Why Is It So Hard to Get an ADHD Evaluation in College?

49% of campuses prohibit students from accessing stimulant medication for ADHD on campus.¹ 89% require neuropsychological testing before diagnosis—testing that is expensive, time-consuming, and often clinically unnecessary.¹ 73% of campuses offer no clinical services for ADHD diagnosis at all.¹

This happens despite clear evidence that untreated ADHD affects at least 8% of college students,² consistently lowers GPA across all semesters,² and reduces graduation rates by 10 percentage points.² Students with ADHD also develop anxiety and depression at 8-10 times the rate of other students during freshman year.² ADHD is associated with increased risk of accidental injury, substance use disorders, and premature mortality, reducing overall life expectancy by approximately 13 years when the condition persists into adulthood.³

These barriers create a crisis affecting millions of students, yet change is possible. New clinical tools show promise for improving both diagnostic accuracy and clinician confidence, and clearer frameworks are emerging for how institutions can balance safety with accessibility.

Understanding the Barriers to Diagnosis and Treatment Access

Access to ADHD evaluation and treatment remains limited across U.S. universities. Despite growing awareness of the ongoing difficulties associated with ADHD in adulthood, college policies often create procedural and financial barriers that delay or block students from receiving care. Unclear service pathways, requiring high cost and unnecessary neuropsychological testing, and a general lack of mental health practitioners on campus frequently place diagnosis out of reach for those without external support. Even with a diagnosis, campus clinic policies blocking the prescription of stimulant medications and an absence of support group services put treatment out of reach. And at many smaller schools, published policies regarding ADHD diagnosis and treatment aren’t available.

These barriers rarely reflect neglect. Instead, they arise from institutions trying to balance clinical responsibility, liability, medication safety, and many other student needs. As universities manage compliance standards and limited health-service budgets, ADHD care has often fallen into a gray area between counseling and medical services.

And that’s just the schools themselves. State laws governing the prescription of medication make it so students cannot continue to receive stimulants for ADHD from their doctor at home if they go to school in a different state. Federal laws governing the prescription of stimulants require a new prescription to be written every 100 days. Many insurance companies refuse to pay for a prescription covering more than 30 days. So many high school students who are already on medication for ADHD arrive on campus with a small supply that will only last the first weeks. Only to discover at many schools that there are no clear policies and extremely limited resources for continuing their ADHD treatment once on campus. Or worse, there are specific policies meant to prevent accessing medication, which often require months of waiting for available service providers to “confirm” an already established diagnosis before medication can be obtained.

Institutional Policies Limiting Access to ADHD Services

A 2024 study by my colleague, Dr. James Aluri at Johns Hopkins, analyzed ADHD assessment and treatment services across 200 U.S. colleges and universities. He and his team confirmed and quantified what I had already seen firsthand on campuses in multiple states and discussed at length with colleagues across the country: a lack of clear guidance for incoming students and widespread restrictions crafted specifically to prevent accessing care.¹ Although ADHD is recognized as a common condition affecting college performance, most institutions provide minimal structured support or actively block receiving treatment.

Access To ADHD Services¹

These limitations have practical effects on academic functioning. Students who suspect ADHD often encounter referral loops, directed from counseling centers to off-campus specialists with waiting lists exceeding a semester. Because many institutions restrict stimulant prescribing, students may need both an external evaluation and a separate off-campus prescriber, compounding delays and expenses during the crucial first year when significant comorbidities like anxiety, depression,² and substance use including nicotine⁴ develop rapidly in these young adults.

Campus clinicians interviewed in follow-up analyses often cite resource allocation and medication liability as primary concerns. ADHD evaluation requires longer, more specialized appointments than typical counseling visits, which can strain student health budgets already focused on acute care and crisis response. Institutions that rely on contracted counseling services may also lack psychiatrists authorized to prescribe stimulants, creating another procedural barrier. And, fundamentally beyond the control of campus administrators, there are very few practitioners in this country who are well-trained, experienced, and comfortable diagnosing ADHD in transitional-age youth and adults.

