Adhd In University Students: Understanding The Prevalence And Impact

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and frequently persists into adulthood. The prevalence of ADHD in college students is estimated to be between 2% and 8% in the United States. However, some studies have found higher rates, with one study reporting that about 7% of undergraduate psychology students from four UK universities self-reported above-threshold symptoms of ADHD. Another study from the USA found that at least 25% of college students with disabilities were diagnosed with ADHD.

College students with ADHD face unique challenges, including increased academic and social demands, diminished support, and elevated risk for anxiety, stress, and mood disorders—that often lead to adverse outcomes. They are also less likely to use disability services and tutoring services. In addition, adherence to ADHD medications in college is quite low, with students taking their prescribed medication about once every two or three days.

To improve outcomes for college students with ADHD, innovative care models and targeted interventions are being developed. For example, the SUCCEEDS ADHD Clinic at the University of Maryland and the University of Illinois aims to help college students with ADHD with academic and/or mental health difficulties by offering individualized treatment plans, organizational skills training, and weekly group sessions. Another pilot study at two public universities focused on organization, time management, and planning (OTMP) interventions, which are directly related to the executive function deficits associated with ADHD.

Prevalence of ADHD in college students

The prevalence of ADHD in college students is estimated to be between 2% and 8% in the United States. However, these estimates are largely based on studies that obtained self-reported symptoms or diagnostic status from a small sample of students at individual campuses and are not representative of the wider student population.

A study by Pope et al. used the Conners' Adult ADHD Self-Rating Scale to assess symptoms of ADHD in 1185 undergraduate psychology students from four UK universities. The findings revealed that about 7% of these students self-reported above-threshold symptoms of ADHD.

In a study from the USA, at least 25% of college students with disabilities were diagnosed with ADHD. Among university students in China and the USA, ADHD was reported to be around 5% in the USA cohort and 8% in the Chinese cohort.

These data suggest that the prevalence of ADHD among university students may be higher than the reported worldwide prevalence of 2-3% for adults. However, it is important to note that these studies may not have assessed functional impairments, which are required for a full ADHD diagnosis.

The categorization of ADHD within higher education institutions also varies. In the UK, ADHD is often categorized as a Specific Learning Difference (SpLD), which may contribute to it being a hidden disability within higher education. There is a need to move away from this notion and recognize ADHD as a mental health condition that requires timely access to treatment and support.

Challenges Faced by College Students with ADHD

College students with ADHD face unique challenges due to increased academic and social demands, diminished support, and elevated risk for anxiety, stress, and mood disorders. They are more likely to experience academic impairments, such as lower GPAs and fewer credits earned, and have a higher risk of discontinuing their studies compared to their peers without ADHD.

College students with ADHD also have higher rates of comorbidities, including anxiety, mood disorders, substance use disorders, and other specific learning differences. They may struggle with organizational skills, time management, and procrastination, which can impact their academic performance.

Improving Outcomes for College Students with ADHD

Improving outcomes for college students with ADHD requires a multi-pronged approach that addresses their unique challenges. Innovative programs and interventions targeting ADHD-specific deficits, such as executive functioning and self-regulation, have shown promising results.

Parental involvement and support continue to be important for college students with ADHD. A strong parent-child relationship, characterized by higher levels of trust, communication, and involvement, may protect against poor outcomes and improve symptoms of ADHD.

Medication adherence is also crucial, as taking prescribed stimulants and other ADHD medications as directed is correlated with success in college. However, the non-medical use of stimulants is a significant issue on college campuses, with prevalence rates ranging between 5% and 10%.

Recommendations for ADHD-Friendly Universities

To create an ADHD-friendly university, institutions should:

• Recognize ADHD as a mental health condition and provide separate coding or categorization to better understand its prevalence and impact.
• Screen for ADHD as part of routine practice, especially in students with learning difficulties or co-occurring conditions like anxiety, depression, or specific learning differences.
• Offer a range of psychosocial interventions, such as academic coaching, cognitive-behavioral therapy, and dialectical behavior therapy, to address ADHD symptoms and associated challenges.
• Provide staff training and development to raise awareness about ADHD, improve screening and diagnostic processes, and enhance support for students with ADHD.
• Adopt Universal Design for Learning to ensure that teaching and learning environments are accessible and inclusive for students with ADHD.

Co-occurring conditions

Attention-deficit/hyperactivity disorder (ADHD) is often associated with other disorders. According to the National Survey of Children's Health, 33% of children with ADHD had one coexisting condition, 16% had two, and 18% had three or more. Oppositional defiance disorder (ODD) was the most common, appearing 41% of the time, followed by minor depression/dysthymia (MDDD) at 22%, and generalized anxiety disorder (GAD) at 15%.

