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ATTENTION DEFICIT DISORDER: THE COLLEGE EXPERIENCE

OF SEVEN ADULTS
presented by

Jennifer Sue Bramer

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ATTENTION DEFICIT DISORDER: THE COLLEGE EXPERIENCE

OF SEVEN ADULTS

By

Jennifer Sue Bramer

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Educational Administration

1 994

ABSTRACT
ATTENTION DEFICIT DISORDER: THE COLLEGE EXPERIENCE
OF SEVEN ADULTS
By

Jennifer Sue Bramer

This study describes and analyzes the college experiences of seven Attention
Deficit Disorder (ADD) adults and the ways in which they dealt with their
experiences. It is known that ADD causes significant problems in education and that
some adults have ADD. However, educators have had little basis for addressing the
needs of ADD students in college. Very little literature has dealt specifically with the
learning experiences of ADD adults, in college or elsewhere. For that reason,
andragogical assumptions have had to be drawn from the literature based on
pedagogy.

In this study, qualitative research methodology was employed to collect.
describe, and interpret data. A standardized nonscheduled type of interview was
used, and each subject was interviewed extensively. In some ways the experiences
that these seven individuals related to me were vastly different, but some common
themes about their college experiences emerged, and those provided the basis for

my assertions.

 

Jennifer Sue Bramer
Many ofthe subjects indicated that their college experiences often contributed
to a diminishing oftheir self-esteem. Many also felt that the personality (attitude) of
their instructors had an influence on their success. Most of them mentioned that
they felt they had serious inadequacies in English or math or both. They all related
a lack of focus in the Classroom and/or while studying. Most said that they are visual
learners, preferring hands-on instruction over lecture-type. Most told me they
usually did not seek out support services, or thought they did not exist. Many told
me that before they were diagnosed and treated for ADD, they preferred a study
environment that was not completely quiet and isolated. None of the subjects
completed his or her initial college program within a traditional time frame. Most told
me they had found success in their careers, but most of them not in the fields
requiring the college program they first pursued. Most also felt they could be/were
more successful if/when they went back to college after diagnosis.
The information included in this study can be helpful to educators. It suggests
attitudes, services, accommodations, and strategies that can enhance the college

experiences of ADD adults.

Dissertation Co—directors: Dr. Cas Heilman and Dr. Douglas Campbell

Copyright by
JENNIFER SUE BRAMER

1 994

This study is dedicated to my daughters, Michelle and Renee, without whom

I would not have had the inspiration and motivation I needed to persevere.

ACKNOWLEDGMENTS

I am grateful to many people for their support and assistance with this
research project. lwould like to thank my employers, my committee, the psychiatrist
I call Dr. Evers, the participants in my study, and myfamin--especially my husband.
Without all of them, this dissertation would not exist.

My previous Dean, Dr. William Schaar, former Dean of Student Personnel
Services at Lansing Community College, was instrumental in convincing me to work
on my doctoral degree. Without his encouragement, I might never have taken the
initiative to begin the program that led to this dissertation. I also appreciate the
support of my current supervisor, Dr. John Cansfield, in securing the release-time
that Lansing Community College granted me to pursue this study.

My program committee members at Michigan State University have been
encouraging and supportive. Dr. Max Raines, Dr. Howard Hickey, and Dr. Lou
Hekhuis have given wise guidance and encouragement. They have had undying
confidence in me, which has fostered my ability to persevere. Dr. Cas Heilman and
Dr. Doug Campbell have co-directed this research project. They both have
challenged me to be thorough, and Dr. Campbell has assisted me meticulously with
the fine details. I am very grateful that I had the benefit of both of their viewpoints

to guide me.

vi

"Dr. Evers" has been a godsend in my life for a variety of reasons. Without
her, this research truly would not exist. She has treated my daughters, educated me
about Attention Deficit Disorder, brainstormed for specific topics with me. acted as
a subject matter expert, referred her patients to me for participation in this study, and
rented me office space to conduct the interviews. She is wonderful, and I deeply
appreciate everything that she has done. (I sincerely regret that I cannot share her
real name, but I must maintain her anonymity in the interest of confidentiality for my
subjects.)

This research also would not exist without the time and openness of
communication provided by the participants in the study. Because of the limits of
confidentiality, I cannot name them, but I do want to acknowledge them. All of them
gave freely of their time, were open and frank in the sharing of their experiences,
and truly wanted to contribute to the research in this field.

To my family, I also am gratefully indebted. My daughters, Renee Irrer and
Michelle White, provided the impetus for my interest in the subject matter. They also
assisted with domestic duties to help free up my time. They, along with my son-in—
law, Brent Irrer, good-naturedly allowed for a modification in holiday festivities sothat
I could work. I appreciate their support.

Last but not least, I am eternally grateful to the support and editorial
assistance of my husband, Bob Bramer. He has the "patience of Job" and truly

knows the meaning of support. His encouragement was undying. He was with me

vii

literally every step of the way—from brainstorming ideas to proofreading and editing.

I absolutely could not have done this without him.

viii

TABLE OF CONTENTS

Page

LIST OF TABLES ............................................... xii
Chapter

I. INTRODUCTION ...................................... 1

Purpose of the Study ................................... 'I

Introduction to the Problem .............................. 1

ADD and Education .............................. 1

ADD in Adults ................................... 4

Research Questions ................................... 8

Definition of Terms .................................... 9

Method of Research .................................. 11

Significance of the Study ............................... 12

Assumptions and Conditions ............................ 13

Summary of the Introduction ............................ 15

II. REVIEW OF LITERATURE ............................. 16

Attention Deficit Disorder-Background .................... 17

History ....................................... 17

Cause ........................................ 20

Characteristics ................................. 21

Diagnosis ..................................... 22

Treatment ..................................... 26

ADD and Adults ...................................... 27

Existence in Adults .............................. 27

Frequency of ADD in Adults ....................... 29

Effects on Adults ................................ 30

Effects on Educative Process ........................... 36

Few Go to College .............................. 36

Symptoms Create Academic Difficulty ............... 37

Cognitive and Academic Skill Deficits ................ 38

Special Learning Conditions ....................... 39
Interventions ........................................ 42
Change Belief Systems .......................... 42
Instructor Effect ................................ 43
Special Education ............................... 45
Restructure Learning Environment .................. 46
Principles of Remediation ......................... 47
Effective Collaboration and Self-Help ..................... 49
Summary of Literature Review .......................... 54

DESCRIPTION OF RESEARCH METHODOLOGY

AND PARTICIPANTS ................................. 56
Rationale for Methodology ............................. 56
Qualitative Research ............................ 56
Interview Method ............................... 57
Research Design ..................................... 58
Research Questions ............................. 58
Population .................................... 61
Data Collection ................................. 63
Interviews ..................................... 64
Data Analysis .................................. 70
Description of Participants ............................. 71
Calvin Jones ................................... 72
Keith James ................................... 72
Sally Smith .................................... 76
Tim Franklin ................................... 76
Mike Mayes ................................... 77
Dale Howard ................................... 77
Kathy Johnson ................................. 78
DESCRIPTION AND INTERPRETATION OF MAJOR
FINDINGS .......................................... 79
What They Encounter ................................. 79
Emotional Reactions ............................. 79
Perceptions of Learning .......................... 99
How They Deal With Experiences ....................... 113
Day-to-Day Tactics ............................. 113
Larger Reactions and Outcomes .................. 124
Summary of Description and Interpretation ................ 148

V. SUMMARY AND CONCLUSIONS ...................... 150

Summary of Individual Case Experiences ................. 151
Calvin Jones .................................. 151

Keith James .................................. 153

Sally Smith ................................... 155

Tim Franklin .................................. 157

Mike Mayes .................................. 159

Dale Howard .................................. 161

Kathy Johnson ................................ 162
Summary of Data ................................... 164
What They Encounter ........................... 164

How They Deal With Experiences ................. 168
Conclusions About Subjects and Data .............. 175
Recommendations for Further Study .................... 176
Types of Data ................................. 177
Types of Subjects .............................. 178

Type of Researcher ............................ 178
Implications of the Study .............................. 179
College Student ............................... 179
Educational Institutions .......................... 181
Society ...................................... 183
Dilemmas .................................... 184
POSTSCRIPT ................................................. 187

APPENDICES

A. APPROVAL LETTER FROM THE UNIVERSITY COMMITTEE
ON RESEARCH INVOLVING HUMAN SUBJECTS ......... 194

B. PARTICIPANT CONSENT LETTER AND CONSENT FORM . . 195

C. INTERVIEW GUIDE ................................. 197
BIBLIOGRAPHY ............................................... 200
GENERAL REFERENCES ....................................... 204

xi

LIST OF TABLES

Table Page

1. Demographic Characteristics of the Study Participants ............ 73

xii

CHAPTER I

INTRODUCTION

Eumoseotthefitudx

The purpose of this study is to describe and analyze the college
experiences of seven adults who have been diagnosed with Attention Deficit
Disorder (ADD). The seven adults who were interviewed had attended college
and had been diagnosed with ADD by the same psychiatrist. This study
describes and analyzes college experiences encountered by these adults and

the ways in which they dealt with their experiences.

In ' n
AQDJDLLEQLLCEIIQD
The descriptions these adults provide of their college experiences and the
ways they have handled their problems could lead to a greater understanding of
other ADD adults who attend college. This understanding is important to college
educators for humanitarian and legal reasons. It is also important because it
relates to the mission of colleges and universities, because these institutions are

seen as community leaders, and because it relates to societal needs.

2

From a humanitarian point of view, all of our citizens deserve the
opportunity to reach theirfull potential. The level of education needed by people
in our society becomes greater all the time, and the diversity of the students in
our educational institutions also becomes greater all the time. It is increasingly
important that we have a thorough understanding of those with special learning
needs. Adult learners with ADD are one group of individuals who merit further
understanding.

Legally, we must provide quality education to ADD students. There are
several federal laws which mandate that educational institutions meet the needs
of people with ADD (CH.A.D.D., 1993a; Fowler, 1992). Children (ages birth
through 21) are guaranteed a free and appropriate public education by the
Individuals With Disabilities Education Act (IDEA). Section 504 of the
Rehabilitation Act of 1973 is a civil rights law prohibiting discrimination against
persons with disabilities. All educational institutions that receive federal funds
must comply with Section 504 by addressing the needs of students with
disabilities as adequately as the needs of nondisabled individuals (CH.A.D.D.,
1993a). The Americans With Disabilities Act (ADA), enacted in 1990, provides
another legal means of requiring all educational institutions to meet the needs of
people with ADD. Compliance with the law is one reason that educators would
want to better understand students with ADD.

Besides compliance. another reason to be more sensitive to ADD students

is to avoid litigation.

3
A new type of student is entering postsecondary education—students with
disabilities who grew up with the protection of various federal laws (such
as the Education of All Handicapped Children Act) and whose parents
have learned how to use the legal system to ensure that all legally
required opportunities are available to their children. (Shepherd, Duston,
Russell, & Kerr, 1992, p. 4)
Because students (presumably including those with ADD) are becoming more
aware of their legal rights, they will be more demanding of educators to
accommodate them, and therefore to understand them.
Greater understanding of college students with ADD is important because
it relates to the mission of colleges and universities. Shepherd et al. (1992)
spoke to this issue in relation to the ADA, but what they said is applicable to the

broader issue. They stated:

ADA compliance—making accessto education a priority--is consistent with
the mission and purpose of community colleges and four-year colleges
and universities. . . . Community colleges have long recognized their
obligations to their local communities to make higher education accessible
to persons from all walks of life, and their mission statements reflect these
beliefs. Many four-year colleges and universities have modified their
mission statements along similar lines. . . . Institutions dedicated to
improving "access" to higher education should place the same emphasis
on physical barriers, communication barriers. and attitudinal barriers
toward persons with disabilities as they do on other types of barriers, such
as economic barriers. (p. 3)

It certainly is within the mission of higher education to provide accessible
education to students with ADD. Therefore, understanding their college
experiences is important.

Colleges and universities are often viewed as leaders in the community.
Because of this respect, those who advocate for awareness of adult ADD will

look to educators for leadership in that advocacy. "Just as women and minorities

4

pushed for Changes in institutional awareness, forcing institutions to be leaders
in diversity and non-discrimination on the basis of race, sex, and religion, many
advocates want to see higher education take the same lead on disability"
(Shepherd et al., 1992, p. 4). Thus, the fact that colleges and universities are
perceived to be leaders within the community is a fourth reason that educators
need to heighten their awareness of ADD in adults.

The fifth reason that an increased understanding about this topic is
important to adult educators is that this awareness is related to societal needs.
Postsecondary education and future employability are becoming increasingly
intertwined ("Education," 1990). If we want the best possible workforce to
contribute to our national economy, we want the best possible education for all
ofour citizens—including those with ADD. Awareness of the needs of ADD adults

can contribute to their education, and thus to their effectiveness in the workplace.

ADDJJAQLLIIS

Until recently, most Child psychiatrists believed that ADD diminished in
adolescence and disappeared in adulthood. Although some say that this pattern
does seem to hold true for some ADD children, there is Increasing evidence that
some people continue to have a variety of ADD symptoms in adulthood. Exact
figures are not available, but estimates of school-age children affected range
from 3% to 10%. Weiss and Hechtman (1993) found that about 40% to 50% or
more of the young adult subjects in their follow-up study continued to have

significant problems with the original symptoms of the hyperactivity syndrome

5

and/or social, emotional, or personal problems. Another 10% were seriously
psychiatrically disturbed and/or seriously anti-social. Barkley (1990) stated that
it is clear that 50% to 80% of Attention-deficit Hyperactivity Disorder (ADHD)1
children continue to have some degree of their symptoms in adulthood. Eyres
(1993) stated that she had not seen anyone outgrow ADD in 15 years of practice
as a psychiatrist specializing in the diagnosis and treatment of this disorder.
Murphy (1992) said that it was a conservative estimate that between 2 and 5
million adults may be affected. He said that most of these are undiagnosed,
untreated, and unaware that help is available. Thus, many more college
students than we might expect are likely to have ADD.

Barkley (1990) explained that ADHD children are likely to represent the
entire spectrum of intellectual development, with some being gifted while others
are normal, slow learners, or even mildly intellectually retarded. He said,

One area of tremendous difficulty for ADHD children is that of their

academic performance and achievement. Almost all clinic-referred ADHD

children are doing poorly at school, typically underachieving relative to
their known levels of ability as determined by intelligence and academic

achievement tests. (p. 75)

Later he stated, "Children with Attention-deficit Hyperactivity Disorder (ADHD)

may exhibit a wider range of problems in the classroom than in any other setting“

(p. 498). The problem areas that he elaborated were staying seated, paying

 

1There is much confusion about the names and criteria of attentional
disorders. The term "ADD" is used in this research ordinarily, but "ADHD" is
used when it is part of a specific quotation. (See the section "Definition of
Terms" for a fuller explanation.)

6

attention, working independently, and following directions and rules. He said that
ADHD children are often disruptive and disorganized, and have difficulty keeping
track of academic materials. A 10-year follow-up study reported by Weiss and
Hechtman (1993) found that, overall, ADD young adults had completed less
education, had lower average marks, and had failed more grades than non-ADD
control group participants. On a psychiatric assessment, ADD adolescents and
young adults had more problems of adjustment, fewer friends, felt more restless,
were observed to be more restless, and were more impulsive and immature. On
a brief psychiatric rating scale, the hyperactive group was significantly higher in
anxiety, tension, grandiosity, and hostility. The sum of all of their scores was
significantly worse.

Barkley (1990) listed 10 complaints of adults who are being evaluated for
ADHD:

difficulty in finding and keeping jobs;

performing below the level of competence on the job;

inability to perform up to intellectual level in school;

inability to concentrate;

lack of organization;

inability to establish and maintain a routine;

poor discipline;

depression, low self-esteem;

forgetfulness or poor memory;

confusion, trouble thinking clearly. (p. 614)

Weiss and Hechtman (1993) reported that although thetarget symptoms--
hyperactivity, distractibility, and impulsivity--had abated by adolescence, they
continued to be present. These symptoms were not the main problems
complained about by the ADD subjects in the follow-up study. The main
complaints were of poor school work, social difficulties, problems related to
authority figures (e.g., teachers), and Iow-self-esteem. Feldman, Denhoff, and
Denhoff (1979) described later life outcomes for hyperactive children. They
reported lower educational achievement, poorer self-esteem, and greater
substance abuse compared to sibling controls.

Barkley (1990) raised some concerns related to the implications for
college students with ADHD. Indirectly, he raised the issue when he said,

Frequently, the significant others in the life of the ADHD adult must be

requested to assist the patient in some of these endeavors, much as

parents and teachers of ADHD Children are indispensable to helping the
children to be more attentive, more compliant, more reflective, and better

organized. (p. 636)

If ADD adults are college students, it stands to reason that some of these
significant others are educators. It also stands to reason that adult educators
should be indispensable in helping adults through the college experience.
Barkley also said, "At this writing the stage is set for an explosion in public

activism that promises to alter both society’s view of the disorder and the manner

in which it is handled by the educational system" (p. 38). Since we now know

8

that this disorder exists in adults, it appears that great pressure may eventually

be put on the higher educational system to deal with it.

Besearchfluestions

The main research question was: How do adults with Attention Deficit
Disorder (ADD) experience this disorder in their college life and deal with the
problems the disorder presents to them in college? In interviews, data were
collected that describe the following:

a. The individual’s understanding of ADD.

b. The individual’s early recollections in relation to ADD.

0. The individual’s experiences in college.

The basic questions that were answered are as follows:

1. What were the demographics of the subjects studied?

2. What were the individuals’ understandings of ADD?

3. What were the individuals’ feelings about ADD?

4. What were the personal histories of the individuals?

5. What were the experiences of the subjects related to selection of
college and admission?

6. What were the subjects’ teaching/learning preferences in college?

7. What were the subjects’ study techniques and support mechanisms
while in college?

8. What were the subjects’ general problems in college?

9

9. What were the subjects’ relationships with instructors?

10. What were the subjects’ thoughts about the future while in college?

Definiflormtlems
This study describes the experiences of seven adults with ADD who have

attended college. The WE

LQSMAII) ofthe American Psychiatric Association (1980) defined Attention Deficit
Disorder (ADD) by stating that "the essential features are developmentally
inappropriate inattention and impulsivity." The DSM-lll also said,

In the past a variety of names have been attached to this disorder,
including Hyperkinetic Reaction of Childhood, Hyperkinetic Syndrome,
Hyperactive Child Syndrome, Minimal Brain Damage, Minimal Brain
Dysfunction, Minimal Cerebral Dysfunction, and Minor Cerebral
Dysfunction. (p. 41)

The diagnostic category for the subjects included in this study. Attention Deficit
Disorder, Residual Type, comes from the DSleJI under 314.80. The criteria for
the category were stated as follows:

A. The individual once met the criteria for Attention Deficit Disorder
with Hyperactivity. This information may come from the individual
or from others, such as family members.

B. Signs of hyperactivity are no longer present, but other signs of the
illness have persisted to the present without periods of remission,
as evidenced by signs of both attentional deficits and impulsivity
(e.g., difficulty organizing work and completing tasks, difficulty
concentrating, being easily distracted, making sudden decisions
without thought of the consequences).

C. The symptoms of inattention and impulsivity result in some
impairment in social or occupational functioning.

10
D. Not due to Schizophrenia, Affective Disorder, Severe or Profound
Mental Retardation, or Shizotypal or Borderline Personality
Disorders. (p. 45)

Much controversy has surrounded the diagnostic labels and criteria for this
disorder. Practitioners agree that it exists, but there has not been a clear
diagnostic category. At the time of this study, the third revised edition of the
WM (D_S_M;|JJ;B) (1987) presented revised criteria
and labeled the disorder Attention—deficit Hyperactivity Disorder (ADH D) rather
than ADD. However, because the psychiatrist who did the diagnosis thought that
the former clinical diagnosis was clearer for her adult patients, she used the ADD
terminology from the DSM-JIL (To complicate the issue further, a new edition of
the D_S_M will be published with new terminology at about the same time the
present study is published. There has been much controversy about how to
represent the disorder, as it exists in adults, in the new diagnostic manual. At the
time of this writing, I am not sure of the outcome.)

Because of the evolution of the terminology for this diagnosis, in this study
theterm "Attention Deficit Disorder (ADD)" is used when referring to the subjects
and the disorder except when quoting or paraphrasing writers who use the term
"ADHD."

This study defines adults as those individuals who are older than 18 years
old. College is defined as an institution of higher education beyond the high
school level. It includes both two-year community colleges and four-year

colleges and universities.

11
W

For the purposes of this study, the research was limited to adults (over
age 18) who had been diagnosed as having ADD. Seven adults who had been
diagnosed with ADD by the same psychiatrist were studied. This psychiatrist
(who has been diagnosing and treating this disorder for 15 years) referred the
subjects to me for research. Each subject was interviewed for approximately 2
to 3 hours to determine the following: their understanding of their disorder, their
early recollections of diagnosis and awareness of difficulties, and their
experiences in college. I used a standard, nonscheduled format. (The same
topics are covered with each subject, not necessarily in the same order or using
the same wording [Gorden, 1980].) The Interviewing time was broken up into two
segments. The convenience and attention span of the subject was taken into
consideration in makingthese individual decisions. For all interviews, permission
to audio-tape was requested and granted.

Qualitative research was the best approach for describing the experiences
ofthese individuals. It would be possible to use quantitative research to identify
the kinds of experiences of ADD adults who have gone to college, and general
features of the experiences, but the results would be limited in their usefulness.
Quantitative research would only tabulate the types of responses. Field
research, on the other hand, can employ interviews to obtain more detailed
information. Qualitative research provides poignant data to provide in-depth

evidence for the assertions. Descriptions of the experiences of these adults

12
provide a rich basis for professionals who contribute to the education of ADD

college students.

Significanceotthefitudy

The significance of this study is obvious: ADD is a disorder that has just
recently been recognized in adults; adults attend colleges and universities; the
characteristics ofthe disorder affect academic achievement; thetreatment forthe
disorder involves education; very little has been written about adults with ADD;
virtually no descriptive literature exists concerning ADD adults; and there is no
published research to date that deals with ADD college students.

The concept of recognizing that ADD exists during and beyond
adolescence has been recognized just in the last decade. There are vast
implications for higher education professionals in relation to ADD college
students. We know that ADD individuals complete fewer years of schooling, get
lower grades, and show lower academic achievement in relation to their abilities.
Many of the characteristics of the disorder create problems in the types of
activities that are expected of students in academe. lttherefore stands to reason
that there are probably ADD college students who are struggling to meet their
potentials.

When treatment of ADD is discussed, both education about the disorder
and the role of the educator are often included in the discussion. In Murphy’s
(1992) list of coping mechanisms, education was listed as the most important

component. He said that it is important to help adults structure their lives to

13

minimize the negative and to raise their self-esteem by helping them realize their
problems stem from neurological causes. There has been a significant amount
of research done with school-age children who have ADD, resulting in literature
to assist K-12 educators. We can infer that in order for ADD adults to reach their
potentials, it is important for adult educators to know more about the ways that
they can best assist their students.
Very little has been written about ADD adults. There are virtually no
descriptive studies of ADD adults.2 Barkley (1992) remarked,
Recently there has been a growing awareness among clinicians of the
persistence of symptoms of Attention-deficit Hyperactivity Disorder
(ADHD) into adulthood, though few descriptive studies of ADHD have
been published. The residual symptoms that may be seen in adults vary
in type and severity, and cause considerable disruption in the lives of
affected individuals. (p. 613)

Hopefully, a descriptive study of ADD adult learners will contribute to the

understanding of those who relate to them.

Assumptions and Ccnditions
This study was based on several assumptions. The first assumption was
that ADD students experience college life differently than non-ADD students.
The second assumption was that ADD students encounter some difficulties in

college. The third assumption was that the subjects would be willing to be

 

All"; 'f Il‘ hll‘no‘ i - ori o A0 It W' Al‘l ' D‘ '1
DisQLder, edited by M. J. Johnson, Toledo: ADDult Support Network (1992), is
a helpful anthology of personal narratives, but it is not a study that employs
research methodology.

14

truthful. The fourth assumption was that I would be able to put the subjects at
ease enough to encourage them to talk about their problems.

It should be noted that ADD is only one variable that has affected the
college experience of the subjects. Subjects may differ with regard to coexisting
conditions such as learning disabilities and oppositional or conduct disorder. The
existence of the high degree of comorbidity (coexistence of two disorders) of this
disorder with other disorders could affect the interpretation of the results. No
attempt was made to control the other variables (intelligence, presence of
learning disabilities, personality type, and so on). It is important that the reader
not overgeneralize the conclusions of this study.

As is explained in the postscript, l have two daughters who have ADD and
have attended college. Although it might concern some that I had some bias,
objectivity was of primary concern. I am a Licensed Professional Counselor who
had been practicing her profession for over 18 years at the time of the data
collection. The objectivity of the data collection was affected positively by my
professional counseling training and experience (I am an experienced inter-
viewer) as well as my effort to maintain neutrality.

The data for this research were based entirely on interviews with the
subjects. No effort was made to verify the accuracy of the responses with any
other source or individual. The subjects’ perceptions of their experiences were

the main concern of the study. I had completed a series of graduate-level

15
ethnographic research courses, in which I conducted a previous study that used
the interview method of data collection.

The data of this study were drawn from a relatively small sample. One of
the reasons for this was to add to the consistency of the diagnosis. All of the
members of this study had been diagnosed and were being treated by the same
psychiatrist. If data were collected from additional ADD adults who have college
experiences, there would be one more variable to consider in analyzing the data

--C0nsistency in diagnosis.

Summanrcflbejmmduflm

This study describes and analyzes the college experiences of seven ADD
adults and the ways in which they dealt with their experiences. Understanding
adults such as these is important to adult educators for a variety of reasons.
Some adults have ADD and attend college, so educators need to know how to
deal with them. They need to know how adults with ADD experience this
disorder in their college life and how they deal with the experiences the disorder
presents tothem. Qualitative research methodology is employed to describe and
interpret data relative to the research topic. Although the study is based on some
assumptions, this description of some ADD adult learners will contribute to the

understanding of those who educate them.

CHAPTER II

REVIEW OF LITERATURE

Since there is very little literature that specifically deals with Attention
Deficit Disorder (ADD) adults and their experiences in college, or their
experiences with adult education for that matter, other related literature has been
reviewed for its relevance and impact on this topic. A brief review of background
literature—covering history, cause, characteristics, diagnosis, and treatment of
the disorder-is given to assist unfamiliar readers with an overall understanding
of the topic. The intent of this chapter is not to provide a thorough analysis of
that literature, but rather to provide a brief overview to give background for
understanding this study. Literature related to the condition in adults, the effects
that ADD has on the educative processes, interventions for educators, and
suggestions for effective collaboration and self-help has been looked at and will

be reviewed here.

16

17
Ulster!

One barrier to understanding the literature in this field is the evolution of
the terminology and constantly Changing clinical opinions about this diagnosis in
adults. The history of the terminology and diagnostic criteria of the syndrome is
explained in various sources (Barkley, 1990; Fowler, 1992; Henker & Whalen,
1989; Kelly & Ramundo, 1993; Njiokiktjien, 1988; Silver, 1992; Weiss &
Hechtman, 1993). The description of the syndrome is not new, and it first
appeared in medical terminology in 1902 (Weiss 8 Hechtman, 1993). Barkley
(1990) summarized the history of the disorder and provided a conceptual
framework for discussion of it. At the beginning of the 19003, ADD became
viewed as a biologically based disorder characterized by inadequate control of
behavior by morals and volitional inhibition. This view has evolved over the last
90 years to the view of ADD as a biological, often hereditary, predisposition to
defects in the regulation of behavior by rules and consequences-defects that
could be significantly modulated by social circumstances.

ADD has been known by many different names. Some of these may be
synonyms: maturational lag, hyperkinetic reaction, immaturity of the nervous
system, and perceptual-motor problems. Two names are often misunderstood:
minimal brain dysfunction and minimal cerebral dysfunction. Two fairly common

names are usually incorrect: minimal brain damage and minimal brain injury.

18

Most people with ADD are 1191 brain damaged. However, this disorder is often
accompanied by learning disabilities (often called dyslexia).

The first medical acceptance of what is now called ADD or ADHD
occurred in the WWW (D_S_M_L|).
published in 1968 by the American Psychiatric Association. The term
"hyperkinetic reaction of childhood" was used. It stated the behavior usually
diminished in adolescence. There was no mention of its continuation into
adulthood. When thethird edition of this manual was published in 1980, theterm
for this disorder was Changed to "attention deficit disorder” (ADD), and two
subtypes were identified: ADD with hyperactivity and ADD without hyperactivity.
The diagnostic criteria reflected three behavioral constellations for defining
symptoms: inattentiveness, impulsivity, and overactivity or restlessness. Anew
diagnostic category was added, "ADD, residual type," to include those individuals
(usually adults) who had (as Children) met the criteria for ADD with hyperactivity.

In 1987, the American Psychiatric Association published Diagnostisand
StatisticaLMamIaLotMemamefls (QSMJJIfi), a new edition of its guidelines
for professionals. This time theterm was Changed to "ADHD." The 1987 Manual
did not say that the term cannot be applied to adults, nor did it give a specific
category such as "residual type." The title "ADHD” is somewhat a misnomer
because it is not necessary for an individual to have "hyperactivity" as a symptom
to qualify for this diagnosis. Additionally, this edition included another term,

"Undifferentiated Attention-deficit Disorder." The fourth edition of the DSM is in

19
the process of being published. There has been much controversy about
whether and how the effects of this disorder on adults will be included.

All of these Changes in the appropriate medical terminology add to the
complexity of understanding the related literature. One must take into
consideration the date of the publication and the proper terminology of the times.
Furthermore, in regard to follow-up studies of people whom we are now calling
ADD or ADHD adults, we must keep in mind that if they were diagnosed as
Children, their diagnosis may have used different terminology depending on the
year and the coding system used by the professional involved in the diagnosis.
Klein and Mannuzza (1991) pointed out that there is no question that ADDH
(from the D_SM_|11) and ADHD (from the DSMJJJit) are overlapping groups
clinically, but it would be inexact to assume that they are exactly the same
disorder, especially because ADHD encompasses a milder range of dysfunction
by not requiring impairment in each domain of attention, impulse control, and
motor activity.

