Unlocking Your Full Potential: Why and How College Students with ADHD Can Embrace Accommodations

Jane Indergaard, DNP, RN

Attention Magazine October 2024

Unlocking Your Full Potential College is a time of exciting growth, discovery, and tremendous changes for young adults. It presents an opportunity for personal transformation, independence, and engagement with a diverse community, while also broadening and deepening knowledge in ways that can shape a future career. It is also a time of new demands, adjustments, and increased academic rigor. This unique period of transition can pose challenges for any young adult. Despite these challenges, every student deserves to savor this special stage of life and flourish in their college experience.*

For students with ADHD, the inherent challenges of impaired self-regulation and executive function deficits can add an extra layer of difficulty in adapting to college life. Yet, it’s equally important to recognize that ADHD is often linked to strengths like curiosity, creativity, innovation, and an enthusiastic drive. These attributes can be powerful assets in the rich environment of college. Success for students with ADHD hinges on leveraging these strengths while effectively managing their challenges—often with the support of accommodations.

One of the most disheartening situations for both students and professors occurs when a student, on the verge of failing a course, reveals that they have ADHD but did not seek accommodations upon entering college. By the time they realize the impact of this decision, it’s often too little, too late in the semester to recover from the academic difficulties they’ve encountered. This outcome is particularly frustrating because it doesn’t reflect the student’s true potential, intelligence, or effort. Many have been struggling silently throughout the term, feeling frustrated, confused, and demoralized as their genuine efforts fail to yield results.

But it doesn’t have to be this way. This article will explore how overcoming barriers to seeking accommodations and understanding their benefits can empower students with ADHD to excel in college. It will identify common obstacles to pursuing accommodations, debunk prevalent misconceptions about college accommodations, and examine their real-world impact. Additionally, it will provide a clear roadmap for students on how to request and utilize these supports, ensuring they have the tools they need to unlock their full potential and succeed.

How ADHD affects the transition to college

College life can be a period of exciting social and academic opportunity. At the same time, the transition and adjustment demands of this rite of passage can pose challenges for any student. This is not high school! Areas of potential struggle include increased academic rigor, loss of parental supervision and structure, adjusting to the social aspects of college life, determining life/school balance, and managing finances.

Successful adaptation to these challenges requires strong executive function skills and developing habits for organization, planning, focused attention, motivation, and self-regulation (alas, the antithesis to common ADHD symptomatology and profile). Knowing there is wide variability in ADHD expression among individuals, a legitimate question raised is which features, traits, or symptoms are most influential for success (or lack of) in the college environment?

There is a fair amount of research examining specific dimensions of ADHD and their relationship with academic outcomes. While one might think that restlessness from impulsivity and hyperactivity might drive poor performance, it has been repeatedly demonstrated that inattention symptoms are the dominant factor for academic underachievement in students with ADHD.

Inattention symptoms have a considerable overlap with executive function difficulties (EFDs) such as poor organization, weak planning, time mismanagement, and restricted forecasting (planning ahead). They also fuel procrastination. Such features are predictive of academic underachievement. They translate into problems such as struggling with length of time to complete coursework, incomplete assignments, challenges starting and staying focused while studying, inferior performance on exams (despite similar hours spent studying), fewer study skill strategies, and challenges with multitasking.

While it would be easy to address EFDs as the sole driver for challenges students with ADHD bring to college, there is more to the story. Closer investigation unveils three other dimensions which contribute to the challenging environment students with ADHD may encounter as they transition to college life.

Hitting the wall. A common phrase for the ongoing experience of adults with ADHD is, “It all works, until it doesn’t.” In other words, even for those who previously developed strategies and habits for managing their ADHD, novel demands which occur during transitional phases of life may exceed their current capabilities. These added demands on executive function capabilities can bring about both higher levels of ADHD symptoms and even new ADHD symptoms that need to be addressed. The good news is that if a student has had previous success with an ADHD management plan, they can do so again, although that might look different in college. Regardless, success builds on success and if a diagnosis or management plan was not in place before, there’s no time like the present to start. It’s never too late!