Many children with ADHD have other disorders as well as ADHD, such as behaviour or conduct problems, learning disorders, anxiety, and depression. Children with ADHD are more likely than other children to be diagnosed with a behaviour disorder such as oppositional defiant disorder or conduct disorder.

ADHD in adults is associated with poor educational outcomes that can have long-term negative effects on mental health, well-being, and socio-economic outcomes of university students. A study by Anastopoulos et al. examined rates and patterns of co-occurring disorders in 443 university students with ADHD. The findings revealed that 55% of these students had at least one comorbidity, while 32% had two or more, and that commonly reported comorbidities with ADHD were depressive and anxiety disorders.

In a study from the USA, DuPaul et al. reported that at least 25% of college students with disabilities were diagnosed with ADHD. Among university students in China and the USA, ADHD was reported to be around 5% in the USA cohort and 8% in the Chinese cohort.

Up to 50% of children with ADHD have a coexisting learning disorder, whereas 5% of children without ADHD have learning disorders. Learning disorders can cause problems with how individuals acquire or use new information such as reading or calculating. The most common learning disorders are dyslexia and dyscalculia.

Approximately 14% of children with ADHD also have depression, whereas only 1% of children without ADHD have depression. In adults with ADHD, approximately 47% also have depression. Typically, ADHD occurs first and depression occurs later. Both environmental and genetic factors may contribute.

Up to 20% of individuals with ADHD may show symptoms of bipolar disorder, a severe condition involving periods of mania, abnormally elevated mood and energy, contrasted by episodes of clinical depression. If left untreated, bipolar disorder can damage relationships and lead to job loss, school problems, and even suicide.

Up to 30% of children and up to 53% of adults with ADHD may also have an anxiety disorder. Patients with anxiety disorders often worry excessively about a number of things (school, work, etc.) and may feel edgy, stressed out, tired and tense, and have trouble getting restful sleep.

Mental health and emotional well-being

The mental health and emotional well-being of university students with ADHD is a cause for concern. ADHD is associated with poor educational outcomes that can have long-term negative effects on the mental health, well-being, and socio-economic outcomes of university students.

Research suggests that college students with ADHD experience less academic success and greater psychological and emotional difficulties than other students and use alcohol and drugs at higher rates. They are also less confident than other students regarding their ability to academically succeed.

The pressure to do well academically and cope with an array of lifestyle changes can impact the mental health and well-being of university students, especially students with ADHD who are transitioning from adolescence into adulthood.

Students with ADHD may be particularly vulnerable during and after transitioning to university. They may be prone to "test anxiety" and experience disabling levels of worry, emotional and somatic symptoms, that exacerbates their ability to focus and perform during evaluative assessments such as examinations. This may further increase the risk that they achieve poor grades, or delay completing their programme of studies.

University students with ADHD can also be prone to using tobacco, alcohol, cannabis, or other drugs; sex, gambling, or gaming as coping strategies. Some students with ADHD may not be able to control their alcohol intake, for instance, and binge drink often or report more drinking-induced blackouts, loss of friends or romantic partners as a result of their drinking habits.

There are also positive aspects of ADHD that can be useful at university. For example, high levels of energy and drive, creativity, hyper-focus, agreeableness, empathy, self-acceptance, and a willingness to assist others.

Recommendations

The following recommendations are proposed to support the mental health and emotional well-being of university students with ADHD:

• Targeted programmes of training for university student support staff should include psychoeducation, how to screen for ADHD and use recommended strategies for supporting university students with ADHD. This training can also be used to raise awareness about the potential stigma associated with ADHD, its consequences and potential impact on the screening and diagnostic process, willingness to disclose ADHD at university and accept treatment.
• A rapid access pathway of care for university students with ADHD should be developed collaboratively between university central support services, and NHS primary and secondary care, or private providers.
• Screening for ADHD should be conducted in all students diagnosed with, or frequently complaining about, anxiety or depression (or other chronic mental health problems), particularly when they are taking medication and there is no or only limited improvements in their mental state.
• Non-pharmacological interventions are particularly important for university students who want or need to learn how to best manage their ADHD and overcome the learning difficulties that they experience.
• Academic coaching, supportive counselling and/or CBT, whether delivered face-to-face or online can be effective non-pharmacological interventions for university students with ADHD.

Academic performance and achievement

Prevalence of ADHD in university students

The prevalence of ADHD in university students is estimated to be between 2% and 8% in the US, with similar rates in other countries. However, these estimates are based on small, non-representative samples and do not meet the full diagnostic criteria for ADHD. A more recent study that used a nationally representative sample of US college freshmen found that about 5.6% of students self-reported having ADHD. This is slightly higher than the reported US prevalence of 4%, which may be due to differences in ADHD self-identification and diagnosis, changes to diagnostic criteria, or late ADHD diagnosis.