Another difficulty in reviewing the literature on ADD or ADHD is that many
studies have confused the difficulties and behavioral characteristics of learning
disabilities with those of attentional disorders (Silver, 1992). Clinically and
neurologically they are separate, but related, disorders. It would be very difficult
for a researcher to distinguish this type of diagnostic contamination in the
research studies. It was deemed unnecessary for the current study, but Silver’s

point does merit mentioning.

20
Cause

There are still many unanswered questions as to the cause of ADD. Over
the years the presence of this disorder has been weakly associated with a variety
of conditions such as prenatal or perinatal trauma, maturational delay,
environmentally caused toxicity such as fetal alcohol syndrome or lead toxicity,
and food allergies. History of such conditions may be found in some individuals
with ADD, but in most cases there is no history of any of the above. Recently,
researchers have assumed that differences in brain biochemistry may be the
cause of ADD. A recent landmark study by Dr. Alan Zametkin and associates
traced ADHD to a specific metabolic abnormality in the brain. The November 15,
1990. issue of IDENEMLELQEWDLMEQMDQ showed a photograph of
a section of clinical brain imagings with and without ADHD. It demonstrated that
there is a metabolic difference between the two brains.

Barkley (1990) said, "There is little doubt among senior investigators in
this field that multiple etiologies may lead to ADHD" (p. 95). Fowler (1992) cited
Barkley and said, "The frontal-limbic system, particularly the striatum, is believed
to regulate inhibition and motivation. Recent brain-based studies on people with
ADD indicate impairments in these areas" (p. 14). Barkley explained that most
investigators endorse a biological disposition to the disorder, much like mental
retardation. Numerous etiologies, such as pregnancy and birth complications,

acquired brain damage, toxins, infections, and heredity can give rise to the

21

disorder. It is a disturbance in the final common pathway in the nervous system.

Heredity seems to play the largest role in the occurrence of the symptoms.

Cl I . I'

Barkley (1990) referred to the "holy trinity of ADHD": inattention,
impulsivity, overactivity. These same symptoms or characteristics are
manifested and described in a variety of ways. K. R. Murphy (Chief of the Adult
Attention Deficit Disorder Clinic at the University of Massachusetts, Worchester)
(1992) described their patients as being restless and easily distracted; having
trouble focusing, concentrating, sustaining attention; being impulsive, impatient;
having inconsistent work performance; being disorganized, failing to plan ahead,
failing to finish tasks they have started; having frequent mood swings, short
tempers; and having chronic patterns of underachievement.

Barkley (1990) said that it is really behavioral disinhibition—impulsivity, or
a deficiency in Inhibiting behavior in response to situation demandsuthat is the
core characteristic ofADHD. He said, "Evidence that behavioral disinhibition, or
poor regulation and inhibition of behavior, is in fact the hallmark of this disorder
has been accumulating recently from several sources" (p. 43). He made a point
of reiterating that it is not inattention that distinguishes this disorder as much as
it is hyperactive, impulsive, disinhibited behavior. So, although the disorder is
named for the former feature (Attention-deficit), the latter characteristics have

been found to be more descriptive in recent research.

22
D' .

Diagnosis of ADD is not a simple process. Although there are
standardized rating scales that are used to assess the ways in which individuals
meet the criteria for the disorder, they are just one kind of tool used by
professionals. Barkley (1990) indicated, "Professionals must rely on several
methods of assessment, utilize different sources of information from different
settings, and interpret the data obtained within both a biopsychosocial and
developmental perspective" (p. 231).

The subjects in the current study were diagnosed according to the third
edition ofthe DiagnosticandfitatisticaLManuaLctMemaLDischem (DSM:III) of
the American Psychiatric Association (1980). They met the diagnostic criteria for
Attention Deficit Disorder, Residual Type, code 314.80, as follows:

A. The individual once met the criteria for Attention Deficit Disorder
with Hyperactivity. This information may come from the individual
or from others, such as family members.

B. Signs of hyperactivity are no longer present, but other signs of the
illness have persisted to the present without periods of remission,
as evidenced by signs of both attentional deficits and impulsivity
(e.g., difficulty organizing work and completing tasks, difficulty
concentrating, being easily distracted, making sudden decisions

without thought of the consequences).

C. The symptoms of inattention and impulsivity result in some
impairment in social or occupational functioning.

D. Not due to Schizophrenia, Affective Disorder, Severe or Profound
Mental Retardation, or Shizotypal or Borderline Personality
Disorders. (pp. 44-45)

23

In their explanation of childhood diagnosis, Weiss and Hechtman (1993)

were very explicit about the complexity involved in diagnosis: "Diagnosis of

hyperactivity is never made on the basis of a single symptom. Clinically, a

number of symptoms (behavioral and sometimes cognitive difficulties) cluster

together in one child for the syndrome" (p. 15). They went on to say that a

comprehensive multidisciplinary assessment is required for diagnosis, and listed

the following types of evaluations that are usually used:

1.

A history of the pregnancy, delivery, and the child’s developmental
milestones from infancy on. A parental history of hyperactivity,
alcoholism, sociopathy, hysteria, may be looked for.

Assessment of the child’s behavioral aberrations; the specific
symptoms present, their severity and frequency, the degree to
which individual symptoms are situational; the duration of the
problem.

An educational assessment to determine if specific learning
disability is present and if so, its nature. This is of great
importance for remedial educational measures.

Assessment of the intrapsychic processes in the child, how he or
she views himself or herself, family, peers, school; what
personality strengths the child possesses.

Assessment of the interactions of the Child and family. . . .

Assessment of the child’s Classroom. Is the educational
environment conducive to learning? . . . .

Assessment of the child’s neurological status if there is any
suspicion of a neurological lesion. Routine neurological
examinations of hyperactive children are usually negative except
for the presence of soft signs whose significance is not known.
EEG’s often show diffuse dysrhythmias which tend to disappear in
adolescence. Again, the significance is not known. (p. 17)

24
Taylor (1993a) summarized the elements of a thorough assessment for

ADHD adults. He said assessment should include the following:

1. Standardized ratings of present and childhood behavior.
2. Review of prior childhood records if available.

3. Input from significant others from the adult’s childhood.
4. Standardized testing of attention and other factors.

Taylor (1993b) listed the inclusionary criteria for diagnosing Adult ADHD as

follows:

Inafienfion:
Trouble directing attention
Trouble completing projects
Easily overwhelmed by tasks
Organizational difficulties
Inconsistent work record
Lack of attention to detail

Impulsivity:
Making impulsive decisions
Not delaying gratification
Restless, fidgety, aimless
Commenting before thinking
Impatient, easily frustrated
Frequent violations of rules

He also listed conditions that professionals must rule out which can be
misdiagnosed as ADHD:

Problems of character

Mood disorders

Alcoholism/substance abuse

Anxiety/obsessive compulsive disorder

Neurological problems, medical problems, low intelligence

25
Again, Barkley (1990) cautioned about the complexity of diagnosis when he

stated:

The very nature of ADHD demands a consideration of the biopsychosocial
and developmental factors in both assessment and treatment. The
primary problem areas of sustained attention, impulsivity, overactivity, and
poor rule-governed behavior reflectthe multidimensionality ofthe disorder
and necessitate a multitrait assessment approach. Because of the
comorbidity of ADHD with other difficulties, such as LD, CD, and
oppositional behaviors, an evaluation must consider these individual
psychological factors. The problem behaviors must be inappropriate
when compared to those of other children of the same mental age, so
these behaviors must be assessed within a developmental context, using
assessment instruments that have appropriate normative data. (pp. 230-
231)

The psychiatrist who diagnosed the adults in the current study used a 2-
hour in—depth clinical interview for diagnosing their condition. During this
interview she looked at the following items:

1. Their medical history and intergenerational medical history.

2. Any differential diagnosis (other things that might present like ADD,
such as anxiety, depression, substance abuse, endocrine abnor-
malities, menopause, thyroid or estrogen imbalance).

3. A very careful summary of educational history, employment
history, and assessment of current functioning.

4. A discussion of the symptoms they related to when they read
either WWLJDLAMI by Paul
Wender, M. D. (1987)orAIIeflIiQILDeflCIIDI§I2[defl[LAdIIII$by Lynn
Weiss, Ph.D. (1992), paying particular attention to the chronicity of
symptoms and the current presenting symptoms that interfere with
functioning.

26

Iteaimem

Barkley (1990) stated that there is very little available in the scientific
literature to guide the clinical management of ADHD in adults, that there is
evidence that pharmacotherapy may be useful in treating some adults with
ADHD, but that treatments should be viewed as suggestions, not well-proven
therapies. He also added that it is unclear to what extent specific behavioral
approaches may augment pharmacological treatment in the adult with ADHD.
Methylphenidate (Ritalin) is in general more effective than other medications.
Wood (1986) noted several areas in which psychotherapy might assist the adult
with ADHD. Targets for such therapy might include increasing self-esteem,
refining interpersonal skills, teaching medication management, providing
vocational assessment, and counseling. Barkley added teaching of time
management, self-organizational skills, and anger-control methods to the list.

Most experts agree that a multimodality approach-medical, psychological,
educational, and behavioral--to the treatment of this disorder is often needed.
This requires the coordinated efforts of a team of professionals, including health
care professionals and educators. Weiss and Hechtman (1993) reported that the
ADHD subjects in their follow-up study said that they would like to have had
available a multimodality type of treatment, including remedial education,

tutoring, cognitive therapy, individual psychotherapy, and family counseling.

27

E . I . g I II

The discussion of the existence of ADD in adults must take into
consideration the historical perspective of the clinical diagnosis elaborated earlier
in this chapter. It must also be noted that there is often a difference between
what researchers and practitioners are observing and what is reflected in the
clinical diagnostic manual of the time. Empirical findings, Clinical impressions,
and theoretical considerations are often confused. Currently there is not a
specific clinical diagnostic category for ADHD in adults in the DSMJIER, but the
literature abounds with reports of its existence and treatment.

As was noted earlier, in the 19603 it was thought that “hyperkinetic
reaction of childhood" diminished in adolescence and did not continue into
adulthood. Klee, Garfinkle, and Beauchesen (1986) related that in 1971
Mendleson, Johnson, and Stewart reported a 2- to 5-year follow-up in which
approximately 75% of their sample (of ADD adolescents) continued to have
difficulty with concentration, overactivity, and impulsivity. In 1975 Wood and
Wender observed two adult females ages 25 and 41 who had all of the signs and
symptoms of hyperkinetic Children. Theytreated them with methylphenidate, and
they had good therapeutic response (Wood, 1986). There had been numerous
other reports of the disorder continuing into adulthood, and the 1980 edition of
the diagnostic manual designated ADD, Residual Type, as a designation for ADD

continuing into adulthood. The 1987 revised diagnostic manual stated that

28

approximately one-third of children with ADHD continue to show signs of the
disorder in adulthood (American Psychiatric Association, 1987).

The review of the literature suggests that about 70% of the adolescents
who had ADHD in childhood continue to have significant difficulties (Gittleman,
Mannuzza, Shenker, 8 Bonagura, 1986; Weiss & Hechtman, 1993; Werry, 1992).
Others (Barkley, Fisher, Edelbrock, & Smallish, 1990) cited studies that generally
indicated that between 30% and 50% of ADHD children continue to be impaired
by their symptoms in adolescence or to meet current diagnostic criteria for
ADHD. Many of the follow-up studies have been done with attention deficit
Children who have become adolescents; however, some recent studies
(Gittleman et al., 1986; Weiss & Hechtman, 1993) indicated that 30% to 50% of
those with ADHD continue to manifest the symptoms in adulthood (G. Weiss,
1990). Hechtman (1992) cautioned that the results of studies on long-term
outcomes have provided diverse pictures because of different methodologies
employed in the studies (e.g., prospective versus retrospective studies, attrition
rates, sample size, diagnostic criteria and subjects’ characteristics, control
groups versus no control groups, assessment methods, age, and length of
follow-up).

One landmark study (Zametkin et al., 1990) of the neurobiology of
attention deficit not only provided a possible biologic basis for ADHD, but also
established verification for the existence of the disorder in adults. This study

showed that adults who had suffered from hyperactivity since childhood

29

displayed normally reduced metabolism in brain regions regulating motor activity
and attention. The researchers studied 25 adults who were diagnosed as
hyperactive in childhood and who were parents of hyperactive children. They
had a control group consisting of 50 nonhyperactives. The PET scans of brain
metabolism in the hyperactive adults showed less overall brain metabolism; the
most pronounced deficits were in the two areas involved in motor activity and
auenfion.

Although a large amount of recent literature has recognized the existence
of Attention-deficit Hyperactivity Disorder in adults, such a clinical concept was
not always understood or accepted. Even today the concept is not fully
accepted. Although the latest diagnostic manual, DSMJLLB, mentioned the
possibility of the disorder continuing into adulthood, it did not include a category
for ADHD in adults. It is not clear whether the recognition of ADHD in adults will

be included in the QSMJM.

WM

Because the existence of ADD in adults is not unequivocally agreed upon,
the frequency of the condition is also speculative. There are figures which
indicate that from 1% to 20% of children have ADHD, depending on a variety of
number of variables, including the definition (MaCAulay, Reed, 8 Johnson-
Fedoruk, 1991; Martin, Welsh, McKay. 8 Barcuther, 1984; Sloan, Assadi, 8 Linn,
1991 ; G. Weiss, 1990). The QSMJJLB (American Psychiatric Association, 1987)

said that the disorder "may occur in as many as 3% of children” (p. 51). The

30
most commonly cited frequency of ADHD in children is 3% to 5% (Barkley,
1990)

As indicated earlier, the D_SM_lll;R speculated that approximately one-third
of ADHD children carry symptoms of the disorder into adulthood. Barkley and
Anastopoulos (1991) cautioned about the limits of the ability of follow-up studies
in representing the nature of ADHD. Studies of adolescents with the disorder
who were referred to a clinic in childhood might represent a group of individuals
who have more severe clinical symptoms and co-existing disorders because they
were referred in Childhood. Or they might have milder symptoms because they
were referred in Childhood and have a more extensive history of treatment than
those referred as adolescents. There are those who speculate that ADD never
completely subsides because it is a neurological disorder and the chemistry of
the brain does not change. There is no accurate way currently to establish the

frequency of the disorder in adults.

EfiecIiQnAQufls

Although there is no accurate way to establish the frequency of the
disorder in adults, the fact remains that recent research and clinical experience
have demonstrated that attention deficits can indeed be exhibited in adults. In
considering the general effects of attention deficits on adults, some inferences
have to be drawn from the research involving adolescents. Because the

literature reflecting follow-up studies and Clinical experiences indicates that not

31
all adolescents outgrow ADD, it stands to reason that some symptoms of youth
continue into adulthood.

When considering the existence. frequency, and effects of the disorder on
adolescents, various factors must be taken into account. Some of these factors
were referred to by Werry (1992) as "situational factors.” Werry stated,

Situational factors also operate to conceal ADD--for example, the move

to the high school multi-teacher system, which results in less close

observations and decrease in the nuisance to any one teacher. Also,
violence and drug problems emerge as the major concern in high school

culture and may serve to relegate ADHD to the status of minor irritant. (p.

302)

His main point was that ADHD does persist in adolescence, but it is more likely
to be masked or be subclinical.

Follow-up studies are unanimous in finding psychopathy continuing into
adolescence. The overall pattern of psychiatric outcome is continuation of the
Childhood symptoms and development of antisocial behavior (Klein 8 Mannuzza,
1991). Adolescents studied by Weiss and colleagues (1993) had retained
significant levels of restlessness and poor concentration. Barkley and
Anastopoulas (1991) reported the following greater percentages of antisocial acts
when compared to a non-ADHD control group: theft 43%, assault 27%,
vandalism 21%, disorderly conduct 12%. Although some studies (Klein 8
Mannuzza, 1991) have shown a correlation between substance abuse and
ADHD, subjects in the Weiss study were not found to have more substance

abuse than the control group, except for Cigarette smoking. The Weiss subjects

were, however, rated by parents and teachers as less socially competent,

32
involved in fewer social and organized activities, and having fewer friends. The
ADHD teens rated themselves as better adjusted than did their parents and
teachers. The only significant differences between the ADHD teens’ and the
control group’s self-evaluations were in depressive symptoms and antisocial
acts.

Kramer (1986) discussed that most longitudinal studies have found a
reduction in core attention deficit symptoms over time. However, overactivity,
impulsiveness, and/or distractibility usually persist to some extent. This author
also mentioned that other symptoms such as poor peer relationships, low self-
esteem, and depression achieve prominence as the subject reaches
adolescence.

Klein and Mannuzza (1991) cautioned that it is important to differentiate
between adolescent and adult outcome of hyperactive boys. They stated that in
early adolescence, all reports indicated a high rate of continued behavioral and
academic dysfunction. A marked diminution of impairment occurs during late
adolescence; but hyperactive boys, as adults, continue to have antisocial
behavior and substance abuse disorders (other than alcohol). On the other
hand, there are few studies that indicate how the disorder does manifest itself in
adults, so we have to draw some inferences from studies of adolescents.

Another limitation is that the literature about effects of ADD on adults does
not attempt to fully analyze the causes of those effects. There has been no

research designed to determine whether the observable effects are caused by

33

earlier or current ADD. Thus, for example, it is not known whether an ADD adult
has problems with basic skills or self-esteem because of the ongoing ADD
syndrome or because the individual got behind in development as an ADD child.

Hechtman (1992) provided an excellent summary of the work that has
been done to demonstrate the effects of ADHD on adults. She stated: "The view
of adult outcome of ADHD can be obtained from four different sources. These
include (1) controlled prospective follow-up studies; (2) retrospective studies; (3)
evidence of a similar adult disorder; and (4) family studies of parents and
relatives of children with ADHD" (p. 557). Hechtman asserted that the controlled
prospective study provides the clearest, most reliable picture of adult outcome,
but unfortunately there have not been many done. Hechtman said that Weiss
and Hechtman, Gittleman and colleagues, and Loney and colleagues have
provided the only three existing controlled prospective studies. Klein and
Mannuzza (1991) summarized these studies. Weiss found that antisocial
personality disorder was the only diagnosis that was significantly more common
in the formerly hyperactive group. Neither Weiss nor Loney found higher rates
of alcohol or drug use disorders in the grown hyperactive group. Gittleman and
colleagues found more of the adults who were hyperactive children had full
ADHD syndrome than the control group, who had never been diagnosed as
having ADHD (31% versus 3%). Also, 27% of the formerly hyperactive had
conduct disorder or antisocial personality disorder, whereas only 8% of the

normal control group exhibited these diagnoses. The hyperactives also showed

34
a 16% drug use disorder (other than alcohol), whereas in the control group only
3% had this diagnosis.

Weiss and Hechtman (1993) reported various other general effects of
attention deficit disorders in the hyperactive children whom they followed over a
15—year period. The hyperactives had less education, more children, more
reported sexual problems, more acts of physical aggression (but not more
reports of verbal aggression), and more suicide attempts than the normal control
group. Although more of the hyperactive group complained of neurotic or
personal problems than the control group, there was not evidence that
hyperactivity in childhood predisposes to psychosis in adulthood. (They disputed
earlier studies that indicated a high risk for psychosis in this group, which they
indicated was not borne out by research.)

Twenty-three percent of the hyperactive group in Weiss and Hechtman’s
study were diagnosed with Antisocial Personality Disorder, but no other single
diagnosis distinguished them from the controls. And, although these researchers
had shown that hyperactive adolescents consumed more alcohol than a control
group, this was not true for the adults in the study. On psychiatric tests, 33% of
the control group scored in the "normal" range, versus 11% of the hyperactive
group.

Overall, the most dramatic difference between the adults who had been
diagnosed as hyperactive in childhood and the control group (who had not been

diagnosed with ADD) was that 66% of the formerly hyperactive complained of at

35

least one symptom of ADHD (restlessness, poor concentration, impulsivity,
explosiveness) versus 7% of those in the control group. The researchers
concluded that about 50% of the hyperactive children grown up had fairly good
outcome, with some continuing, but not significantly disabling, symptoms. About
50% of them had mildly to severely disabling symptoms. Klee et al. (1986) also
reported that those diagnosed as having ADD in childhood continued to show
relative attentional deficits in adulthood when compared to non-ADD adults. This
was true even though they had been treated for a minimum of 1 year. They had
received a complete course of psychiatric treatment, including psychotherapy,
stimulant medication, and remedial education.

Hechtman (1992) classified the outcomes of hyperactive children into
three categories: (a) those who function fairly well and are not much different
from a control group; (b) those who continue to have significant concentration,
social, emotional, and impulsive problems (their problems result in difficulties with
work, interpersonal relationships, poor self-esteem, impulsivity, irritability,
anxiety, and emotional Iability); and (C) those who have significant psychiatric or
antisocial problems, i.e., depressed, suicidal, drug/alcohol problems, antisocial
behavior (e.g., assault, armed robbery, breaking and entering, and drug dealing).
The largest group falls into the second category. The third category is a
relatively small group. Hechtman also stated that generally adult outcome is not
associated with a particular initial variable, but with additive interaction of

personality characteristics and social, familial, and environmental factors. Most

36

of the literature supports the hypothesis that many adults who had some type of

attention deficit disorder as youngsters show continuing effects into adulthood.

EflecIsomEducaIiermcess

One of the assumptions that this study is based on is that there will be an
effect on the college experiences of adults who have been diagnosed with
ADD/ADHD. As was stated earlier, there is no available research on the
educational experiences of ADD/ADHD adults. There are some references to
these types of experiences in the anecdotal anthology AW
Challenge (Johnson, 1992), and in an individual’s autobiography which has been
included in Weiss and Hechtman (1993). But there are no works that deal

exclusively with the topic.

EQMLGILIILQQIIBQE

Kramer (1986) stated that only a few of the subjects of follow-up studies
have gone to college. This might be true of ADD adults, or it might just be true
of the ones in the studies he was discussing. It might also be that there are ADD
adults in college who were not diagnosed as children for any of a variety of
reasons. It is just not known how many ADD college students there are, but it
can be speculated that if ADD children have problems in school, ADD adults

might have problems in college.

37
SvmpIomsCLeateAcademmrficulIv

The references in the literature about the way that ADD affects the school
experiences of youngsters are abundant. lnferences can be drawn from these
sources about the ways in which ADD adults might experience college. The
symptoms of the disorder create general academic problems. Academic skills
deficits are found to be common in ADD young people, and there is some
controversy about the impairment of cognitive functions. Many youngsters with
this disorder exhibit special learning disabilities. Research indicates that they
have symptomatic difficulties in dealing with an academic environment, and that
their overall performance in school is lower than that of the control groups or
general population. There are specific interventions that are suggested to
accommodate the educational needs of these young people.

The symptoms of the disorderninattention, disorganization, impulsivity--
are attributes that are not usually conducive to positive adjustment and
performance in academic settings. The issue of underachievement and
difficulties in school of those with ADD has been discussed repeatedly in the
literature (Barkley et al., 1990; Hechtman, 1992; Henker 8 Whalen, 1989;
MacAulay et al., 1991; Sloan et al., 1991; Weiss, 1990; Wood, 1986). Weiss
(1990) made a point of saying that "they underachieve at school, often in spite
of intelligence and even in the absence of specific learning and reading
difficulties" (p. 1414). MacAulay et al. (1991) stated, "It is evident that symptoms

intensify in contexts where sustained attention is required, such as listening to

38

a teacher in a classroom, or doing homework assignments“ (p. 133). Reflection
on what most academic environments are like and the symptoms of this disorder

lead to a common-sense judgment that the two would not mix well.

C 'I' I9 I 'SI'IlDfi'I

A common finding among studies of hyperactive or ADD young people is
the presence of academic skill deficits and lower-level cognitive functioning than
those in control groups. Kramer (1986) reported most individuals being several
years behind in their reading, spelling, and/or mathematical skills. McGee and
Share (1988) reported 80% of the children in their study having had learning
difficulties in reading, spelling, mathematics, or written language skills. Several
authors made general statements related to educational achievement being
below normal (Barkley, Anastopolous, Guevremont, etal., 1991; MacAulay etal.,
1991; Martin et al., 1984; Weiss, 1990).

Although there is very little, if any, question about the deficits in the
academic skills and performance of these individuals, there is some controversy
around the issue of cognitive functioning. Some say that cognitive deficits are
a primary problem with ADHD individuals. A study of Werry, Elkind, and Reeves
(1987) indicated general cognitive deficits in their groups with ADHD. They
stated that ADHD children showed few differences from normal children that
were not due to verbal IQ except in restlessness. Werry (1992) expressed the
opinion that "Research has shown that the primary cause for academic failure is

primary cognitive deficit aggravated by inattention and hyperactivity" (p. 305).

39
Klein and Mannuzza (1991) cited Cohen and colleagues and Hoyt and
colleagues and stated that there were worse performances reported on cognitive
tasks. They did point out, however, that it is not known whether the children who
had poor academic histories were also the ones with cognitive deficits.

Of primary interest in the current research, however, is that the only
mention of cognitive deficits in ADD adults is that there is no evidence to
substantiate the existence. Klein and Mannuzza (1991) stated that the findings
concerning long-lasting impairment of cognitive functions in children are
ambiguous. They based this observation on follow-up studies of adults whose
symptoms had remitted, and contrasted them with those whose symptoms still
existed. Klein and Mannuzza also stated, "In adulthood, no cognitive deficits
have been documented" (p. 386). One cannot be sure if they do not exist or if
they just have not been documented because there is such a lack of reliable

research on the topic.

5 . l I . E II

Whites. Although there is some controversy
around the topic of whether or not people with ADD exhibit cognitive deficits,
there is no controversy about the fact that ADD and learning disabilities are often
co-existing conditions. Up to 40% of those in a follow-up study (Barkley et al.,
1991) had been in special education. One article (McGee 8 Share, 1988)
pointed out such a high degree of comorbidity of ADHD and learning difficulties

that the authors believed that it is unclear whether most researchers are talking

40

about children with ADHD who have learning difficulties, or children with learning
disabilities who show inattentiveness and hyperactive behavior. They reviewed
evidence that ADD in the classroom is a consequence of learning disabilities, not
the other way around. They stated that others had made similar proposals,
which they thought had not received sufficient attention. The research that they
cited was published between 1978 and 1984; it is doubtful that many would
subscribe to this attitude today, but it is a viewpoint worth mentioning and does
indicate the extent to which learning disabilities and ADD are related.
Qiffisumesjealjngmmjneenyimnmem. The literature supports the fact
that ADD Children have symptomatic difficulties in dealing with an academic
environment, and that those difficulties are retained when they become young
adults. In one study (Klee et al., 1986) where former ADD children were
compared to a non-ADD control group, the ADD group continued to retain a
relative deficit in the acquisition of new learning material. Their symptoms also
yield more antisocial behavior and conduct disorder. Kramer (1986) stated,
“Initially, researchers concluded that hyperactive Children engaged in these
behaviors (antisocial) because of frustration with school and peer rejection" (p.
91). It is noteworthy, however, that these researchers gave data which
suggested that ADD symptoms at referral did not suggest later antisocial
behavior, but aggression (e.g., fighting and destruction of property) did predict

later antisocial behavior.

41

On the other hand, a study by Gittleman and Mannuzza (1985) showed
that, "If the original symptoms of hyperactivity had not remitted, the chances of
developing a conduct disorder were almost fourfold greater than if the childhood
condition was no longer present" (p. 944). Also related to the current study are
data that Gittleman and Mannuzza presented, indicating that the former patients
(ADD) compared with the controls had significantly more conflicts with teachers.
Also, in the McGee and Share (1988) article, the authors stated they believed
that ADD behaviors might be considered a disorder of conduct in the classroom
because the child with learning difficulties is excluded from much of the normal
classroom activity. Although there is some limited controversy about which is the
primary disorder—learning disabilities or ADD--there is not any controversy about
the fact that the symptoms that they exhibit create behavioral difficulties in
dealing with a traditional classroom environment.

W. As has been indicated in the last several pages, there is
much in the literature which demonstrates that performance in school is low for
those with ADD/ADHD. They get lower grades, have more omissions and errors,
lack vigilance, repeat more grades, and fail to finish high school more than do
their counterparts in control groups of non-ADD/ADHD individuals. Hechtman
(1992) reviewed the literature and summarized by stating, "Subjects frequently
have educational problems with poor performance" (p. 557). Several studies
(Barkley et al., 1990; Borland 8 Heckman, 1976; Klein 8 Mannuzza, 1991) have

found that the hyperactive group performed less well in their school grades. Klee

42
et al. (1986) reported a greater number of omissions and total errors on a
Continuous Performance Task test. Barkley et al. (1991) showed poorer
performance on vigilance. A common finding in studies is that ADD individuals
have repeated or failed grades in school (Barkley, 1990; Barkley et al., 1990;
Kramer, 1986). Weiss and Hechtman (1993) found that as many as 35% may
have failed to finish high school. Barkley et al. (1990) found that the hyperactive
group were eight times more likely to have been expelled or drop out of school

compared to the normal controls.

nt ti

Because providing quality education to ADD college students is important,
it is imperative to review some of the literature in relation to the interventions
suggested for this type of student. There is no research available on college
students or adults with attentional deficits, and very little literature, so inferences
must be drawn from the research and literature about children. The writings
about Children seem to suggest that educators need to change their belief
systems, use instructors whom ADD students find effective, provide special
education programming, restructure the learning environment, and apply

principles of remediation.

QhangeBeIieLSvsIems
The W (Fowler, 1992) is the most

comprehensive handbook about ADD and education that is available. It was

43

written by Mary Fowler in collaboration with Russell Barkley, Ph.D., Ron Reeve,
Ph.D., and Sydney Zentall, Ph.D. Fowler’s collaborators have all conducted
substantial scholarly research on the topic of ADD. They discussed the
importance of the impact that parents and educators can have on the lives of
ADD individuals. They stated:
If we, the parents and educators of such children are to have any effect
at all in changing the negative outcomes that result from this disability, we
have to take the first step. That step is CHANGE OUR BELIEF SYSTEM.
We must ACCEPT that ADD is a disability, and that these children behave
in a way that comes naturally to them. (p. 8)
They went on to quote Dr. Ross Greene, Assistant Professor of Psychiatry and
Pediatrics at the University of Massachusetts Medical Center, who said,
First you have to establish the level of understanding and knowledge on
the part of everybody concerned. To the extent that knowledge, attitudes,
and beliefs guide a person’s behavior, these factors may have
considerable impact upon a teacher’s interactions with the student with
ADD.
The basis of sound interventions by ADD educators, then, is expanding their

knowledge base, increasing their understanding, and accepting this disorder for

what it is.

