Studying with ADHD: challenges and solutions

I recently ran a workshop for university staff who support students with ADHD.  Delegates were surprised at the extent of the difficulties which may face these students throughout each day, and at the students’ resilience and determination.  As well as discussing potential challenges, we shared ideas about managing ADHD at university.  In this post, I present the key points.

Challenges which may face students with ADHD:

1.  Getting up on time

• went to bed too late
• forgot to set an alarm
• felt too tired to get up
• had enough sleep but couldn’t ‘get going’

2.  Getting ready to go out

• problems with organisation and motivation
• becoming distracted
• inability to find things such as clothes and books
• nothing in the house for breakfast
• the kitchen is too untidy to prepare breakfast
• concerns about the day ahead leading to a reluctance to leave the house

3.  Arriving at the university on time

• leaving the house too late
• misreading timetables
• getting on the wrong bus
• getting distracted on the way

4.  Getting to lectures, concentrating during lectures, taking and filing notes

• confusion over arrangements
• arriving late
• forgetting equipment such as paper, pens, and lap-top
• flat battery in lap-top
• difficulty with sitting still
• losing concentration
• becoming distracted
• difficulty with ‘picking up the thread’ again once distracted
• falling asleep
• difficulties with retaining information
• inability to identify key points when taking notes
• slow handwriting speed (particularly if dyslexic and/or dyspraxic)
• problems with filing both paper notes and electronic notes

5.  Group work, tutorials and seminars

• talking too much
• losing concentration
• difficulties with contributing due to a failure to follow the discussion
• making inappropriate comments
• offering to do a great deal but not delivering
• delivering on practical aspects of tasks, but being unable to complete written work (particularly if dyslexic)

6.  Independent study in the library (writing an assignment)

• avoiding going at all
• forgetting or losing brief
• becoming overwhelmed with information when researching
• problems with reading comprehension
• visual stress
• not addressing the question directly
• producing a poorly-structured response
• including too much information
• difficulties with evaluating own work and with proof-reading
• problems with referencing
• failure to submit work in requested format
• missing deadlines
• completing work but failing to submit it
• failure to complete cover sheets

7.  Presentations

• difficulty with remaining focused on the brief when carrying out research
• problems with time-management when preparing
• confusion over practical arrangements such as times and rooms
• forgetting resources such as memory sticks
• deviating from main points
• problems with assimilating questions
• problems responding to questions directly and concisely

8.  Food shopping, cooking and tidying up the kitchen

• forgetting to buy particular items
• impulsive buying
• inability to queue
• insufficient money due to difficulties with budgeting
• cooking is an effort
• burning food due to distractibility
• wasting food due to problems with planning
• resorting to ‘junk food’
• problems with clearing up

9.  Personal paperwork and emails

• forgetting to pay bills
• failing to complete forms
• problems with filing paperwork
• overlooking important emails

10.  Exercise

• lack of motivation
• procrastination
• difficulties with finding (clean) kit

11.  Meeting friends

• failing to respond to messages
• problems with getting ready on time
• arriving late
• becoming excitable in company
• becoming bored in company
• difficulty with following conversations

12.  Getting to bed/sleeping

• not feeling tired at bedtime
• mind being too active to sleep
• being involved with activities at bed-time (e.g. hyper-focusing on computer games)
• waking during the night
• being too active during sleep to share a bed
• problems with getting up

Strategies for managing ADHD at university:

1.  Attendance/keeping appointments

• living on or near the campus
• living with house-mates who have the same time-table
• setting the same time and place for regular appointments
• receiving reminders

2.  Punctuality

• increasing motivation by rating the importance of punctuality in different situations and evaluating the impact of lateness
• creating a time-plan for getting ready

3.  Focus during lectures

• sitting near the front
• making lecturers aware of difficulties so that they can monitor levels of focus, provide subtle prompts if necessary, and engage directly with the student
• taking frequent breaks
• reading notes through beforehand
• taking notes
• doodling
• fiddling with a toy or plasticine

4.  Note-taking

• developing note-taking skills
• annotating handouts instead of taking full notes
• making electronic notes which can be edited
• making recordings
• being provided with a note-taker

5.  Filing notes

• having help to set up and use a system to file both paper-based and electronic notes
• avoiding the need for notes by using materials on electronic learning platforms for assignments and revision

6.  Following and remembering instructions

• check that the student is listening
• keep it brief
• check understanding
• back up information in writing

7.  Checking university emails and using electronic learning platforms

• ensure that emails can be accessed on smart phone
• train in use of electronic learning platforms
• provide reminders to check and respond to emails
• provide reminders to check electronic learning platforms for notices

