ADHD and Higher Education

ADHD and Higher Education

Abstract Overview Further Insights Issues Terms & Concepts Bibliography Suggested Reading.

Abstract Attention deficit hyperactivity disorder (ADHD), is a medically recognized neurological disorder that is defined as a pattern of behavior characterized by inattention, hyperactivity, and impulsivity. Diagnosed in adults as well as children, college students with ADHD have difficulty paying attention, initiating or finishing projects, and keeping up with organizational tasks such as e-mail. People with ADHD are easily bored or frustrated, may struggle with short memory spans, and in many cases change jobs frequently.

Overview Brief Historical Background. Research studies illustrating ADHD for the childhood stage of the disorder are ample since more emphasis has been placed on labeling it as a childhood disorder. However, recent studies have provided evidence that at least 50 percent of children with this neurological disorder continue to experience difficulty as adults (Bernfort, Nordfeldt & Persson, 2008). While the focus of researchers has shifted in recent years, and they have been conducting research on ADHD for the adult stage in the last decade, little research exists with regard to the history of ADHD. A problem persists in accurately estimating the number of adults who suffer from ADHD, and adult students generally do not disclose information about their disorder to higher institutions unless they need accommodations.

At the beginning of the twentieth century, George Still recorded forty-three cases of the childhood stage of ADHD in his clinical practice. The children had problems with “moral control” of their behavior and demonstrated difficulty sustaining their attention. Still reported that these patients exhibited a liking for cruelty, dishonesty, spitefulness, and lawlessness, and their parents were either unaware or neglectful of their children’s problems, considering the aberrations in their behavior to be childhood traits. Still argued that immediate gratification was the typical characteristic behavior of such children. The first published paper describing ADHD in adults came in 1960s, and the disorder was labeled as minimal brain damage or dysfunction (MBD). The first effort to highlight adult stage ADHD was made by Edward Hallowell and John Ratey in their bestseller, Driven to Distraction (1994). An estimate made by the National Institutes of Mental Health in 1996 claimed that 30 percent to 70 percent of children diagnosed with this disorder carry ADHD into adulthood. In adults, trouble paying attention and maintaining concentration often persists, whereas hyperactivity and impulsivity may fade at later stage (Bernfort, Nordfeldt & Persson, 2008). ADHD and Dropouts. Many recent studies suggest that a large number of adult learners drop out of high school. Bridgeland, Dilulio, and Morison (2006) specify that around seven thousand students leave formal schooling daily. Contributing factors such as poverty, lack of resources, and ineffective teaching-learning environments are especially burdensome for ADHD patients. Educators point out that low literacy is the chief reason for dropping out of high school. If students struggling with low literacy abilities enroll in higher education, they are far more likely to drop out than their high-performing peers. Adult individuals suffering from ADHD are a large part of the drop-out population. Wagner, Newman, Cameto, Garza, and Levine (2005) noted that adult students suffering from ADHD are functioning at reading levels below the sixteenth percentile. Some of these learners get remedial media classes and assistive technologies as teaching accommodations—for example, electronic text and text-to-speech software—which help them achieve academically. Nevertheless, the chasm between their ability to read and write and their existing knowledge grows wider during their stay in school. Higher

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education systems generally provide them with extended deadlines for assignment submissions and for writing tests, but their lack of access to knowledge does not actually benefit them with time extension. The higher drop-outs rate (41%) for secondary education and lower graduation rates (70%) has always been a matter of concern for teaching professionals (Wagner, Newman, Cameto, Garza & Levine, 2005). This data provides useful insights for curriculum designers and teaching professionals so that a better course can be structured for students with ADHD, which includes modification in school climate, course content, and teaching methodologies. Since traditional learning methods and techniques seem ineffective for the majority of the population with ADHD, counselors and applied linguistics experts lay emphasis on multiple academic pathways for enrolling and sustaining students in higher academic environments. Academic pathways provide an eclectic range of methods and techniques, including meaningful evaluation, modified instructional and organizational strategies, and boundary-extending curricula.

Further Insights ADHD and Lower Socioeconomic Status. Lower socioeconomic status (SES) also poses a hindrance to completion of postsecondary education. A comparison of the data on students coming from the high SES and from lower SES groups indicates a distinct disadvantage to poorer students. Only 65 percent of adult learners from lower SES groups pass from high school, whereas the number is far higher—95 percent—for the high SES groups. Wagner and colleagues (2005) show that adult learners with ADHD who come from low income households perform lower on achievement tests than students with ADHD from moderate income households. The reason for the gap in performance likely lies in lack of support for student achievement. Students in higher SES receive better, more tailored instruction and more guidance, including greater attention from counselors and school administration. These students are also more likely than their poorer counterparts to request and receive media and other resources to accommodate learning and performance disabilities. ADHD and Older Adults. Many older learners choose to pursue postsecondary education. These so-called non-traditional age learners constitute a heterogeneous group in which some learners are repeating their coursework, some are experiencing higher education for the first time, and some are diversifying their field of knowledge or changing fields. The diversity of nontraditional age learners includes an unknown percentage of adults with learning disabilities, which may or may not be diagnosed. Educational institutions should meet the needs of these different learners, but there is no accurate record of the number of ADHD older learners in the group of diversity learners. The unassessed need creates difficulties for curriculum designers whose task is to provide modified curricula and services sensitive to the individualized requirements of learners.