W

Fowler (1992) stated, "Psychology has long embraced the notion that
people, environments, and individuals are either suited to each other (good
matches), or they are not (poor matches)" She then went on and related that
anecdotal reports have told us that school success for Children with ADD varies

from yearto year and that the teacher is the most commonly cited reason for the

44

Greene, who provided a list of 20 teacher characteristics that are likely indicators

of positive student outcomes, which he had gleaned from the work of researchers

on disabilities. He listed the following:

1.

2.

10.

11.

12.

13.

14.

15.

16.

Positive academic expectations.
Frequent monitoring and checking student work.
Clarity (e.g., clear directions, standards, expectations).

Flexibility (adapts as necessary, e.g., to modifications needed by
certain students, schedule changes).

Fairness (lack of favoritism).

Active involvement with students (remains actively involved with
students as they work).

Responsiveness (attention to students’ responses and comments).

Warmth (good relationship with students, receptive to students’
approaches).

Patience.

Humor.

Structure (highly structured, predictable lessons).

Consistency (sets and maintains contingencies).

Firmness.

Knowledge of different types of behavioral interventions.
Positive attitude toward mainstreaming.

Knowledge and/or willingness to learn about working with students

with emotional and behavioral problems and exceptional children
in general.

45

17. Willingness to work with special education teacher (e.g., share
information regarding student’s progress, seek assistance when
needed, participatein meetings orconferences involving students).

18. High perception of self-efficacy (perceives self as competent
teacher).

19. High sense of involvement (professional responsibility).

20. High professional job satisfaction. (pp. 34-35)

In an article authored by Dr. Greene (1992) himself, he cautioned that
many recommendations regarding the characteristics ofteachers thatmatch with
ADHD students are not based on empirical studies. The characteristics that are
usually listed relate to positive attitudes and beliefs, knowledge of behavior
management, and knowledge of disability. The indication is that students with
ADD need teachers who have these characteristics, but this judgment is largely

based on speculation, not on scientific evidence.

5 . I E I l'

Barkley et al. (1990) suggested that the availability of federally mandated
special education has had an effect in managing some of the problems
presented by ADHD youngsters in school. Specifically, they speculated that
children might not be retained in a grade as readily as they used to be in an effort
to solve their problems. Special education services can address some of the
problems presented by youngsters in an academic environment, but there are

also other intervention strategies that have been recommended to enhance their

46
educational experiences. Similarly, special accommodations for college students

can address some, but not all, of their problems.

B I l I . E . l

Njiokiktjien (1988) stated that experiences with and observation of
classroom-based intervention suggest that when cognitive and learning
environments are restructured, the problem of the ADHD child is effectively
addressed. While the attention deficit does not disappear, it is accommodated
within a supportive environment and teaching framework. MacAulay et al. (1991)
stated, "The hyperactive child is thus at the mercy of the teacher’s repertoire of
skills in terms of understanding and dealing with attention deficits in the
Classroom" (p. 140).

Zametkin (1991 ) elaborated on thetype of environment that ADHD people
perform best in: high structure, low distractibility, consistent positive
reinforcement, consistent limit-setting, consistent consequences for inappropriate
behavior, highly nurturing. CH.A.D.D. (Children and Adults With Attention Deficit
Disorders) published a document called W
W (1993b). They, too, stated that the effective
classroom environment for the student with ADD generally needs to be highly
ordered and predictable. They listed three general categories in which educators
can modify the classroom environment: classroom organization, classroom

management, and curriculum.

47

Martin et al. (1984) suggested that academic tasks and teacher
expectations need to take into account the child’s short attention span. They
further suggested that assignments should be brief initially, then gradually
extended as the child’s capabilities increase. They also suggested that
acceptable outlets for excessive energy could be anticipated and planned, for
example, allowing the child to run errands after completing assigned work. They
also endorsed the environment described by Zametkin above: freedom from
extraneous stimuli, behavior modification, and token reinforcement for modifying
inappropriate behaviors and improving academic performance. Barkley (1990)
suggested adapting some behavior modification methods and self-control
therapies for the young ADHD adult trying to meet the demands of a college or

vocational training program.

E . . I [B I' l'
Fowler (1992) stated, "Children with ADD are Leam_b.y_ELLQL._ILiaLand

ELLQLLeamers. They will learn to work for the following: (1) to get something
(stimulating or novel); (2) to get out of or away from something (repetitious,
boring)" (p. 15). She then went on to list several principles for remediation,
which are based on recommendations that Dr. Sydney Zentall submitted to the
Council for Exceptional Children Task Force on ADD. Some of these remedia-

tions, which seem particularly applicable to the current study, are as follows:

48

Principles of Remediation for Failure to Sustain Attention to Routine
Tasks and Activities

Decrease the length of the task.

-Break one task into smaller parts to be completed at different
times.

-Give two tasks with a preferred task to be completed after the less
preferred task.

-Give fewer spelling words, math problems.

-Use fewer words in explaining tasks (concise and global verbal
directions).

-Use distributed practice for rote tasks, rather than mass practice.

Make tasks interesting.

-Allow work with partners, in small groups, in centers.
-Alternate high- and low-interest tasks.

-Use overhead projector when lecturing.

-Allow child to sit closer to the teacher.

Increase novelty especially into later time periods of longer
tasks.

-Make a game out of checking work.

-Use games to over-learn rote material.

Do not teach or reinforce 'dead-man’s behavior—that is, do
not assume the child is not paying attention just because
slhe looks out the window or at another child. . . .

Principles of Remediation for Noncompliance and Failure to
Complete Tasks

Generally increase the choice and specific interest of tasks
for the child.

-Allow a limited choice of tasks, topics, activities.

-Determine child’s preferred activities and use as incentives.
-Bring child’s interests into assignments.

Make sure tasks fit within child’s Ieaming abilities and

preferred response style.

-Allow alternate response modes (typewriter, computer, taped
assignments).

-Alter assignment difficulty level (give advanced-level assignments
or lower the level of difficulty).

49

-Make sure disorganization is not reason for failure to complete
tasks.

Principles of Remediation for Low Self-Esteem
- Generally recognize the child’s strengths and efforts.
—Call attention to areas of child’s strengths by allowing for a

consistent time each day or week during which child can display
his/her talents.

-Recognize that excessive activity can also mean increased energy
and productivity.
-Recognize that bossiness can also be leadership potential.
-Recognize that attraction to novel stimulation can also lead to
creativity.
- Increase child’s feeling of success by increasing child’s skills.
-Recognize these children’s playfulness and use itto develop skills.
~Mark student’s correct performance, not the mistakes. (pp. 15-16)
In reviewing the research and literature about interventions that educators
can use to enhance the learning of ADD students, it is apparent that several
strategies can be used. There are several "Principles of Remediation" such as
those listed above. Educators can also work to change their belief systems
about students with the disorder, work to match students with effective

instructors, use special education accommodations, and restructure the learning

environment.

I- l
Besides the specific interventions of educators discussed above, the
research and literature also suggests other ways of enhancing the college
experience of ADD adults: effective collaboration by professionals and self-help

by the ADD students. As was mentioned in the "Treatment" section of this

50
chapter, most experts agree that a multimodal treatment approach is necessary
for this disorder. For effective treatment, educators must collaborate with other
professionals. ADD adult students can also assume responsibility for their own
welfare.

The Michigan Department of Education organized an ADHD Task Force,
which published a report, AIIQDIIQDMCIIflyDemMILQISQLdeL (1993). In this
report, the task force specifically dealt with the importance of collaboration and
communication. They listed four requirements for effective collaboration: that
the individual parties involved recognize the need and importance of
collaboration, that efficient yet informative reporting devices be used in the
interest of time, that all parties have an understanding and acceptance of the
constraints of confidentiality, and that the professionals involved know what is
reasonable to expect from one another. This report then went on to list
expectations for the various different professionals (e.g., faculty, counselors,
administrators, physicians, psychologists) who could be involved in thetreatment
team. Because of the numbers and diversity of those professionals, effective
collaboration and communication are essential.

Dr. Frank Gersh, a clinical psychologist who works with ADD college
students, provided some suggestions in his article "Treatment of the ADD
College Student" which also indicate a need for collaboration among
professionals. He said that there are a variety of therapeutic approaches to use

with ADD college students. He stated:

51
These include medication trials, longer-term medication use, improvement
of study habits, accommodations in the student learning and test-taking
environment, psychiatric or psychological treatment of associated
disorders such as substance abuse or depression, developing daily
routines and organizational ability, vocational counseling, cognitive
therapy, relaxation training, assertiveness training, and training in social

skills. (1993, p. 11)

Gersh allowed that treatment must be highly individualistic, depending on the
needs identified during a comprehensive, careful assessment. The ideas he
discussed seem to present a fairly comprehensive list of treatments, calling for
collaboration among various professionals.

Although ADD adults need to rely on the services of professionals, they
also have a role to play in their own treatment and development through self-
help. As was mentioned earlier, there is very little written about ADD adult
students, and there are no research-based studies. However, there is some
literature that is anecdotal or clinician-based. This literature encourages ADD
adult self-help and self-advocacy.

Although their works are not scholarly research studies, Johnson (1992)
and Selkowitz (1993) both provided some anecdotal information that shows the
advantages of ADD adult college students helping themselves to become
successful students. Selkowitz told her story:

I re-entered college this past fall. ltook three courses, receiving three

A’s. I worked hard but there were things available to me that made the

difference. I use Support Services at school. This means if I need a

notetaker or tutor, the school provides them. I also hand my professors

a letter that introduces me as a student with a learning difference

explaining how I learn. I break larger tasks into smaller ones. . . . I am

able to obtain my textbooks on tape to help me retain information. I read
along with my textbooks and listen to the taped book at the same time.

52

When appropriate, I ask my professors for any visual aids that might help
me better understand the materials. I sometimes use rhymes or songs to
train my memory. With permission from my professor, Itape lectures so
that I can fill in the blanks of my notes after class. Color coding my notes
and textbook helps keep me organized. (p. 2)

Like Selkowitz, other ADD adult students can take initiative in finding and

requesting professional accommodations, and like her they can use other self-

help strategies that complement those accommodations.

Nadeau (1992) is a clinician who is in private practice at a clinic

specializing in working with individuals of all ages who have attentional problems.

Her article listed 14 suggestions and guidelines for college students with

attentional problems. The list, which is annotated in the article, is as follows:

1.

10.

Obtain special services which ADD students are eligible for under
Section 504 of the Rehabilitation Act. . . .

Consider a small college with a strong pro-student attitude. . . .

Look for a school with a well-developed learning disability support
program. . . .

Develop strong self-advocacy skills. . . .

If your choice of a major requires a large university setting, plan to
transfer after your sophomore year. . . .

Think about signing up for a "single" in the dorm. . . .
Take a reduced course load of 12 hours. . . .

Plan to take your most difficult or challenging courses during
summer school. . . .

Select your major carefully. . . .

Plan your class schedule carefully. . . .

11.

12.

13.

14.

53

Learn how you study best. . . .

Don’t try to deny that attention, concentration, time management
and organization are difficult for you. . . .

You can still benefit from medication through college and even in
your work life afterward. . . .

Counseling can be highly beneficial to ADHD college students. . . .
(pp. 56)

Nadeau made a strong case for students to help themselves become successful.

Kate Kelly, RN, MSN, a specialist in psychiatric nursing, and her co-

author, Peggy Ramundo, a teacher with graduate work in learning disabilities,

are both adults who have recently been diagnosed with attentional disorders. In

their book WW (1993), which has received

broad professional endorsement, they discussed the importance of self-help for

ADD adults. They encouraged these adults to identify their individual preferred

learning styles and to use their strengths. They also listed and elaborated five

"general learning tips” for ADD adults. These are as follows:

1.

2.

Use Music or Background Noise. . . .

Schedule Learning Times. . . .

Use Color to Maximize Learning. . . .

Walk, Ride an Exercise Bike. . . . Any physical activity paired with
data input can be helpful for visual, auditory and kinesthetic

learners. . . .

Get Comfortable. . . . (pp. 297-298)

54

Although these guides to learning are more than likely based on research
involving the education of children, they are the only resources in the literature
with suggestions for ADD adult learners.

Effective collaboration by professionals and effective self-help by ADD
adults are important possibilities in the higher education experiences of ADD
students. Most experts agree that a multimodal treatment approach is ideal for
this disorder. Thus, educators probably must collaborate with other
professionals. In addition, ADD adult students can assume some responsibility

for their own educational success.

' r vi

This review has provided background information about ADD, about the
manifestation of the condition in adults, and about the education of ADD
individuals. Background about ADD-~its history, cause, Characteristics,
diagnosis, and treatment—was given to assist the reader in understanding the
current study. Background about ADD in adults has obvious, special relevance
for this study. The educational research and literature, also clearly relevant,
covers the effects of ADD on the educative processes in young peOple, some
interventions that have been recommended for teaching children, and effective
collaboration and self-help.

Very little literature has dealt specifically with the learning experiences of

ADD adults, in college or elsewhere. For that reason, much of the research and

55

literature reviewed in this section is related to children and adolescents, is
anecdotal, or is based on clinical impressions.

Because there is no scholarly research to guide educational practices for
ADD adults, andragogical assumptions must be drawn from the literature based
on pedagogy. However, some of the literature about educating ADD children
does not lend itself readily to drawing such assumptions. For example, some
interventions are designed to respond to hyperactivity, a form of behavior quite
common in ADD children but not so apparent in ADD adults. This review does
not focus on the literature describing such interventions. On the other hand, the
review emphasizes pedagogical literature which does suggest helpful
andragogical strategies. Such strategies are those that respond to
impulsiveness and inattentiveness, characteristics common both in ADD children
and in ADD adults. In addition, the review considers some literature that is
anecdotal or is based on clinical impressions, and that provides some direct

suggestions for educating ADD adults.

CHAPTER III

DESCRIPTION OF RESEARCH METHODOLOGY AND PARTICIPANTS

My main research question was: How do adults with Attention Deficit
Disorder (ADD) experience this disorder in their college life and deal with the
experiences this disorder presents? Qualitative research methodology was used
to describe and analyze the college experiences of seven adults with ADD. The
seven adults in the study had all been diagnosed with ADD by the same
psychiatrist. The research design included interviews to collect data about the
college experiences they encountered and the ways in which they dealt with their

expefiences.

Rationale for Methodology
O I! l' B I
Qualitative research seemed to be the best approach for describing and
analyzing the college experiences of these ADD adults and the ways in which
they dealt with them. Bogdan and Biklen (1982) explained that qualitative
researchers proceed on the theoretical assumptions that meaning and process
are crucial to understanding human behavior, that descriptive data are what it is

important to collect, and that analysis is best done inductively. Because my

56

57

primary purpose was to better understand some elements of human behavior,
ADD in college life, qualitative research methods were used. The data analysis
gives a detailed description of the experiences of these adults and provides a
rich basis for understanding for professionals who contribute to the education of

ADD college students.

InIenLimrLMerQfl

Because I wanted to provide a rich basis for college educators to
understand students with ADD, I used interviews to gather descriptions of the
experiences of seven ADD adults. Gorden (1980) stated, "There is much
literature devoted to studies and experiments on the relative value of interview.
. .‘ . Interviewing is most valuable when we are interested in knowing people’s
beliefs, attitudes, values, knowledge, or any other subjective orientations or
mental content" (p. 11). Bogdan and Biklen (1982) pointed out that interviews
are used to gather descriptive data in the subjects’ own words so that the
researcher can develop insights on how subjects interpret some piece of the
world. In this study interviews provided valuable information because I was
attempting to discover individual knowledge and subjective orientations. The
data collected in the interviews helped me develop insights into how these

subjects interpreted their college experiences.

58
Beseamhflesign

Reseatchfiuesflons

The main research question was: How do adults with Attention Deficit

Disorder (ADD) experience this disorder in their college life and deal with the

experiences this disorder presents? The answer to this question draws on the

answers to subsidiary questions.

Some research questions were related to personal information. That

information provided background for understanding subsequent research

questions. The personal information questions were as follows:

1 . Demographics

a.

What is the individual’s age?

b. What is the individual’s gender?

c. What is the individual’s race?

d. When did he/she attend college?

e. Where did he/she attend college?

f. For how long did he/she attend college?

9. Which of the 14 D§M_IIJ:R characteristics have been
exhibited by the individual?

h. What is the individual’s current educational or occupational
status?

2. Understanding of Attention Deficit Disorder
a. What is the individual’s understanding of ADD?
b. Where did he/she obtain most of his/her knowledge about

the disorder?

59

3. Feelings About ADD

a. How does the individual feel about having ADD?

b. How does the individual feel about being labeled ADD?

c. Has the individual ever felt that helshe was different from
others because helshe had ADD?

4. Personal History

3. What was the individual’s experience in being diagnosed
with ADD?

b. Has helshe ever been diagnosed as having any learning
disabilities?

C. What history does helshe have with medication?

d. What does helshe remember about experiences in
elementary or high school that might be related to ADD?

e. Was helshe ever retained in a grade? If so, what kind of
messages did that give to him/her?

f. How does the individual Characterize his/her relationships

with friends and family?

(1) What were the reactions of others to problems
related to ADD?

(2) Did helshe tell friends/co-workers about the ADD?
(3) Has helshe experienced any difficulties in his/her

dating/marriage relationships that helshe attributes
to ADD?

Some research questions elicited data aboutthe experiences the subjects

encountered in college. These were as follows:

5. Selection of College and Admission

a.

How did the individual select the college attended?

60

b. What, if any, problems did helshe encounter in being
admitted to college?
6. College Teaching/Learning Preferences
3. What kinds of classes did helshe prefer (lecture, discussion,
etc.; self-paced, regular classroom, laboratory, etc.; small,
large)?
b. What types of instructional delivery did helshe prefer

auditory, visual, etc)?

Other research questions elicited data concerning how the subjects dealt

with their experiences. These were as follows:

7. Study Techniques and Support Mechanisms While in College

a.

What types of study habits/study environments did helshe
have?

b. What types of coping mechanisms did helshe employ?

c. What special services did helshe obtain from the college?

(I. Were there any special accommodations available at the
college to assist in studying, test-taking, etc?

e. Did helshe attempt to receive any special help (tutoring,
special instruction) from anyone, either within the college or
outside of the college?

8. General Problems in College

a. What, if any, problems were encountered while in college?

b. Did he/she feel a need to struggle to concentrate/focus in
Classes or while studying?

0. Did his/her performance ever vary greatly from one time to

another?

61

9. Relationships With Instructors

3. Did the personality/attitude of the instructor make a
difference in his/her learning?

b. What were the instructors’ reactions to problems?
c. Did the individual tell instructors about ADD?
10. Advice

3. What advice does the individual have for college instructors
who have ADD students in their classroom?

b. What advice does the individual have for ADD students who
are going to college?

Although each of these subsidiary questions was asked in some form, my
data analysis offers answers only to those questions that seemed particularly

useful.

Emulation

W. An application to protect the rights of
human subjects was submitted for approval to the Michigan State University
Committee on Research Involving Human Subjects (UCRIHS). This application
outlined the potential risks to the subjects, and included consent forms and a
prospectus of the study. UCRIHS approved the study, indicating that the rights
of human subjects had been assured protection (Appendix A).

Selectionfloria. For the study, seven adults who have ADD were
referred to me by a psychiatrist who had diagnosed and treated them. Before

referring her patients to me, the psychiatrist briefly described the purpose of the

62

research to them. She also assured them that she knew me personally, that I am
a professional counselor, and that I would handle their reports in a professional
and confidential manner. The psychiatrist obtained a release-of-information form
from each of the subjects. She then provided me with the name, address, phone
number, and birth date for each subject.

I contacted each subject first through a letter accompanied by a consent
form (Appendix B). Then I called them on the telephone and talked with them
briefly about the purpose of the study and their willingness to participate. We
then set a time for the first interview. A written consent form was obtained from
each subject before I interviewed them.

WWW. Before I began asking the subjects
questions in my first interview with them, I again reviewed the policies of
confidentiality and anonymity. ltold them that we would not use their names and
identifying information about them after the audio recording had begun, and that
the only person besides myself who would hear the tapes would be a
transcriptionist. The transcriptionist has a long history of handling confidential
information in the school district where she is employed as a secretary. I
identified the transcriptionist to each individual in case one of them would know
her and think that she might recognize his/her voice or personal information. I
also told them that the psychiatrist who referred them to me would probably read
my complete study and that she would more than likely be able to identify them

even though I would be using pseudonyms.

63

I also explained to each subject that the pseudonyms would be used to
protect their identity. This policy has been carried forth in presenting the data in
this study. The names of organizations and the individuals, and other identifying
characteristics, have been changed to protect the anonymity of those being
studied. Care has been taken so that substance of information has not been

altered.

Datafllleflion

IyoeoLdata. Each subject was interviewed at length at least twice. The
first interviews lasted between 45 minutes and 1.5 hours. The second interviews
lasted between 45 minutes and 2 hours. Those who had shorter interviews the
first time tended to have longer interviews the second time. All interviews were
audiotaped. Firstinterviews were transcribed. llistened to the second interviews
repeatedly and took notes. In some cases, individuals were telephoned and
asked to clarify data for accuracy. Notes were taken of these telephone
conversations.

Elaoo. All of the first interviews were conducted in a room that I rented in
the office complex where the psychiatrist who referred the subjects to me has an
office. Most of the second interviews were held in the same place. One second
interview was held in a hotel room in the hometown of the subject. Another
second interview was held in a meeting room Of the intermediate school district
office in the hometown of the subject. These settings were chosen to make them

easy for the subjects to find, to put the subjects at ease in a familiar setting, and

64

to be considerate of their time. These settings also ensured privacy and lack of
interruptions.

Intentiewguide. During the first interview, I used an interview guide (see
Appendix C) that I had prepared ahead of time to assist my memory with the
items that I wanted to be sure to cover with each individual. I included a review
of the purpose of the study, my interest in this study (both professional and
personal), a reassurance of anonymity and the confines of confidentiality, the
format, a clarification of terms, and a list of topics for the interview. The items I
discussed based on this guide were designed to refresh the memory of the
participants, to clear up any misconceptions, and to help put them at ease, as

well as to gather data.

Intemiews

Iyoe. A standardized, nonscheduled type of interview was used.
"Standardized" (in relation to "nonstandardized") refers to collecting preciselythe
same categories of information from a number of respondents. "Nonscheduled"
interviews are those in which the interviewer has some choice as to the order of
questions and the freedom to attempt alternative wording. In the book
Wm. Gorden (1980) explained that
there are several situations in which the nonscheduled interview would be
capable of more valid measurement. He mentioned that this might be the case
in dealing with topics pertaining to private spheres of experience. He also

reasoned that the nonscheduled type is needed where communication is

65

inhibited by respondents’ "fading memory." He said that the interviewer must be

free to exercise "low topic control" and vary the sequence of questions. The

standardized, nonscheduled type of interview was deemed the best tool for

collecting the types of data I sought.

Inhibitnmndiagifiiam. Gorden (1980) described eight categories of

inhibitors and eight categories of facilitators in the interview process. He defined

inhibitors as any social or psychological barrier that impedes the flow of relevant

information by making the respondent unable or unwilling to give it to the

interviewer at the moment. Facilitators enhance the flow of relevant information

from the interviewee to the interviewer.

The categories of inhibitors listed by Gorden are as follows:

1.

2.

Competing demands for time.
Ego threat (withholding information that threatens self-esteem).

Etiquette (desire to avoid embarrassing, shocking, or threatening
the other).

Trauma (unpleasant thoughts brought to the surface from talking
about“)

Forgetting (inability to recall certain types of information).
Chronological confusion (often original conditions are forgotten and

subsequent conditions which are recalled are more readily
assumed to be true in the prior situation).

lnferential confusion.

Unconscious behavior. (p. 91)

66

The categories listed by Gorden as facilitators are as follows:

1. Fulfilling expectations (people tend to respond consciously or
unconsciously to the expectations expressed verbally and
nonverbally by another).

2. Recognition.

3. Altruistic appeals.

4. Sympathetic understanding.

5. New experience.

6. Catharsis (release from unpleasant emotional tensions by
expressing feelings).

7. Need for meaning (desire to fill the void between desired
knowledge and available knowledge).

8. Extrinsic rewards (rewards which motivate the respondent other
than those gained from the interview itself). (pp. 107-117)

In as many ways as possible, I attempted to manipulate the variables
involved in the interviews to decrease the inhibitors and to increase the
facilitators. The first four inhibitors listed above reduce the willingness of people
to communicate in interview situations. A skilled interviewer who plans well can
diminish those. The last four inhibitors listed above can render the interviewee
unable to give information. The style and timing of the interviews can minimize
those.

To eliminate or minimize competing demands for time, I made sure that
the times of the interviews were arranged at the subjects’ convenience. Not only
did ltell them how long I expected each one to take, ltold them at the outset that

I would Check with them after we had been talking for 45 minutes or an hour to

67

see if they wanted to break or continue. I followed that plan. To reduce the
chances of ego threat inhibiting the interviewees’ willingness to share with me,
ltold them that l have two adult daughters with ADD and conveyed empathy and
understanding of the disorder. To avoid the restraints of etiquette in our
communication, I told the subjects that I have been working for 18 years as a
counselor. My hope was that they would infer that not much shocks me. As a
professional counselor l have gained experience in clinical interviewing skillsthat
help to prevent trauma and to reduce people’s resistance to communicate.
One of the primary controls that I exerted over the inability of people to
give information wasthe use of the standardized, nonscheduled interview. I had
the flexibility to have almost informal interactions with them, inasmuch as I
allowed them to talk at length about a topic and to often go off on tangents which
elicited other relevant information that they might have otherwise forgotten. I also
sometimes asked them questions on a certain topic within various contexts,
which drew different memories or implications from them. Another control that
I exerted was that I interviewed them more than once and left them with the
understanding that we could have further contact if either of us thought of other
data that would facilitate the research. I often asked them questions during the
second interview that were similar to those during the first interview. Sometimes
they had thought of things between the two interviews that were helpful. These

strategies enhanced the ability to capture memories and to reduce some

68
Chronological confusion. There was not much beyond this that could be done to
minimize inferential confusion or to control unconscious behavior.

I also attempted to manipulate the variables that would increase the
communication facilitators. In the first place, the subjects were participating
because they were "fulfilling expectations." They had agreed with their
psychiatrist to participate. They were responding to her expectations as well as
to mine. I also took advantage of opportunities to express sincere recognition
when it was appropriate during an interview. This intervention contributes to the
desire of people to perform in an interview situation (Gorden, 1980). Explaining
to the participants the purpose of my research probably appealed to the altruism
in many, if not most, of them. They are all ADD adults who have had problems
in college. It stands to reason that they would find it worthwhile to participate in
research that they thought might help others in similar situations.

Gorden (1980) said,

The desire to be understood and to have someone offer a "sympathetic

ear" is seen not only in the therapeutic interview, but also in many

information-gathering interviews. . . . Interviewers who reflect a

sympathetic attitude and who know how to direct it toward the objectives

of the interview will find their percentage of successes much higher than

those who do not. (pp. 111-112)

Being experienced in conducting therapeutic interviews, I provided a sympathetic
ear when it seemed appropriate and conducive to the interviewing process.

Another facilitator Gorden (1980) mentioned in his list was the human

need for some form of new experience. Participating in thistype of research was

a first for all of the subjects. Many, if not all, of them told me after the interviews

69

how much they enjoyed the opportunity to talk about these things. Many of them
mentioned to me the catharsis this experience provided for them. Catharsis was
also listed as a facilitator of communication. In addition, for some of them, this
interview fulfilled a need for meaning-4t contributed to their self-knowledge by
providing some confirmation of what ADD can mean in their lives.

Beyond the benefits of the facilitators discussed above, the subjects may
have received no rewards. They were not paid to participate, and perhaps there
were no extrinsic rewards for them. Even so, they all seemed highly motivated
to be interviewed.

Gorden (1980) listed eight types of inhibitors to good communication and
eight facilitators. I consciously designed the interview in this study to minimize
the inhibitors to communication and to maximize the facilitators. In whatever
ways possible, I tried to plan and execute the interviews to produce the most
valid and relevant data possible.

I he interviewer. The interviewer is a variable that must be considered in
this type of research. I personally interviewed all of the subjects of this research
each time they were interviewed. No data from their communication with anyone
else provide information for this study. My personality and Characteristics are
those that would have a bearing on the respondents.

When Gorden (1980) discussed the appropriate interviewer, he said that
skill in interviewing is assumed. I have two graduate degrees in Guidance and

Counseling and 18 years working as a counselor. In addition, I completed a

70

series of graduate-level Classes in qualitative research methods, in which I
completed a project using interviewing for data collection. So it seems fair to
assume that I am proficient at interviewing.

Gorden (1980) went on to list four other criteria of the interviewer that
have a direct bearing on maximizing the flow of relevant information: overt
Characteristics (age, sex, race, ethnicity, social Class, manner of dress, and
speech), basic personality traits, attitudes toward subjects, and knowledge. I
was cognizant of these criteria and did everything possible to control my
approachability with the participants (e.g., dressed professionally, but informally;
matched my vocabulary to the individual; conveyed respect and empathy).
Although it is impossible to control all of these variables, I think that I did the best

that was possible for me to do.

DaIaAnaIvsis

The process of data analysis began when l was interviewing the
participants and continued through several months of scrutinizing transcriptions
and audiotapes. I began to see some patterns emerging even after interviewing
the first few individuals the first time. After I interviewed all of the subjects once,
I had the audiotapes transcribed. I studied the transcriptions, noting themes,
ideas, and areas for further investigation. lthen formulated questions for each
participant that I would like to ask him/her in a second interview.

I interviewed each subject a second time and audiotaped the interviews.

Afterwards, I listened to the audiotapes and took general notes about the

71
interactions. Then I studied my notes from the transcriptions and my notes from
the tapes, again noting themes and topics that emerged. I developed a coding
system and searched the data for regularities and patterns. Then I developed
assertions and matched the data with the assertions that I had formulated. I
selected assertions that dealt most specifically with college experiences, and that
had a substantial amount of supporting data. I then reviewed the data for each
assertion to be sure that the data matched my first impression. I altered the

assertion to convey each idea most accurately before writing my final analysis.

