The Need for Better Accommodations for ADHD in Higher Ed

College Graduates

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In his book, Taking Charge of Adult ADHD, Dr. Russell Barkley (2022) cited research that found only 9% of individuals who were diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) as children and 30% of individuals who were diagnosed as adults will graduate from college with a 4-year degree. This is compared to about 40% of the general population according to the United States Census Bureau.

While laws such as The Individuals with Disabilities Education Act (IDEA) and The Americans with Disabilities Act (ADA) have ensured that colleges are required to give reasonable accommodations, low graduation rates in the ADHD population reflect that the accommodations are insufficient. In my observations, both as a professional who specializes in supporting individuals with ADHD and as a family member of many ADHD-ers, I believe that this lack of success in higher education stems from a few main issues:

1. Colleges putting the burden of obtaining help on the person with ADHD
2. Insufficient supports and accommodations available for students
3. Harsh grading penalties for aspects of assignments that require attention to details, but are not related to the content of the class, and later not used in the workplace

In order to support further discussion, a review of ADHD as a diagnosis and how this impacts school functioning, is important. ADHD is a neurodevelopmental disability which affects a number of regions in the brain that are directly related to the traits seen in the individual. Research on ADHD has shown differences and delays in key brain structures and functions that directly affect executive function. Research has also shown that individuals with ADHD have lower than average rates of dopamine and norepinephrine, both of which also affect executive functioning. This is why things like organization, task initiation and completion, time awareness, paying attention, and emotional regulation are so difficult for this population.

So how does this impact success in higher education? For people with ADHD, self-advocacy can be very difficult. For many, they have had bad experiences with self-advocacy. Many of my clients have reported asking for help and being chastised for not paying attention, for not wanting to do all the work, or they have shared that they simply were not believed when they say they are struggling. Also, because ADHD is a genetic condition, they may not have had the same parental support as their peers have had if their parents also have ADHD. By the time they get to college, they have often learned the hard way that asking for help is not helpful.

For those that do choose to access 504 accommodations, the system is set up so that the adult is required to do a bulk of the work by themselves. This means initiating contact in order to make an appointment, remembering the appointment, showing up, then following through on recommendations. It also usually entails the person approaching each of their professors to inform them of their 504 accommodations. All of these things take executive functioning, which is problematic as difficulties with executive functioning are why the person is struggling in the first place. This would be equivalent to asking someone in a wheelchair to build their own accessibility ramp.

So, let’s say that the ADHD-er does all of these things. The next thing they run into is often insufficient supports. What they need may be a peer mentor, someone to help edit their reference pages, extra time on tests, or some other accommodation. Colleges often either do not have these as options, or they do, but they require even more executive functioning for the individual to obtain and utilize. It also often requires the individual to know what supports they need, which they may or may not know depending on their level of insight and knowledge of what accommodations help them succeed.

What does this look like in practice? I remember several year ago I had a client who was struggling to get homework done. Each day that they fell behind in their homework, the more depressed they became. They managed to go to class and to work, but then would come home and lay on the couch, engaging in a downward spiral of negative thoughts, unable to start any tasks. I convinced them to reach out to the accessibility department at their college, which they did. They set up a meeting, met with their assigned support person, who gave them a list of things to try.

I gave them praise for all their hard work and asked when their next appointment was going to be. I was shocked when they reported that no follow up appointment had been scheduled. With very limited natural support systems, this put all of the burden of follow through on recommendations, as well as setting up any follow-up supports, on the individual. Before the end of the semester, they dropped out.

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Unfortunately, this story is not unique and is reflected by the low number of students with ADHD who successfully complete their bachelor’s degree. This is an unfortunate reality that negatively impacts all of us. While ADHD-ers struggle with a number of executive functioning tasks, they have a number of strengths to offer as well. For example, people with ADHD have been shown to be much more likely to be entrepreneurs as they are novelty seeking and always looking for the next great idea. They have a lot of dynamic energy to bring to a team, especially when they are enthusiastic about the work being done. Because they have lower than average rates of norepinephrine, they tend to perform better in stressful jobs because they are less likely to get overwhelmed than their neurotypical peers.

By failing to adequately accommodate ADHD as a disability in higher education, these energetic and vibrant individuals are being barred from adding their strengths to a number of fields. To bridge this gap in educational attainment, I would recommend that each college review the latest research on what accommodations are most helpful for the ADHD population. Recommendations to consider include:

1. Make it easier to sign up for 504 accommodations and ensure that someone is following up with the students on a regular basis.
2. Offer peer mentor programs. I often recommend this to my adult clients (both in higher education and the work place) and have been surprised how few colleges offer this support. Paring up ADHD-ers with students who are good at things like organization, scheduling and task initiation/completion has been shown to be a very helpful tool. Colleges could potentially create a volunteer or work study program for students studying things like psychology, social work, or education to give them experience in their chosen careers, and would be relatively low cost.
3. Hold the ADHD-ers to the same standards in things like citations, but don’t over penalize grades when it is not done perfectly. This is the kind of task that requires attention to detail that will likely be very difficult for students with ADHD. Struggling to get perfect citations should not significantly lower students’ grades if they are able to reflect that they have learned the content. Most professions do not require perfect APA or MLA citations, but do require the person to be familiar with the content of their college courses.

It may not be possible to fully estimate the cost of not accommodating students with ADHD, but by not making sufficient accommodations in higher education, I suspect that our entire society is missing out on a potential workforce that would bring energy and new ideas to a number of industries. The best way to find this out is for those in higher education to work together to make systemic changes that will bring those graduation rates up so that they are closer to that of the general population.