Adult ADHD and higher education: improving the student experience

The prevalence of ADHD symptoms in adult learners and staff affects measures of success within the higher education system. There is no reason why adults with ADHD shouldn’t have comparable academic experiences if the right support is available. We propose five evidence-based suggestions for improving the student experience within universities by supporting better understanding and structures for ADHD adults to thrive.

Adult ADHD and the student experience

Adult ADHD is a complex, heritable neurodevelopmental condition that sits somewhere between disorder and neurodiversity. Presenting as a complex and individual blend of inattention, hyperactivity and impulsivity, ADHD has an estimated prevalence of about 2 to 4 per cent in adults, with a broadly equal gender distribution. There is clear evidence that adult ADHD is linked to educational and vocational underachievement.

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Since the pandemic, the waiting list for an ADHD diagnosis in the UK has moved from months to several years, according to Freedom of Information requests from the BBC to several NHS trusts in 2020. This means that students may start their degree with a referral and then graduate before a diagnosis can be made.

ADHD poses many challenges in higher education. ADHD adults are less likely to reach post-secondary education, and those who do have been shown, in a number of studies, to achieve lower summative grades across all years. Disturbingly, they are also more likely to withdraw from their programme and require more support prior to and throughout university. Academic support often isn’t available or isn’t evidence-based. Support for postgraduates and academic staff with ADHD is alsoimportant, but there are almost no studies on these groups in the literature.

Why is this? Beyond the hyperactivity and impulsiveness, ADHD adults also have a lower capacity for many elements of executive function that are important for success in our neurotypical higher education culture. Examples include planning, long-term goal setting and time-awareness. There are common responses outside the diagnostic criteria such as inappropriate emotional responses to stimuli and extreme sensitivity to rejection that can lead to severe negative consequences in higher education. Examples include the reaction to “surprise” feedback, response to academic failure and the emotional understanding of social rules in conversational spaces.

Universities are expected to take positive steps to remove the barriers faced by people with a disability following the Equality Act 2010. This is to ensure that they can access the same services, as far as reasonably possible, as someone without that disability. The exact nature of the support – eg, wheelchair ramps or dictation software – depends on the specific and agreed needs of the individual. For students with ADHD, “reasonable adjustment processes” (RAPs) do exist in some universities, but a formal diagnosis is often required. On top of that, due to the executive dysfunction challenges faced by students with ADHD, less than half of those qualifying students access this support. Worryingly, these RAPs often include interventions without strong evidence of their effectiveness, such as extended exam times and separate rooms.

Through our work as academics with ADHD and as the founders of the charity ADHDadultUK, we propose the following five recommendations that could be used to improve the experience of students and staff with ADHD:

Recommendations to improve the ADHD student and staff experience

1. Better education about ADHD as a recognised neurological disorder and how to manage the symptoms at all levels within the higher education sector. These efforts should be directed at the students and staff with ADHD, to help them learn how to manage their own symptoms in a university context and highlight the support available to them. Efforts also need to be made to educate teaching staff and support teams so they are better equipped to work with ADHD adults. Identifying and appointing an on-site champion with lived experience or a deep understanding of neurodiversity would be ideal to support this.
2. Provide support without diagnosis. In light of the difficulty of getting a diagnosis, allowing RAP implementation based on self-identification in partnership with the university support service would be appropriate.
3. Shape teaching and support to take into account executive dysfunction such as impaired time perception. Consider these challenges when planning seminars, assessments and lectures, agreeing timed goals and other deadlines. Typically, shorter, clearer milestones and deadline reminders are helpful.
4. Enable and empower staff with ADHD, and students where possible within their learning objectives, through strength-identification, self-authored goal-setting and providing only solicited feedback. Coaching can be a very useful platform for these conversations.
5. Include a broad awareness of commonly co-existing conditions in conversations around available support and work adjustments. ADHD is often found in combination with mental health issues such as anxiety, Tourette’s and depression. Psychiatric and non-psychiatric concurrently occurring conditions can result in severe impairment of mental health, quality of life and psychosocial adaptation.

The greatest barrier to services for adult ADHD is lack of awareness and stigma associated with the disorder. Supporting students and employees with adult ADHD would almost certainly improve the metrics associated with success in the higher education sector. ADHD is a mixture of disorder and neurodiversity. When the disorder side of ADHD is supported through evidence-based and employee-authored reasonable adjustments, the resulting neurodivergence can be creative, dynamic and a fantastic resource for success across all higher education.

Alex Conner is a reader in biomedical science communication and a National Teaching Fellow at the College of Medical and Dental Sciences, University of Birmingham. James Brown is a reader in biomedical science at the College of Health and Life Sciences, Aston University.
Alex and James co-founded the charity ADHDadultUK in 2021 to improve the lives of adults with ADHD through psychoeducation, advocacy and peer-support.

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