Comorbidity. Multiple studies document the negative impact of psychopathology (depression, anxiety, mood disorders, etc.) on college student performance. For those with ADHD, comorbidity tends to be the rule, not the exception. Common comorbid conditions associated with ADHD include depression, anxiety, learning disabilities, and others. It is necessary to consider and address any comorbid condition associated with one’s ADHD. They do not go away and require their own specific treatment plan.

Not self-advocating. In the college environment, a student must be their own first line of defense when problems or challenges occur. Students who may have relied on the structure and support systems of the high school or their parents must now be able to help themselves. Often students come to college having little to no experience advocating for themselves to get the support they need. Learning how to engage in self-advocacy is powerful in reducing barriers to learning and a critical element of survival for college students with ADHD.

College students with ADHD are clearly at a greater risk for poor academic performance and adjustment to college life than nonaffected peers. Importantly, their underachievement is not related to their potential; rather it is driven by brain-based differences in processing information and self-regulation that their non-ADHD peers do not experience. As described by therapist and author Stephanie Sarkis, students with ADHD are “not getting out of the starting gate at the same time as everyone else.” To level the playing field, students with ADHD who struggle may need to adjust their learning practices or environment to offset the disadvantages posed by their brain differences and allow their true potential to show. This is the purpose of accommodation.

The Accommodation Process

The process of exploring disability services at the college level can feel daunting. High school accommodation plans like the 504 do not transfer to college. Accommodation does exist at the college level but with different regulations and specific procedures to acquire it. The encouraging news is that the process at the college level is pretty straightforward and not as complicated as one might think. It does, however, require knowing the process, and taking initiative and effort on the part of the student.
Here are summary lists for (1) the differences in regulation for accommodation for colleges; (2) the common procedural steps to request accommodation at the college level; and (3) important considerations to dispel common student concerns.

REGULATIONS
Unlike high schools:

The standard for accommodation at the college level is from the Americans with Disabilities Act (ADA), where institutions are charged with equal access and a ban on discriminatory practices. (High schools also have this standard but must also comply with the free appropriate public education mandate from the Individuals with Disabilities Education Act [IDEA], whereas colleges do not.)
Colleges are not required to seek out students in need, nor to monitor students.
Students must initiate the process.
The need for accommodation is assessed by two factors: necessity and reasonableness.

PROCEDURE: HOW TO SEEK ACCOMMODATION
Follow these four steps.

First, contact the campus’s disability service office (DSO) to find out what resources are available for students and to register as a student with a disability.
The DSO will typically require recent (times vary) documentation from a healthcare provider related to proof of disability. An official meeting with a DSO representative will be scheduled to share documentation and discuss information regarding the student’s experience, thoughts, and concerns with any learning challenges, determine if they qualify under the ADA, and explore the types of accommodation which may best help the student thrive in college.
Once approved, the DSO may either notify professor(s) of a student’s accommodation or may require the student to bring a letter of documentation for the accommodation to their professor(s)- practices vary among institutions.
Support and review. The student is responsible to remind professors about the services available to the student, as needed. Professors must provide the accommodation. At the end of each semester (term) there is a required review in order to renew the accommodation plan.

