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characterized by developmentally inappropriate levels of inattention and/or hyperactivity-impulsivity that affects approximately 3 10% of school age children and adolescents . Research indicates that increasing numbers of high school students with ADHD are pursuing college and in a recent national survey, 6.4% of male and 3.9% of female freshman reported having ADHD . College students with ADHD are entitled by the American Disabilities Act to receive educational support services, and approximately 25% of college students receiving disability support services receive services for ADHD. This percentage has increased substantially since 1975 . The prognosis for college students with ADHD varies across studies, but most suggest that college students with ADHD are at increased risk for academic problems, executive function deficits, lower grade point average, compromised academic coping skills, and higher than average risk for psychological and interpersonal difficulties [4,5,6,7,8,9]. A number of non-pharmacological treatments are available for ADHD (e.g., behavioral support therapies, cognitive-behavior therapy, biofeedback) and studies attest to their varying effectiveness. To date, however, the majority of ADHD treatment outcome studies have shown that, in general, the most effective treatment for reducing ADHD symptoms is stimulant medication (e.g., amphetamine, methylphenidate) although questions remain regarding the magnitude of these effects given various methodological problems in the literature . Questions also remain regarding the extent to which placebo effects and responding contributes to observed improvements in cognitive and behavioral functioning in children and adults. For example, Fageera and colleagues recently found a significant placebo response in both parents and teachers of children with ADHD during a randomized, placebo controlled clinical trial of methylphenidate with more robust effects observed in parents than teachers. Mateeton et al. reported that lisdexamfetamine (LDX) is efficacious and well tolerated in the treatment of ADHD in adults, however its acceptability is no higher
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careful read of the anecdotes reported in the media and entries on websites on the topic suggest that a great deal of individual variation exists with regard to purported effects and experiences. A prevailing attitude, shared by many parents and physicians, is that the nonmedical use of prescription stimulants is benign and therefore not a major concern. In a recent article on the nonmedical use of stimulant medications as & x0201c;study aids,& x0201d; a distinguished physician said, & x0201c;It doesn& x02019;t seem to be causing too much trouble since most [students] use the drugs not to get high but to function better. When exams are over, they go back to normal and stop abusing the drugs.& x0201d; 17 We believe this commonly expressed attitude trivializes nonmedical prescription drug use and exacerbates a serious problem that requires an effective multidisciplinary response. Despite its appeal, there are some serious problems with the RDS model. I'll name just two. We know from dozens of studies that drug or alcohol use itself leads to a reduction in dopamine receptor density, or at least dopamine receptor activation, because those receptors tend to burn out or become desensitized when we keep bombarding them with fun stuff. Now that's getting closer to B. B. King's complaint: The thrill was there for awhile, but now it's gone. The question remains: is your dopamine landscape more determined by your genes or by how you use them? Problem 2 is that teenagers as a group are often described in terms of reward deficiency syndrome. Teens can be seen as under-stimulated, probably because the reorganization of the nervous system in adolescence is pretty uneven, with new motives often preceding new opportunities for fulfilling them. RESIDENCE SOCIALE PLESSIS TREVISE. On Friday, someone in New Bedford paid a dealer $2 for a 5-milligram hydrocodone pill, a price deemed ?heap in the busy black market for prescription opioids. That same day in Winchendon, a person spent $5 on a 30-milligram Adderall, rated ?ot bad for the popular stimulant. Many mental health advocates, including representatives of the National

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