Impact of ADHD on academic performance and achievement

ADHD is associated with poor educational outcomes, including lower test scores and grade point averages, difficulties in reading, and other academic challenges. This can have long-term negative effects on the mental health, well-being, and socio-economic outcomes of university students. University students with ADHD are less likely to graduate from high school and attend college, and those who do enrol may struggle academically and be at risk of dropping out.

Research suggests that students with ADHD perform less well academically than their peers and are more likely to have lower overall grade point averages (GPAs) and lower GPAs in all academic domains. They are also less likely to hand in completed assignments on time and more likely to fail courses and drop out prematurely. This achievement gap may be due to barriers in the higher education environment that compromise the success of diverse learners, such as a lack of understanding of different learning and studying approaches required by students with ADHD.

Co-occurring conditions

Students with ADHD were more likely to report co-occurring conditions, including learning disabilities, autism spectrum disorder, psychological disorders, physical disabilities, chronic illnesses, and other disabilities. They were also more likely to report feelings of depression and overwhelm in the past year.

Academic aspirations

A higher proportion of students with ADHD reported that obtaining a bachelor's degree was their career aspiration, and a lower proportion rated themselves in the highest 10% on academic ability and drive to achieve. Fewer students with ADHD reported aspirations for a medical or health-related degree.

Standardised test scores

Students with ADHD scored, on average, 10 points lower than their counterparts on SAT Math.

Non-academic strengths

Students with ADHD reported several non-academic strengths, including artistic ability, computer skills, creativity, public speaking ability, social self-confidence, self-understanding, understanding of others, compassion, and risk-taking.

Non-academic strengths and confidence

Students with ADHD have a unique set of strengths and talents that can be leveraged to help them succeed in their academic and personal lives. Here are some of the key non-academic strengths and areas of confidence for students with ADHD:

Creativity and Innovation

One of the most notable strengths of students with ADHD is their creativity and innovative thinking. They often have a unique perspective and approach to problem-solving, which can lead to new and creative solutions. Their ability to think outside the box is highly valued in fields such as art, music, and entrepreneurship.

Hyperfocus

Although hyperactivity is often seen as a negative symptom of ADHD, it can also be a strength. Students with ADHD can become deeply focused and engaged for extended periods when they find something that interests or passions them. This can be beneficial for academic pursuits, as they may be able to study for long periods without getting distracted. It can also be an asset in the workplace, as they can produce high-quality results when they are engaged and passionate about their work.

High Energy and Enthusiasm

Students with ADHD tend to have high energy and enthusiasm, which can be valuable in group projects and team-building exercises. They often bring contagious enthusiasm to their peers, motivating and driving the team forward. They are also excellent multitaskers, easily switching between projects if they are engaged and interested.

Social Self-Confidence

Students with ADHD often possess strong social self-confidence. They are comfortable interacting with others and have well-developed social skills. This confidence can help them build relationships, work effectively in teams, and advocate for themselves when needed.

Understanding of Others

Students with ADHD often have a strong ability to understand and empathize with others. They can put themselves in others' shoes and consider different perspectives, which can lead to better collaboration and conflict resolution. This strength can be beneficial in both academic and social settings.

Risk-Taking

Students with ADHD are often comfortable taking risks and embracing new challenges. They are willing to step outside their comfort zone and try new things, which can lead to personal growth and the development of new skills. This trait can be advantageous in many areas, including entrepreneurship and innovation.

Compassion

Students with ADHD often exhibit high levels of compassion and empathy towards others. They are sensitive to the feelings and needs of those around them and are willing to offer support and assistance. This strength can foster positive relationships and enhance their social connections.

Public Speaking Ability

Students with ADHD often possess strong public speaking skills and are comfortable presenting their ideas to an audience. They are able to engage and connect with their listeners, making them effective communicators. This strength can be beneficial in a variety of settings, including academic presentations and group discussions.

Artistic Ability

Students with ADHD often have strong artistic abilities and a talent for creative expression. They may excel in visual arts, music, or other creative fields. Encouraging their artistic pursuits can help build their confidence and provide an outlet for self-expression.

Computer Skills

Students with ADHD often have strong computer skills and a natural aptitude for technology. They may be early adopters of new technologies and enjoy exploring different software and hardware. Their technical skills can be an asset in various academic and professional pursuits.

By recognizing and nurturing these strengths, students with ADHD can develop confidence and a positive self-image. It is important to create structured learning environments and emphasize strengths-based learning to help them thrive academically and personally.

Frequently asked questions