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Do ADHD drugs really help college students without ADHD?

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Over the past 15 years there has been grow­ing aware­ness that many col­lege stu­dents with­out an ADHD diag­no­sis use ADHD drugs. On some cam­pus­es, rates of self-report­ed non-med­ical use have exceed­ed 30% of stu­dents.

The pri­ma­ry rea­son stu­dents report tak­ing ADHD drugs is to enhance their aca­d­e­m­ic per­for­mance. And, the strong major­i­ty of stu­dents — over 80% in a study I con­duct­ed — believe it is help­ful for this pur­pose.

Fur­ther­more, stu­dents who report prob­lems with atten­tion are more like­ly to report non-med­ical use than oth­er stu­dents; this sug­gests that some self-med­icate to address their per­ceived atten­tion dif­fi­cul­ties.

Non­med­ical use of ADHD drugs cre­ates com­pli­ca­tions for stu­dents with a pre­scrip­tion because they are fre­quent­ly approached to sell or give away their meds. And, many col­lege men­tal health cen­ters that dis­pense oth­er psy­chi­atric med­ica­tions do not dis­pense ADHD med­ica­tion because they are con­cerned about diver­sion.

Despite stu­dents’ wide­ly held belief that no-med­ical use of ADHD drugs improves their cog­ni­tive func­tion­ing and aca­d­e­m­ic per­for­mance, to date there has been vir­tu­al­ly no good data on this issue. I was thus pleased to see a recent pub­li­ca­tion in the jour­nal Phar­ma­cy that direct­ly exam­ined this pos­si­bil­i­ty: Neu­rocog­ni­tive, auto­nom­ic, and mood effects of Adder­all: A pilot study of health col­lege stu­dents.

The Study

Par­tic­i­pants were 13 health col­lege stu­dents (i.e., col­lege stu­dents with­out ADHD, oth­er psy­chi­atric con­di­tions, or drug use his­to­ry) who vol­un­teered to com­plete two 5.5 hour test­ing ses­sions after ingest­ing 30 mg of Adder­all or a place­bo.

Mul­ti­ple aspects of neu­rocog­ni­tive func­tion­ing were mea­sured includ­ing a com­put­er­ized test of atten­tion, work­ing mem­o­ry, read­ing flu­en­cy, and read­ing com­pre­hen­sion. In addi­tion, stu­dents report­ed on their lev­el of emo­tion­al acti­va­tion to assess how they felt the drug had affect­ed them.

Because this was a with­in-sub­jects design, the researchers com­pared stu­dents’ per­for­mance after ingest­ing the real drug vs. place­bo; this pro­vides for the most sen­si­tive test of how Adder­all affect­ed stu­dents’ func­tion­ing.

To elim­i­nate poten­tial practice/order affects, half the stu­dents were test­ed first after Adder­all and then after place­bo, while for oth­ers, the order was reversed. Test ses­sions occurred at the same time each day to elim­i­nate cir­ca­di­an effects.

The Results

Effects of Adder­all on neu­rocog­ni­tive func­tion­ing were mixed. Over­all, there were mod­est improve­ments on stu­dents’ atten­tion skills but a sig­nif­i­cant wors­en­ing on a mea­sure of work­ing mem­o­ry. There was no impact — either pos­i­tive or neg­a­tive — on read­ing per­for­mance.

In con­trast to mod­est and incon­sis­tent effects on neu­rocog­ni­tive func­tion­ing, there were large effects on emo­tion­al acti­va­tion. While on Adder­all, stu­dents felt ‘high’ rel­a­tive to their report after tak­ing place­bo. There were also sub­stan­tial effects on their report of pos­i­tive emo­tion­al acti­va­tion, i.e., they felt bet­ter.

Summary and implications

The authors con­clude that con­trary to pop­u­lar belief, Adder­all had lit­tle impact on neu­rocog­ni­tive per­for­mance in healthy col­lege stu­dents. This reflects the appar­ent adverse impact that Adder­all had on stu­dents’ work­ing mem­o­ry and the lack of any pos­i­tive impact on read­ing per­for­mance.

How­ev­er, the find­ings also explain why stu­dents with­out ADHD would be moti­vat­ed to use ADHD drugs. Adder­all was found to improve stu­dents’ per­for­mance on a com­put­er­ized atten­tion test. Because some stu­dents may use ADHD meds to address their per­ceived atten­tion dif­fi­cul­ties, these results pro­vide evi­dence of actu­al atten­tion ben­e­fits.

And, oth­er find­ings high­light that stu­dents sim­ply feel more pos­i­tive emo­tion­al acti­va­tion after using ADHD drugs, anoth­er poten­tial moti­va­tor.

Two oth­er issues are worth not­ing.

First, par­tic­i­pants were screened to exclude any with psy­chi­atric prob­lems or drug use. How­ev­er, stu­dents who engage in non­pre­scribed use of ADHD drugs are more like­ly to strug­gle with these dif­fi­cul­ties than oth­er stu­dents. Thus, it is pos­si­ble that ADHD meds may pro­vide greater ben­e­fits to stu­dents most like­ly to use them than they do to healthy col­lege stu­dents.

Sec­ond, this study did not direct­ly test whether non­pre­scribed ADHD drug use actu­al­ly helps stu­dents to study longer and/or more effec­tive­ly, and thus to per­form bet­ter on an exam the next day.

This would have required a design in which stu­dents were giv­en aca­d­e­m­ic mate­r­i­al to learn sim­i­lar to what they would study for an actu­al exam, and sub­se­quent­ly test­ed on it. This is the main rea­son stu­dents use ADHD drugs with­out a pre­scrip­tion and would be inter­est­ing to exam­ine more direct­ly in sub­se­quent research.

– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­o­gy and Neu­ro­science at Duke Uni­ver­si­ty. He pub­lish­es the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

The Study in Context:

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Categories: Attention and ADD/ADHD, Education & Lifelong Learning, Health & Wellness

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