As thoughts turn from summer vacation to the return to school, I am struck by some interesting trends in my patient population being evaluated and treated for ADHD.

Ages 6 and 7 have long been common ages when children are brought to my office because of possible ADHD symptoms. That’s not surprising given the fact most of those diagnosed with ADHD had evidence of those symptoms during their early school days. I have also noticed many young people making the transition from elementary to middle school having a tough time going from class to class and keeping up their focus.

Similarly, high school students in their junior and senior years might be struggling with standardized tests and the addition of honors or AP classes even though these students are very bright. I have often referred to ADHD as an “over-under” condition because the patients feel overwhelmed and are underachieving. This seems particularly true with new college students and that is the group I wish to focus on here.

Going from high school to college can be quite a jolt to the system under the best of circumstances. Those with untreated ADHD seem to have a tendency to go to larger schools. Time management is no longer Mom and Dad’s issue; instead, the responsibility falls squarely on the student. They are bright enough to work around the symptoms in high school, but now the symptoms have caught up with them.

College freshmen have to take core curriculum courses–not classes they want to take. The classes are offered in auditorium-style classrooms with hundreds of students present. I like to ask my patients where they sit in those classes with a vast majority saying they sit in the back with all the distractions in front of them. They sit there often because they arrive late and don’t want to disturb anyone else. These core classes are commonly taught by the least experienced lecturers they will see throughout college and these instructors frequently are not the most gifted speakers. Ten minutes into the presentation, the student with untreated ADHD is at the beach, for all practical purposes.

These young people then really struggle with this less than spellbinding subject matter. They don’t keep up; rather, they do fall behind and then procrastinate until the last possible moment to turn in papers and study for exams. Then the grades come out for the semester and the results can be rather shocking. We hear plenty about the so-called “Freshman 15″ that refers to the number of pounds many students gain during that freshman year. I am increasingly concerned about the “Freshman 1.5,” the GPA so many of these bright people have that first year.

The “Freshman 1.5″ is something these young people and their parents have never seen. The students are frequently anxious, depressed, confused, and embarrassed about these newly-found problems being experienced for the first time. I see an increasing number of students getting ready for, going through, or having just completed their freshman year. The key is getting an evaluation since not every focus or concentration problem is automatically ADHD. However, if ADHD is indeed part of the equation, there is hope if the young person seeks help and follows through when treatment is needed.

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