Supporting Students with ADHD

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What is ADHD? 

Attention Deficit Hyperactivity Disorder, or ADHD, is a neurodevelopmental condition that typically affects people chronically over their lifetime and consists of impairment in the brain’s executive functions. Specifically, people with ADHD often struggle with organization, impulse control, and attention, as well as emotional regulation. 

While some view ADHD as a disorder, the neurodiversity movement argues that ADHD simply represents a different kind of thinking. The evolutionary mismatch theory states that it is only within the last several hundred years that people have been expected to sit still and concentrate on academic tasks for many hours during the day, and that these current environmental demands do not fit the ADHD brain. This means that the exploratory drive, flexibility, and novelty-seeking of ADHD are not negative but merely do not match the current expectations of students. 

How prevalent is it? 

In general about 3-5% of adults worldwide are diagnosed with ADHD, though according to data from the 2019 National College Health Assessment, almost 8% of Canadian students were treated or diagnosed with ADHD in the past 12 months. There is a common misconception, reinforced by the media, that ADHD is being over-diagnosed. However, a recent meta-analysis found that ADHD rates have been stable over the past 30 years, and in fact, some researchers argue that ADHD is under-diagnosed.  

For some time, it was thought that ADHD was a condition specific to boys and men, but research has shown this to be false. Women still receive fewer diagnoses of ADHD than men, due in part to differences in expressed behaviours, but that gap in prevalence has lessened in recent years. 

What makes ADHD difficult in the post-secondary context? 

While staff and faculty may also struggle with ADHD, the post-secondary context often presents particularly new challenges to students with ADHD, with some students moving away from home and finding themselves with fewer supports and less structure. University or college also presents an increase in the expectations and responsibilities of these students. These changes usually call for students to engage their executive functions, however those are exactly the functions with which these students struggle. 

Students with ADHD have been found to have lower grade point averages, as well as being more likely to withdraw from courses or be placed on academic probation. In general, students with ADHD also take notes less frequently during lectures and perform worse than their non-ADHD-peers at planning, completing class assignments, studying for exams, and avoiding distractions. One study found that only 15% of young adults with ADHD held a four-year post-secondary degree, compared with 48% of the control group. 

Red Flags for ADHD in Post-Secondary Students 

• Time management difficulties 
• Missed appointments 
• Frequent late and unfinished projects 
• Inconsistent academic performance 
• Substance use or other addictions 
• Difficulty maintaining routines 
• Difficulty managing finances 
• Emotional dysregulation 
• Frequent accidents from inattention or recklessness 
• Low self-esteem or chronic under-achievement 

ADHD and Mental Health 

Adults with ADHD are significantly likely to suffer from mood disorders like depression or bipolar disorder, anxiety disorders, and substance use disorders. About 85% of adults with ADHD also have a second condition. In some cases, these disorders are “secondary” to ADHD, in that they are prompted by the frustration of coping with symptoms of ADHD, and often the treatment of ADHD will alleviate the symptoms of the other disorders. Sometimes, however, these disorders will need to be treated alongside the ADHD. 

Non-Pharmacological Interventions 

Medication is the most effective and most common treatment for ADHD, and often a conversation with one’s doctor about the symptoms being experienced can be helpful. A doctor or psychiatrist can take students through an ADHD screening and can recommend the appropriate medication. However, other non-pharmacological interventions also exist that have been shown to be useful for post-secondary students. 

Coaching 

ADHD coaching, also sometimes referred to as executive function coaching, is a psychosocial intervention that aims to support individuals to develop skills, strategies, and behavioural habits to cope with the executive function impairments seen in ADHD. Most coaching programs are founded in cognitive behavioural therapy and aim to support planning, time management, and organization skills, tending to focus on specific goals.  

Several studies on ADHD coaching in post-secondary students have found that participants engaged in more positive thoughts and behaviours, like using goal-attainment skills, modulating emotions, and increasing positive expectations for performance. Participants also reported improved study skills and learning strategies. Improvements have also been seen on measures of self-efficacy, motivation, anxiety, and test-taking strategies. 

Study Skills 

According to a pilot study on ADHD among college students in the United States, organizational and study skills interventions may also be effective in supporting students to manage their ADHD impairments. This manualized intervention consisted of six weekly group sessions and two individual sessions, with a focus on organizational, time management, and planning skills, as well as including study skills and psychoeducation around ADHD. 

The results suggest that this intervention shows promise, with significant improvements in ADHD symptoms and use of organization, time management, and planning skills. Participants also reported being satisfied with the intervention, supported by the high attendance rate. More research is needed to collect objective outcome measures. 

ADHD Programs in Post-Secondary 

A number of universities and colleges across Canada offer ADHD support groups. These are often drop-in groups where students with ADHD are invited to share their experiences and sometimes gain learning strategies that can benefit their unique brains. These groups often discuss topics such as time management, communicating with faculty, and advocating for themselves. 

The University of Prince Edward Island partnered with its provincial government to establish a clinic to support adults living with ADHD. The clinic sees individuals aged 16 or older who have ADHD, as well as adults with symptoms of ADHD, and can be accessed by having their primary care provider complete a referral form. 

Recommendations for Supporting Students with ADHD 

Transition Planning 

Neurodivergent students often struggle with transitioning from the structured high school environment to the less structured and more complex post-secondary environment. Supporting students early on with transition planning and setting transition goals can help them to navigate this challenging time. 

Education 

Institutions should educate students, staff, and faculty on ADHD as a neurodevelopmental condition as well as how to manage the symptoms of ADHD, and what some of the common comorbid mental health issues are. One way to accomplish this would be to appoint a champion with lived experience of ADHD. 

Provide Support Without a Diagnosis 

Given the significant difficulty in obtaining a diagnosis of ADHD at this time, many students who are struggling with ADHD may not be officially diagnosed but may still require support. Therefore, it is critical that support services for students with ADHD be based on self-identification. 

Adjust Teaching Models 

Faculty should consider impairments in executive functioning when planning their lessons and assessments. Issues such as impaired time perception can impact students’ abilities to perform similarly to their non-ADHD peers. Shorter clear milestones and frequent deadline reminders may be helpful. 

Empower Students and Staff 

Using strength identification and self-authored goal setting, staff should provide students with ADHD with the opportunity for autonomy and the ability to own their coping mechanisms. This is likely to support their self-esteem. 

Encourage Students to Seek Accommodations 

Accommodations can mean the difference between students languishing and flourishing in the post-secondary context. Staff should have a general understanding of the accommodations process to be able to refer students to the office for accommodations. 

Consider a Peer Mentorship Program 

Peer mentorship can offer an opportunity for students with ADHD to connect to peers with similar lived experiences and to feel less alone.  Similarly, peer support groups can offer another outlet for students with ADHD or other learning disabilities to connect with each other. 

Develop a Campus Climate of Inclusion 

Students are most likely to thrive when their environment is inclusive of all their differences. Campus staff should be aware that creating accessible learning environments for students with ADHD will benefit all students, for example, in the use of the universal design principle.