[1 'l' [Elm I

Seven participants provided data for this research. All of them were
Caucasian. Two of them were female; five of them were male. Their ages
ranged from 26 to 41. They had all attended college at one time or another.
They had all been diagnosed with ADD by the same psychiatrist. None of them
had any other major (significant or serious) psychiatric diagnosis. No clinical
data were available about the co-existence of learning disabilities. Two of the
subjects reported being diagnosed with learning disabilities, one was unsure, and
the others had never been tested.

Most of them (at least four) had not yet been diagnosed and treated for
ADD when they were in college. Two of them were diagnosed and treated during
their college careers. One of them was not certain how his diagnosis coincided
with his college career, but thought that it was either during his last year of

college or shortly before he completed it. Their amounts of college experience

72

covered a wide spectrum. There were two who had a year or less, and one who
had 2 years. Two had bachelor’s degrees, and one had a bachelor’s degree plus
a term of law school. One was in her third year of medical school at the time of
the Interviews.

Data about the experiences of each subject provide the evidence for the
assertions in Chapter IV. Chapter V includes a summary of each individual’s
case. The information in the following paragraphs and in Table 1 will present the

reader with a demographic skeleton to assist with understanding the data.

93111010335

Calvin Jones was a 38-year—old two-way radio technician at a major
university at the time of my Interviews with him. He had not completed high
school, but later attended some machine shop classes at the community college.
He successfully completed emergency medical technician training at the same
college, but then dropped out of the paramedical training that followed. He had
never been tested for learning disabilities and was not aware whether he had
any. He had been diagnosed with ADD 3 or 4 months before my first interview

with him and had not attended any college classes after treatment.
KeiIhJames
Keith James was a 35-year-old owner of multiple businesses when I

interviewed him. Following graduation from high school, he had the goal of

73

 

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76

obtaining a bachelor’s degree, but only attended 1 year at a small state
university. He was not aware of ever having been tested for learning disabilities.
He had been diagnosed and had begun treatment for ADD 6 to 9 months before
my interviews with him. He had not attended any college classes after his

diagnosis.

SallLSmflh

Sally Smith was a 34-year-old homemaker at the time of our interviews.
When she first graduated from high school, she wanted to earn a bachelor’s
degree and become a teacher. She attended a small private college for 2 years
and dropped out; then several years later she attended 1 year at a vocational
school. She reported that she was dyslexic in math. She had been diagnosed
with ADD and had begun treatment about 7 or 8 months before our interviews.

She had not attended any college classes since her diagnosis.

I' E l I'

Tim Franklin was a 39-year-old security officer and owned his own
desktop publishing business at the time of our interviews. Although his initial
educational goal was to obtain a university degree in photography, he received
an associate’s degree in law enforcement and later returned for a bachelor’s
degree in a nontraditional program for adult students. If he had any learning
disability, he was not aware of it. He had been diagnosed with ADD about 2

years before I interviewed him. He was uncertain about the relationship between

77

the time of his ADD diagnosis and the completion of his bachelor’s degree. They

had happened at roughly the same time in his life.

MikeMaxes

Mike Mayes was a 40-year-old benefits representative forthe United Auto
Workers at a major automobile manufacturing plant. His initial educational goal
was to obtain a law degree. He completed a bachelor’s degree at a small private
college and attended law school for one term. He had no knowledge of having
any learning disabilities. He had been diagnosed and had been receiving
treatment for ADD for 10 years when I met him. His diagnosis and treatment
began after he dropped out of law school, but he had taken some classes at the

community college after that.

Dalefloward

Dale Howard was a 26-year—old computer technician for a state
government agency at the time of our interviews. His initial educational goal was
to obtain a bachelor’s degree in music. Instead, he obtained a bachelor’s degree
in telecommunication from a major university. He had attended a community
college for 3 years before transferring to the university. He reported that he may
have been diagnosed with nonspecific learning disabilities during high school, but
he was uncertain. His diagnosis for ADD occurred during his community college
career--about 6 years before our interviews. He was receiving treatment for ADD

during most of his college career.

78
W

Kathy Johnson was a 41-year—old student in her third year of medical
school during our interviews. Her initial educational goal had been to obtain a
bachelor’s degree from a private university. She dropped outjust after beginning
her second semester, got married, and had five children before returning to
college. She was in her first year of medical school when she was diagnosed
with learning disabilities and ADD. She had received treatment for ADD, and had
been in school, for 2 years preceding our interviews.

In some ways the experiences that these seven individuals related to me
were vastly different; in other aspects they were similar. There were some
common themes that emerged when I talked with them, and those provided the
basis for the assertions that l formulated. The data presented in Chapter IV
produce the groundwork for greater understanding ofthe college experiences of

ADD adults and the ways in which they deal with these experiences.

CHAPTER IV

DESCRIPTION AND INTERPRETATION OF MAJOR FINDINGS

The data presented in this chapter are derived from interviews with seven
Attention Deficit Disorder (ADD) adults regarding the experiences they
encountered in college and how they dealt with their experiences. Their
descriptions of their encounters in college relate their emotional reactions and
their perceptions of their learning. The ways they say they dealt with their
experiences involve both day-to-day tactics and larger reactions and outcomes.

We:
EmoinnaLBQaQflQna

Selfiesteem. The first assertion that I can make is that experiences in
college often contributed to the diminishing of the self-esteem of these adults
with ADD before they were diagnosed. All except one of the subjects related
having low self-esteem sometime during their lives. For most of them, this was
especially true during their times in college before they were diagnosed and
treated.

Sally Smith went to a small private college right after she graduated from

high school. Her goal was to get a degree in education and become a teacher.

79

80

After struggling academically for two years, she dropped out. Sally related to me
the struggles that she went through during her two years in college. She told me:
I really shouldn’t have been accepted into college, but they take anybody
where lwent. And I really shouldn’t have been accepted because lfound,
because of my poor English skills, I could not write a term paper. . . . I
found that l was embarrassed, very embarrassed. . . . Ijust didn’t have the
skills to do it. So, it made me feel bad. . . .
Sally’s final decision that she must leave was because she "couldn’t do the book
work."
I empathized with her frustration and reflected, "That’s sad."
She said, "Yeah, Ithought it was sad and I was embarrassed. . .
She talked a little more about how overwhelming it was, and I asked, "And
how were you feeling about yourself by that time?"
"Um, emotionally?" she asked.
"Uh huh," I responded.
She thought a minute and then replied:
Confused. Confused and not really knowing what I was going to do with
myself and how I would support myself. I didn’t know what I was going to
do. Ijust decided that lwould have to leave. So after two years, I moved
back home.
Sally’s voice echoed the despair that she must have felt at that time.
I asked, "Were you thinking you were not smart enough or questioning
your ability at that point?"
Sally’s reply was, "Yeah, I really didn’t know what to do. I didn’t know

what was wrong with me."

A few minutes later in response to my query, she said,

81

. . . I knew that lwasn’t making it and I wasn’t going to get better. I had

two years into it and my class would graduate in two years and I wasn’t

even close to it. And, not only that, I couldn’t do it. And I realized that it
was an awful expensive playtime, so to speak. So, I realized I just
couldn’t do it.

She is an exceptionally attractive female physically and interpersonally,
and she admitted that her looks and pleasing personality had carried her along.
Her experience in college made it clear to her that those things couldn’t sustain
her in that environment. She left—confused and defeated. Even now, 14 years
later, she still doesn’t believe that she is capable of being successful in college.
The impact on her self-esteem was crushing.

Tim Franklin also suffered some crushing blows to his self-esteem while
he was in college, and he wondered if he was intelligent enough. Although Tim
had shown enough academic promise to gain acceptance into a major state
university with competitive admissions standards, he started college twice before
he finally became motivated to get an associate’s degree in law enforcement,
and then a bachelor’s degree many years later. Tim’s first attempt at college was
at a community college. He did so poorly there that they did not allow him to
return for the third term. Then he went to a university out of state and flunked out
of there, also. He told me he just "blew everything off."

As we talked about these struggles in his early years of college, Tim said
to me, "There were times I would wonder if I was smart enough. You know, if

this is something I’m capable of doing. Now, in retrospect, that’s a stupid

argument, but that’s something going through your head. 'Can I do this?"'

82

He also related how he felt in relationship to other students: “Well, they
must have something up on me because they’re just picking everything right up
and I’m struggling like hell and I’m treading water.“ It was obvious that Tim found
the situation frustrating and that his self-esteem suffered.

Mike Mayes had a lot to say about the way that his self-esteem suffered
in college. Mike sailed through high school fairly easily with a strong positive
self-concept. He was an athlete; he did fine academically, and his parents
provided a substantial amount of positive reinforcement. Then he went to
college, and the story changed.

Mike aspired to be an attorney and attended a small Catholic college to
get his bachelor’s degree. As an undergraduate, he was aware of having to work
longer and harderthan other students (especially his roommates), but his grades
were satisfactory, and he wasn’t overly concerned about his situation. Then he
attended law school for a year, and he really felt defeated. He related the
following scenario to me:

As things progressed at Woodrow [law school] and I started finding it

harder and harder to even get the C’s, that’s where I really began to feel

defeated. I think that’s where I really felt defeated and I didn’t know why.

Ithought, I’m putting in the time; I’m reading it—or at least I told myself I’m

reading this material. ltook the notes; I read; I studied; I did all the things

I thought were going to help me, but I was not getting it.

Mike drew me a verbal graph to illustrate what happened to his self-

esteem. He said,

If I were to draw a graph, you’d start from kindergarten and obviously you
work up and you progress. It probably would have peaked academically

83

somewhere between the twelfth grade and my junior year in college and
then you would be looking at a gradual decline.

“Of self-esteem?" I clarified.

"Um huh," Mike confirmed.

I said, "Okay. So, the first few years of college your self-esteem wasn’t
that bad. But law school really got to be the pits."

"It was the pits! It was extremely the pits!" Mike said emphatically.

With his self-esteem at an all-time low, Mike dropped out of law school
and soon afterwards got diagnosed and began being treated for ADD. His
diagnosis was approximately 10 years before my interviews with him. Since
diagnosis and treatment, he has been very successful in some classes that he
has taken at the local community college. These successes, he says, have
reinstated his self-esteem. He was reflecting on these experiences when he
said, “I’m convinced that, had I not had it stopped right after law school, I’d be a
sour old man. . .

Dale Howard and Kathy Johnson both disclosed feelings of low self-
esteem during high school and the early portions of their college careers. They,
however, were diagnosed and treated for ADD during their college years. Dale
was struggling through community college when he was diagnosed. He obtained
medication and behavioral therapy, and went on to earn a bachelor’s degree at
a major university. Relatively early in our first interview, Dale told me,

. . . l have always had very low self-esteem. . . . It’s like, ”How come you

can’t do this?" It was always, like, ”What’s wrong with you?" I knew
something. I knew I was different. I always knew I was different as a kid,

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but I didn’t know why. "What is up with me?" "Oh, I’m different. I’m not

like the others. Something’s wrong with me.” And then I got real
withdrawn.

In our second interview, Dale was telling me about his employment
positions since he had graduated from college, when the self-esteem issue came
up again. I observed and reflected to him, "You described yourself as quiet, shy,
and withdrawn when you were younger. . .

”Uh huh," he confirmed.

”Now you have these two jobs since you’ve been out of college that
require pretty high-level people skills. Do you think that your personality has
changed or what?" I inquired.

"I think I’ve learned to be more confident in myself," Dale replied. He went
on to explain in more detail:

I think part of my insecurities—l still have insecurities, but I mask them
pretty well, or at least try to. But I think the Attention Deficit Disorder was
probably a very good facilitator of keeping me shy and somewhat
withdrawn. I think that once I came to terms with what was going on with
me-—that I wasn’t stupid or that I wasn’t dumb—that there was actually
something facilitating this process-~then I could say, "Hey, these are the
opportunities I have; now I understand where I’m coming from and what
is the proper medication to help me focus." And it really helped improve
my self-esteem. . . .

Dale said that he had always had low self-esteem, but that it improved after
treatment for ADD.

Like Dale, Kathy felt "different" most of her life and related many stories
connected to an economically deprived childhood. Shetold me, "I can remember

being in high school and I really felt like everybody else walked around and knew

85
what they were doing all the time and I always felt like I was in a fog.” She rarely
felt like she fit in with classmates, and often felt ostracized.

She said that one of the things that led to her dropping out of college (the
first time she went) was feeling ostracized by the other students. We were
talking about the multiple reasons she had dropped out of college (i.e., the flu,
a snow storm, finding out she was pregnant), when she said to me,

I think I’d also begun to hit maybe a little bit of a stonewall, because I took

a psych. class and we were doing some stuff that was hard for me to do

and I think I felt one more time some of the ostracism that I couldn’t keep

up with everyone else in doing some things. And that was just another
subtle little thing of, "Okay, you don’t have to do this."

"So the fact that you felt different from other people motivated you to quit
because you didn't have to do it?" I asked.

"Well, it wasjust one more thing on top of everything else," Kathy replied.

Feeling ostracized and inadequate (indications of poor self-esteem) was
one of the reasons that Kathy dropped out of college. Fourteen years and five
children later, she returned to college. She graduated with honors from a small
state university and was in her first year of medical school when she was
diagnosed ADD.

Keith James and Calvin Jones are possible exceptions to the assertion
that experiences in college contributed to the diminishing of self-esteem in the
ADD subjects whom I interviewed. Keith is relatively well-read in the field of

ADD. We were discussing his knowledge of the subject when I said to him, "Do

you see yourself as having more or less friends than the ’average Joe?’"

86

“Many more," was his quick response. "And I know everybody. I know
everybody."

"Okay," I responded.

”Okay? That’s what everybody says about me. No matter where I go, I
run into somebody that I know."

”Um, I sense you feel real comfortable with yourself,and that you’re not
having any self-esteem problems," I observed out loud.

Laughingly, Keith responded, "How could you tell?"

I didn’t respond to his rhetorical question, butjust laughed knowingly, and
went on, ”We often talk about the self-esteem problems that ADD people have."

”They have extremely low self-esteem," Keith said.

"You see yourself as an exception to that?" I asked.

"Yes, I do," Keith said, and went on to explain why:

I am very different. Because of my father. My father had this attitude,

“You get knocked down; you get back up; you try something else. There’s

a ton of room in this world for you, Keith; you just find it." I mean, when

somebody tells you that, that’s pretty great. . . .

Keith James is self-confident and sees himself as having more friends
than the average person, but realizes that there is much in the literature about
the low self-esteem of people with ADD. He sees himself as an exception to this.
There is nothing in the data which I collected to lead me to believe anything
different.

Calvin Jones related to me that he had low self-esteem as a child. He

related to me that he had had to repeat the second grade. I said, "Do you

87
remember how you did feel about yourself? Like, when people were making
reference to you having been held back--to being stupid, to being lazy-~those
types of things, do you remember if you believed them or not?"

"Yeah. I believed them. I mean, at that age. I had very low self-esteem.
I was overweight, too, and that didn’t help any."

Calvin’s college expectations and career were somewhat different than
those of the other subjects. He did not finish high school, and did not go
immediately to college to seek a degree. He was asked to leave high school.
Some time later, he attended a machine shop class that his father was teaching
at the local community college. This was a positive experience for him: his
family owned a machining business, and he tells about "teaching the class."

Calvin’s experiences in college were probably colored by the fact that he
had expertise in the subject matter before he began the classes. Not only did he
have work-related experience before he took the machining class, he also had
work experience in the other field he pursued. A little later in his life, after he had
been working as a police officer, doing volunteer emergency medical work for
awhile, he completed emergency medical technician training at the community
college.

Since Calvin told me that he had had low self-esteem as a youngster, I
went on and asked about his self-esteem during his emergency medical
technician (EMT) training. Isaid, "Now, what about your self-esteem during your

EMT training?"

88

Well, I would say it was pretty good, actually. I was extremely confident

in what I was doing. I had a lot of support from co-workers and people

that I worked with. They would let me do things that they wouldn’t let
other people do. They were confident in my abilities and l was, too. So,
as far as that goes, I felt pretty good about that.

We didn’t talk specifically about his self-esteem during other periods of his
college career. (Later, Calvin dropped out of paramedic training and never went
back.) Keith James and Calvin Jones are possible exceptions to the assertion
that experiences in college contributed to the diminishing of self-esteem in the
ADD subjects whom I interviewed.

Experiences in college often contributed to the diminishing of the self-
esteem of these adults with ADD before they were diagnosed. All except one of
them related having low self-esteem some time during their lives. For all but two
of them, this was especially true during their times in college before they were
diagnosed and treated.

WWW. Like many students, most of the ADD
adults whom I interviewed felt that the personality (attitude) of their instructors
had an influence on their success in the classroom. Two of them directly stated
that their success depended on the teacher. Two others indirectly indicated that
instructors could influence success when they told of experiences about the
types of instructors to whom they related positively. Two subjects did not discuss

their opinions about college instructors, but supplied strong data in relationship

to elementary and secondary teachers. One subject was somewhat

89
contradictory in her responses about whether or not instructors make a
difference.

Keith James was satisfied with his academic success in college. Although
he attended only one year, his reason for dropping out was not due to academic
standing or struggle. As a matter of fact, he earned better grades at the
university than he had in high school. He attributed his success to luck in getting
certain professors. He said, "Considering what my high school was like, you
know, lthink I did quite well. lwas really happy with it. Igot lucky. Really lucky.
I had some great professors up there. I had a professor that taught me how to
read.“

Keith then went on to describe two of his university teachers who made
a keen impression on him. First he described a speed-reading teacher:

This old bird took me under his wing and he taught me how to read. And

. . . that’s what I remember about college. I remember him and the

physics teacher I had. And he taught me how to read and he taught me

how to speed read. He taught me how to sort and pick and do everything
that you needed to do to read. From then on, man, I was just a reading
idiot.

Afew minutes later, Keith elaborated: the instructor had taught him "to get
the main topics and cull the information and just pass over the stuff that’s trivial."
He said that what the instructor had changed was his attitude about reading. He
said that he used to hate to read, but "now I can’t find enough to read. I read
while I’m standing mixing feed. I read while I'm going down the road." To sum

up his memories of his reading teacher, Keith said, "It was only six weeks, but

it was the best six weeks I had."

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Then Keith went on to tell about another teacher whose personality/
attitude made a real impression on him: his physics teacher, whom he had
mentioned earlier. When Keith registered for the class, it had a rather vague
course title and he didn’t realize that it was a physics class until after the drop
and add period was over. When he learned that it was a physics class that he
had registered for, he exclaimed out loud in class, and the instructor told him to
stay after class. Keith told me the story this way:

So I stayed and he said, "What's the problem?"

I said, "My God, I’ve never had physics before in my life; Ijust
struggled my way through biology. What am lgoing to do? I can’t get out
of your class now; I paid all of this money. What am I going to do? This
is physics, oh my gosh, oh my God."

He said, “Do you live on campus?"

I said,

He said, "Well, I’m in this lab every night until 10:00. What I’d like
you to do is, tomorrow, come on down. If you’ve got your readings,

you’ve got your information. If you don’t understand anything, come on
down.“

. . . Well, it took about three weeks and l was setting up all the lab

experiments for him, was doing everything in front of the class with him.

What he did, he would teach it to me while we were setting up the project.

After Keith told me this story and the one about his reading teacher, he

summed it up by saying, “It’s exactly the same old thing of somebody not

knowing exactly what they are doing for a student, but he took me under his wing

and he said, ’These are the concepts. . . He said that with both teachers, a

difference was made in his life because they displayed a caring attitude and were
able to extract and relate the most important basic concepts for him.

In a later interview, Keith again talked about the importance of the

instructor’s personality. This time he was talking about the type of lecturer he

91

thought made an impact: ”What it takes is for someone to get up in front of class
and have a little bit of stimuli to them—then we’re ’suck city’: anything that comes
out of their mouth gets pulled right in." He related the physics instructor to this
concept, also. He said, "He had tons of fire. That man was a walking
firecracker--waiting for him to explode all the time. I learned a lot. He was good.
We never had an empty seat in that class. Everybody came to that class." Keith
definitely had some strong examples to support his opinion that the personality
and/or attitude of instructors influences a person’s success.

Dale Howard also stated directly that an instructor can "make or break" a
class. He told several stories of high school teachers who made a direct
negative impact on him. When I was asking him about his high school
experiences, he said, "I found very few of the classes that I had were really
interesting or inspiring. There were a few that, you know, the instructor really
made a difference in the class and it was fun to learn."

A few minutes later he was telling me about his main interest, music, and
I questioned him about what classes he had had. Dale said, "Oh, I played in
symphonic orchestra and I played an acoustic bass. And I played in the jazz
band as well."

I said, "And you did that throughout high school?"

Dale replied,

Yep, I played for four years, actually three and a half years, for the

orchestra, and then jazz band for one or two, and I quit that primarily just

because of the instructor. I didn’t feel he had the type of leadership and
inspiration qualities that would pull people together, and thistype of thing.

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Dale went on talking about his interest and experience in music, but I
brought him back to the issue of instructors: ”A couple of times now, . . . you just
mentioned something about an instructor. . . . I’m wondering if the kind of
instructors you had made a difference in the courses you selected?”

Dale affirmed my suspicion:

Oh, of course. I think that most people would probably say that in the

college experiences an instructor can really make or break a course.

They can have the same materialnit’s like telling a joke. One person can

tell a joke one way and have the timing down and, oh, it’s hilarious. But

the other person can deliver the same lines and it falls on the floor. . . .

Throughout my interviews with him, Dale said, for the most part, the
classes he enjoyed were based on the instructor. (However, he did tell about
one college writing class where he liked the class because of the writing project
he did, but he disliked and disrespected the teacher.) He was also very adamant
about the negative impact that the unpleasant personality of instructors had on
his college career. When he was struggling along at the community college, he
had two classes that he flunked because he quit going to class. Ironically, the
two classes that he failed because of lack of attendance were music classes, and
Dale is gifted in music. His primary interest for most of his life had been music.
He could play by ear, and he played in bands from the time he was 15 or 16
years old. His description of one teacher was, "The instructor in this case was

a real asshole . . . was just real negative, a real cynic: ’What do you mean you

don’t know!’ This type of thing. A real attitude."

93

Dale also attributed failing the other music class to instructor attitude. He
reported that he had been getting about a 3.5 (on a 4.0 scale) in that class when
he dropped it to play in a band. The teacher’s attitude, he said, was derogatory.
"What are you doing, dropping my class because you’re playing in a rock band!"
Then, the teacherjust told him to sign a drop form, and it was his understanding
that he would get a withdrawal grade based on his performance so far in the
class. When his grades came, he received a failing grade, which he partially
attributed to the teacher’s attitude and partially to the fact that he never pursued
an appeal for a grade change.

In a later interview, I asked Dale what advice he would give to college
instructors who knew that they would have some ADD students in their
classrooms. Part of his response to his question was that it is a matter of
instructor personality. He said,

From the classes I’ve had, there are good instructors and there are poor

instructors. There’s information and materials that needs to be

disseminated--that needs to be taught. It’s just like someone telling a

joke. One person can tell a joke one way and have half the room

laughing, and another person can tell the same joke and you’ve just got
dead air."
Dale also mentioned that even in lab-based classes he liked the "human
element." He didn’t like classes that he thought treated students like cattle and
just pushed them through. He definitely thought that the personality and attitude
of instructors were important to his success.

Tim Franklin and Calvin Jones implied that instructors could influence

success when they told experiences about the types of instructors to whom they

94
related positively. I asked Tim if the personality or methods of the instructors
made any difference to him. He answered affirmatively by saying,

The instructors that stayed with me were the ones that were more

dynamic, would interact with the class, would ask you questions. . . . So,

if they were moving around a lot in the classroom and keeping my

attention on them. . . .

So, although he didn’t come right out and say that the personalities (attitudes) of
instructors influenced his success, he did agree when I asked him about it, and
he gave examples of the types of behavior he liked in teachers.

Tim did so poorly academically that he had been withdrawn from college
before he finally settled on law enforcement for a major and then completed his
associate’s degree. He thinks the reason that he was successful that time was
because he was motivated by a career goal. Furthermore, he said that he thinks
one of the reasons why he liked law enforcement classes was because they
were taught by “ex-cops." He said,

You’re always taught by ex-cops and they always have these stories to

tell. When they tell stories they get excited and they start moving around

the classroom, and that would keep my focus. The guys that came out
and stayed in one spot, and get their papers out and start talking, would
lose me in a few minutes.

Cal had also struggled academically (was “kicked out" of high school) and
didn’t return to pursue training (other than one machine shop class) in college
until he was older. He told me about the pressure that he felt in classrooms,

which could either be exacerbated or alleviated by the personality of the

instructor. He was implying that the personality/attitude of the instructor made

95
a difference to him in his success in the class, but he didn’t acknowledge it quite
that directly until I asked him.

When we were talking about the types of classes he preferred, he began
to talk about how he felt pressured in some classes. He said,

I felt pressured because I might get called on and not know the answer--l

feel pressured because I don’t know these students and I don’t know this

instructor. I’m uncomfortable and I’m thinking of all these things that could

go wrong. . . .

In his emergency medical technician training, he said the class was made
easier because he knew the instructor ahead of time and he didn’t feel like he
had to prove himself. Then, he went on to paramedic training and contrasted the
way he felt in the presence of one instructor with the way he felt with another
instructor.

During the middle of this discussion, I said to Calvin,

Several people have told me that the personality or attitude of instructors

they had in class made a big difference. It sounds like in this case it made

a difference because you didn’t feel the pressure or intimidation—you

didn’t have to prove yourself.

"Right, right," Calvin responded.

"Do you remember any other classes where the instructor made a
difference?" I asked.

He told about his cardiology instructor: "She was one that, if you didn’t
know it, she’d just pick at you, chip at you. . . . It just made that, ’Oh, my God!’

you know a hundred different things go zipping through my head." He said he

had a lot of problems with her.

96

Another instructor’s personality, Cal related. created a much more posi-
tive atmosphere for him to learn in. In describing that situation, he said,

That was much more laid back because that was her personality. She

was an RN. and the whole nine yards, and she was a very easy person

to get along with. . . . She wasn’t so inclined to make you feel little
because you didn’t know it right then and there.

"And the other one, the one that picked at you?" I asked. "One of the
feelings that you had, at least with her, was feeling belittled?“

"Yes, very much so, because then I’d feel inadequate and the whole nine
yards. . . Calvin responded.

After I questioned them specifically, both Tim Franklin and Calvin Jones
seemed to support the assertion that the personality/attitude of their college
instructors influenced their success.

Sally Smith and Mike Mayes did not discuss their opinions about college
instructors, but they supplied strong data in relationship to elementary and
secondary teachers. Much of Sally Smith’s academic life was a struggle. She
told me that, from year to year throughout her entire life in school, her success
depended on whether or not the teacher liked her and she liked the teacher. I
asked her, "What kind of grades did you get in elementary school?"

"Each year it varied," she said, "depending on the teacher. One year I
would just do terrible, and the next year if she believed in me and I liked her, then
I would get B’s."

A few seconds later she was talking about her college experiences and

how terrible she was in English, when she said, . . although in freshman year,

97

I received a B in English class, which would be incredible, but I liked the teacher.

I asked her to try to generalize and tell me if the teachers she liked had
anything in common. She said, "They paid attention to me. . . . They liked me as
a person. They paid special attention to me. . . . They believed in me. That is
so important."

Mike Mayes didn’t relate much to me about the personality/attitude of his
college instructors. He did, however, relate a story of a high school math teacher
who intimidated him so badly that he never took math again. He was telling me
about his academic achievement when he said, "My hardest courses, I think,
were math."

"Were they?" I asked.

"Uh huh," Mike replied. "Algebra totally. . . . However, I feel the instructor
was intimidating."

"Now, this was college math?" I asked for clarification.

"No, this was high school math," Mike clarified. "He was an intimidating
figure to me, anyway. And, at that age, I still wasn’t into the groove of asking
questions or being in front of a class saying, ’I don’t understand it,’ when
everybody else did."

"Sure," I supplied to indicate understanding.

"So, ultimately, I barely. . . Mike broke off and went on, "That was my

weakest and it scared me to death from ever taking any further math class. . . ."

98

Next, I asked Mike, "Do you remember what he did to intimidate you?"

Mike said,

I think it was his teaching methods more than anything, and maybe just

his physical appearance. I know a lot of the girls in the class didn’t like

him, and some of them even dropped out of the class. He was the

football coach . . . and he had that coaching demeanor with him in the

classroom. . . . At that age I was intimidated.

"Do you think you had math trouble before?" I asked.

"No," Mike said without hesitating. "In fact, ldid relatively well. Iwon’t say
I was an A student, but I was about in the B’s."

Other than a modern math class that was required for college graduation,
Mike never went near another math class after the teacher/coach experience.

Kathy Johnson was somewhat contradictory in her responses about
whether or not instructors make a difference. When I asked her if she felt that
the personality or attitudes of instructors had anything to do with her
performance, she said no. But the context of her responses leads me to believe
that she wasjust focusing on her current medical school instructors, because she
said, "In medical school you are just a number." However, in a later interview
she went into some detail telling me about a physician who had been one of her
instructors the previous summer. Kathy stated that he was really good because
he was a "down to earth" person. Furthermore, she mentioned an instructor she

was scheduled to have in the future that she was really looking forward to

because he had a similar reputation. So Kathy sees no relationship between her

99

success and the personality of her instructors, but she does enjoy the classes

that some teach more than others.

Eerceptionufleaming

WWW. Most of the subjects in this study
reported that they believe they have serious inadequacies in English or math or
both. For the most part, these observations are their own (except where noted
in the anecdotes below) and are not substantiated by standardized test results.
These observations of theirs were unsolicited. I had no question in the interview
guide about their performance in any specific course of study. Two of the
subjects mentioned inadequacies in English; three of them mentioned
weaknesses in math, and one mentioned weaknesses in both areas.

Kathy Johnson, the medical student, told me,

One of the most difficult things that I find to do is composing. And that will

probably never be easy for me. My vocabulary is-l had it tested—l think

it was about a seventh-grade level. . . . I swear I’m going to keep records

that a street person could read because I don’t know if I’ll ever be

comfortable with all those Latin words and that kind of crap.
Kathy had recently undergone a complete series of testing and was well apprised
of her learning disabilities. She was weak in verbal skills, and she knew it.