The Recognition Gap: High Prevalence, Low Diagnosis

A Hungarian university study of 395 students found that 28.6% exhibited clinically significant ADHD risk factors, yet only 2.9% had received a prior diagnosis.³ In the United States, even among college students with existing ADHD diagnoses, more than one in four had no contact with a healthcare professional about their ADHD within the past year.⁵ Together, these findings suggest that both initial diagnosis and ongoing treatment access remain significant barriers for college students internationally.

In clinical practice, students often present for ADHD evaluation only after multiple semesters of academic difficulty, having previously attributed attention and organization problems to stress or inadequate study skills. Without institutional guidance or accessible screening, evaluation typically occurs reactively rather than proactively.

Academic Outcomes for Students with Untreated ADHD

The long-term academic impact of untreated ADHD is well documented. The TRAC (Trajectories Related to ADHD in College) Study followed students with and without ADHD across four academic years.² Those with ADHD demonstrated consistently lower grade-point averages and were less likely to persist through degree completion, even when controlling for intellectual ability and study effort.

Academic Outcomes for Students with ADHD²

Beyond academic metrics, executive-function deficits emerged as strong predictors of whether students would drop out before graduating.² While inattention symptoms affect day-to-day academic performance and GPA, executive-function deficits appear to determine whether students persist through the demands of sustained degree completion. These findings emphasize that academic accommodations alone may be insufficient without clinical intervention. Without medication or therapy addressing executive function, students with ADHD face ongoing dropout risk even with academic support services.

Untreated ADHD also correlates with elevated rates of academic probation, course withdrawal, and delayed graduation.^{2, 3} Müller et al.’s research further demonstrates that the consequences extend across multiple domains:

Consequences of Limited Access^2,3

These findings suggest that delays in diagnosis do not merely postpone treatment but also alter developmental trajectories. Students who leave college without support often enter the workforce with unresolved attention and regulation difficulties, limiting career progression and overall well-being. People with ADHD can solve complex problems with ease and creativity, but they can’t manage to remember where their ID card went. And sadly, this data suggests that graduating from college seems to be more about managing a daily planner than offering meaningful insight into problems that others struggle to solve.

Balancing Access and Risk: Understanding University Caution

University leaders frequently cite concerns about stimulant misuse as justification for restrictive prescribing policies. Studies estimate that 5–35% of college students engage in nonmedical stimulant use, most often for perceived academic enhancement.⁶ Because prescription misuse carries both legal and health implications, many institutions err on the side of caution by limiting medication availability altogether.

However, such restrictions can inadvertently create the opposite effect. Research shows that peers with prescriptions are the primary source of diverted stimulants, with 62% of students who have stimulant prescriptions reporting they have shared or sold their medication.⁶ When students with legitimate ADHD cannot obtain appropriate evaluation or medication through campus health services, the existing underground market of peer sharing fills the gap—increasing the very risk institutions aim to reduce. Restrictive policies that block access to diagnosis and treatment may inadvertently drive both supply and demand in this informal distribution system.

Liability considerations further complicate the issue. Campus health centers operate under varying state regulations, and many lack psychiatrists who are comfortable managing controlled substances for a transient student population. In this context, strict policies can appear pragmatic, even if they reduce legitimate access.

Clinical Training Gaps in Adult ADHD Recognition

Another contributor to limited campus support is the shortage of psychiatrists and mental-health providers trained to evaluate adult ADHD. Almost no psychiatry residencies have access to practicing psychiatrists who specialize in working with adults with ADHD. So they cannot provide the in-clinic training experiences that psychiatrists-in-training need to build skills in diagnosing and managing ADHD in adults. ADHD has historically been considered a childhood problem. So the available training experiences involve working with children. And often these don’t take place until after residency, in Child and Adolescent Psychiatry (CAP) fellowships. Psychiatrists who work with adults do not do a CAP fellowship, and so never have these training experiences.