ADHD and Females. Females with ADHD experience more problems than males in securing accommodations. Symptoms in girls and women are more likely to be ignored and not referred to a specialist. Many studies indicate the male-female ratio of adult learners with this disorder ranges from 1.8:1 to 2.6:1. However, This gap is narrowing, with the number of adult women learners with ADHD increasing. Identification of candidates for remedial courses and accommodations are made on the recommendations of teachers as they shortlist and select candidates for special education services in secondary school. Therefore, it is crucial that their beliefs and perceptions with regard to disability are not biased. During measurements their expectations and standards should not vary for males and females’ performances. Interestingly, Maniadaki, Sonuga-Barke, and Kakouros (2006) calculated the behavior severity and self-efficacy of both mothers and educators with respect to learners with ADHD, and they found that mothers were better managers of students’ behaviors. Further, they were better equipped to manage females than males. However, the rating indicated that educators marked female behavior as less severe than males.

Issues ADHD and Myths. Misconceptions and uninformed perceptions of ADHD have resulted in skepticism toward the disorder. Some groups, such as the church of Scientology, and many social critics assert that ADHD is actually an excuse to avoid hard work and for not obtaining formal education. Other critics cast doubt on the sudden increase in ADHD diagnoses in recent years, questioning the diagnosis practices and clinical decisions employed in identifying patients. More specifically, they raise concerns about inadequate knowledge, the efficacy of tools and techniques and methods, and the judiciousness of policies used for selecting students for special education accommodations. An abundance of empirically based literature and the results of numerous studies, including the UMASS and Milwaukee studies, refute the concerns of skeptics. Students suffering from ADHD score lower in phonemic knowledge, readability criterion, active memory, and processing speed. Learners with ADHD seem to employ different and less efficient linguistic and cognitive processes than their peers. The cognitive and linguistic measures used by learners with ADHD to access reading and writing skills are shown to be reasonable, though significant, variations from learners without disabilities in these areas. The overall profiles of learners with ADHD are also different from other learners. Several behavioral inhibitions and other executive functions single them out from the group. Learners with ADHD show altogether different symptoms from other individuals in their peer age group, which result in performance limitations. These symptoms are not absolute deficits in formerly typical functioning or static pathological states and must be determined by age-relative thresholds.

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ADHD is a developmental disorder, and if it is properly diagnosed in childhood a student with ADHD can significantly benefit from learning accommodations. However, it is critical to establish and measure severity thresholds for symptoms in a uniform and scientific manner. Accurate diagnoses and robust education policies are critical in ensuring students with ADHA will receive the benefit of proper accommodations and services. Such advantages determine how likely a student with ADHA is able to thrive in a higher education setting. ADHD and Laws. Section 504 of the Rehabilitation Act of 1973 protects the right of individuals with ADHD to access accommodations. Laws dealing with ADHD and education they fall under either “eligibility” or “entitlement” statutes. A provision of free special education with appropriate accommodations exists under entitlement laws such as IDEA 2004. However, mere diagnosis is not the criterion for singling out students covered by the law; for adult learners, a strong recommendation from a selection committee determines whether a student requires and receives special education and/or related services (Wright & Wright, 2007). The Americans with Disabilities Act (ADA), similar to Section 504, is an eligibility criterion rather than an entitlement statute. Under ADA, individuals who are employed or pursuing postsecondary education are protected from discrimination by eligibility laws; they are not automatically entitled to have services reserved for them.

Terms & Concepts Accommodations: Tailored programs for adults with ADHD, including special arrangements in organization, rewards, materials and resources, instruction, and assessment. Attention Deficit Disorder (ADD): ADHD was initially known as ADD, and it was considered to be a childhood disorder. Attention Deficit Hyperactivity Disorder (ADHD): A medically recognized neurological disorder that is defined as a pattern of behavior characterized by inattention, hyperactivity, and impulsivity. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR): The American Psychiatric Association (APA) provided guidelines for uniform standard criteria for categorizing, classifying, and diagnosing mental disorders. This manual is widely used by medical practitioners, regulatory agencies, drug manufacturers, insurance companies, and clinical researchers. Individuals with Disabilities Education Act (IDEA 2004): Legislation addressing disorders under the umbrella term “other health impairment.” It specifically includes disorders that result in limited alertness with respect to the educational environment, such as epilepsy, hemophilia, leukemia, ADD, ADHD, and diabetes.