Tim Franklin said his reading and writing skills are good, but he hates to
write and his spelling is terrible. Relatively early in our first interview, I asked Tim

if he had ever sought out any support services in collegeulike study skills or

reading classes. He responded, "My reading is excellent. When I went to State

100

and went through their entrance exam and all that and the reading exam, it came
out way up. . .

Later on in the interview, I questioned him about his writing skills. I said,
"I think you told me that you like to write."

Tim replied, ”I hate to write, but I have good writing skills."

Later still, when we were talking about Tim’s expertise with computers, he
told me, "What got me started into computers is that I can’t spell worth a damn."

"You cannot?" I queried.

"I cannot spell," Tim reaffirmed. "And I think that goes back to spelling
means concentration, repetition. And I could never sit and do it. Computers
have spell checkers. . .

It is interesting that Tim’s current passion is desktop publishingua skill he
taught himself after being introduced to the wonders that computers could do to
assist him with writing and spelling.

Mike Mayes, Dale Howard, and Calvin Jones all said that math was
difficult for them. Mike Mayes wasn’t sure why his math skills were weak, but he
felt that they were. He told me: "My math was very weak. . . . I don’t know if it
was just my lack of interest, the instructor, a combination of my problems, or
what. I didn’t do well in algebra, and ultimately I avoided a lot of math classes.
. . ." (He is the subject who was mentioned earlier as being intimidated by the

football coach/math teacher in high school.)

101

Dale Howard attributed his lack of math skill to his dislike of the subject
and his inability to focus long enough to practice the skills. He said, "I hated
math. And the reason I hated math was practice; procedurally you have to go
through, you know, the sequence of events, and you have to practice, practice,
practice. And I could never keep my concentration on anything." Later he said,
"I was very poor in math. And it wasn’t because I don’t have the mind for math
or nothing like that; it was, ’I hate it; it’s a pain in the ass. I can’t concentrate on
it and I don’t want to do it.’" Dale, like Mike Mayes, had mentioned being
intimidated by a football coach/math teacher in high school. Dale felt the
inadequacy in math, but did not feel that it was an intellectual lacking.

Calvin Jones, who has become a very accomplished electronics
technician, declared that he never could do math: "Math was one of my worst
subjects. I’ve never been able to do it. My mother, we would spend hours and
hours and hours, and I’d be accused of being dumb and lazy and don’t want to
do it. Oh, geez, it was really something." Calvin didn’t attribute his lack of math
to anything in particular, but at one point he did say that he now realizes that a
lot of his high school problems were due to his impulsivity. Math was the worst
part of a terrible entire K-12 educational experience that ended in his being
expelled.

Sally Smith is convinced that she is terrible at both English and math. She

is absolutely convinced that her lack of English skills was her nemesis in college.

102
She said that she never should have been accepted into college because of her
poor English skills.

Throughout both of my interviews with her, Sally repeated over and over
again that she failed at college because she could not write a term paper. At one
point when she was expressing fear about having to go back to college to
support herself, Sally said, "I couldn’t write a term paper to save my soul!"

I tried to reassure her a little bit by telling her about some support services
available at the community college where she plans to attend. She said, "I don’t
even know if I can do it. . . . I couldn’t write a term paper. I haven’t got the
faintest idea. . . . I don’t know."

I said, "I know you’re really afraid of term papers."

"I am," Sally said. "My English is extremely poor."

Since I had heard this same theme several times, I said, "But you speak
very well. You’re very, very articulate."

She said, "Everybody tells me that, but I cam put it down on paper."

We went on talking about how ovewvhelming the thought of returning to
college was for her, and she said, . . And math, you might as well forget that--l
am terrible at math. I mean awful. I remember taking one elementary math class
at Nesbitt and l_c9_uld_ngj_d_o it." She dragged the words out for emphasis,
and then went on, "I could not get it. All of my roommates were taking it. . . . I
would study right along with them and get it and then go in and take a test and

Iflunked..."

103

A short time later we were discussing her experience at the vocational
school where she got her medical assistant training. I said, "But, I think maybe
you’re discounting your Rotman experience a little bit."

"Really?" she asked. As soon as l reaffirmed mythought for her, she said,
"I didn’t like it. They had record keeping, and I didn’t like that because I also
have dyslexia: l invert numbers. . .

Sally feels very inadequate about her abilities in both math and English.

Keith James is the one subject who never mentioned any feelings of
academic inadequacy. This could be for a variety of reasons. It could be
because the topic was never broached. It could be because he doesn’t feel that
he has any inadequacies, or it could be that he didn’t want to disclose these
weaknesses to me. I tend to think that he doesn’t feel much inadequacy in the
academic arena. He told me that he has thought about going back to college
now to become a psychologist, and didn’t mention any concern about his lack of
ability. He also disclosed some pretty personal things to me. Near the end of
our second interview, I prefaced a question about the relationship between ADD
and his family relationships with, "This might be something you’re not
comfortable disclosing. If not, just tell me and we won’t talk about it. . .

Keith responded, "Hey, this will probably be the last time I see you again
the rest of my life or material written by you, or I might call you for guidance, but
I’m never going to see you again and I’m not easily embarrassed. . . He went

on to talk about some things that had gone on in his marriage/family life. I

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believe that he wasn’t trying to hide his weaknesses, that his self-esteem was
positive.

Lackptjogus. Not surprisingly, there was one assertion that all of the
subjects substantiated resoundingly. They all related lack of focus—~all of them
in the classroom, and some while studying as well. All of them said that a
problem they had was staying focused in the classroom. Seven of them said
they fell asleep or daydreamed in classes. Four of them said that they had
difficulty focusing while they were studying. Focus was definitely a problem for
these ADD people while they were in school.

Much of what Dale Howard said about his lack of focus in the classroom
related to his K-12 school experiences rather than his college experiences. This
could be because he was diagnosed and treated relatively early in his college
career so that maybe he didn’t experience so much of a lack of focus during
college, or it could be that my line of questioning didn’t draw out his memories
about college adequately in this area. He said, . . I had difficulty in
concentration or focusing on anything. I didn’t know it; Ijust thought I was just
plain lazy." Later, when he was talking about how much he hated math, he said,
"And I never could keep my concentration on anything. I really tried. . .

Calvin Jones also told me that his mind wandered in class, that hejust got
bored. He also told about how stress and fear in the classroom exacerbated the
problem for him. When he told about one instructor whom he especially disliked,

who "chipped away" at him if he didn’t know an answer, he told about the type

105

of stress and lack of focus that created. When I asked him to describe that
experience, he said, "Like, ah, what the other people in the class were thinking,
will I ever get through this? A lot of stressful feelings that I can rememberumy
hands would start sweating and I’d almost start shaking." He explained that his
reactions depended on the subject matter: "If I was into it, it was not a problem;
if I kinda, like I don’t know, it was a problem and I had all these things race
through my head. . . ."

Sally Smith also talked about her head always racing. She said,

And my mind, my mind was always racing, but I never wanted to look

strange so I always had to be in control and appear very relaxed and, so

to speak, and don’t want to be stared at. Ijust had to learn that your head
is always racing on to the next thing, on to the next, never enjoying the
moment. Looking at the clock always; I only have to sit here an hour. If

I can sit here for an hour, this will be over, this will pass. I’ll be on to the

next thing. And feeling that way after only about three orfour minutes, it’s

difficult.

In a later interview, she said that she could only stay focused about ten
minutes of an hour. When she discussed a data-processing class that she had
taken at the community college after her vocational school experience, but before
her diagnosis and treatment for ADD, she said, "It was beyond me; I couldn’t stay
focused." She did say that she had more success in staying focused at the
vocational school because she was more interested in the subject matter.

Similar to Sally, Mike Mayes mentioned not paying attention in the
classroom, but covering up for it well. He said,

. . . Well, it wasn’t that I was distracted formally. I mean I was doing one

of these numbers: looking right at the instructor and he or she probably
believed, "This boy’s attentive," but it was going right through. I mean I

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wasn’t hearing a word they were saying. I was hearing it, but I wasn’t
grasping it.

Later he explained this concept further:

. . . I really looked attentive, but I’m watching the second hand on the

clock behind you or I’m looking at the fly over there or I’m listening to

anything--the clock ticking, the fan running. It could be any number of
things. And, like I said, I was good at masking it.

Kathy Johnson also had a lot to say about her lack of focus in the
classroom. She said that she didn’t notice it so much as an undergraduate, but
when she got to medical school, it became very apparent. She said, "I did
experience some difficulty during my first year before diagnosis; I had begun to
experience some difficulty in being able to really tune everything out. . . . My
attention wanders really bad when I listen to lectures. I really have a hard time
with that." She gave a specific example of what happens to her now that she is
in the clinical portion of her training; she said, "People start talking and it’s like
the words run together, and there are times when I can just feel myself fade right
out and come back. And I say, ”Okay, now, what are they talking about?”

Tim Franklin and Keith James also complained of a lack of focus in the
classroom. The examples they gave most specifically illustrate the problem that
so many of them talked about—falling asleep or daydreaming. Tim said:

I remember trying not to fall asleep a lot. Being bored . . . daydreaming

a lot, not picking up on the instructor. It was very hard to focus on what

he was saying and stay on track with him. This was probably the hardest

thing in college or even high school. I’d get one of these guys that wanted
to lecture and either I would start falling asleep or I’d start daydreaming
or something else would happen. I was a great doodler when l was a kid.

. . . Never really stayed on track with what the central focus should have
been. I was off in different directions.

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Keith James mentioned doodling and sleeping, also. When I was talking
with him about his preferences in instruction, he began talking about boring
lecturers. I said, "What happens when you get in a class like that?"

His reply was, "Zzzzzz [feigned a snoring sound and closed his eyes] . . .
or draw or play--doodle."

Other subjects also mentioned falling asleep in the classroom. Calvin
Jones said, "I’d sit there, and the prof would be talking or something, and I’d start
nodding off. It wasn’t because lwas tired! Ijust can’t sit through it. I lost interest
in it or something."

Kathy Johnson said, "The second year it was really bad; sometimes I’d
sleep through 15 minutes of an hour lecture."

Mike Mayes said, "Lecture classes literally would put me to sleep. . .
(But then he reiterated that he wouldn’t look asleep because of his Catholic
school upbringing, which taught him to look attentive.)

Although Dale Howard was the only subject who did not complain about
falling asleep in class, he did talk about daydreaming in the classroom and the
problems that created. He said,

My attention, you know in terms of listening skills, were pretty poor. . . .

I mean like the instructor would be talking about something, and most of

the time I’d end up daydreaming and then caught in the situation: "Okay,

Dale, would you show us how to do this particular problem?" and I didn’t

Egogwhat he was talking about. I’ve been caught in that position a few

The situation of becoming inattentive in the classroom was definitely a

problem expressed by all of the subjects. Most of them also expressed

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frustrations over the related problem, losing focus while studying. Dale Howard
recalled instances when he was supposed to be studying and something else
would attract his attention. He intended just to delay momentarily, to be with a
friend, read another book or magazine, or pay attention to some music, but his
delays would be more than momentary.

Mike Mayes told poignant stories about the way that he would agonize
over his studying, spending at least an hour each study session longer than his
roommates, only to produce less. He said, "I didn’t want to fail. Ldjdnotwamjo
fall. So lfound myself reading and rereading. And sometimes I didn’t know ifl
knew what Ijust read." A little earlier he had told me he was distracted by every
movement. He said if he sat by a window and even if he saw the shadow of a
bird that flew by, it distracted him. In the final analysis, he compared his
effectiveness while studying to that of a stockbroker. We were discussing the
fact that he was working a lot harder than most people, but not doing as well. He
said, "I wasn’t getting a return on my investment. I mean, if I were a stockbroker,
l was a failure. I was not getting a good return on my investment."

Kathy Johnson mentioned this same type of poor return on her investment
when we were discussing her knowledge about ADD, and I asked her how she
saw that it has affected her academic life. She said that it explained some of her
difficulties with "staying on task." I could hear the frustration in her voice when
she said, "I did spend a tremendous amount of effort making myself stay on task,

and I just assumed that that was the way everybody was."

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Keith James didn’t complain of a lack of focus while studying as much as
some of the other subjects did, but he did mention it. The context in which he
mentioned it was that he had more difficulty studying in the dorm than he did
when he was out on the road playing with his band. He said, "I did better on the
road than in the dorm; in the dorm I’d get screwing around."

Since inattentiveness is one of the primary characteristics of ADD, we
would be surprised if these subjects did not complain of a lack of focus in the
classroom or while studying. All of them did issue this complaint in one way or
another. Most of them related in great detail, over and over again, the types of
problems this created for them.

MW. Most of the subjects of this study said they are visual
learners and they prefer hands-on instruction over lecture-type. As was
discussed above, many of them reported falling asleep during lectures. Six of
the subjects definitely stated a preference for visual, or even hands-on, learning.
Three of them specifically mentioned preferring hands-on types of learning
activities. A seventh subject possibly preferred the auditory, but was unclear
about her preference.

Calvin Jones is definitely a visual learner, with a preference for hands-on
experiences. When I asked him what types of classes he preferred in college,
he said,

The hands-on stuff--actually doing injections, actually drawing the fluids,

things of that nature; the hands-on was much better than sitting through

two hours of lecture on the pharmacology and that type of stuff.
Cardiology was interesting because we got to do hands-on stuff--running

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strips, run EKG’snthat was pretty interesting. Anything that was hands-
on.

Calvin also told me about hands-on learning that he does even now in his career
as an electronic technician. He said he rarely reads instructions when he
assembles something, and when he designs something he often builds it before
drawing it on paper.

Keith James also stated a preference for visual and hands-on learning.
He attributed his preference to his poor reading skills when he was in school. He
said, "If you’re a poor reader, you have to have some way to take the material
in." He also referred back again to the positive experience he had with his
physics teacher, who had Keith assist with the laboratory demonstrations. Keith
learned that way. Other subjects he had enjoyed were photography and graphic
arts, project-oriented classes.

When Tim Franklin was relating to me the type of instruction he preferred,
he told me that he liked the use of visuals. He said, "If they had something that
they were showing me, describing—you know, pictures, . . . I guess I’m looking
for stimulus, something to keep me interested." Tim also specifically mentioned
a liking for hands-on learning. He said,

In photography, we did a lot of hands-on, which, obviously, I was back in

my element so I did well. In law enforcement we did a lot of hands-on . . .

defense tactics, driving, search and seizure, approaching cars,

approaching people. You know, a lot of different things they’d have you
do, have you practice on.

As Tim said, he liked to be stimulated. Classroom activities that included hands-

on or other visual learning stimulated him.

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In response to questions about his learning style preference, Mike Mayes
did not express so directly a preference for hands-on, but he did express a
preference forthe visual. He mentioned liking classes especially for that reason.
When he talked about falling asleep during lectures, he said that illustrations
helped keep him focused:

Any time there were classes that, for instance on the blackboard there
were illustrations, that would keep my attention. . . . Also, if I were
distracted, I could come back and I had something there to put me right
back on track. Where a lecture, if you’ve lost two or three minutes of his
lecture, then try to focus, you’ve missed it because there is nothing there
to bring you up to speed.

Mike also said, "Maybe that’s one reason I liked accounting so much,
because you could always read your book, but you always had your little
problems on your forms--your paper set up to do that-~and it was systematic and
that’s why I think I liked it." After discussion of his classroom preferences, Mike
also mentioned preferences for hands-on and other visual experiences in his
training for his current job.

Kathy Johnson knows she is a visual learner—the psychological testing
she had done to diagnose her learning disability disclosed an auditory processing
deficit. Kathy explained to me,

I think I have always kind of noticed it, but it really became apparent in

anatomy class, and that really threw me the first quarter because people

would be talking to me, be rambling off these long words and everything,
and they’d be two or more questions on down the road and I’d be still
deciphering and putting together what that question was.

Later, she said, "I think I used my visual a lot." Obviously, she did; she was in

her second year of medical school.

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Dale Howard didn’t go into a lot of detail about his learning style
preferences, but he did say that he had poor listening skills, so I conclude that
he prefers the visual. At one point I thought that perhaps he was going to say he
didn’t like hands-on learning because he expressed displeasure with a science
laboratory he had experienced. However, upon close scrutiny, lfound that it was
not the hands-on activity that he objected to, but the lack of what he referred to
as the "human element."

We were discussing the types of classes that Dale liked and disliked when
he was in college, when he mentioned a certain science class that he had taken
at the local community college, which has an independent learning lab as a part
of it. I said to him, "Somebody else mentioned that very class to me earlier
today, about liking it because it gave an opportunity for hands-on, you know,
more of an experiential learning rather than. . .

"The lab, yeah," Dale said. "The physics class was like that, too. But
actually, quite honestly, I thought the labs were a pain in the ass."

"Did you?" I stated, hoping for more information.

Dale went on,

You know, I liked the idea of discovering and so forth, but the way it was

presented was, "Here, go in here and scratch these rocks with a hardness

tester, then go over here and. . . ." So it was, kind of like, Ifelt like, you
know, cattle. "Come on, move through and finish the project and then
move on; next!"

"How would you have liked it to have been?" I asked.

Dale said,

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Having the instructor there, going over the lab and then showing,
providing example, and then after providing example, having everyone
initiate it and going through and doing it. . . . But I just like the human
element interaction when you can have someone there to demonstrate
and then you can go through and discover stuff and have that interaction.

Dale seemed to prefer not only the visual, but also to have an instructor
available with whom to interact.

Sally Smith related negative memories and extreme feelings of
inadequacy. She said that she liked lectures, discussions, and paperwork, but
she cheated on her labs. When she said this, she was referring to experiences
at the vocational school, where she obtained certification as a medical assistant.
However, the vocational school she referred to as "pretend school, not real
college." I am not sure that she would view her preferred learning style in "real
college" the same way that she described these. In any case, she was the one
subject from whom I did not obtain clear data about this assertion. It could be

that she prefers the auditory--or it could be that she just wasn’t clear in her

explanation.

ll WII D IIII'II E .
Dafimuaflacfics

W. Many, if not all, colleges and universities
currently offer support services for students with special needs. This might or
might not have been true when and where these individuals obtained their
educations. However, it is true that most of them did not seek out special

support services. Four ofthem didn’t seek out the services, or didn’t want to use

114

them. One individual said that support services didn’t exist at the university he
attended (my guess is that maybe services existed, but that he was unaware of
them). One individual said she tried some support services and they didn’t work.
She later went to a vocational school and said she never used support services
there. There is one definite exception to the assertion that these students did not
use support services: one student had sought out and used every possible
mechanism she could to enhance her success.

Calvin Jones did not elaborate about why he did not use any special
support services while he was in college. I asked him, "Did you use any special
accommodations as far as helping you with your studying, like tutoring or
assistance with test taking or anything like that?"

He simply answered, "No," and I didn’t pursue the line of questioning any
further.

When I asked Tim Franklin a similar question, his response was, "I was
not interested."

Later, within a different context, Tim and I were discussing whether or not
his decision not to seek tutorial services was because he didn’t want to feel
singled out. He told me, "No, I didn’t want to socialize with people. When you’re
dealing with tutoring, you’re dealing one-on-one with somebody I don’t know. I
don’t know how I’m going to react to it."

He paused a moment and then reiterated and clarified by saying, "I don’t

know how I’m going to react with it. I don’t want to deal with it. . . . I remember

115
looking. I knew they were there, but just no. I didn’t want to get into that
situation."

Dale Howard had received special supportive services when he was in
elementary school and high school, but did not use them in college. At one point,
when he was telling me about having a math tutor in high school, I asked him if
he ever used tutoring in college. His response was, "No."

I questioned him about support services further by asking, "Did you ever
have a study-techniques class or reading class or anything like that?"

Again, his response was "No."

During my second interview with Dale, we were discussing what advice
he would have for college instructors who have ADD students in their classes.
His main theme was that, as an ADD student, he would not want to be singled
out. He described to me his feelings of alienation from the other students that
had been generated when he had to leave the classroom to obtain special
learning assistance in elementary school. He wouldn’t want others to have
reason to feel like that. He said, rather sardonically, "I wouldn’t feel like I’d want
a press release sent to the instructor: ’Hey,’" raising his voice, he continued, "’I
have a deficiency, so just in case I don’t do well on a test it’s because I have
ADD.’" He was very adamant about not wanting to be singled out.

Following that discussion, I said to him, "I know you didn’t use any

accommodations because you didn’t want to be different, but do you know if

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there were any accommodations available at the community college or university
when you went there to assist you if you had wanted them?"

Dale’s response was, "Yes, I think there was like a Learning Resource
Center. I think most universities have that. I think the community college had
that. lnever took advantage of it. ldidn’t feel likelneeded it. The classes lwas
taking I was doing quite well in." My guess is that Dale might not have done
quite as well in his classes if he had not been diagnosed and treated for ADD
relatively early in his college career. Of course, there is no way of knowing
whether or not that would have made any difference in his use of support
services.

Mike Mayes made it all the way through undergraduate school and into
law school without using any support services either. When I asked him about
the availability of them, he said:

I know there was tutoring, which I never took advantage of. And, I guess

I was just like one of these people, for whatever reason, "I don’t have a

problem." lknew I did, but lwanted to deny it. And I didn’t want to admit

that maybe I’m not quite as smart as these guys. That was kind of my
approach more than anything. I hid it.

Keith James didn’t think that the university that he attended offered any
support services. When I questioned him, he said, "I went to Southfield State
University, and they never offered anything."

Perhaps some surprise was evident in my voice when I said, "They
didn’t?"

Keith replied, "No, at that time there were no support services."

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When Sally first went away to the small private college to pursue a
teaching degree, she felt like she tried all of the support services possible and
still didn’t succeed. She related the following:

. . . I tried having tutors; I tried taking classes over, and I would fail them.

And I couldn’t do it. . . . I tried a type of, teaching you how to study, that

type skill—it was a class--a four-week help type of class, but it didn’t help

me because I didn’t have the background. I couldn’t write a term paper.

I couldn’t try to get 12 years of school in four weeks in a self-help class.

It wasn’t going to work.

In a second interview, Sally and l were discussing her experiences at the
vocational school where she received her certificate in medical assisting. When
I asked her if she used any special accommodations there, she said she never
tried them. She didn’t say whether she knew if they were available or not.

Kathy, the subject I interviewed who was in medical school at the time,
had used just about every special support service imaginable. She used tutoring,
counseling, an MCAT preparation course, phonics instruction at Handicapper
Services, extended time limitations, and support and tutoring from a special
services assistant in the medical school. She is a distinct exception to the
assertion that these individuals didn’t usually seek special support services.

She took special preparation courses when they were available to her.
Before Kathy took her MCAT exam for admission into medical school, she spent
eight weeks during the summer on campus in a class preparing for it. Then, after

acceptance but before beginning medical school, she attended another special

preparation course to give her a head start in medical school.

118

During Kathy’s first year in medical school, she was doing poorly in her
classes and was diagnosed with a learning disability. This sparked a mild
depression for her, and she sought assistance. She told me, . . I went down
and talked with the assistant director down at the Southfield campus, and she put
me in with a counselor. I began to do some work with a Ph.D. at the Southfield
campus."

The next accommodation that Kathy took advantage of was extending the
time that she took to complete her schooling. She said, "I went into Thanksgiving
break saying, ’l'm going to quit.’ And they’re like, ’extend, extend.’ . . . And I was
like ’Okay.’ So I extended, and it backed off my load tremendously."

Kathy told me also of other support services that she sought and used.
She said, "I went to teachers sometimes if I needed a little bit extra, to get a little
bit of something extra on the side ifl needed it. . . . I worked with someone over
in Handicapper Services and actually went back and did second-grade phonics."

During her second year of medical school, Kathy again had trouble and
thought about quitting. Again, she went to the assistant director. This time the
administrator referred her to someone for special assistance. Kathy said, "And
at that time she hooked me up with someone at Southfield who does a lot of
tutoring with students, and 'second semester was much better for me, much
better."

This special tutoring assistant in the medical school has been extremely

beneficial to Kathy. The person was doing some consulting out of the country at

119

the time of my second interview with Kathy, and Kathy told me, "When she
comes back, I’ll live in her lap." It is obvious that Kathy will go to any length to
seek support services and to be successful.

It is interesting that Kathy, the person who has achieved the highest
degree of academic success among the seven people whom I interviewed, is
also the individual who has sought out and used the most support services. It is
difficult not to wonder about cause and effect in these cases. Most of the other
individuals didn’t show the interest in support services and didn’t want to use
them, didn’t think they needed them, or didn’t think any existed.

WW. Because these ADD adults have related
such explicit stories about being easily distracted, we might jump to the
conclusion that they prefer a study environment that is completely isolated and
free of distractions. I found that this was not true for many of them. At least
during the time period before they were diagnosed and treated, many of them
preferred a study environment that was not completely quiet and isolated. Four
of them expressed a desire for some extraneous stimuli while they were
studying; two said they liked to be completely isolated, and incomplete data were
obtained from the seventh subject.

When I first asked Kathy Johnson about her best study environment, she
told me that when she first started college she couldn’t study at home, but would

go to the community college cafeteria to study. I thought from her comment that

120

she preferred complete isolation, so I clarified, . . I want to make sure I heard
you clearly: your best study environment is to completely isolate yourself?"

Her response surprised me when she said, "Yes, but in a very busy
environment. Because when I went from community college to Southfield, it took
me awhile because I didn’t find that it worked well in the library because
everybody was quiet. . . . And what I ended up doing was, I had a restaurant
where I’d go sit with a pot of coffee and the restaurant noise was the background
noise, but I was focused on what I was doing, and that was what really centered
down for me."

From this description I was about to infer that what she needed was some
background noise, so I said, "So there has to be some background noise?"

She said, "Yeah. And it’s not a TV; it’s not music or anything like that. It’s
people noise, but noise that I don’t have to think about--that really is not part of
me and I don’t have to respond to in any way."

She told me that she had never used music much as noise to study by—
that she didn’t think the radio was quite "where it’s at" for her. She summed up
her discussion of her ideal study environment by saying, "But I do know that I use
that background as a way of, I don’t know, walling myself off and really being
able to concentrate."

When Keith James described his ideal study environment to me, he
described his present situation. Even though he is not currently in school, he

does a significant amount of reading and public speaking. Keith does not take

121
medication constantly—only when his daily activities seem to demand it. He
described needing a different kind of study environment when he was off
medication than when he was on medication. He said, "But if I really want to sit
down and I want to get a presentation ready, I want to research a lot of
information, and I want this something to be put together real well, I’ll take my
Ritalin; I’ll sit down and read my information. . .

So I said to him, "So, no noise is better for you than noise?"

He said, "Yeah, well for me, when I’m on Ritalin. When I’m not, it doesn’t
matter. But, well, because, see you’re not completely focusing when you’re not
on Ritalin, right? So outside noise is just stimuli for you."

I asked him how it was when he was in college (which was before he was
diagnosed and treated): "You didn’t try to have a quiet environment to learn
things?"

"No," he said, "I couldn’t take it. . . . I couldn’t take a quiet environment."

Mike Mayes stated a preference for background noise when he was
studying both before and after treatment with medication. The one difference
that he has observed about himself is that he preferred louder music when he
was younger and undiagnosed. He said:

You know, my mother used to ask me, "How can you study with that loud

music?" And right now I could not do that like I used to. But I think that

loud music was a cover for all the outside distractions. Sitting in a quiet
room where you could hear chairs squeak or if you were in a library for
instance, without the meds, l was in a position to hear the squeaky chair
or to hear the guy in the next study carrel turn a page. It was amazing the

little things that would take my focus away from what I was reading. . . .
You know, my mother couldn’t understand it. And now, I’m not sure I

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could do that. I mean, when I do read, whether it’s academic or the
newspaper, I can have the TV on or the music, but it’s not loud; it’s kind
of a background. Where then, it was loud. And it was kind of designed
to put me in my own world—which it did to some extent. Because I wasn’t
hearing the lawnmower or the shouting in the dorm or two down or
wherever it may be.

Dale Howard was diagnosed relatively early in his college career, and had
just graduated four months before my first interview with him. When he
responded to the question about study environment, I am fairly certain, he was
speaking about his recent college experience--which was while he was taking
medication. He didn’t refer to his preferred study environment before. He also
prefers some extraneous stimuli; he likes people around when he studies. Dale
said:

I like quiet, but I like to have other people around. When I’m by myself,

especially when I’m in my apartment or at my parents’ house or

something by myself, I’m very easily distracted. It’s hard for me to
concentrate sometimes studying by myself because I daydream a lot.

When I’m in an environment like the library where other people are around

studying, it kind of inspires that mind set. When I’m by myself, lend up

going off. . . . Sometimes I listen to music, but generally that’s not a good
idea because I end up losing focus.

Calvin Jones and Tim Franklin were two exceptions to the assertion that
many of these subjects, before they were diagnosed and treated, preferred a
study environment that was not completely quiet and isolated. Both of them told
about having a terrible time trying to study, but said that they needed to be

completely isolated if they were going to be successful at all. The first time I

interviewed Calvin and asked him about his preferred study environment, he

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said, "I really had no study environment. I mean, I didn’t have any set way to
study. Truthfully, I don’t remember studying that much."

During my second interview with him, I pushed him a little harder to
describe his ideal study environment. I said,

If you had to study, do you remember where and what was most

comfortable for you? Like some people say that they want absolute quiet;

some people say they can’t stand it to be real quiet—they have to have
some background noise. Some people say they want to be isolated, but
with people around. Can you relate to any of that?

To this, Calvin responded,

. . . I needed to be alone by myself, quiet, no distractions, nothing--no TV,

no nothing. Normally I’d go into the bedroom; I’d sit on the bed and try to

read. I could never--and I tried it—sit at the kitchen table and try to work;
that never worked.

"Whjr?" I asked.

"Distractions," Calvin responded.

"Other people around?"

"Other people," Calvin confirmed. "I’d hear something, and then I’d start
thinking of something, and then I was lost on what I was doing."