Beyond this, ADHD is difficult to identify when the inattentiveness predominates or the hyperactivity is internalized. This is a documented change in the experience of ADHD as people age: hyperactivity wanes and inattentiveness persists.⁷ As a result, clinicians may underrecognize ADHD when symptoms appear as internalized hyperactivity, disorganization, or emotional dysregulation rather than more obviously observable externalized hyperactivity.

To address this gap, Dr. Aaron Winkler has developed new initiatives to provide training experiences for psychiatrists still in training and also help those already in practice to increase their comfort and skill in diagnosing and treating ADHD in adults. He developed and deployed a lecture and clinical-experience curriculum for the psychiatry residents and fellows at Stanford University in Palo Alto, California. The lecture component has now been successfully piloted via remote teaching for the psychiatry residents at George Washington University in Washington, D.C.

Dr. Winkler has also developed a clinical tool that significantly improves the comfort of practicing clinicians of all training backgrounds, not just psychiatrists, in managing ADHD in adult: California Symptom Tracking for ADHD (CAST ADHD), which he has made freely available to clinicians around the world. Dozens of clinicians in at least 8 countries are regularly using CAST ADHD. And clinical research studying the effectiveness of CAST ADHD for improving patient care is underway. These programs aim to expand clinician competency in adult ADHD diagnosis and treatment, improve diagnostic precision, support ethical prescribing, and illuminate the importance of integrating advanced psychotherapy skills with medication management.

Improved clinician education may help reduce institutional hesitancy while maintaining safety standards. Well-trained providers can more confidently evaluate ADHD, differentiate misuse from legitimate treatment, and advocate for evidence-based campus policies. Addressing these training gaps is one component of a broader set of systemic changes needed across higher education.

A Framework for Moving Forward

Addressing the gap in ADHD evaluation for college students requires coordination among campus health systems, those who educate clinicians, policymakers, and the students themselves. Key steps include:

• Expanding clinical training for psychiatrists and other campus clinical providers in adult ADHD recognition and treatment.
• Developing standardized, affordable evaluation protocols that meet diagnostic accuracy standards without imposing prohibitive costs. CAST ADHD may already have achieved this. If so, ongoing research will soon answer that question.
• Implementing medication-management campus policies and legal frameworks that safeguard against misuse while preserving legitimate access.
• Strengthening partnerships between universities and community providers to reduce delays in care.
• Encouraging ongoing data collection to evaluate the impact of institutional policies on academic and health outcomes.

By integrating educational reform with institutional accountability, universities can better align student support with current evidence. The goal is not unrestricted access, but balanced access, a model that protects safety while ensuring that capable students are not left without the resources to succeed.

Learn More About Dr. Aaron Winkler’s Clinical Training Curriculum

Learn More About CAST ADHD

For those in California, Dr. Winkler diagnoses and treats adults with ADHD.

Sources

1. Aluri, J., et al. (2024). ADHD Assessment and Treatment Services in a Sample of U.S. Colleges and Universities. Psychiatric Services.

2. Anastopoulos, A.D., et al. (2018). Academic Trajectories of College Students with and without ADHD: Predictors of Four-Year Outcomes (TRAC Study). Journal of Clinical Child & Adolescent Psychology.

3. Müller, V., et al. (2024). Dropout Intention among University Students with ADHD Symptoms. Education Sciences.

4. Dvorsky, M.R., Langberg, J.M., Becker, S.P., & Evans, S.W. (2019). Cigarette and E-Cigarette Use and Social Perceptions Over the Transition to College: The Role of ADHD Symptoms. Psychology of Addictive Behaviors, 33(3), 318-330.

5. American College Health Association (2023). National College Health Assessment Reference Group Executive Summary.

6. Benson, K., Flory, K., Humphreys, K. L., & Lee, S. S. (2015). Misuse of stimulant medication among college students: A comprehensive review and meta-analysis. Clinical Child and Family Psychology Review, 18(1), 50-76.

7. Wilens, T. E., Biederman, J., & Spencer, T. J. (2002). Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 53, 113-131.