An exploration into the effect of late ADHD recognition and student engagement in Higher Education

In the UK, it is estimated that 3.62% of boys have been diagnosed with ADHD, compared to 0.85% of girls. Globally, it’s estimated that on average, 5% of people have ADHD. (Hire, Ashcroft, Springate, Steinke, 2015) Of the 0.85% of girls diagnosed with ADHD, Sheffield University completed a study which revealed that 41% of women in prison have ADHD, with symptoms of poor self-control, aggression and risk taking behaviours (Farook, Emerson, Keoghan, Adamou, 2015). ?

Recent studies by neuroscientists have revealed that ADHD is associated with a deficiency of the neurotransmitter norepinephrine, which is linked to dopamine. The impact of ADHD on individuals varies depending on their filters and impulse control, with the core symptoms typically including excessive distractibility, impulsivity, restlessness and can also include symptoms such as a poor ability to recognize one's own strengths, excessive talking and interrupting (and lack of ability to listen), difficulty finishing tasks and often lead to chronic academic underachievement or inconsistent performance (Holloway, 2005).

To support those with ADHD and to take the condition seriously, it’s essential to understand that if an individual has all the symptoms of ADHD, but there is no negative impact on their lives, this is not classed as a disorder. Within the HE sectors, there is clear evidence which links under educational and vocational achievement of those with ADHD, who are much less likely to progress to HE level. (Loe, Feldman, 2007) Those who do progress to HE level can encounter many issues, such as difficulty taking exams, executive functioning challenges, and a lack of time awareness as well as extreme sensitivity to rejection and academic failure, and an increased likelihood of withdrawal from University. (DuPaul et al, 2021). Currently, there is no precise data available on the number of students with ADHD at universities, as they are grouped within a larger disability category. Consequently, it becomes difficult to determine the adequacy of reasonable measures in supporting this group of students (Sedgwick-Müller, 2022). ?

My talks and research are driven by my personal experience within the education system with undiagnosed ADHD. Despite receiving positive feedback and good grades in a lot of subjects at school, inconsistency and challenges emerged, especially during exams. I faced barriers, such as an inability to finish some work, losing items at school frequently, and avoiding choosing certain subjects I loved at A Level because of the anticipated difficulties surrounding exams.

Some comments in school reports stated, ‘she’s not giving her best in many of her subjects’ or ‘She needs to develop the determination and enthusiasm that will ensure she finds success.’ In maths, my work was simply ‘erratic’ and it was suggested that ‘when she puts her mind to it, she can reach a good standard’. The advice was to work harder. In 2010, Michael S Jellinek estimated that “In school alone, a child with ADHD could receive 20,000 corrective or negative comments by the time he or she is age 10” (Jellinek, 2010). ?

Despite ADHD being the most researched psychiatric disorder, it wasn’t until the age of 37 that I was made aware of the condition. It was a potential answer, but I had little knowledge about it. Several years later and after receiving a formal diagnosis, a book titled 'Faster than Normal' by Peter Shankman changed my perspective entirely on ADHD, revealing its positive attributes such as creativity and hyperfocus, exceptional divergent thinking, networking abilities, verbal presentation skills, idea generation, personal drive, competitiveness, the ability to make connections in any situation and problem-solving proficiency. With adequate support, these attributes are conducive to the ability to thrive at university and in many industries. However, in an unsupportive environment without proper assistance, life can pose significant challenges. In institutions offering creative degrees, it becomes increasingly crucial for universities to be mindful of the prevalence of ADHD.

ADHD symptoms consist of traits that exist in varying degrees within the general population, such as occasional risk-taking tendencies, moments of inattention, or instances of misplacing objects due to distractions. The prevalence of these traits contributes to the challenge of comprehending, or even acknowledging the disorder, for many individuals. However, ADHD manifests when these symptoms reach a level of severity that significantly impacts daily functioning. In the absence of the pronounced features associated with ADHD, our overall quality of life would be markedly improved (Wilens, Spencer, 2013).

My interest in women with ADHD developed after observing the rising statistics of women seeking diagnoses later in life and the negative media coverage surrounding this. Women often face misdiagnoses and receive treatments and medication for other mental health issues like depression, anxiety (Waite, 2007). Moreover, individuals with ADHD commonly experience burnout, leading to the diagnosis of additional mental health conditions, but not addressing the root cause.

Girls are often considered less likely to exhibit hyperactivity compared to boys, primarily because their behaviour at school is assumed to be less disruptive, leading to a lack of concern. However, what is commonly overlooked is that girls may display mental hyperactivity (excessive thinking and often catastrophising situations) and masking skills; unlike boys who tend to externalise their symptoms, girls often internalise them. Unfortunately, the diagnosis of ADHD seems to be based on the level of disruption caused to others rather than considering these subtler manifestations in girls; this oversight may lead to potential challenges later in their lives.

In recent years, there has been a rise in university students arriving on campus already taking medication for anxiety, depression, or other mental health conditions. For students who were not diagnosed with ADHD during childhood, the transition to university life can be overwhelming due to the absence of parental support and the expectation of increased independence. Students with ADHD can struggle with deadlines, self-organisation, balancing social life and academic life, understanding instructions, and managing healthy sleep patterns (Sedgwick-Müller, 2022). I have witnessed students arriving late with unfinished, crumpled work after all-nighters, which doesn't portray organization or creativity, but rather suggests struggle. In my experience of studying Architecture at University and working in the industry, late nights and ‘all-nighters’ were commonplace.?