Calvin wanted to be isolated to study; so did Tim. Furthermore, Tim didn’t
see any difference in his preference for an isolated environment either before
treatment for ADD or after. When I asked him about his preference he said,

I had to have complete quiet. . . . I even do now. Like I was working on

a newsletter this morning, and I’ve got to have the radios off, the TVs off,

everything off. If the radio is playing, it’s going to catch my attention and

I'm going to start listening to the song. If the TV is going, I’m going to

want to go up there and see what’s going on. I’ve got to be isolated. It’s
got to be totally quiet; the same thing if I was going to study.

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I didn’t obtain any data from Sally Smith that relate directly to this
assertion, but she did tell me an amazing story about how she remembers trying
to isolate herself in the first grade so that she could concentrate in her classroom.
She told me,

Even in the first grade, I remember putting up all my books around the

desk to block myself in by myself to concentrate. But they wouldn’t allow

me to do that. But I remember doing that now, and I think back that it was
because I was trying to keep everybody out so I could zero in on my
papers. I just could not concentrate.
It’s not clear from this which category Sally would fit into because she was telling
me about classroom activity in elementary school, not about study environment
during her college years. It is evident, however, that she thought isolation would
be helpful.

The majority of these ADD subjects preferred a study environment that
was not completely quiet and isolated--at least before they were diagnosed and
treated. For some of them, being on medication made a difference in how much
background noise they preferred. They seemed to want less background noise
after diagnosis and treatment. There were two subjects, however, who definitely
wanted complete silence and isolation for their ideal study environment. From

one subject, there was not any precise information given about her favored study

environment in college.

LargeLBeactionsandOutcomes
W. A larger reaction of the subjects to their

experiences in college was to change their original plan. All the subjects

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changed their plan in one way or another. They either extended their completion
time, some of them dropping out temporarily and returning later, orthey dropped
out altogether. One individual consistently persevered and accomplished an
original goal. However, that goal, a bachelor’s degree, took him eight years to
complete. Two subjects dropped out of their bachelor’s degree programs, but
returned several years later to complete their degrees. Four dropped out of the
degree programs they were pursuing and have not returned.

Dale Howard was the one individual who never dropped out after starting
his college work. He began at the community college straight out of high school
to embark upon the beginning of a four-year bachelor’s degree. Actually, I’m not
even sure it is accurate to say this was his goal. He didn’t really want to go to
college then, but he told me his parents made him do it. He said, ". . . I went right
in. Of course, against my wishes. I wanted to do the old ’take a year off and try
to get focused on what you want to do.’" He didn’t have a selected major. He
started off in music, then changed to media technology, then settled on
telecommunications. However, the goal when he began was to get a bachelor’s
degree, and he never stopped persisting for eight years until this goal was
accomplished. Dale’s story, as he summed it up for me, was as follows:

I started attending Capitol Community College in the fall of 1986 and was

at CCC until 1989. Then, from there I transferred to Midwestern State

University. I basically had a variety of different studies ranging anywhere

from, originally what they had called their music block, music curriculum,

to media technology. And once I got focused, I ended up transferring to

Midwestern State inthetelecommunications program. Andjustgraduated
actually last May.

126

Of all the people I interviewed, Dale is the only subject who has
accomplished an initial out-of-high-school degree goal without dropping out.
Even he, however, took about twice the traditional time for earning a bachelor’s
degree. He was telling me that he had played in bands and worked all the way

through college, and he gave me the following example of a typical schedule of

his:
Our band would practice maybe two to four days a week, have gigs at
least once a week, sometimes spaced out longer. I would work at least
20 to 25 hours and then take anywhere between 8 and 12 credits--usually
8. I’d take one or two classes. . . .
I asked him, "I wonder if just taking 8 to 12 credits helped you stay more
focused?"

He responded, "It did." Then he went on to tell me about one time at the
university when he had a very stressful experience in trying to take 12 to 14
credits at a time. Taking it slowly was an asset to Dale.

Kathy Johnson has also taken her course of study slowly, and she
interrupted it by dropping out. In fact, she didn’t make a really good start until 14
years after she graduated from high school. She began her college education
in small private colleges-—working toward a bachelor’s degree. She said, . . I
went from September to December at Anderson, and then in January I started
at Alward. I only went like three or four weeks and had such a--it was like one
comedy of errors after another. . .

l interrupted, "This was just after you were out of high school—like when

you were 18 or 19 years old?"

127

She continued, "Yeah, yeah. I turned up being pregnant and I had the flu
and I mean—l had the flu—and then there was a storm and then I found out that
I was pregnant and l was just like, ’Enough is enough--the die is cast and this
isn’t yielding me anything!’"

Then she told me that 14 years later, after having five children, she began
classes at Deerfield Community College in her home town. She spent two and
a half years at Deerfield getting an associate’s degree; then she went to
Southfield State University and took three years to get a bachelor's degree with
a double major. At the time of our interviews, she was in her third year of
medical school at Midwestern State University. She had opted to extend the first
two years of medical school into three years. Of this, she said, "Medical school
is going to take me five years because I extended during the first two years,
which is one of the options that they give you there at Midwestern State
University—the first two years you can spread out over three years." Kathy, like
Dale, used taking a lighter load as a way of dealing with some of the problems
college presented.

Tim Franklin did not complete the original goal he set out to accomplish
right after high school, but after an extended time period he did complete a
bachelor’s degree in a different area through a nontraditional program for adults.
Tim originally thought he wanted a university degree in photography. He began
at a community college and told me,

I went to Capitol Community College because it was the only way they
would release me in January from high school. I went there for awhile

128

and basicallyjust didn’t do well. I got a letterthe next spring saying, ’We’d
like you to take a term off and see if you’d rather come back or not.’ My
major at the time was photography, so I tried Overhill State University,
and maybe six months later I went down there for a term. Had a great
time. . . . Didn’t learn much-didn’t do well academically, but had a real
good time down there.

"You had a good time. Partying?" I asked.

"Partying, yeah. The dorm I got into was all the art students--they were
all heavy partiers at the time, so we all just kind of got caught up in that scene."

At an earlier interview, Tim told me, . . I came back from Overhill, went
to CCC again, finished up my associate’s, and then 10 or 12 years later I went
to Silver Springs and got my BA."

I asked him if his associate’s was in an art-related field, and he told me
that it was not-~it was in law enforcement. The Silver Springs bachelor’s degree
that he obtained several years later was in business. Silver Springs offers a
nontraditional course for adults who have associate’s degrees; they can get a
bachelor’s degree byjust attending class one night a week. So Tim eventually
did complete the bachelor’s degree he began pursuing after high school, but it
was not in photography, and it was almost 15 years later.

Mike Mayes intended to be an attorney. After he graduated from high
school, he immediately went to a small liberal arts college to study pre-Iaw. He
made it through his bachelor’s degree within the traditional four-year time frame,
but dropped out of law school during his first year. He told the story this way:

I attended college immediately after high school, which was 1971-75.

Studied history, political science and the pre-law curriculum and
graduated from St. John’s College. . . . I think I really realized I had a

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problem when I went into law school. I went one year to Calvin Law

School, . . . and the amount of reading was enormous. . . . Had I stayed

another term, I would have flunked out.

Mike never completed his initial goal-to become an attorney.

Sally Smith went away to Nesbitt College, a small liberal arts college not
too far from her home, with the goal of obtaining a teaching degree. She spent
two years there, and then left because she felt certain that her goal was
unattainable for her. College was too much pressure for her. She said, "I
couldn’t do it. I couldn’t do it, so I decided after two years that I was spending a
lot of money and I wasn’t getting anywhere."

She said she had no choice but to leave. I asked her if it was because the
college asked her to leave, or if she just knew she wasn’t going to make it.

Sally replied,

I knew I wasn’t making it and I wasn't going to get better. I had two years

into it, and my class would graduate in two years, and I wasn’t even close

to it. And, not only that, lcouldn’t do it. And I realized that and it was an
awful expensive playtime, so to speak.

A few years later, Sally did attend a vocational school and obtained a
certificate as a medical assistant, but she has never achieved her original goal.

Keith James didn’t have a clearly established goal when he graduated
from high school, but he did attend Southfield State University for one year--
presumably to pursue a bachelor’s degree. He went that one year and then left
to accept employment. He never returned.

Calvin Jones’s goal was less clear than Keith’s when he left high school.

Calvin had been expelled from high school for behavior problems. About two

130

years after he was expelled from high school, he took some machine shop
classes at the community college. Then he completed emergency medical
technician (EMT) training. After the EMT training, he began an associate’s
degree in paramedic training, but never finished it. Calvin told me the story like
this:

I went for a semester of machine shop type of stuff. My dad owned a

machine shop, and he got a chance to teach down there at CCC, so I took

a class with him and ended up teaching some of the class myself. I knew

more than those people. . . . I went into emergency medical technician

training in ’78, I think. And then in 1980 lwent into paramedic training.

And at that point I was going through a divorce so I never finished. I got

through one term, and that was about it.

Calvin did not complete the paramedic training program that he started.

All the subjects altered their original plan, either by extending their
completion time or by dropping out and not returning. One individual, without
interrupting his education, accomplished his original goal of getting a bachelor’s
degree, but it took him eight years. Two others completed their bachelor’s
degree programs, but only after dropping out and returning several years later.
Four of them, having dropped out of their degree programs, have not returned.

WWW. One of the
outcomes that has resulted from the way the subjects in this study have dealt
with their experiences is that most of them have found success or satisfaction in
their careers. However, most of them are not in fields that require the college

program they first pursued. All five of the males in the study have found a certain

degree of success in their careers. All of them have found satisfaction at one

131

time or another, but two of them were beginning to get somewhat frustrated or
bored at the time I interviewed them. One of the women was still in college at the
time of the interviews, so her career success could only be measured in terms
of academic success. The seventh subject, the other woman, was a discrepant
case in relation to this assertion.

Mike Mayes’s primary goal in life was to be an attorney. He went to a
small liberal arts college because the attorneys his family knew had gone there.
He got accepted into law school, but he only completed one year. He declared
that he thought he would have flunked out if he had tried to complete his law
degree. He began working in the paint department of an automobile assembly
plant 15 years before I interviewed him. When I asked Mike about his current
occupation, he said, "I am the benefits rep for the UAW at Major Motor Company
at the proving grounds. Originally, I started as the training representative there,
and I handled technical training. . .

When I asked him how he had reached this point in his career, he told me,
"I had 15 years in August 7. . . . I started off in Paint at Washington Automotive
Assembly. . . . ltried different things, and I knew I didn’t want to do that kind of
work."

In our first interview, I had asked him if he ever thought about going back
to law school. He said, "I’m not sure I would be happy. . . . I’ve got a good job,
I’ve got possibilities for advancement within the union, not so much within Major

Motor Company, but within the union. . .

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Also during that interview, but within a different context, he told me, . . I
don’t know for sure, but I believe this, if you were to talk to anyone I've ever
worked for, they would say I was a good employee—as far as attitude and
production and things like that--in anything I’ve done."

If those positive statements are not enough to convince us of Mike’s
success in a field outside of law, this question and response should confirm it.
I said, "You like what you’re doing now, don’t you?"

He said, "I love it!"

He reiterated a similar sentiment the second time I interviewed him, when
he was reflecting on the fact that he didn’t complete law school and become an
attorney. He said,

I was disappointed, but looking back or saying would I be happier-mo, and

I think a lot of that is l have a job I enjoy; I have a family; I have a wife. I

see a future in a new home and advancement in my present job. I have

absolutely no remorse or regrets for the way things turned out. . . .
There is no doubt that Mike Mayes has found success and satisfaction in his
career, which is not in the same field he began to prepare for in college.

Calvin Jones has also found success and satisfaction in a field that is
different from the course of study he began in college. Calvin was expelled from
high school and afler a couple of years took a machining class at the community
college. A few years after that, he became certified as an emergency medical

technician, and then dropped out of college before completing his paramedic

training. At the time of my interview with him, Calvin had been working in the

133

electronics field for about 12 years and had been employed by Midwestern State

University for nine years. This is the way that he explained his occupation:
I work with a lot of high-tech electronics computer-based equipment.
Actually, my job title is a Two-way Radio Technician. Electronics has
always been my hobby, and I got into the profession in 1981 doing it full
time and I’ve just stayed in it ever since. And I went to work out here at
the University; I’ll be starting my ninth year. And I’m a senior technician,
and I do a lot of trouble shooting with what other people can’t figure out.
I work a lot with computers. My department is a media-based department,
so we do audio-visual things—video projectors, VCR, TV, set-up in the
classrooms. Another portion of my department is a video production
studio. So I do a lot, I maintain a lot of the equipment in the production
studio; plus I do the--when we go out on sites to do production work--l’m

the technical director. I set up everything. I make sure all the cameras
are right.

It seems that Calvin has mastered a very complex job that is far from any of his
initial goals of machining, emergency medical technician, or paramedic.

Not only has Calvin found success in what he does, he has found
satisfaction. When we were talking about his current job, he said, . . I don: get
bored with it. . . . I can sit down--beepers, pagers--you can bring me in 20 to 30
pagers, I average about 10 minutes a radio to repair it—and that’s a complete
strip-down, diagnose, replace, repair, whatever. . .

l reflected and told Calvin that it seems that many of the people I had
talked with found something they really liked to do and are successful and
focused within their fields.

Calvin agreed with my analysis. He said,

I can sit—if I didn’t have any other distractions or anything else--l could sit

from the time I get up in the morning until the time I drop at night with my

computer work or my electronics work, period, that’s it. Now, you ask me
to do something else, you might’s well forget it 'cause I’m going to sit

134

around and procrastinate ’til hell freezes over—not because I can’t do it,
because Ijust get into it and I’m into it and I cannot stay focused on it.

A few minutes later in this interview, Calvin made it perfectly clear that he
is not only successful, but satisfied. He said, "My fortune is the fact that l have
found something to make a profession out of, something I love to do. . .

Dale Howard began his college career majoring in music, ended up
getting a degree in telecommunications, and is working in the latter field. My first
interview question with Dale was, "Okay, tell me, first of all, about your
experience in going to college--when you went, where you went, just a little
background."

Dale’s response was:

A little background? I started attending Capitol Community College in the

fall of 1986 and was at CCC until 1989. Then, from there I transferred to

Midwestern State University. I basically had a variety of different studies

ranging anywhere from, originally what they had called their music block,

music curriculum, to media technology. And once I got focused, I ended
up transferring over to Midwestern State in the telecommunications
program. And just graduated actually this last May.

It was September and October of 1993 when I interviewed Dale, so it
might be premature to conclude that he has found success and satisfaction in a
field outside ofthe one he initially began in. He was successful in completing his
degree in a field other than his first major, music. At the time of our interviews,

he was employed by a State agency that uses a telecommunications network.

He was working in the field that his degree was in.

135

Dale was feeling a certain amount of satisfaction in his work. During our
second interview, he was describing to me the contrast between him and his
siblings. (They had always been very athletic and had become successful in
business professions. He was always very musically or creatively inclined, which
didn’t hold as high a premium in the family’s values.) Dale's assessment of his
current situation was: "At least at this point in my career I’ve found something
that allows me to express my potential." It seemed that Dale was satisfied with
his current career.

Keith James began a baccalaureate degree program at Southfield State
University, but he never went back after the first year. At the time of our
interviews, he was the owner/operator of multiple businesses. He owned a 50-
acre farm, a rooming house, and a feed store and feed manufacturing company.
Although he was currently a little bored with his feed company, by his own
analysis, he was successful in what he was doing. He was talking about his feed
business when he said, "I’ve been in it for four years now--l went from nothing
to 15 ton a week; so, which is for one guy. . .

"Fifteen ton?" l interrupted for clarification.

Keith confirmed it: "Fifteen ton, a week, yeah. It’s good; it’s good money.
I mean, I have a 40% profit margin-4 make 40% on my feed. Elevators usually
make 9%, 10%, 15%. . .

He went on to tell me how he is able to make so much profit, then

reflected that he is getting a little bored with what he is doing. He told me,

136

I love stimuli--it’s not exciting any more. This is a great business; I have

a tremendous income from it. The same thing—my rooming house does

well, too-that’s another one of my businesses, a rooming house-and that

does real well. I’m just kind of in a rut, kind of bored.

Laughing, I said to him, "Time to start a new business, Keith."

He said, "Yeah, there ain’t nothing I can’t do."

As I mentioned earlier, Keith didn’t see himself as having any self-esteem
problems. When we were discussing the issue of being successful in life, he told
me he thought he compared favorably to his siblings.

It was with pride in his voice that he told me,

I had two sisters and two brothers. Two of them had masters’, one a

Ph.D., and one a bachelor’s--all from Big Ten universities. I am the black

sheep, okay? . . . When it comes to "You’ll never get this and you’re not

smart enough, you know you can’t do that, and geez, you’re not going to

be successful and on and on." Well, my income is twice what theirs is.
Although Keith wasn’t completely satisfied with his current occupations, in his
own eyes, he was successful.

Tim Franklin began his college career majoring in photography, changed
his major to law enforcement, and is currently working in two careers: hospital
security and desktop publishing. Although Tim is not currently enjoying his law-
enforcement-related career ("It’s not that I’m really enjoying it, but it permits me
to do the things I enjoy doing"), he has worked in that field for 15 years. When
I asked him if he was working in the law enforcement field now, he said, "I did for
about, oh God, 15 years. I did security work plus law enforcement work, back to

security work and now I’m working security at Mercy Hospital for three days a

week in 12-hour shifts . . . and doing desktop publishing."

137

He also attributed his success at college to his switch to the law
enforcement curriculum, which he found interesting. When I asked him if his
associate’s degree was in an art-related field, he said,

It started out in photography, and that’s what I went to Underhill State for

was photography, and I did so, so there. I was invited not to return for a

term so I could figure out which way I’m going, and then I changed over

to law enforcement. And that’s where I got my associate’s is in law

enforcement.
A few minutes later during this same interview he said to me, . . When I came
back I switched into a law enforcement curriculum. And for some reason, I
seemed to catch fire. My grades were not great, but they came up to around a
3.0-—which was far better than I was doing before." And a few minutes after that,
he said, ". . . I think going into law enforcement brought everything up. I think I
left Capitol Community College with a 3.2 average or something like that." Tim
Franklin was successful in studying the law enforcement curriculum, and did well
enough in the field to remain in it for about 15 years.

Tim was relatively successful in law enforcement, but at the time of our
interview, he was really enjoying his other careerndesktop publishing. He told
me, ". . . I’ll get into manuals about computers or design manuals or things like
this and I can get lost in them. . .

Later on in this first interview of ours, Tim gave me examples of the ways
in which he becomes hyper-focused on the desktop publishing work that he

does. He said,

Last night I got another client with my publishing. So I spent the morning
working on getting a presentation for her—to show things to her first thing

138
for a newsletter. I was supposed to see Dr. Evers this morning. Well, I
got focused over there and everything else was gone. I didn’t think about
it. And yet, when she [Dr. Evers] called me and I heard her voice, I went,
"Oh, shit."
When I told him that there are some people who have ADD who speak
about getting hyper-focused on some things, he agreed that is what happens to

him. He said,

That’s what happens. Because like Deb will come home and I’ll be
working on the computer, and you know the house could blow up around
me. And I’ll block everything out. It’s just like a tunnel. I have tunnel
vision right now. And it’s a safe world, maybe that might be part of it. It’s
a good way to describe it. It’s hyper-focus. You know, the world blocks
out at that point.

Considering the waythat Tim becomes so absorbed in his computer work,
it came as no surprise to hear him say that he finds it rewarding and is successful
with it. He said,

The desktop publishing to me is very rewarding--when you put something

together and like I’m doing all the art work for the newsletters—all the

headers (I call headers for the top) . . . to me that is very rewarding

because when I’m done it’s there, it’s mine and I’ve done it. . . .

I said to him, "And you’ve become pretty successful at this?"

He responded, "So far it seems to be--yeah. I’ve got eight solid accounts
now, and it looks like it’s going to expand."

Tim began his college career majoring in photography, but he has found
success and satisfaction in the fields of law enforcement and desktop publishing.

Kathy Johnson was still in college at the time of the interviews, so her

career success could not be measured. It is clear, however, that she is on the

road to successfully completing medical school—a goal she did not have when

139
she first began college right after high school. She told me about making her
career decision when she went back to school after a 14-year lapse. During her
first year, she told me she had a 3.75 grade point average, and then she spent
the next summer thinking about what she wanted to do. She said,

And it was at that point that I kind of set my sights on becoming a doctor.

. . . And, so, that was kind of it, and I had a marvelous counselor at

Deerfield. So when I decided I wanted to be pre-med, the counselor, he

was a marvelous man, he didn’t look at my age as a deterrent. . . .

A few minutes later, she shared with me some of the success she has
experienced in that academic decision: . . I graduated with a double major.
And I graduated cum Iaude."

Shortly after that in our interview, she again reflected back to her
motivation during her undergraduate days. She said, ". . . Ijust dug my heels in
so hard that when I got to school, I was going to do it, by hook or by crook. . . .
Whatever it took, I was going to do it." Data that were related earlier in relation
to the use of support services substantiate the fact that Kathy did do whatever
it took. At the time of our interviews, she was in her third year of medical school.
It would be premature to say that she is successful and satisfied with her
occupation, but she certainly has been successful in the academic preparation
for it.

The seventh subject, Sally Smith, was a discrepant case in relation to this
assertion that most of these individuals have found success and satisfaction in

their careers and that most of them are not in fields requiring the college program

they first pursued. Sally, like the others, is not in a field requiring the college

140
program she first pursued, but she has not found satisfaction in the field she now
pursues. She wanted to be a teacher, and she is a homemaker. l have no data
to support whether or not she is successful as a homemaker, but she is not
satisfied with it.

Sally talked to me at length about her unhappy personal life at the time of
our interviews. (I have some hesitancy about going into too much detail because
of her expressed concern that it not be shared. I will only relate those things
which lam sure that she would not object to.) She has two children who are both
ADD also. Concerning her parenting responsibilities she said, "Even now, it’s
very difficult. Very difficult, I should say."

She told me about her response to her son’s diagnosis by saying, "I went
through a period of depression after that." Then she said,

There’s no escape from ADD for me. There’s no escape for me. I

sometimes resent that. . . . l have to deal with it all the time. Of course

having it and then having the children, there’s no escape. My whole life
exists around ADD, and sometimes I resent that.

Sally also feels dissatisfied with the way that she is unable to maintain her
home. She said, "The disorganization . . . my house is a mess."

She also related current difficulties in her marriage. She wastalking to me
about differences in herself when she started on Ritalin, and she said, . . He
[her husband] sees a difference, but I notice that it irritates him terribly. . . . He’s

a disaster, and I didn’t know it. . . . But I was so far beneath him, we weren’t on

the same level, I didn’t seem to notice."

141

During our second interview, she talked at length about the current state
of her marriage. It was not positive. There did not seem to be much, if anything,
about her role as a homemaker that Sally found satisfaction in.

With Sally as a definite exception, most of the subjects in this study have
found success and satisfaction in their careers--or at least (in the case of Kathy
Johnson) in the academic preparation for their career. Dale Howard has not
been in his career very long, but expressed satisfaction by saying that he feels
that he is using his potential. Tim Franklin and Keith James were becoming
somewhat bored with parts of their current occupations, but overall, felt satisfied.
Mike Mayes and Calvin Jones both said they "love" their jobs.

WM. Most of the subjects in this study feel that they
could be/were more successful if/when they went back to college after diagnosis.
Three of them had not taken any college courses after they were diagnosed with
ADD. Of these three, two felt they would be more successful if they went back;
the third one is an exception to this assertion. Two other subjects had completed
most of their college classes before diagnosis and treatment, but have taken
some classes since, and feel that they have done better. Another two of the
subjects were actively pursuing their college degrees at the time of their
diagnosis and treatment. Both of these individuals felt that they did better after
treatment. Six of them definitely felt that the treatment they received for ADD

would/did enhance their college success.

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Keith James had been away from college for approximately 15 years
when his ADD was diagnosed and his treatment began. He was not speaking
of college specifically when he was describing the benefits of diagnosis and
treatment of ADD, but I believe that his comments are applicable. He said,

If you go into treatment and you start treating yourself for this, then all of

a sudden all of these doors open. All of these doors open for interests

that geez, "I can do this now, I can do that now, I can do that now." You

can do all of these other things. . . .

A few minutes later in the same interview, Keith said, "See, I would love
to go back to college."

I responded, "Would you?"

He said, "Hell, yes. Oh, yeah. First thing I’d like to try, I’d like to try a
broadcasting course. . .

A few minutes later he said, "I’d love to do what Dr. Evers does. I’d love
to be a psychologist or a child psychologist, you know. I don’t think I’d want to
be a psychiatrist, I don’t have enough years left in my life to complete the studies.
. . .Thirty—five years old, man."

When I reflected that he had a long time to work ahead of him and lots of
energy, he said, "That’s right. I’ve got all kinds of time to be successful in a
number of different things."

Keith feels that "doors opened" up for him after he got treatment, and that
he could be successful if he went back to college.

Calvin Jones had also been away from college for about 15 years when

his ADD was diagnosed. He had experienced problems all the way through

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school, and didn’t complete high school with his class. Reflecting on the loss that
he feels about not being diagnosed earlier, he said,

lmean, I look back and if I would have been on Ritalin or any medication

at that time when l was coming up through school, I know I would not

have had any problems in school. I would probably have been able to go

to college and get a degree in something. . . .

A few minutes later, I summarized what I thought I had heard him
expressing. I said,

I sense that what you’re thinking now is that you wouldn’t have any

problem. I mean, if you could drop everything, iftime and money were no

object and you could go to school now, you could do whatever you want
to do. Is that what you’re feeling?

Calvin replied, "Yeah, lfeel I could accomplish at least a four-year, easy."

I asked, "Whereas before?"

"No way! Overwhelming," Calvin responded.

Mike Mayes had finished his bachelor’s degree and had dropped out of
law school before his ADD was diagnosed and treated, but he has taken some
courses at the community college since treatment. When he was telling me
about how easily distracted he had been in classrooms, he reflected on the
difference treatment had made for him. He said,

. . . l was taking classes at CCC off and on; I still had the difficulty. After

I had seen Dr. Evers and l was placed on the medication, it made a world

of difference, and it did so by keeping me focused, on task, if you will. . . .

I found I learned more in less time, if you will. And part of it was not

reading and rereading.

During our first interview, I had asked Mike how he thought his

undergraduate experience might have been different if he had been diagnosed

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and treated at that time. He said that he thought it would improve his self-
esteem. He explained it this way:

I think I would have the self-esteem. I wouldn’t have the loss of self-

esteem or at least the deterioration of it, the gradual deterioration, that I

experienced. I would also be more apt to seek out the assistance of the

people around me, whether it be my roommates, instructors, or whatever.

During the second interview, I posed the question to Mike more directly.
I asked, "Do you feel you could be more successful if you went back to college
after your diagnosis and treatment?"

He responded emphatically, "Oh, I know I would. lwould bet everything
I own on it!"

His response was clear, but I probed some more anyway. I said, "Tell me
more about that."

Mike told me more:

In my mind—and, in fact, I feel that I’ve proven it substantially (since I’ve

seen Dr. Evers) in my college classes and in the classes that I’ve got that

are work-related. I’m more apt to participate; I’m more apt to stay on-task

when you have projects. I know I participate more; there is no doubt in

my mind. I know that ifl started today in any program, I would do better.

Mike certainly feels strongly that he did better in college after his diagnosis
and treatment for ADD.

Tim Franklin is uncertain about whether or not he had any college classes
after his diagnosis and treatment, but if he did they were in a nontraditional

degree program, which he saw as quite different from "regular" college classes.

During our second interview, I asked him, . . If you went back now--now that

145

you’ve received treatment and are on medication, do you think that anything
would be different?"

Tim replied, "I think I’d do better. I think I’d do a lot better."

"Tell me what ’better’ means to you," I asked.

"Well, now I have a better direction of what I want to do, which would help.
And I know that I have better concentration level and I’m a lot calmer. . .

Dale Howard was one of the subjects who was diagnosed relatively early
in his college career. He was in treatment for six of the eight years that he was
working on his degree. When I asked him what difference the Ritalin made in his
life, he told me about the way that it positively affected his college career.

I said, "What kind of differences did you notice?"

"After taking it?" Dale asked.

"Um huh," I affirmed.

He replied,

Urn, elevation ofmood. Mostdefinitely, elevation ofmood. Felt good, felt

happy. . . . And I could focus and then get inspired. I mean it made me

feel, "Hey, I feel really good. I’m going to get this done; I’m going to do it."

And I would get it done. And I’d say, "I did it! I got it done!" Where

before, I’d be kind of like, you know, kind of uninspired. But it really

provided a platform to allow me to concentrate, most definitely, most

definitely. I think that it was the catalyst for getting the change. ’Cause

I was just, I didn’t know what I wanted to do, I was wasting time, taking

classes, wasting my parents’ money. Finally, I said, you know, "You get

your shit together." And I said, "Okay." . . . I got focused, and if anything

what it did, it put me on the right track and I got focused. . . .

Dale felt that his treatment for ADD made him more successful in college

than he had been before.

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Kathy Johnson was the other subject in this study who was diagnosed and
treated while she was still pursuing her course of study in college. She was in
her first year of medical school at the time. I asked her, "After you were
diagnosed and got on Ritalin, did you see differences then in your performance
in school?"

"Yes," Kathy replied, "from the standpoint that I could stay on-task longer.
I could get a little bit more out of studying--stay on studying a little bit longer."

Kathy also felt that the psychotherapy that she did as part of her treatment
helped her with self-management in group dynamics in her classes. She told
me,

I did a lot of work with Dr. Evers about handling disruptiveness, as far as

being in a group . . . impulsiveness in talking in a group--impulsiveness to

just butt in. l was not truly aware of what I was doing until I started to
address just what ADD meant.

Another benefit that Kathy gained from her diagnosis was that she had the
option of requesting individual testing, with unlimited time, rather than taking her
tests with a whole group. She described how that was helpful to her:

. . . and then, when I got the diagnosis, the one thing they offered me was

I can take my tests by myself. I have unlimited time. And I thought,

"Umph, I don’t need that." Well, I’ve been through two tests now, and I’ve

gone to them and said, "This is the way I want it to be." During this past

year, taking the tests by myself, that has begun to be the way I function
the best. . . . Some of it is that I can sit there and read questions out loud

to myself, less distractibility. I don’t have to be worried about tuning out
everybody else.

147

I also asked Kathy if she thought there would have been any differences
had she been diagnosed and treated before her bachelor’s degree. She
answered affirmatively.