Milwaukee Study: Long-running study conducted at the Medical College of Wisconsin in Milwaukee beginning in 1977, popularly known as the Milwaukee study and published in a text by Barkley, Murphy, and Fischer. The secondary outcomes of the individuals with ADHD was observed, including professional, educational, and anti-social behaviors. UMASS Study: Study conducted at the University of Massachusetts in about 2003-2004, popularly known as the UMASS study, and published in a text by Barkley, Murphy, and Fischer. The study focuses on the secondary outcomes of patients living with ADHD disorder.

Bibliography Agobiani, S. S., & Scott-Roberts, S. S. (2015). An investigation into the prevalence of the co-existence of dyslexia and self-reported symptomology of Attention Deficit Hyperactivity Disorder in Higher Education students and the effect on self-image and self-esteem. Widening Participation & Lifelong Learning, 17(4), 20–48. Retrieved October 23, 2016, from EBSCO Online Database Education Source. http://search.ebscohost.com/login.aspx? direct=true&db=eue&AN=115737037&site=ehost-live Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). What the science says. New York, NY: Guilford. Bernfort L, Nordfeldt, S., & Persson, J. (2008). ADHD from a socioeconomic perspective. Acta Paediatr, 97, 239– 245. Bridgeland, J. M., Dilulio, J. J., & Morison, K. B. (2006, March). The silent epidemic: Perspectives of high school dropouts. Washington, DC: Civic Enterprises. D’Alessio, K. A., & Banerjee, M. (2016). Academic advising as an intervention for college students with ADHD. Journal of Postsecondary Education & Disability, 29(2), 109–121. Retrieved October 23, 2016, from EBSCO Online Database Education Source. http://search.ebscohost.com/login.aspx? direct=true&db=eue&AN=118210679&site=ehost-live Hinshaw, S. P., & Ellison, K. (2016). ADHD: What everyone needs to know. New York, NY: Oxford University Press. Maniadaki, K., Sonuga-Barke, E., & Kakouros, E. (2006). Adults’ self-efficacy beliefs and referral attitudes for boys and girls with AD/ HD. European Child and Adolescent Psychiatry, 15(3), 132–140. Retrieved October 23, 2016, from EBSCO Online Database Education Source. http://search.ebscohost.com/login.aspx? direct=true&db=eue&AN=20253470&site=ehost-live

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Sadek, J. (2014). A clinician’s guide to ADHD. New York, NY: Springer. Wagner, M., Newman, L., Cameto, R., Garza, N., & Levine, P. (2005). After high school: A report from the National Longitudinal Transition Study–2 (NLTS-2). Menlo Park, CA: SRI International. Wedge, M. (2015). A disease called childhood: Why ADHD became an American epidemic. New York, NY: Avery. Wright, P. W., & Wright, P. D. (2007). Special education law (2nd ed.). Hartfield, VA: Harbor House Law Press.

Suggested Reading. Buzick, H. H., Oliveri, M. E., Attali, Y., & Flor, M. (2016). Comparing human and automated essay scoring for prospective graduate students with learning disabilities and/or ADHD. Applied Measurement in Education, 29(3), 161–172. Retrieved October 23, 2016, from EBSCO Online Database Education Source. http://search.ebscohost.com/login.aspx? direct=true&db=eue&AN=117908835&site=ehost-live Druga#, M. M., & Druga#, I. I. (2013). Therapeutic interventions in ADHD. A training needs analysis for psychology students. Romanian Journal of School Psychology, 6(11), 69–81. Retrieved October 23, 2016, from EBSCO Online Database Education Source. http://search.ebscohost.com/login.aspx? direct=true&db=eue&AN=88864682&site=ehost-live Meyers, C. C., & Bagnall, R. G. (2015). A case study of an adult learner with ASD and ADHD in an undergraduate online learning environment. Australasian Journal of Educational Technology, 31(2), 208–219. Retrieved October 23, 2016, from EBSCO Online Database Education Source. http://search.ebscohost.com/login.aspx? direct=true&db=eue&AN=108488463&site=ehost-live Mytkowicz, P. P., & Goss, D. D. (2012). Students’ perceptions of a postsecondary LD/ADHD support program. Journal of Postsecondary Education & Disability, 25(4), 345–361. Retrieved October 23, 2016, from EBSCO Online Database Education Source. http://search.ebscohost.com/login.aspx? direct=true&db=eue&AN=90141850&site=ehost-live

Essay by Amitabh Vikram Dwivedi, PhD

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