For many students with attention-deficit/hyperactivity disorder, the transition to college is not simply a change of address. It is the sudden disappearance of the support system of their families, teachers and friends.
Parents who reminded them about assignments are no longer down the hall. Teachers who checked in after class are replaced by syllabi, office hours and long-term projects. Formal Individualized Education Programs and 504 plans do not automatically carry over. And college requires more planning, more independence and more sustained self-management than many students have ever had to practice.
That collision between rising expectations and vanishing structure is forcing colleges and mental health providers to reconsider how they identify and support students with attention-deficit/hyperactivity disorder — especially those who arrive on campus undiagnosed.
“College is this really exciting period, but it’s also a period of a lot of vulnerability,” says Carla Chugani, vice president of clinical programs at Mantra Health. This digital mental health company partners with colleges and universities.
In K-12, students often benefit from “structure and scaffolding.” When that support falls away, the executive functioning challenges associated with attention-deficit/hyperactivity disorder can become much more visible, she says.
Chugani’s interest in the issue is both professional and personal. She began her career as a counselor in a college counseling center, later became an assistant professor at the University of Pittsburgh School of Medicine and has focused much of her work on the intersection of mental health and higher education. She was diagnosed with attention-deficit/hyperactivity disorder at 36, after years of academic success.
“Getting diagnosed for me was life-changing,” she said. “Getting treatment was life-changing.”
A new attitude
Her experience reflects a growing recognition that ADHD does not always match the stereotype of a struggling student unable to succeed in school. Chugani says many students are bright, high-achieving and able to compensate for years, until college demands overwhelm the systems they built for themselves.
“There are a lot of young people out there who have attention-deficit/hyperactivity disorder, but are also really smart,” she said. “It’s not until they get to college or maybe even into the workforce where their compensatory mechanisms just can’t keep up.”
Joshua Langberg, professor of Clinical Psychology and dean of the Graduate School of Applied and Professional Psychology at Rutgers University-New Brunswick, described the same transition as a systems problem rather than an individual failing. Students with ADHD, he said, are often as academically capable as their peers but may struggle with organization, time management and long-term planning.
“When students transition to college, both informal — parents, teachers, peers — and formal systems of support are no longer available,” Langberg said. “This occurs at the same time that demands on executive functions are increasing.”
The challenge for colleges is not only how to provide support, but how to evaluate students in a way that is both accessible and clinically responsible. For years, comprehensive neuropsychological evaluations were often treated as the gold standard for ADHD diagnosis. But those evaluations can be expensive, time-consuming and difficult to access. Langberg said community-based evaluations can cost around $2,000, raising equity concerns for universities that require documentation before students can receive accommodations or treatment.
At Rutgers, Langberg said, the university chose to focus its evaluation resources on the most common conditions affecting students — ADHD, anxiety and depression — while screening for other concerns and referring students when needed. The goal is to use best-practice procedures without making access to an outside assessment dependent on a family’s ability to pay.
Mantra Health has taken a similar interest in balancing access with rigor. Chugani said the company recently rebuilt its ADHD evaluation program in partnership with Qbtech, adding objective testing to a broader assessment process conducted by psychiatric providers. The aim, she said, is not to replace clinical judgment, but to strengthen it.
“It has to be more than just an interview with a clinician,” Chugani said. “It has to be more than filling out a self-report scale of your symptoms.” Objective measures, she said, can help clinicians evaluate the core symptoms of ADHD while keeping assessments less costly and more scalable for campuses.
The issue is especially sensitive because an ADHD diagnosis can open the door to accommodations and, in some cases, medication. Stimulant medications are a first-line treatment for ADHD but are controlled substances, requiring careful assessment and monitoring. Chugani said that Mantra does not prescribe controlled substances as a virtual-only provider. Still, it can work with campus prescribers who may be comfortable following a treatment plan developed after a student has been evaluated.
A variety of supports
Diagnosis, however, is only one part of the picture. Both Chugani and Langberg emphasized that students often need a combination of supports and that ADHD frequently appears alongside anxiety, depression or other concerns.
Langberg pointed to skills-based interventions, mentoring and peer support as particularly important. At Rutgers, he said, the university uses the Accessing Campus Connections and Empowering Student Success (ACCESS) intervention, an eight-week skills group that includes psychoeducation, executive function training and cognitive behavioral strategies designed to improve motivation. But teaching skills is not enough, he said; students need help applying them week after week.
“It is one thing to be taught skills, and it is a totally different thing to actually implement them,” Langberg said. Consistent support can help students set achievable goals, connect with campus resources and take small steps toward academic stability.
Researchers are also testing new approaches. Langberg described a five-year National Institute of Mental Health study in which college students use virtual reality headsets and noise-canceling headphones while completing homework or studying. One condition provides a distraction-free environment; another tracks productivity and gives feedback every few minutes about whether the student is on task. The study is examining attention, concentration and objective measures such as reading comprehension problems completed accurately in a set period.
For many campuses, the larger question is whether higher education itself is designed in ways that unnecessarily disadvantage students whose brains work differently.
Chugani says that educational systems and workplaces have largely been built around neurotypical learning styles. She said universal design principles could create environments where more students can thrive, not merely receive accommodations after they struggle.
Langberg made a similar case for rethinking academic pathways. He said students with ADHD often excel when a subject engages them and can see its practical application, yet many colleges reserve applied coursework for juniors and seniors. By then, he said, some students may already have disengaged or left school.
“The first semester is the most important semester,” Langberg said. Rather than waiting for students to fail, he said, universities should use orientation and advising to connect students directly with counseling, disability services and learning centers, then follow up to ensure those connections happened.
That proactive model may matter not only for individual students, but for institutions. Chugani noted that students with ADHD are more likely to leave school, affecting retention and long-term outcomes. She also described students with ADHD as the largest segment of students with disabilities in higher education, making the issue one of access as well as health.
Still, both experts cautioned against framing ADHD only through deficits. Chugani said the conversation often centers on accommodation, remediation and treatment, all of which are important. But she said students should also hear that different ways of thinking can be strengths.
She recalled a mentor once telling her, before her own diagnosis, that she did not fit in “in the best possible way.” It became a formative moment, revealing that seeing the world differently could be a source of creativity and innovation.
“Your brain working differently allows you to see things that other people don’t see,” Chugani said. “That’s where a lot of innovation and creativity come from.”
Langberg echoes those sentiments, “I understand what it is like to struggle,” he said. “Now I get to help students rewrite that story for themselves and help to prove that with the right support, every student can succeed.”
Opinions expressed by SmartBrief contributors are their own.
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