As educators, we can empower students to take control of their deadlines and avoid unhealthy habits, maintain a tidy studio and workspace, utilise calendars and notes for better practice and maintain healthy eating and sleep habits. Putting these measures in place (for all students) can potentially lead to happier and more prepared individuals for the workplace. Increased education and awareness about ADHD also has the potential to reduce illegal or harmful behaviours such as excessive drinking, drug misuse, gambling, promiscuity, and risk-taking, which often come hand in hand with ADHD (ADHDUK).

Outcomes and Impact

The challenges that some students face with executive functioning skills in their undergraduate degree are often perceived as a lack of effort or laziness, as they were for me at school, and they appear to be simple obstacles for neurotypical individuals, or those who have developed their own strategies, to overcome. The following points highlight the impact of raising awareness about the possibility of undergraduate students having ADHD, or ADHD traits, in a university setting and how we can offer support -

?Determining the key stakeholders who need to be aware of the gender and achievement gap and its impact on undergraduate students with ADHD is the first step to raise awareness. This includes university administrators, faculty members, students, parents, and the wider community. Informational materials can be developed, such as brochures, posters, presentations, or digital content that explain the issues (and opportunities) surrounding ADHD. The material can include relevant statistics, research findings, personal stories, and strategies for supporting students with ADHD. We can also partner with relevant organisations or departments within the university, such as disability services, student support services, or counselling centres, to raise awareness about the potential difficulties students with ADHD encounter. We can work together to organise conferences, events, workshops, or guest lectures within the University of Lincoln that shed light on the issue.

Neurodiversity awareness training sessions are accessible within the University of Lincoln, and we can encourage our institutions to make these sessions mandatory for faculty, staff, and students to increase their understanding of ADHD and its impact on academic performance.

Success stories of undergraduate students, and staff, with ADHD who have overcome challenges and achieved academic success can be collected, shared, and celebrated. These stories can serve as inspiration and evidence of the impact of raising awareness and can serve as a networking tool – an ADHD community (virtual or in person) is essential for students to know they’re not alone. If students are identified as having ADHD, rather than categorised into a broader category, data can be gathered on academic performance, retention rates, and student feedback to measure any improvements in the achievement gap for students with ADHD (Sedgwick-Müller, 2022).

The data and findings can be compiled into reports or presentations to share with university administrators, faculty, and other stakeholders which highlight the positive changes that have occurred because of the awareness-raising efforts.

It is necessary for those who are interested in raising awareness about ADHD to sustain the impact by maintaining ongoing communication, organising regular events or workshops, and collaborating with key stakeholders. Raising awareness and supporting students with ADHD ensures a university's focus on this priority while uncovering hidden talents. People with undiagnosed ADHD often struggle, experiencing confusion as to why they can hyperfocus on their interests but find other tasks nearly impossible. They may expend excessive energy trying to operate as neurotypical individuals, especially if they've received negative comments about their performance.

Conclusion

This research demonstrating the effect of late recognition of ADHD in women, particularly in the context of higher education, has significant implications for improving the student experience, sharing best practices, and uncovering talent. By raising awareness and understanding of ADHD among stakeholders in the university setting, we can begin to address the achievement gap and provide better support for students with ADHD.

The key findings of this research highlight the underdiagnosis of ADHD in girls and women, leading to significant challenges in their academic and personal lives, often resulting in the development, or misdiagnosis of mental health issues such as depression and anxiety. It is crucial to recognise that ADHD is not limited to disruptive behaviour and can manifest differently in girls, often resulting in internalised symptoms and masking skills. By increasing awareness about the diverse presentation of ADHD, we can ensure that women are not misdiagnosed or left without proper support, reducing the risk of negative outcomes such as mental health issues and involvement in the criminal justice system. (Young, Adamou et al, 2011). ?

To inform practice and improve the student experience, various strategies can be implemented including the production of materials and resources, as well as collaborating with relevant university departments. We can promote understanding and share best practices for creating an inclusive and supportive learning environment.

Merely urging a student to be punctual or work harder will not make ADHD symptoms disappear and will reinforce negative filtering. Instead, individuals require appropriate support and understanding tailored to ensure their success.

As an institution, what can we do now? We can take ADHD seriously as a neurological condition and educate Staff on ADHD and student impact. We can offer extra writing time in exams, separate rooms, and rest breaks for students with a diagnosis, but also for those who are not diagnosed and express difficulties. Where speaking therapies can be helpful, executive function coaching can also be extremely useful for individuals to keep on track of tasks during the week. However, everyone experiences ADHD differently and student needs may vary dramatically from person to person (Burns, Conner, ADHD in higher education).

The crux of the matter lies in the fact that a considerable number of individuals remain unaware of their ADHD condition and lack the knowledge on how to seek appropriate support or possess knowledge of the potential positive attributes of ADHD including divergent thinking, networking abilities, and problem-solving proficiency.

There exists a considerable array of books, podcasts and academic papers dedicated to discussing ADHD. Among these, we can direct students to the following, The ADHD Adults podcast (and charity), CHADD.org , ADDitude magazine, UK Adult ADHD Network, ADHD UK.