There was one exception to the assertion that these subjects felt that they
could be/were more successful if/when they went back to college after diagnosis.
Again, Sally is the exception. However, Sally’s situation might have been
skewed at the time of the interviews. She was undergoing some personally
traumatic times, which probably influenced to some degree her self-concept and
her response to my questions. She was feeling that her livelihood was
threatened and that she had no choice but to go back to college to prepare
herself for a career. She told me that she had to go back to college now-~that
she had no choice.

I tried to encourage her by saying,

Well, the good news is that the people I’ve been talking to that started out

poorly in college and then got focused and decided what they wanted for

a career were able to really focus on it and do well in school, so I’m

hoping that will be true for you, too.

She didn’t sound very hopeful when she said, "I have no idea." Then she
went on talking about how desperate she feels, and how inadequate she thinks
she is for college. She said, . . I don’t even know if there is anything up here
in this brain."

Again, ltried to encourage her and referred her to the Women’s Resource

Center at the college she was talking about attending. But I don’t think that my

words made an impact. Her voice was full of desperation when she said,

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I don’t know if I can do it. I don’t know if I can do it. Not drive—l have the
drive; I don't know ifl have the brains. I mean, what I find when I go back
to do this type of thing is that-for one thing my test-taking ability. I don’t
know--l really don’t—because of all those years I missed. I mean, I
couldn’t write a term paper--l don’t have the faintest idea-I don’t know.

I don’t know, but I don’t have a choice!

It didn’t seem at this point that Sally was rationally reflecting on the fact
that she had been diagnosed for ADD since she was in school last, or that some
of the problems she experienced previously might be alleviated by the treatment
she was receiving. Emotionally, she was distraught, so I am not sure how valid
these data are as a discrepant case in relation to this assertion.

Six of the subjects in this study definitely felt that the treatment they
received for ADD would/did enhance their college success. The ones who were
not in college at the time of their diagnosis felt that they would do better if they
went back now. The ones who received treatment while they were pursuing
college programs felt benefits from the treatment. The seventh subject did not
express any hope that her treatment for ADD might help her if she went back to

school now. She, however, was suffering emotional trauma, and it is not certain

whether her response was an entirely rational one.

I r r t '
These seven ADD adults who had attended college shared with me what
they encountered in college--their emotional reactions and perceptions of their
learning. One emotional reaction that many of them shared was that their

college experiences often contributed to a diminishing of their self-esteem.

149
Another that most of them shared was that they felt the personality (attitude) of
their instructors had an influence on their success. One perception of their
learning that most of them mentioned was that they have serious inadequacies
in English or math or both. They all resoundingly related a lack of focus in the
classroom and/or while studying. Most of them say they are visual learners:
they prefer hands-on instruction over lecture-type.

These same adults shared with me the ways in which they dealt with their
experiencesuday-to-day tactics and larger strategies and outcomes. When
relating the day-to-day tactics, most of them told me that they usually did not
seek out support services, or they thought they didn’t exist. Many of them also
told me that during the time period before they were diagnosed and treated for
ADD, they preferred a study environment that was not completely quiet and
I isolated. When they told me about the larger strategies and outcomes in relation
to dealing with their experiences, I found that none of them completed their initial
college program within a traditional time frame. Most of them also told me that
they had found success and satisfaction in their careers—most of them not in
fields requiring the college program they first pursued. Most of them also felt that
they could be/were more successful if/when they went back to college after
diagnosis. All of their experiences were unique, but there were certainly some

common threads in many of them.

CHAPTER V

SUMMARY AND CONCLUSIONS

Seven individuals who had all been diagnosed and treated for Attention
Deficit Disorder (ADD) by the same psychiatrist were interviewed for this study.
All of the individuals had attended or were attending college. The experiences
they related to me described their emotional reactions and their perceptions of
their learning in college. They also related to me how they dealt with their
experiences--the day-to-day tactics and the larger reactions and outcomes.

When we look at these individual case studies, we might at first think that
the subjects are not much different from many other college students we have
encountered. In many ways, this is true. People with ADD do not have a major
psychiatric diagnosis, nor do they all even have learning disabilities. What these
seven do have in common is that they all have been diagnosed with Attention
Deficit Disorder, Residual Type. This means that they once met the criteria for
Attention Deficit Hyperactivity Disorder, and that signs of hyperactivity are no
longer present but other signs have persisted, as is evidenced by both attentional

deficits and impulsivity.

150

151

Taken individually, the characteristics that are listed as symptoms of
inattention and impulsivity are not uncommon in many, if not most, people. It is
the combination and the intensity of these characteristics that lead to a clinical
diagnosis of ADD. The individuals in this study are clinically more
inattentive and impulsive than is developmentally appropriate. This is

what makes them different from the average college student.

m f In ivi l i n

These seven individuals represent a wide range of experiences and
educational levels. At one end of the educational spectrum was Calvin Jones,
who was expelled from high school and has completed about a year of college.
At the other end of the spectrum is Kathy Johnson, who scored high enough in
academic achievement on the American College Test (ACT) to earn a competi-
tive scholarship in her state. She was in the third year of medical school when
I completed these interviews.

To summarize the findings, I will first capsulize the individual case studies.

QaMnJQnes

When I first interviewed him, Calvin Jones was a 38—year-old white male
who had been diagnosed as having ADD and had begun treatment approxi-
mately 3 months earlier. About 20 years earlier he had been expelled from high
school, and he had not gone immediately to college to seek a degree. A year or

two later he attended a machine shop class that his father was teaching at

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Capitol Community College. Later yet, he completed Emergency Medical
Technician training atthe community college, but, because of personal problems,
he dropped out of paramedic training and never went back. Calvin discussed his
experiences in college and how he has dealt with them.

Concerning his emotional reactions to college, the machine shop class
was a positive experience for him: his family owned a machining business, and
he tells about "teaching the class." Aside from this, we didn’t talk specifically
about his self-esteem during college. Calvin did relate to me that he had low
self-esteem as a child. It could be that his self-esteem didn’t fluctuate much one
way or the other during those periods, or it could be that my queries did not elicit
responses that provided this information. He told me about the pressure that he
felt in classrooms, which could either be exacerbated or alleviated by the
personality of the instructor. He said he felt pressured because he might get
called on and not know the answer and be embarrassed because he didn’t know
the instructor or the students.

In discussing what he encountered in college, Calvin also related his
perceptions of his learning. He declared that he never could do math. He also
told me that his mind wandered in class, that he just got bored. He is definitely
a visual learner, with a preference for hands-on experiences.

We discussed the day-to-day tactics that Calvin did or did not use while
he was in college. He did not use special support services and did not elaborate

about why. Calvin preferred a study environment that was completely quiet and

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isolated. His case might be an exception to the assertion that these individuals
either did not complete their initial program of study or did not complete it within
traditional time frames. Calvin didn’t really have an "initial program of study," so
I can’t say that he didn’t complete one. On the other hand, he did not complete
the paramedic training program that he started.

Calvin Jones has found success and satisfaction in a field that is different
from the course of study he began with in college. At the time of my interview
with him, Calvin had been working in the electronics field for about 12 years and
had been employed by Midwestern State University for 9 years, working with
high-technology electronics-based equipment. His title is Two-Way Radio
Technician, and he is the senior technician. He is self-taught, and he really
enjoys his work. He was diagnosed and began treatment for ADD just 4 months
before my first interview with him. He said that, if he had been on Ritalin or any
medication when he was coming upthrough school, he knows he would not have
had any problems in school. He said he probably would have been able to go

to college and get a degree.

KeitLJames

When I interviewed him, Keith James was a 35-year-old white male who
had been diagnosed and had begun treatment about 6 to 9 months earlier.
When Keith graduated from high school, he didn’t have a clearly established
goal, but he did attend Southfield State University for a yeah-presumably to

pursue a bachelor’s degree. He went for 1 year and then left to accept

154

employment. He never returned. Although he attended only 1 year, his reason
for dropping out was not low academic standing or struggle. As a matter of fact,
he earned better grades at the university than he had in high school. Keith
discussed with me his reactions to college and how he has dealt with his
expenences.

Keith is self-confident, and sees himself as having more friends than the
average person. He is relatively well-read in the field of ADD and realizes that
there is much in the literature about the low self-esteem of people with ADD. He
sees himself as an exception to this. Keith was satisfied with his academic
success in college, and he attributes his success to luck in getting certain
professors.

He is the one subject who never mentioned any feelings of academic
inadequacy. Keith James didn’t complain of a lack of focus while studying as
much as some of the other subjects did, but he did mention it. He mentioned
doodling and sleeping in class. When I was talking with him about his
preferences in instruction, he talked about boring lecturers. Keith James also
stated a preference for visual and hands-on learning.

When we discussed day-to-day tactics that help students deal with
academic life, Keith said he didn’t think that the university he attended offered
any support services. Keith had been diagnosed and treated for ADD less than
a year when we talked. Although he had been out of college for numerous years

at the time, he has done a considerable amount of preparing presentations for

155
public speaking. He described needing a different kind of study environment
when he is off medication than when he is on it. When he is on Ritalin, he likes
a quiet environment. Without Ritalin, he can’t take the quiet.

At the time of our interview, Keith was the owner/operator of multiple
businesses. Financially he is very successful. With pride he told me that his
income is twice that of his three siblings, all of whom have graduate-level
degrees from major universities. He is feeling a little bored with his current
businesses, but by his own assessment, he feels that he is successful and there
is nothing that he can’t do. Keith feels that "doors opened" for him after he got

treatment, and that he could be successful if he went back to college.

Sally Smith

Sally Smith was a 34-year-old white female at the time of my interview
with her. She had been diagnosed and treated for ADD for about 8 or 9 months.
Right after she graduated from high school she had gone to Nesbitt College (a
small private school). Her goal was to get a degree in education and become a
teacher. After struggling academically for 2 years, she dropped out. Sally never
completed her initial program of study tobecome a teacher. A few years after
dropping out of Nesbitt, she did attend a vocational school and obtained a
certificate as a medical assistant. (She didn’t consider the vocational school "real
college") Sally discussed her experiences in college and since that time.

The emotional reactions that Sally experienced in college have had a

long-lasting effect on her. Even now, 14 years after dropping out of Nesbitt, Sally

156

still doesn’t believe that she is capable of being successful in college. The
impact on her self-esteem was crushing. Sally did not discuss her opinion about
college instructors, but she told me that from year to year throughout her entire
life in school, her success depended on whether or not the teachers liked her and
she liked them.

Sally is convinced that she is terrible at both English and math. She said
that she is dyslexic in math, that she inverts numbers, and that she flunked
elementary math twice. But she is absolutely convinced that her lack of English
skills was her nemesis in college. In regard to a lack of focus while in the
classroom or while studying, Sally talked about her head always racing. She
said that she could stay focused only about 10 minutes out of an hour. She did
saythat she had more success staying focused at the vocational school because
she was more interested in the subject matter. I did not obtain clear data from
Sally about whether she is a visual learner. It could be that she prefers the
auditory, or it could be that she just wasn’t clear in her explanation.

When Sally was at Nesbitt College, she felt like she tried all of the support
services possible and still didn’t succeed. When she went to vocational school
to get her medical assistant certification, she never used any special
accommodations. She didn’t say whether or not she thought any were available.
I didn’t obtain any data from Sally Smith that relate directly to the type of study
environment she preferred in college before diagnosis, but she did tell me a story

about trying to isolate herself in the first grade so that she could concentrate.

157
Sally is a homemaker. l have no data to support whether or not she is
successful as a homemaker, but she is not satisfied with it. Sally did not feel that
she could be more successful if she went back to college after diagnosis and
treatment. However, Sally’s situation might have been a little skewed at the time
of the interview. She was undergoing some personally traumatic times, which
probably influenced to some degree her self-concept and her response to my

questions.

Tim Eranklin

When I interviewed him, Tim Franklin was a 39-year-old white male who
had been diagnosed about 2 years earlier. Although Tim had shown enough
academic promise to gain acceptance into a major state university with
competitive admissions standards, he didn’t attend there. He started other
colleges twice before he finally became motivated to get an associate’s degree
in law enforcement, and then a bachelor’s degree many years later. Tim’s first
attempt was at Capitol Community College. He did so poorly there that they did
not allow him to return for the third term. Then he went to a university out of
state, where he flunked out. His beginning major was photography. He returned
to the community college to earn an associate’s degree in law enforcement.
Several years later, he earned a bachelor’s degree in business through a
nontraditional degree program for adults. Tim shared his experiences with me

during two separate interviews.

158

He told me about some crushing blows to his self-esteem that he suffered
while he was in college, and about wondering if he was intelligent enough. Tim
also indicated that instructors could influence success. He said it was easier to
stay focused in law enforcement classes because the instructors were ex-police
officers and they told stories and moved around the room when they lectured.

Tim said that his reading and writing skills are good, but that he hates to
write and his spelling is terrible. He complained about lack of focus in the
classroom, and he told about falling asleep a lot and daydreaming. Tim said he
preferred the use of visuals in instruction and liked hands-on learning.

Tim said that he wasn’t interested in support services while in college. To
him, that meant socializing or dealing one-on-one with people—-things he didn’t
like to do. He didn’t see any difference in his preference for an isolated study
environment either before treatment for ADD or after. He said he always has had

to be totally isolated to study. Tim did not complete the original goal he set out
to accomplish right after high school, but after an extended time he did complete
a bachelor’s degree in a different area.

Tim Franklin is currently working in two careers: hospital security and
993M013 publishing. He has worked in law-enforcement-related careers (law
enforcement or security) for 15 years. He has been relatively successful in the
law enforcement field, but at the time of our interview he was really enjoying his
Other career-desktop publishing. Tim was uncertain about whether or not he

had any college classes after his diagnosis and treatment, but if he did they were

159

in the nontraditional degree program, which he saw as quite different from
"regular classes." He felt that if he went back to college now that he has had
treatment for ADD, he would do a lot better. He said that he not only has better
direction for what he wants to do, but he also has a better concentration level and

is calmer.

William

Mike Mayes, at the time of my interview with him, was a 40-year-old white
male who had been diagnosed with ADD about 10 years before. He had sailed
through high school fairly easily. He was an athlete, and he did fine
academically. He aspired to be an attorney and attended St. John’s College, a
small Catholic college, and got his bachelor’s degree. Then he attended Calvin
Law School for a year, ran into personal and academic problems, and never
returned.

As Mike told me about his experiences, he had a lot to say about the way
his self-esteem suffered while he was in college--at St. John’s, but particularly in
law school. When we discussed his emotional reactions in college, Mike didn’t
relate much to me about his college instructors. He did, however, relate a story
Of a high SChooI math teacher who intimidated him so badly that he never took
math again.

Aside from the fact that his high school math teacher intimidated him, Mike
f9“ sure that his math skills were weak. In describing his experiences in college

classrooms. Mike mentioned not paying attention in class, but covering up for it

160

well. He said that lecture classes would put him to sleep, but that he covered up
for it- He also talked about how distractible he was both in class and while
studying. He agonized over his studying, spending tremendous amounts of time
reading and rereading things so that he could understand them. He did not
express a preference for hands-on instruction, but he did express a preference
for the visual.

Mike made it all the way through undergraduate school and into law
school without using any support services. He indicated that he knew there were
some available, but that he was into denial about needing any extra help. Mike
stated a preference for background noise when he was studying, both before and
after treatment with medication. However, he said he preferred louder music
when he was younger and undiagnosed.

Mike never completed his initial goal of becoming an attorney. He has
worked for Major Motor Company for 15 years and is currently a benefits
representative forthe United Auto Workers union. He sees himself as successful
both in his career and in his family life and states that he loves his job. Mike has
taken some personal-interest and job-related classes at the community college
since he was diagnosed and treated for ADD, and he says that treatment has
made a World of difference. He said he would bet everything he owns that he

WOU'd have done better if he had been diagnosed and treated before he ever

attended college.

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Daleljoward

When I interviewed Dale Howard, he was a 26-year-old white male who
had been diagnosed about 6 years earlier. Dale began going to Capitol
Community College in pursuit of a bachelor’s degree as soon as he graduated
from high school. His initial primary reason for attending college was to satisfy
his parents. He was struggling through community college when he was
diagnosed and began treatment for ADD. His major was music, but he later
changed his major, and he consistently pursued his bachelor’s degree. Eight
years after he began atthe community college, Dale Howard earned a bachelor’s
degree in telecommunications from Midwestern State University.

As he talked with me about his emotional reactions to college, Dale said
that he always had low self-esteem, but that he felt more confident after
treatment. Dale also stated that he feels an instructor "can make or break" a
class. He was very adamant about the negative impact that the unpleasant
personalities of instructors had on his college career.

Dale said that math was difficult for him. He attributed his lack of math
skill to his dislike of the subject and his inability to focus long enough to practice
the skills. Much of what Dale said about his lack of focus in the classroom
related to his K-12 school experiences rather than his college experiences. This
could be because he was diagnosed and treated fairly early in his college career,

or it could be that my line of questioning didn’t draw out the college memories.

162

Dale didn’t go into a lot of detail about his learning style preferences, but he did
say that he had poor listening skills, so I concluded that he prefers the visual.

Dale had received special supportive services when he was in elementary
school and high school, but he did not use them in college. He thought that they
probably were available, but didn’t think that he needed extra help. When Dale
talked about his preferred study environment, I think he was talking about his
preference after medication. He likes it quiet, but he does like some extraneous
stimuli; he likes people around.

At the time of our interviews, Dale had been employed in the telecommu-
nications field for just a few months. He was employed by a state agency and
felt satisfaction in his work. Dale felt that his treatment for ADD made him more

successful in college than he had been before.

KathLQDflm

At the time I interviewed her, Kathy Johnson was a 41-year-old white
female medical student. She had been diagnosed and had begun treatment for
ADD while she was in her first year of medical school, about 2 years before I
interviewed her. She had begun her college education in small private colleges--
working toward a bachelor’s degree. She dropped out after a little more than a
semester. Then, 14 years later, after having five children, she began taking
classes at Deerfield Community College. She spent 2-1/2 years at Deerfield
getting her associate’s degree; then she went to Southfield State University and

took 3 years to complete her bachelor's degree with a double major. At the time

163
of our interviews, she was in her third year of medical school at Midwestern State
University.

Kathy Johnson said that one thing that led to her dropping out of college
the first time she went was feeling ostracized by the other students. Her self-
esteem was not good. Kathy was somewhat contradictory in her responses
about whether or not the personalities or attitudes of instructors had anything to
do with her performance. She seemed to say that she sees no relationship
between her success and the personalities of her teachers, but she seemed to
be focusing only on her medical school experiences when she was responding.
And she did say that she enjoys the classes that some instructors teach more
than others.

Kathy underwent a complete series of testing and was well apprised of her
learning disabilities. She was weak in verbal skills. Although she was in her third
year of medical school, she said that her current vocabulary level was about
seventh grade. Kathy had a lot to say about her lack of focus in the classroom.
She said she didn’t notice it so much as an undergraduate, but when she got to
medical school, it became very apparent. She also complained of sleeping
through parts of lectures, and she discussed difficulties with staying on task.
Kathy knows she is a visual |earner--the psychological testing she has done to
diagnose her learning disabilities disclosed an auditory-processing deficit.

When Kathy discussed with me the day-to-day tactics that she had

employed to deal with her experiences, it became apparent that she has used

164

just about every support service imaginable. She also described her best study
environment. It is to isolate herself, but to have some background noise. The
noise that she prefers is not television or music, but what she refers to as "people
noise." The "people noise," however, can’t be the type she has to think about.
She liked to study in a restaurant.

Kathy took her course of study slowly. She did not finish her original post-
high-school goal. She had opted to extend the first 2 years of medical school
into 3 years. She used taking a lighter load as a way of dealing with some of the
problems college presented. It would be premature to say that she is successful
and satisfied with her occupation, but she has been successful in the academic
preparation for it. She saw differences in her performance in school after she

was diagnosed and treated.

m f t
As their individual cases were examined, I began to see some common
qualities emerge in what these ADD adults said about their college experiences.
Academic underachievement is characteristic of most children with this disorder,

so it is not surprising that we would find difficulties in adults who have ADD and

attended college.

W

The signs of both attentional deficits and impulsivity are evident in some

of the experiences that these subjects have encountered and have in common.

165
These signs are apparent in both the emotional reactions and the perceptions of
learning that they discussed.

Low self-esteem: Low self-esteem is listed as an associated feature of
attention deficit disorders in both the DSMAJI and the QSM;LIJ;B, so it is not
surprising that these subjects describe themselves as having low self-esteem.
When we add the fact that it is characteristic of ADD individuals to underachieve
academically, we can understand why college might lead to a further diminishing
of their self-esteem.

Experiences in college did often contribute to diminishing the self-esteem
of the interviewed adults. All except one of the subjects related having low self-
esteem sometime during their lives. For most of them this was especially true
during their times in college before they were diagnosed and treated.

Personality (attitude) of instructors: Many students, regardless of
whether they have ADD or not, would probably say that the personalities
(attitudes) of their instructors make a difference in their performance. Since
school is generally a fairly negative experience for these individuals (both the
D_SM;III and DSMjll_-B list school failure as the major complication of attentional
disorders), it is not surprising that they might support the assertion that the
teacher’s personality (attitude) makes a difference.

Most of the ADD adults whom I interviewed felt that the personalities

(attitudes) of their instructors had an influence on their success in the classroom.

 

166

Two of them directly stated that their success depended on the teacher. Two
others implied that instructors could influence success when they told of
experiences about the types of instructors to whom they related positively. Two
subjects did not discuss their opinions about college instructors, but supplied
strong data in relation to elementary and secondary teachers. One subject was
somewhat contradictory in her responses about whether or not personalities
(attitudes) of instructors make a difference.
r ' l r '

lnadequacies in English or math: Proficiencies in both English and
math are definitely the basis for much other academic performance. If people
have difficulty in school, it stands to reason that they would feel they have a
deficiency in one of these basics. It is also true that there is a high correlation
between ADD and learning disabilities (Barkley, 1990). Learning disabilities
often manifest themselves most prominently in language or computational skills
or both. (In this study only two of the individuals reported having been tested for
learning disabilities. Kathy Johnson and Sally Smith reported a positive
diagnosis. Dale Howard had been tested, but he was unsure of the results. The
others had never been tested.)

Most of the subjects in this study reported that they believe they have
serious inadequacies in English or math or both. For the most part, these
observations are their own and are not substantiated by standardized test

results. These observations of theirs were unsolicited. I had no question in the

167
interview guide about their performance in any specific course of study. Two of
the subjects mentioned inadequacies in English, three of them mentioned
weaknesses in math, and one mentioned weaknesses in both areas.

Lack of focus: The two major symptoms that ADD adults must exhibit
are inattention and impulsivity. The criteria in the DSMALI that were used to
diagnose these individuals include five characteristics of inattention (three of
which must be present to confirm the symptom). These are: (a) often fails to
finish things he or she starts; (b) often doesn’t seem to listen; (c) easily
distracted; (d) has difficulty concentrating on schoolwork or other tasks requiring
sustained attention; and (e) has difficulty sticking to a play activity. To confirm
the symptom of impulsivity, at least three of the following must apply: (a) often
acts without thinking; (b) shifts excessively from one activity to another; (c) has
difficulty organizing work (this not being due to cognitive impairment); (d) needs
a lot of supervision; (e) frequently calls out in class; and (f) has difficulty awaiting
turn in games or group situations. With these as the diagnostic symptoms, if the
subjects of this study did not complain of a lack of focus in the classroom or while
studying, we would question either their diagnosis or their truthfulness in the
interview.

All of the subjects resoundingly related a lack of focus in the classroom,
and some while studying as well. All seven of them said that they fell asleep or

daydreamed in class. Four of them said that they had difficulty focusing while

 

 

168

they were studying. Focus was definitely a problem for the ADD adults while
they were in school.

Visual learners: "Often doesn’t seem to listen" is one of the listed
characteristics for the criterion of "inattention" in the diagnostic manual. "Easily
distracted" is another characteristic of "inattention." If they don’t seem to listen,
if indeed they do not listen much of the time, and if they are easily distracted, it
is not surprising that many of them would report that they are visual learners.

Most of the subjects of this study say they are visual learners and that
they prefer hands-on instruction over lecture-type. As was discussed above,
many of them report falling asleep during lectures. Six of the subjects definitely
stated a preference for visual, or even hands-on, learning. Three of them
specifically mentioned preferring hands-on-type learning activities. A seventh

subject possibly preferred the auditory, but was unclear about her preference.

Th Wi x i
It is interesting that there also are some common features in the way that
the subjects of this study have dealt with their experiences. There are some
common features both in their day-to-day tactics and in their larger reactions and

outcomes.

 

 

169

Seeking support services: Many, if not all, colleges and universities
currently offer support services for students with special needs. This might or
might not have been true when and where these individuals obtained their
educations. However, it is true that most of them did not seek out special
support services. Four of them did not seek out the services or didn’t want to use
them. One individual said that support services didn’t exist at the university he
attended. (My guess is that maybe services existed. but he was unaware of
them.) One individual said that she tried some support services and they didn’t
work. She later went to a vocational school and never used support services
there. There is one definite exception to this assertion: one student has sought
out and used every possible mechanism she could to enhance her success.
(Interestingly, this is the student who has the highest level of academic
achievement, the medical student.)

There is little data to explain why most of these individuals did not seek
support as they were going through college; we can only speculate. One
individual said that he didn’t like to have to "socialize" with tutors one-on-one.
"The symptoms of inattention and impulsivity result in some impairment in social
or occupational functioning" (American Psychiatric Association, 1987). Possibly,
it is this lack of social functioning that would inhibit these individuals from seeking
help or knowing that it was available. Perhaps this is also an issue related to

their self-esteem: they may have lacked the confidence to think that they were

170

worthy of help, or that their problems could be addressed. On the other hand,
in some cases they didn’t perceive themselves as needing help. It is also very
possible that the colleges that these individuals attended did not offer, or did not
adequately publicize, support services for students.

Preferred study environment: Because these ADD adults have related
such explicit stories about being easily distracted, we might jump to the
conclusion that they prefer a study environment that is completely isolated and
free of distractions. I found that this was not true for many of them. At least
during the time period before they were diagnosed and treated, many of them
preferred a study environment that was not completely quiet and isolated. Four
of them expressed desire for some extraneous stimuli while they were studying;
two said they liked to be completely isolated, and incomplete data were obtained
from the seventh subject.

Again, there are insufficient data to explain why the majority of these
subjects prefer extraneous stimuli while they are studying. One speculation
might be based on a hypothesis that researchers are beginning to converge on:
that the fundamental problem in attentional disorders lies in the failure of those
with ADD to regulate behavior by its consequences (Barkley, 1990). Another
speculation might be based on a hypothesis of other researchers: that those with
attentional disorders have higher than normal thresholds for arousal by
stimulation; as environmental stimulation decreases, hyperactivity and inattention

increase as means of compensating for this reduction. They need the stimulation

171
to maintain an optimal level of central nervous system arousal (Zental, 1985).
If this hypothesis has foundation, we could speculate that studying in an isolated
environment decreases stimulation, and consequently inattention increases.
Therefore, studying in an environment that has some stimulation, but is not
distracting, might help to maintain the optimal level of central nervous system
arousal and facilitate concentration for these students.

WWW.

Change original plans: One of the larger reactions by the subjects of
this study to deal with their experiences in college was that they changed their
original plans. All of them changed their plan in one way or another. They either
extended their completion time, some of them dropping out temporarily and
returning later, or they dropped out altogether. One individual consistently
persevered and accomplished an original goal. However, that goal, a bachelor’s
degree, took him 8 years to complete. Two subjects dropped out of their
bachelor’s degree programs, but returned several years later to complete their
degrees. Four dropped out of degree programs they were pursuing and have not
returned.

It is not surprising that one of the reactions to their difficulties was to
change their plans. Since "often fails to finish things he or she starts" and "easily
distracted" are two of the characteristics of inattention that are symptomatic of
ADD, it is obvious that many would not complete an original program of study or

would take longer to complete one. The fact that "shifts excessively from one

 

 

172
activity to another" is a characteristic of impulsivity also provides a foundation for
speculation about why the subjects in this study dropped out or extended the
time period in which they earned their degree.

Success and satisfaction outside initial college program: One
outcome of the way the subjects in this study have dealt with their experiences
is that most of them have found success or satisfaction in their careers.
However, most of them were not in fields that require the college program they
first pursued. All five of the males in the study have found a certain degree of
success in their careers. All of them have found satisfaction at one time or
another, but two of them were beginning to get somewhat frustrated or bored at
the time I interviewed them. None of them were in career fields that use the
college course of study that they entered shortly after the completion of their high
school experiences. One of the women was still in college at the time of the
interviews, so her career success could only be measured in terms of academic
success. The seventh subject, the other woman, was a discrepant case in
relation to the assertion that they have found success or satisfaction in their
careers.

These seven individuals are not necessarily representative of the entire
population of adults who have ADD. They might not even be representative of
those who are fortunate enough to have been diagnosed and treated for ADD.
There are simply not enough data to lead to speculation about why most of these

individuals feel satisfied and successful in their careers. Perhaps they have

 

 

173

other qualities in common that were not researched (e.g., appropriate parental
intervention and motivation, quality treatment by the psychiatrist who referred
them, and so on). We can’t guess why it is so, but it is gratifying to know that
despite the obstacles encountered by people with ADD, some career satisfaction
and success is attainable for those with this diagnosis.

College after diagnosis: Most of the subjects in this study feel that they
could be/were more successful if/when they went back to college after diagnosis.
Three of them had not taken any college classes after they were diagnosed with
ADD. Of these three, two felt they would be more successful if they went back;
the third one is an exception to the assertion. Two other subjects had completed
most of their college classes before diagnosis and treatment, but have taken
some classes since, and felt that they have done better. Another two of the
subjects were actively pursuing their college degrees at the time of their
diagnosis and treatment. Both of these individuals felt they did better after
treatment. Six of them definitely felt that the treatment they received for ADD
would/did enhance their college success. The seventh subject did not express
any hope that her treatment for ADD might help her if she went back to school
now. She, however, was suffering emotional trauma, and it is not certain
whether her response was an entirely rational one.

