD are seeking postsecondary degrees. The lower rate of degree attainment among these students strongly impacts the long-term financial and mental health status of this population and society at large. Reduced access to postsecondary education places an unnecessarily low limit on workforce potential and the long-term contributions these individuals can make – at a time when our community needs the talent, innovation, and motivation these students can bring.
The Study. Dr. Arthur D. Anastopoulos tackles this growing problem in his research. His five-year National Institutes of Health project will follow students with and without AD/HD from their freshman year onward to determine how the disorder impacts educational, vocational, psychological, and social functioning over the college years.
Dr. Anastopoulos will collaborate with co-Principal Investigators George J. DuPaul at Lehigh University and Lisa L. Weyandt at the University of Rhode Island to conduct the project, which will draw student participants from ten institutions. The investigators will follow two cohorts; each cohort will comprise 210 students (105 with AD/HD and 105 without). Researchers will track Cohort One’s progress using questionnaires, interviews, and psychological testing over years one through four. They will track Cohort Two’s progress along the same parameters from years two through five. The project will amass a broad range of information on these students that will include measures of educational outcomes, psychological functioning, alcohol use, drug use, and sexual behavior. It will also assess social impacts, vocational functioning, and the extent to which students utilize campus resources and other treatment services for aid.
The study is the first of its kind. By tracking AD/HD student trajectories across the college years, the project will fill a major gap in current understanding of this disorder. Moreover, the study will inform AD/HD evaluation and treatment on college campuses and therefore hold enormous potential for impact. If successful in their goals, the project investigators will increase the likelihood of degree attainment among students with AD/HD.
Doing Something Bigger Altogether. UNCG could not have won such a large and significant grant in this field if not for the infrastructure and reputation already in place at UNCG in the form of the Attention Deficit/Hyperactivity Disorder Clinic.
The AD/HD Clinic has operated as a part of UNCG for sixteen years. Over this time, it has pursued three missions. The clinic:
1) provides state-of-the-art mental health care services and education to the community, the Triad region, and the state;
2) increases understanding of AD/HD through clinical research; and
3) gives clinical practice training to psychology graduate students and other health care professionals in North Carolina.
These three missions weave together to form a cohesive whole wherein knowledge gained from research informs clinical practice; clinical practice enables clinical research; and clinical practice and research enhance clinical training. Though all patients do not participate in research, the clinic serves as a major pool of potential research subjects. It also provides the necessary infrastructure, reputation, and services to successfully execute research and interventions. When the AD/HD clinic began, it took in about 60 patients per year. With a move in 2006 to a highly visible and accessible setting, intake numbers began climbing rapidly. 2007 saw 147 intakes; 2009 saw 310. In the last two years, the clinic had over 350 new intakes each year. Patients come to the UNCG AD/HD clinic from as far east as Chapel Hill and Durham, as far west as Hickory, and as far south as Charlotte. These patients range from 4-year-old children to adults.
Dr. Anastopoulos developed his NIH grant in response to growing demands at the AD/HD clinic over the last several years. Until recently, roughly two-thirds of the clinic’s intake population were children. However, in the last two to three years, this ratio has reversed, with college students representing a significant number of the clinic’s intakes. Anastopoulos found the seeds of inspiration for his current grant in his clinical work with these patients. As his student patient numbers increased, he became more and more aware of information gaps regarding college students struggling with AD/HD and their treatment options. Now, thanks to the supportive environment provided by UNCG, Dr. Anastopoulos can pursue his cutting-edge research while simultaneously making a meaningful difference in the lives of our students and our community at large.