8.  Practical sessions

• check that instructions have been understood
• check periodically that the student is on task
• provide extra time

9.  Seminars/Tutorials

• engage directly with the student
• avoid putting the student ‘on the spot’

10.  Group-work

• provide on-going monitoring and coaching

11.  Presentations

• support with preparation and practice
• help with arrangements such as booking rooms
• encouragement to stay focused on the topic
• repeat verbal questions and give time to prepare responses

12.  Time-management

• evaluate skills so that areas of weakness are identified, and progress is monitored e.g. ‘Do you make plans for your time?’
• set goals
• make lists
• prioritise activities
• estimate time to complete tasks
• schedule tasks
• incorporate a reward system

13.  Procrastination

• evaluate what is happening e.g. ‘Which tasks do you delay?’, ‘Were instructions clear?’, ‘What support was in place?’, ‘What are the consequences of not doing the task?’, ‘What cues do you use to begin a task?’, ‘Do you have breaks?’
• break tasks down
• use rewards
• work with others
• identify emotional obstacles (such as negative automatic thoughts)

14.  Concentration

• use external strategies e.g. low level music, quiet place, earplugs, phone on silent
• use internal strategies e.g. novelty, goal-setting, competition, rewards, breaks, alarms
• manage visual distractions e.g. have visual materials out of line of vision, face into a room, use bright colours to attract attention to task, use cue-cards or posters e.g. saying ‘Focus!

15.  Researching for assignments

• support to identify a manageable amount of information
• develop reading comprehension skills
• use text-to-speech software and audiobooks
• manage visual stress (e.g. with coloured overlays, tinted glasses, changing the colour of computer monitors)

16.  Assignment writing

• support to develop essay-planning skills
• use appropriate software
• support to develop proof-reading skills

17.  Revision

• address procrastination and concentration
• plan
• test knowledge
• complete past papers

18.  Exams

• separate invigilation
• distraction-free room
• prompter
• rest breaks
• extra time
• word-processor

Managing ADHD at home:

1.  Organisation at home

• have few possessions
• label drawers etc
• use see-through boxes
• set a place for everything
• receive support

2.  Keeping track of personal possessions

• name items
• use a check-list of items which are often left behind
• use blue-tooth tags
• purchase inexpensive items

3.  Shopping

• shop for the same menu each week
• keep a standard shopping list on smart phone
• shop for food online

4.  Cooking

• make simple meals
• cook in batches
• cook with flat-mates

5.  Laundry

• use a laundry basket
• have a set day for washing
• set alarms for taking washing out of the machine and dryer
• do laundry with a friend

6.  Personal hygiene

• establish a routine
• ask someone to check up on you

7.  Paperwork

• set up a filing system
• have a special place for urgent paperwork
• deal with paperwork immediately
• have a supply of envelopes, stamps etc.
• discard unneeded paperwork

8.  Money management

• set up direct debits
• cut up credit card
• avoid online shopping
• seek advice from a money adviser

Managing ADHD in relation to well-being:

1.  Exercise

• keep it simple e.g. go out running, join a gym near to accommodation
• have a routine
• go with housemates
• establish a routine for having kit laundered and ready

2.  Sleep

• address sleep hygiene e.g. reduce caffeine, no screens before bedtime
• discuss medication with GP
• seek advice from ADHD clinic

3.  Mood

• keep active
• remain social
• seek help
• attend to sleep
• attend to diet

4.  Self-esteem

• capitalise upon areas of strength
• development other areas
• recognise that problems are related to ADHD and not laziness etc

5.  Mental health

• seek therapy
• engage with specialist mentor
• engage with addiction services if necessary
• explore option of medication with GP
• work with professionals who have knowledge of ADHD

6.  Medication

• NICE recommends drug therapy as the first-line treatment for ADHD.
• stimulants include methylphenidate (Ritalin, Concerta), dexamphetamine, and modafinil
• non-stimulants include (atomoxetine, bupropion, clonidine, tricyclic antidepressants, venlafaxine)
• these need to be prescribed by a specialist psychiatrist or nurse

Useful books

Kirby, A. (2013).  How to Succeed with Specific Learning Difficulties at College and University: A Guide for Students, Educators & Parents.  London: Souvenir Press Ltd.

Tuckman, A. (2012).  Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook.  USA: Speciality Press Inc.

Young, S. and Bramham, J. (2007).  Cognitive-behavioural Therapy for ADHD in Adolescents and Adults: A Psychological Guide to Practice.  West Sussex: Wiley-Blackwell.