It stands to reason that most of these individuals felt that there is a
positive correlation between treatment for ADD and academic performance. The

treatments that these individuals have received have included a combination of

174
behavior modification, psychotherapy, and psychopharmacology. Most clinicians
agree that a m'ulti-modal approach to treatment is necessary in the case of ADD
(Barkley, 1990).

At the time of the interviews, these subjects were all taking medication—six
of them were on a central nervous system stimulant, methylphenidate (Ritalin),
and one was on an anti-depressant, imipramine (Tofranil). One of the effects of
central nervous system stimulants is that they help sustain attention to tasks--
decrease the inattentiveness and impulsivity. The anti-depressant reduces
inattentiveness, but it does not affect impulsivity. These subjects have
responded positively to the medication that they are taking. It is reasonable to
assume that they would perform better academically if they were more attentive
and less impulsive. It is also reasonable to assume that behavior modification
and psychotherapy would enhance their treatment and its effect on school
performance. It is not surprising that these individuals felt that they could
be/were more successful if/when they went back to college after diagnosis and
treatment.

These seven adults with ADD are all unique individuals with different
backgrounds and experiences. They encountered different experiences in
college and dealt with them in a variety of ways. There were, however, some
common patterns in the narratives they related-~most of which were not

surprising, considering the characteristics of ADD.

 

175
E I . II I S I . l I E l

The individuals in this study might not appear to the reader to be much
different from the average college student, but they are more unique than they
first appear. Taken individually, many of the characteristics that are listed as
symptoms of inattention and impulsivity are not uncommon to many, if not most,
people. It is the combination and the intensity of these characteristics that leads
to a clinical diagnosis of ADD. The individuals in this study are clinically
more inattentive and impulsive than is developmentally appropriate. This
is what makes them different from the average college student.

All seven of the individuals studied have ADD, but I am not attempting to
generalize about the whole universe of ADD college students. The purpose of
this study is to describe and analyze the college experiences of these seven
adults and the ways in which they dealt with them. I have found and summarized
some common patterns in their experiences.

The following assertions can be made about what experiences they
encountered in college:

1. College experiences often contributed to a diminishing of their self-
esteem before they were diagnosed.

2. Most of them feel that the personality (attitude) of their instructors
has an influence on their success in the classroom.

3. Most of them feel that they have serious inadequacies in English
or math or both.

4. They all resoundingly related a lack of focus in the classroom
and/or while studying.

5.

176

Most of them say that they are visual learners and that they prefer
hands-on instruction over lecture-type.

The following assertions can be made about how they dealt with their

expefiences:

1.

They usually did not seek out special support services--or they
thought they didn’t exist.

During the time period before they were diagnosed and treated,
many of them preferred a study environment that was not
completely quiet and isolated.

They changed their original plans.
Most of them have found success and satisfaction in their careers;
however, most of them are not in fields requiring the college

program they first pursued.

Most of them feel that they could be/were more successful if/when
they went back to college after diagnosis.

Because of the in-depth study, we now know more about the college

experiences of these individuals. We know more about the subjects than if we

had only superficial understanding of any one or all seven of them. While human

beings are unique and difficult to generalize about, and while it is not the purpose

of ethnographic research to generalize, the nature of this study has been to

identify some common experiences among some or all of these subjects.

tin

It is apparent that further research would enhance or supplement the

findings of this study. Three major categories of additional research are these:

types of data, types of subjects, and type of researcher.

177
We

W. The data obtained from the types of questions asked
in the interviews in this study covered the subject fairly adequately. However,
other significant topics could be covered. For example, one characteristic of
impulsivity that was not covered specifically deals with difficulties related to
organization. Many ADD individuals have difficulty organizing their work
(American Psychiatric Association, 1980), and there were no questions in the
interview that asked whether or not this had posed difficulties for them in their
college experiences.

Wm. Most of the subjects in this study were not
currently attending college. Therefore, the data collected rely largely on their
memories of their experiences. A further study could interview subjects who
were currently attending colleges or universities.

W. A further study could be enhanced by
asking the subjects to provide documents to substantiate facts or to aid their
memories. In some cases, the subjects were not sure exactly when they had
been diagnosed and whether or not they had attended any college classes after
diagnosis. This uncertainty led to their being more speculative than they could
have been if they had documents (even access to clinical records) that

substantiated their memories.

 

 

178

W:

Mmhjems. The results of this study would be enhanced if more adult
ADD patients were interviewed. To preserve the consistency of the research, the
additional subjects should be individuals who had been diagnosed by the same
psychiatrist who referred the subjects in this study. The greater the size of the
data base, the more credibility the study would have.

SubjectsjjaghosetheLgflhjciahs. To maintain consistency, this
study was restricted to subjects who had been diagnosed for ADD by the same
psychiatrist. A different study could use subjects who had been diagnosed by
other qualified clinicians.

WW. There might be
some variability in the types of experiences students have who attend different
institutions or different types of institutions. For example, those attending
community colleges might have different experiences than those attending
private colleges or major universities. Some institutions might be more
accommodating than others. A study that separated the subjects according to
the type of institution they attended, or according to the specific institution they

attended, might yield different results.

W
W. I think that my personal experiences in dealing
with ADD within my family and my counseling practice increased my empathy

with the subjects and my understanding of them, and thus yielded more intimate

 

179

data than might have been otherwise possible. However, researchers with no
bias about ADD might produce some useful data because of their greater

objectivity.

I I. I. [II S! I

This research provides new information about the college experiences of
some ADD adults. As the introduction to this study indicated, the information is
important to college educators for humanitarian reasons, legal reasons, reasons
related to the missions of many colleges and universities, community leadership
reasons, and reasons related to societal needs. In essence, the assertions
developed in this study (listed on pages 175 and 176) have positive implications
for individuals, institutions, and society. However, this new information also

poses some problematic questions.

QQJJBQQSIUJBmfi

There are many implications in this study for college students who have
ADD or think that they might have it. To enhance their college experiences, this
study implies that ADD students need to take responsibility for their own self-
knowledge and their own learning. They would be wise to seek visual rather than
auditory learning opportunities. Because focus is a problem, they might want to
tape lectures so that ifthey miss something they will have another opportunity to
obtain it. They might want to learn or apply alternative strategies for note taking

(e.g., mapping). They should try different study environments and identify and

180

use the one that is most conducive to their own concentration. This study implies
that individuals can enhance their educational opportunities through awareness
of their ADD and their individual needs.

This research also suggests that college students would be wise to select
their classes and instructors with care. They might want to consult with others
to find out what teachers have reputations for being accommodating to students
with special needs, and for being dynamic and stimulating in the classroom.
They might also want to sign up for developmental English and math classes to
improve their skill or confidence in those areas. Individuals might plan to spread
the times of their classes out so that they do not have to maintain focus for long
blocks of time. They also might consider taking a reduced course load. Results
of this study suggest that the experiences that college students encounter are
related to the teachers they interact with, their perceptions about their English
and math skills, and their lack of focus. The implications are that there are things
they can do to enhance these experiences.

This research also implies there are various types of support services that
ADD individuals might want to seek. They might want to seek counseling
services that could help them improve their self-esteem, establish goals, and
identify and accentuate their strengths. Individuals would be wise to seek out
basic skills assessment if they think that their English and/or math skills are
weak. And, if they have not received diagnosis and treatment for ADD, they

should consider doing so.

181
Another important implication for individuals is attitudinal: maintain hope
and a positive attitude. The subjects in this study thought that they could
be/were more successful if/when they went back to college after diagnosis and
treatment. Also, most of them had found success and satisfaction in their
careers. These are important factors for college students to know if they are
experiencing difficulty in college. They need to know that others have faced

similar impediments and have become successful in spite of them.

In t' t' n

As was stated, the primary implications of this study are for individuals, but
the results also have implications for educational institutions. lnstitutions’ legal
obligations toward ADD individuals are quite clear. Those individuals are
covered under various laws regarding disabilities and civil rights. For example,
as was outlined in the introduction to this study, there are federal laws (IDEA,
Section 504 of the Rehabilitation Act, ADA) mandating that educational
institutions meet the needs of people with ADD.

In addition to the legal implications for institutions, the specific mission
statements of many colleges reflect philosophies that indicate the need for
understanding ADD. A goal in many mission statements is to make services
accessible to a diverse population of students. Growing understanding of ADD
argues strongly for including ADD students in that diversity.

This study also has implications related to institutions’ educational

purpose. It implies that helpful educational attitudes, teaching strategies,

182
services, and accommodations can be developed on the foundation of ADD
awareness. This study has many practical applications for educators—academic
administrators, providers of student development services, and classroom
faculty.

For many educators, new awareness about ADD adult learners can
produce new attitudes that can support the educational purpose of their
institutions. They can be supportive of ADD advocacy, so that erroneously
adverse preconceptions of ADD adults’ abilities do not jeopardize their
educational and occupational opportunities. The educators can be alert for ways
to contribute to the ADD students’ self-esteem. They can also be alert for ways
to motivate these students and reinforce their efforts to learn, e.g., by
communicating a caring attitude, treating the students with respect, avoiding
intimidation, and being approachable. Methods that might motivate ADD
students and develop their self-esteem are probably those that have been
identified as effective methods for students in general, but possibly ADD students
might need them more than the average student.

Various classroom strategies that can be helpful to ADD students also can
be employed. Faculty can provide stimuli in the classroom by being dynamic,
animated, and expressive, e.g., by telling stories, moving around the room, and
interacting with the students. They can vary their instructional methods.

Instructors can provide visual and hands-on learning opportunities when they are

183

needed and reasonably possible. Also, they can reinforce basic skills by such
approaches as incorporating reading and writing across the curriculum.
Awareness about ADD college students can also be the basis of many
services and accommodations that can enhance their educational experience.
Educators can be alert for symptoms of ADD and provide appropriate counseling
and referral, possibly leading to treatment, including medication. They can
provide and publicize support services such as diagnosis of basic skills, classes
in study techniques, and developmental instruction in English and mathematics.
Educators also can provide academic advising and career counseling based on
awareness of the strengths and limitations of people with ADD. Alternative
environments and facilities for study and learning can be provided for ADD
students when they are needed and reasonably possible. Also, the students can

be given extended time for testing upon request.

Society

The results of this study also have societal implications. Society is
affected because colleges are seen as community leaders and because they are
contributors to economic development. Because academic institutions are seen
as community leaders, advocates look to education to provide advocacy for ADD.
ADD advocates expect the same type of institutional awareness that has been
provided to ethnic minorities and women.

Awareness of ADD college students also is tied to societal needs in the

area of economic development. Much has been written in the past decade about

184

providing the best possible education to our workforce to enhance productivity,
and therefore the national economy. ADD individuals are a significant part of the
workforce, and society benefits from their being educated optimally.

This study has many positive implications for individuals, educational
institutions, and society. The possibilities for improving the college experiences
of ADD students, through heightened awareness and committed effort, appear
to be substantial. However, we should not underestimate the difficulties,

uncertainties, and dilemmas that are involved.

Dilemmas

EQLihdjyjduaLs. Dilemmas arise for the individual with ADD. Without
substantial financial resources, it is often difficult to obtain diagnosis and
treatment for ADD. College students manytimes do not have much discretionary
income. How do they obtain services if they do not have these resources? If
they cannot afford the medication and treatment they need, how can they
optimize their experiences? To seek out and receive support services, they
would have to identify themselves as having ADD, and thus risk being "labeled"
and being the objects of discrimination or prejudice. Should they identify
themselves or not? How can they get the help they need if they do not identify
themselves to educators?

WW Questions also arise for educational
institutions. There are questions related to classroom instruction, support

services, and the definition of student success.

185

Educators might face various dilemmas related to classroom instruction.
Many of the strategies suggested in this study are those employed by the most
effective classroom teachers, but should we assign all of the ADD students to the
best teachers, thereby depriving other students of the opportunity to interact with
those teachers? Would matching ADD students with the best instructors create
a "tracking system" which has proven nonproductive in classrooms? Would
having many ADD students in the same classrooms create distracting dynamics
that would exacerbate their inattentiveness and impulsivity? Would having to
deal constantly with a number of these students lead to teacher burnout and thus
be counterproductive? Is it better for instructors to know that a student has ADD
so they can accommodate him/her, or not to know so they can avoid
inadvertently applying a "self-fulfilling prophecy"?

There are questions for educators also about support services. How can
we ensure that students receive appropriate support services? How can we
facilitate the removal of students’ emotional blocks created bytheir denial of their
situation and needs? Do we need to change institutional paradigms that place
stigmas on the use of support services, and if so, how can we do that? Should
we assume that those who use support services will be more successful?

There are questions about the way that educators define success. It is
interesting that most of the ADD adults in this study consider themselves
successful, but most of them probably would not be defined as successful by the

educational institutions they first attended. Have they found career success

 

186

despite the academy and its assumptions? Are there things that could have
been done to facilitate their success without diminishing their self-esteem?

EQLsociety. There also are societal questions concerning success and
the use of resources. ls society defining success through the eyes of educators?
Are there effective ways of educating and training adults outside of traditional
college settings? How much money do we want to allocate to provide services
and accommodations for students with special needs? What is the appropriate
balance between developing human resources and spending economic
resources?

Formidable questions and problems arise as we contemplate universal
and comprehensive application of the data in this study. However, it seems
desirable to individuals, institutions, and society to act gradually and cautiously
on the information they have, while trying to get more information, resolve the
unanswered questions, and solve any problems that may arise. There is
nevertheless substantial justification for applying the results of this study in
immediate and practical ways, and for supporting the pursuit of further research
that addresses the enduring dilemma of providing equitable educational

opportunities to those with ADD, as well as to our citizenry more generally.

POSTSCRIPT

/ have alluded in the main text se vera/ times to my personal experiences
with, and thereby interest in, the issues of A DD and education. Here, /
would like to share more explicitly what this experience has been and how
it led me to do this study.

As I finish this dissertation and look back into my daughters’ records to
account for my history in relation to Attention Deficit Disorder (ADD), I smile at
my naivete of 20 years ago, and I am intrigued by how classic their clinical
records are. lam also sad that the mental health and medical professionals did
not know then what we know now, but I feel gratitude for what I have learned in
the past few years.

I was a high school teacher, working on my master’s degree, when my
older daughter began school. I believe that objective observers considered her
an exceptionally beautiful child physically. Renee had a truly beautiful face, was
tall and strong. She had developed quickly (e.g., had walked when she was 9
months old), and through my parental eyes she appeared to be "obviously"
destined for something extraordinary.

I took it for granted that she would do well in school. School had always
been easy and enjoyable for me. So it was rather surprising when her first-grade

teacher said she was not doing quite as well as expected. But that was nothing

compared to the shock I felt when a friend of mine--a special education

187

188

consultant--told me that she had met Renee’s teacher at a conference. What?
My child in special education! After I nearly raised the roof off the
superintendent’s office, organized a "concerned parents" group of other parents
whose children had been placed in this classroom without receiving the legally
mandated diagnostic testing, and contacted the State Board of Education, Renee
received the appropriate testing to diagnose her specific problems.

Afterthe school psychologist had finished with her report, and Renee was
diagnosed as having a borderline learning disability, we took her to a
neurological MD. The physician’s report stated, "She has been described as
being hyperactive in school but ’not really’ at home." (Everything is relative--she
didn’t act much differently than many other members of my family! I now know
that ADD is hereditary.) He also reported, "She has been on Ritalin . . . for
several mon[th]s 8 seems to help but mother ’does not believe’ in giving med."
(This was 1975. I had been a high school teacher for 6 years. I did not want my
daughter to develop the attitude at an early age that it was acceptable to use
drugs to alter one’s consciousness. I had seen too many dysfunctional young
people with that attitude using marijuana, LSD, and other street drugs.)

The neurologist agreed with me that Renee could "try without med as
hyperactivity appears not to be a major problem at this time." Whew, I was
relieved--l wouldn’t have to encourage this little psyche into drug abuse! The
neurologist’s diagnosis: "Mild Brain Dysfunction--a good candidate for a learning

disability or perceptual development program." (We know now that "Mild Brain

 

 

189

Dysfunction" was a term that was a precursor to what we now call "Attention
Deficit Disorder [ADD]" or "Attention-deficit Hyperactivity Disorder [ADHD]." In
Renee’s case it was attributed to the possibility that she had damaged her brain
when she suffered a skull fracture in an automobile accident at the age of 2.)

At the time of this diagnosis, Renee was in second grade in a rural school
district, which was located outside a university town. We discontinued the Ritalin
and continued with the assistance of the special education teacher through
second, third, and part of fourth grade. During the middle of her fourth-grade
year, we moved to a more rural school district, which was even further from any
sophisticating influences of the university.

I was a school counselor in this district where Renee would be going to
school; lkhewwhat types of children were in that special education classroom--
largely mentally impaired and a rather severely emotionally impaired child. The
special education teacher was also an elementary counselor. He and I decided
that the damage to Renee’s self-esteem by having to be in that classroom would
probably outweigh any benefits she would receive from the specialized
instruction. Renee's use of special education services ended at that point, when
she was in the fourth grade. She made it through the rest of grade school,
middle school, and high school, avoiding the most demanding classes, and got
average grades. She was pretty, personable, and athletic. She did not

encounter any major obstacles.

 

190

It was not until Renee was about 20 or 21 and attending community
college that she began to have difficulties. She had boyfriend problems, moved
in and out of our home, did not sustain attention in her classes, and impulsively
spent money. At this point she was diagnosed as an adult with ADD and began
treatment—Ritalin and counseling.

My other daughter, Michelle, is 6 years younger than Renee. She was a
freckled-nose cutie--bright, fun-loving, and energetic. She seemed "normal" to
me, but by the time she was in first grade (1980), her teacher suspected that she
was "hyperactive." (We now know that "Hyperactivity" is a term that was used
to describe what we call "ADD" or "ADHD" today.) We consulted with a
pediatrician, who confirmed the diagnosis and started Michelle on Ritalin. Her
teacher reported a "miraculous transformation" in Michelle’s behavior.

Despite the apparent benefits, I discontinued giving her the Ritalin before
long, probably at the end of her first—grade year. (I was probably still worried
about developing in my children values that would promote substance abuse
when they got older.) Between first and second grades, I sent Michelle to a
special reading clinic, and in second grade the school tested her for special
education services. The school psychologist’s report said that Michelle seemed
to have a learning disability in reading and perhaps also in listening
comprehension. She stated, "Michelle has many of the other characteristics of
a learning disability such as distractibility, excessive activity, fluctuations in

performance and difficulty in attending to a task until it is completed." (These are

 

 

191

all classic symptoms of ADD/ADHD; we know that now.) Michelle was placed in
the special education resource room for reading assistance. She continued in
that mode-no Ritalin, but special assistance an hour or two a day--through
second, third. and fourth grades.

Fourth grade was a crisis: she and her teacher were not compatible. He
thought she was "unladylike," and was lacking in supervision because she came
from a "broken home." His suggestion was to retain her in the fourth grade. I
had been told repeatedly by professional educators in the past that retention
would not be good for her--that her deficits were because of a learning disability,
not a lack of intelligence. The school principal said that the decision was up to
me.

It was at this point, when l was trying to decide whether to have her repeat
fourth grade or not, that we were referred to Dr. Evers. (Dr. Evers is the
psychiatrist who subsequently has treated both of my daughters and whose
patients I interviewed for this study.) She diagnosed the ADD, encouraged me
to let Michelle go on into fifth grade, and educated me about the necessity for
drug therapy. At my protestations concerning my daughter developing attitudes
that would lead to substance abuse, she said, "If your daughter had epilepsy,
would you deny her medication?" Of course lwouldn’t! She reasoned with me
that ADD is a neurological disorder and similarly responds to medication. That
was 11 years ago, and it put an end to my misgivings about Ritalin. Michelle is

almost 21 now, and she is still taking the drug.

 

 

 

 

192

The ways in which I responded to ADD in my two daughters were quite
different for a variety of reasons. First of all, Renee was older, and mental health
and medical practitioners did not know as much when she was young.
Furthermore, during Renee’s early years we lived in a much more rural setting
and were not fortunate enough to have access to knowledgeable professionals
like we did with Michelle.

Renee’s and Michelle’s experiences in college have also been quite
different. Renee registered for classes and dropped out without completing them
several times, and then got diagnosed as an adult with ADD when she was 20
or 21. Michelle’s experience has been quite different. She had had 8 years of
treatment for ADD before she began college. She has consistently been a full-
time college student for the last 3 years, and hopes to have her bachelor’s
degree in 2 more years. I have no data to prove that there is a correlation
between when their treatment began and how they have experienced college.
Obviously, they are distinct personalities and have been influenced by a variety
of environmental factors, but I do believe that the Ritalin and counseling that
Michelle has received have had a positive impact on her academic success.

The experiences I shared with my daughters in relation to ADD have
created plenty of motivation for me in doing my research. Bogdan and Biklen
(1982) said, "Self—discipline can only take you so far in research. Without a touch
of passion you may not have enough to sustain the effort to follow the work to the

end, to go beyond the ordinary" (p. 57). It was the experiences that my

 

 

 

193

daughters have had that provided the passion I needed to do this research. It
was their experiences that motivated me to look for an answer to the question of
this research project: How do adults with ADD experience this disorder in their
college life and deal with the problems the disorder presents to them in college?
My research findings are the beginning of an answer, one that I hope and

assume will be strengthened by others’ research projects in the near future.

 

 

 

APPENDICES

 

 

APPENDIX A

APPROVAL LETTER FROM THE UNIVERSITY COMMITTEE ON

RESEARCH INVOLVING HUMAN SUBJECTS

 

 

OFFICE OF
RESEARCH
AND
GRADUATE
STUDIES

University Committee on
Research Involving
Human Subjects
(UCRIHS)

MICIIIg-HI'I State University
225 Administration Bolldmg
East Lansing. Mcmgan
488244046

517/355-2180

FAX 517/336-II71

MSU IS an Jitlrmarwe-Jchon,
mualvopporrunrty institulzcn
O

  

194

MICHIGAN STATE
0 N l v E R s I T Y

June 7, 1993

TO: Jennifer Bramer
362 Hitching Post Road
DeWitt, MI 48820

RE: [RB #:
TITLE:

93-266

ADULT ATTENTION-DEFICIT HYPERACTIVITY DISORDER: THE
COLLEGE EXPERIENCE

CATEGORY: l-C

REVISION REQUESTED: N/A

APPROVAL DATE: June 7, 1993

The University Committee on Research Involving Human Subjects‘ (UCRIHS) review of this project
is complete. I am pleased to advise that the rights and welfare of the human subjects appear to be
adequately protected and methods to obtain informed consent are appropriate. Therefore, the
UCRIHS approved this project including any revision listed above.

UCRIHS approval is valid for one calendar year, beginning with the approval date shown above.
Investigators planning to continue a project beyond one year must seek updated certification. Request
for renewed approval must be accompanied by all four of the following mandatory assurances.

1. The human subjects protocol is the same as in previous studies.

2. There have been no ill effects suffered by the subjects due to their participation in the study.

3. There have been no complaints by the subjects or their representatives related to their
participation in the study.

4. There has not been a change in the research environment nor new information which would

indicate greater risk to human subjects than that assumed when the protocol was initially
reviewed and approved.

There is a maximum of four such expedited renewals possible. Investigators wishing to continue a
project beyond that time need to submit it again for complete review.

UCRIHS must review any changes in procedures involving human subjects, prior to initiation of the
change. Investigators must notify UCRIHS promptly of any problems (unexpected side effects,
complaints, etc.) involving human subjects during the course of the work.

If we can be of any future help, please do not hesitate to contact us at (517) 355-2180 or FAX (517)
336-1171.

Sincerely,

David E. Wright, Ph.D.
UCRIHS Chair

DEW:pjm

cc: Dr. Douglas Campbell

 

 

 

 

APPENDIX B

PARTICIPANT CONSENT LETTER AND CONSENT FORM

 

 

195
Dear (interviewee’s name):

As a doctoral student at Michigan State University I am studying the college
experiences of Attentionbeficit Hyperactivity Disorder (ADHD) adults. I am
interested in how you have experienced this disorder in your college life and how
you deal with the academic problems that you have been presented with. I hope
that I will develop a fuller and more refined understanding of ADHD college
students that could be shared with other educators.

l have worked closely with (a local psychiatrist) in devel-
oping the proposal for my study and will be interviewing patients of hers who
have consented to do so. You have signed a consent form with
(psychiatrist’s name) agreeing for her to provide me with your name as a possible
participant in my study. I will be calling you within a week to see if we can set up
a time to meet.

 

If you agree to meet with me, I will interview at a time that is most convenient for
you. We will meet in a location of your choosing where you will feel as comfort-
able as possible. We will meet one or two times for approximately an hour at a
time. To get an accurate record of interviews, I will ask you if I can audio tape our
discussion.

On the form on page two of this letter, would you please indicate whether or not
you are willing to participate in the study? Because your participation should be
completely voluntary, you can decide that you will not be a part of this study at all,
or you can withdraw from the study at any time, without penalty. If you do
participate in the study, you can choose not to answer any particular interview
questions. For any audio taping that I might do, you have the right to have me
stop the recording at any time. If you do not give permission to be taped, I will
not record you.

All of the data that I collect will be treated with strict confidence; your name will
not be used in any reports about this project, and any identifying characteristics of
you will be disguised. As indicated on the attached form, you can restrict the
uses I make of the materials I collect which include you.

I hope you will agree to participate in this study. While no specific benefits can be
guaranteed, I believe that the knowledge I gain will be valuable to me and other
professionals who are trying to understand the academic experiences of ADHD
college students. If you have any questions or concerns about this study, please
feel free to call me at (517) 483-1184 (at work) or 669-5234 (at home).

Thank you very much for considering participation in my study.

Sincerely,

Jennifer S. Bramer, Ph.D. Candidate
Licensed Professional Counselor

 

 

196
CONSENT FORM

The goals of this study and the nature of my involvement in it have been
explained to me in the attached letter. I understand that the data from the study
will be maintained indefinitely, to be used for documenting Jennifer S. Bramer’s
study of ADHD college student experiences and for sharing with others the
information learned from her study.

The data will be used in meeting the requirements for Jennifer Bramer’s doctoral
degree, in reports about the study, in published articles, in presentations at
conferences, and in the planning and implementation of educational programs. I
have been assured that in any such uses, my identity will not be revealed. I do
understand that in audiotapes in which I am recorded, I might be recognizable
even though no names will be used. I may choose to have any segment of an
audiotape in which I am identifiable not used in the study or in presentations.

I have also been assured that I can decline to participate in any or all of the
activities listed below, including declining to answer any particular questions. I
can withdraw from any of these activities at any time, without penalty.

I agree to participate in the activities I have indicated below (please use your
initials):

You may talk to me about my experiences as an ADHD college student,
covering my understanding of the disorder, my personal history, and the impact of
these on my academic life.

iti : You may audiotape these interactions.

You may use (in presentations, publications, and reports) audiotapes and
other data from observations and interviews that include me as long as you do
not identify me by name or through other background information about me.

Name

 

(please print)

Signature: Date:

 

APPENDIX C

INTERVIEW GUIDE

197
INTERVIEW GUIDE

I. Purpose of the study

To describe how adults with ADD experienced this disorder in their college
life and how they dealt with the experiences this disorder presented to them in
college. In order to provide me with the appropriate background for my questions
about your college experiences, I will also ask you questions about your understand-
ing of the disorder and your early recollections of ADD.

II. My interest in this study

I am a Licensed Professional Counselor who has been working in that role
for 18 years, primarily in high schools and colleges. l have two adult daughters who
are ADD and who have attended college--one who has dropped in and out and one
who has attended continuously. They have been treated by Dr. Evers forthe last 10
years, so I have had an opportunity to observe both personally and professionally
the effects of ADD. I am now completing my doctoral degree in Adult Education.
This topic is one that I’ve become very interested in and look forward to learning
more about as we talk.

III. Anonymity and confidentiality

l have obtained from you a release form allowing me to interview you and to
audiotape these interactions. However, to ensure your anonymity, l have chosen not
to begin recording until after I have obtained your name, age, and other identifying
information. The person who will be transcribing these tapes is a secretary at DeWitt
schools who is used to dealing with confidential information. If you think you might
know her and that she might recognize your voice, I will find another typist for your
tape. Dr. Evers will probably read my completed study, and there is high likelihood
that she will be able to figure out who said what in the interviews. Do you have any
concerns about your anonymity or confidentiality?

IV. Format

I might have explained to you on the phone that I am uncertain about how
long my interviewing will take. After about an hour today, I will tell you how far we
are on the list of topics, and we can decide if we want to continue for another half
hour or so, or schedule another meeting. Because of my schedule, I will have to end
our session today no later than

 

 

198

V. Topics for the interview

1. Demographics
a. Age
b. Gender
0. Race
d. When individual attended college
e. Where individual attended college
f. How long individual attended college
9. DSM III-R characteristics
h. Current educational or occupational status

2. Understanding of Attention Deficit Disorder

 

a. Individual’s understanding of ADD
b. Source of the individual’s knowledge

3. Feelings about ADD

 

a. Feelings about having it
b. Feelings about the label
0. Feelings of being different from others
4. Personal history
3. ADD diagnosis experience
b. Diagnosis for learning disabilities
c. History with receiving medication
d. Elementary or high school experiences that might be related to
ADD
e. Experiences with and feelings about repeating any grades in
school
f. Description of relationships with friends and family
(1) Reactions of others to problems
(2) Telling friends about ADD (when, where, how)
(3) Experiences of difficulties with people dated/spouses
that can be attributed to ADD
5. Selection of college and admission
a. Factors in selecting a college

b. Problems encountered in being admitted to college

10.

199

College teaching/learning preferences

a. Types of classes preferred (lecture, discussion, etc.; self-
paced, regular classroom, laboratory, etc.; small, large)
b. Types of instructional delivery preferred (auditory, visual, etc.)

Study techniques and support mechanisms in college

Description of study habits/environments

Coping mechanisms employed

Special services obtained

Accommodations available at the college to assist in studying,
test-taking, etc.

e. Special assistance sought (tutoring, special instruction)

9.0.65»

General problems in college

a. Problems encountered while in college
b. Problems with struggling to concentrate or focus
0. Awareness of variability in performance from time to time

Relationships with instructors

a. Personality/attitude of instructors

b. Instructors’ reactions

0. Disclosing diagnosis to instructors (when, where, how)
Advice

a. Advice you have for college instructors

b. Advice you have for ADD college students

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