Supporting students with ADHD: Indications for and effectiveness of teaching and exam accommodations Dieter Baeyens & Lotte Van Dyck

Attention Deficit Hyperactivity Disorder July 2011 Supporting students with ADHD 2 Inattention Hyperactivity/ Impulsivity ADHD-IAADHD-COMADHD-HI

Worldwide prevalence in children +/- 7% Between 2 and 4% of university students More students with ADHD in higher education because of increased screening at earlier age and better diagnosis at primary school age With increasing demands in secondary and postsecondary education, this group is primarily facing increasing problems with attention, planning and organization. ADHD July 2011 Supporting students with ADHD 3 (Weyandt & DuPaul, 2006)

ADHD July 2011 Supporting students with ADHD 4 If I really want to study efficiently, I get on the train. The ongoing noise seems to block all other stimuli. I dont get distracted anymore and there is only me and my books.

ADHD July 2011 Supporting students with ADHD 5 This is the third key of the house, the seventh key of my bike and my second mobile since January. I loose everything because I am not able to pay attention.

ADHD July 2011 Supporting students with ADHD 6 My mother knows the telephone number of the bus company by heart to claim objects I have lost. They are really friendly people.

Important to know that ADHD is best described in terms of not being able rather than not wanting understanding Symptoms are present in all settings it is not personal ADHD in childhood ADHD in adulthood many people outgrow the typical DSM-IV symptoms but still show impairment ADHD July 2011 Supporting students with ADHD 7

Important to know that At the basis of the disorder lies a genetic vulnerability that can be positively or negatively affected by environmental factors through these factors we have a moderate impact on the disorder ADHD July 2011 Supporting students with ADHD 8 Need for evidence based diagnostics, treatment and support for each age group

Evidence based diagnostics July Supporting students with ADHD Diagnostics of ADHD ClassificationAssessment Universal Age and person specific

Evidence based diagnostics July Supporting students with ADHD Diagnostic process of ADHD Number and peristence: 6 symptoms of inattention and/or 6 symptoms of hyperactivity/impulsivity Age of onset: 7 years Pervasiveness: present in 2 settings Classification (1) Heterogeneity Developmental perspective

Evidence based diagnostics July Supporting students with ADHD Diagnostic process of ADHD Impairment: social, academic/occupational Not only during the course of/better accounted for by other disorders Classification (2) Interpersonal variation Comorbidities

Evidence based diagnostics July Supporting students with ADHD Diagnostic process of ADHD Assessment (1) Heterogeneity Interpersonal variation Comorbidities Recent, comprehensive assessment Developmental perspective

Evidence based diagnostics July Supporting students with ADHD Diagnostic process of ADHD Assessment (2) Identify the current cognitive processes responsible for the impairment Clear indications of students strengths and weaknesses

Psycho-education For the student with ADHD For the context Psychopharmacology Cognitive behavioral therapy/techniques For the student with ADHD For the context Evidence based treatment July Supporting students with ADHD

ADHD – students Lower grade point averages More academic problems Higher chance of dropping out … As a result students with ADHD are encouraged to advocate for teaching and exam accommodations provided by Disability Services Offices (DSO). Evidence based support July 2011 Supporting students with ADHD 15 (Barkley et al., 2008)

Students with ADHD could potentially benefit from teaching and exams accommodations (Harrison & Rosenblum, 2010) However, little research available on effectiveness of accommodations in secondary education (SE) and postsecondary education (PE) Evidence based diagnostics July 2011 Supporting students with ADHD 16

This study: Overview of accommodations for students with ADHD in SE and PE quantitative approach Exploring indications for and effectiveness of accommodations qualitative approach Aims July 2011 Supporting students with ADHD 17 Survey Interviews

Quantitative study A survey on accommodations in 91 settings of PE (n=49) and SE (n=42) Qualtrics ( Qualitative study 23 semi-structured interviews: Students in PE and SE DSO in PE and SE Nvivo8 (QSR International, 2008) Methods July 2011 Supporting students with ADHD 18

