Blog by Roberta Waite EdD, MSN, RN and Meghan Leahy MS, NCC
Research suggests that college students with ADHD are more likely to fail and have to repeat classes, have lower grade point averages, and leave college before obtaining a degree in comparison to students without ADHD (Advokat, Lane, & Luo 2011; Antshel et al. 2011; DuPaul et al. 2009). In January each year, clinical practices see an influx of college students with ADHD, specifically freshman who struggled during their first semester, including being placed on academic probation.
Very often, the students and their parents are shocked by the poor performance in the first semester. These students were generally successful in high school, scored well on standardized tests, and were expected to continue along the same trajectory in their post-secondary career. In meeting with these clients, it becomes apparent that their understanding of course content is not the problem. The main complaints include: inability to focus in the classroom, trouble with taking notes, difficulty handing in assignments on time, being repeatedly absent or late for class, lack of time management skills, and an inability and/or reluctance to ask for help. Said differently, the experience of college students with ADHD is characteristic of ADHD being a performance problem and not a knowledge problem.
This makes sense as studies have shown that students with ADHD can encounter problems with executive functions, for example, organizing and planning, time management, working memory, cognitive flexibility and inhibition (Barkley & Murphy 2011; Reaser et al. 2007). Second, students with ADHD have difficulties with sustained and focused attention, with carrying out tasks and experience frequent daydreaming, hyperactivity and impulsivity (Weyandt & DuPaul 2008). Finally, students with ADHD can struggle with other problems, for instance, difficulties with selecting main ideas and prioritizing, social functioning, as well as motor coordination (Reaser et al. 2007; Weyandt et al. 2013).
Overall, it is presumed that approximately 2–8% of all students in post-secondary education experience symptoms related to ADHD and at least 25% of college students with disabilities are diagnosed with ADHD (DuPaul et al. 2009). The Americans with Disabilities Act (ADA) mandates that colleges provide “reasonable accommodations” to those students with disabilities in order to provide them with access to education for which they are otherwise qualified. The domain of disabilities includes learning disabilities, which is the domain most relevant for students with ADHD (as the diagnosis of ADHD alone is not sufficient documentation, at least using the current ADA guidelines). Psychoeducational testing that documents the presence of a learning disability is necessary to justify the need for accommodations. The requirements for psychoeducational evaluations as part of a petition for accommodations in college are:
- Be conducted by an appropriately credentialed and qualified professional
- Be conducted within the past 3 years
- Be comprehensive including:
- a diagnostic interview
- measures of cognitive ability
- academic achievement
- Include recommendations for accommodations with a rationale based on the current needs and functional limitations of the individual
- Critical college entrance and placement exam accommodations may also require very specific justifications (e.g., exactly what increment of extra time is needed for exams and why) (Joyce & Grapin, 2012).
Students with ADHD are attending colleges and universities in growing numbers, yet funding for disability support services has been diminished on many campuses (DuPaul et al. 2009). Also, while there is extensive research determining how college students with ADHD struggle, there is a knowledge gap and lack of empirical evidence when it comes to knowing how effective the common accommodations actually are for these students and how often and how well students utilize them (Cawthon, Leppo, & Bond, 2015).
The typical scenario for applying for academic accommodations in colleges in the United States starts with students submitting their testing documentation to the campus Disability Office. Assuming that the documentation is approved as sufficient for documenting a disability, a Disability Office staff member meets with the student at the beginning of each semester to specify the accommodations that will be implemented. A letter is written to each of the student’s professors, informing them of the accommodations to which the student is entitled. Most often, the Disability Office will disseminate the information to faculty by e-mail, though on occasion students are expected to deliver letters to their professors. Subsequently, it is the student’s responsibility to follow up with the professor and to ensure any logistics to obtain the accommodations are in place (e.g. arranging for extended time can mean starting an exam early in a professor’s office, staying late in the classroom, or possibly having the test proctored in the Disability Office). Importantly, Titles II and III of the ADA delineate the scope of accommodations to which postsecondary students are permitted. Similar to Section 504 of the Rehabilitation Act of 1973, the ADA is a civil rights law and its Titles II and III pertain to schools that accept any type of federal funding, including universities, community colleges, and vocational schools (Becker & Palladino, 2016).
For many students who are away from home and their support system for the first time, following through with the multi-step process of utilizing accommodations may be overwhelming if they do not have the ability or confidence to self-advocate. If the student is already struggling with inattention and/or impulsivity, as well as various executive function issues, he or she may simply avoid the entire process. Others may meet with the Disability Office and obtain the letters, but never follow through with the professors to make use of the accommodations.
Ultimately, to help college students with ADHD be successful in the first year and beyond, it is important that they understand their own strengths and weaknesses, are prepared to self-advocate, are willing to ask for help, and develop strategies to support their executive function issues. Without these skills and strategies, reasonable accommodations alone will not ensure success.
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Antshel, K. Hargrave, T., Simonescu, M., Kaul, P., Hendricks, K. & Faraone, S. (2011). Advances in understanding and treating ADHD. BMC Medicine. Retrieved from https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-9-72
Barkley R. A. & Murphy K. R. (2011). The nature of executive function (EF) deficits in daily life activities in adults with ADHD and their relationship to performance on EF tests. Journal of Psychopathology and Behavioral Assessment, 33, 137-158.
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Weyandt, L., DuPaul, G. J., Verdi, G., Rossi, J. S., Swentosky, A. J., Vilardo, B. S., ... & Carson, K. S. (2013). The performance of college students with and without ADHD: Neuropsychological, academic, and psychosocial functioning. Journal of Psychopathology and Behavioral Assessment, 35(4), 421-435.
Weyandt, L. L., & DuPaul, G. J. (2008). ADHD in college students: Developmental findings. Developmental disabilities research reviews, 14(4), 311-319.