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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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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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