1. Comparison ADHD – Learning Disorders 2. Teaching accommodations 3. Exam accommodations 4. Needs Outline results July Supporting students with ADHD

Significantly more accommodations for learning disorders (LD) than for ADHD (χ²(1)=3.82, p<0.05) Results – comparison July 2011 Supporting students with ADHD SEPE LD100 % ADHD75.5 %90.2 % 20 Survey

Possible hypotheses: Results – comparison Are students with LD applying more often than students with ADHD? More acceptance for impairments caused by LD than ADHD? More knowledge about accommodations in case of LD? More students with LD than ADHD in SE/PE? July Supporting students with ADHD More need for accommodations in case of LD?

DSO: Knowledge about the disorder in adolescents/young adults: LD > ADHD Guidelines about effective accommodations: LD > ADHD Results – comparison July Supporting students with ADHD Interviews

Students: Fear social stigma Refuse to accept support Positive effect of accommodations unknown Option of applying for accommodations unknown Results – comparison July Supporting students with ADHD Interviews

Top 3 reported teaching accommodations: 1.Teaching staff receives information on ADHD 66% 2.Developing strategies to coach the student 41% 3.Supporting self-management in students 40% Results – Teaching July 2011 Supporting students with ADHD 24 Survey

Results – Teaching July 2011 Supporting students with ADHD 25 Survey * *** * = p<.05 *** = p<.005

DSO: Little is known about ADHD in adolescence and young adulthood Psycho-education for the teaching staff could increase awareness of ADHD symptomatology The teaching staff fears the additional effort Results – Teaching July 2011 Supporting students with ADHD 26 Interviews

Students: Fear a lack of understanding by making use of accommodations - this is less the case for LD Fear social stigma Open communication between the student with ADHD, peers, teaching staff and DSO is needed Results – Teaching July 2011 Supporting students with ADHD 27 Interviews

Top 3 reported exam accommodations: 1.Students receives more time 73% 2.Option of (at least partial) oral exams 40% 3.Option of taking breaks during exams 13% Results – Exams July 2011 Supporting students with ADHD 28 Survey

Results – Exams July 2011 Supporting students with ADHD 29 Survey * * ** * = p<.05 ** = p<.01

DSO: No guarantee that the accommodation is effective The teaching staff fears the additional effort The teaching staff fears doing too much for students with ADHD Results – Exams July 2011 Supporting students with ADHD 30 Interviews

Students: Most accommodations are not effective Taking exams in a separate room is perceived as the most effective exam accommodation Medication is perceived as the most effective treatment A single typical accommodation profile for the student with ADHD does not exist Fear social stigma Results – Exams July 2011 Supporting students with ADHD 31 Interviews

Needs according to DSO: 1.More information on coaching student 71% 2.A national policy on accommodations 50% 3.Help from external specialists 37% Results – Needs July 2011 Supporting students with ADHD 32 Survey

There are no clear guidelines from the government: The selection of accommodations is made locally and on intuitive basis Results – Needs July 2011 Supporting students with ADHD 33 Interviews

Because of the heterogeneity in ADHD, a recent, comprehensive assessment is needed: To identify the current cognitive processes responsible for the impairment on which to base accommodations Reports from qualified specialists should provide clear indications of students strengths and weaknesses Results – Needs July 2011 Supporting students with ADHD 34 Interviews

Extra effort, motivation and creativity often insufficient to deal with school and academic impairments of ADHD If some specific conditions are met, teaching and exam accommodations are potentially effective to alleviate these impairments: Conclusions July 2011 Supporting students with ADHD 35

Accommodations should be individually designed by the DSO based on recent comprehensive assessment of the students strengths and weaknessess, reported by a qualified specialist Open communication and a better knowledge of ADHD will result in more goodwill on the part of the teaching staff, as is already the case for students with learning disorders. Conclusions July 2011 Supporting students with ADHD 36

A clear (national) policy on accommodations for disabilities should guarantee sufficient and effective support for students with ADHD as well as adequate resources for SE and PE settings to organize these accommodations. Conclusions July 2011 Supporting students with ADHD 37