IMPORTANT CONSIDERATIONS: FACTS

One’s registration, healthcare documentation, and conversation with the DSO is confidential and cannot be shared without the student’s consent.
All healthcare information shared with the DSO is protected under HIPAA (Health Insurance Portability and Accountability Act).
Professors are not told the underlying diagnosis or reason for the accommodation; this is not disclosed unless the student chooses to do so.
Once registered and need determined, students’ use of accommodation is optional; but professors must provide the accommodation if requested by the student—which is why getting them in place before the start of the term is advisable, rather than waiting to see if one needs them. The process takes time, and a student runs the risk of not getting them in place if waiting until later in the term.
Because of how they are administered, accommodations in college typically can be used without peers knowing about it.
The DSO is not required to track student progress for its students with accommodation, they are only required to provide the accommodation and ensure students have access to it. But this doesn’t mean there are not mechanisms in place to flag any and every admitted students’ risk for academic progress at the college level (typically through course faculty detection and advising).
It is the student’s responsibility to determine if the accommodation is working for them and to reach out in self-advocacy if adjustments need to be made.
Students are encouraged to start early, beginning by reaching out to the DSO when applying for admission to a given college to see what services are available. This may even impact a student’s choice of college.
Once admitted, students are strongly advised to immediately notify the DSO and start the process rolling. By applying the “better safe than sorry” principle, they will have their insurance policy in place to fall back on during the term, as needed.

Unlocking Your Full Potential All of us in academia (students, professors, coaches, staff) must embrace the belief that like those with physical disabilities, there is no shame in using appropriate support when one has academic challenges from ADHD.

Barriers to accommodation

While it is difficult to find hard statistics for how many college-bound students with ADHD apply for accommodations, data and experience illustrate student use at alarmingly low rates. Why do students not use them? Common reasons reported by students fall into the following five categories:

Stigma and misperceptions. They do not want to be different from their peers; they fear being labelled; they do not want to be defined at college by their disability or diagnosis; they are tired of needing and having accommodations in K-12 and want a “fresh start”; they are concerned about confidentiality.

Fear of judgment. They do not want to disclose their challenges; they do not want to be seen going to “those departments” such as counseling, tutoring, or academic support and be thought of as “different”; they fear that others (professors in particular) will not understand the purpose of accommodations and look at them as unnecessary “crutches.”

Misjudging college rigor. Without a clear understanding of the increased rigor and different environmental demands in the college setting, students may not think they need accommodation. Some simply want to see if they can handle college without them; others plan to put them in place later when and only if they need them (this unfortunately all too often leads to “too little, too late” as described above).

Lack of awareness. They don’t know that accommodations are available at the college level. Not having experienced college-level academics, they aren’t sure what accommodations they will need (they don’t know what to ask for).

Overwhelm. They don’t know where to go or how to access services; they are worried that the process will be embarrassing or difficult; they are concerned that they won’t have time for appointments, counseling, or tutoring sessions; they find that the hours of offices with their needed service are not conducive to their class, study, and work schedules.

Some of these concerns stem from myths, misinformation, and a lack of clear information about college accommodation. Others, such as service hour conflicts with class schedules, can be very real. Nonetheless, with the stakes so high, it is imperative for students to put themselves in a position to succeed by getting informed about ADHD support at the college level, the benefits of accommodation, and their options.

Benefits of accommodation

It is well established that the challenges from ADHD are real and cannot simply be willed away or improved by better effort, any more than asking someone with nearsightedness to “try harder” to see the board without their glasses. But the good news (paraphrasing author and clinician Ned Hallowell) is that there is no outpatient mental health diagnosis that responds so well and turns around so significantly, when properly diagnosed, treated, and managed.

In the academic world, some ADHD challenges may require a disability** perspective. That is to say certain features of one’s ADHD that objectively interfere with a specific task or demand of a course (this is formally called a functional impairment) can be mitigated by specifically tailored support and structure, otherwise known as accommodation.

We have to learn to think of accommodation of these “hidden” disabilities, often associated with a behavioral health diagnosis, in a similar manner to the person with mobility issues who needs a wheelchair to get to class, or the individual previously mentioned with poor eyesight who needs glasses to see the board. These supports do not give them an advantage over their nonaffected peers. Rather they reduce the impact of the disadvantage their disability poses, allowing them to achieve their academic potential. The good news is that across the country, due to advocacy efforts and training, this understanding and awareness is growing in postsecondary education.

All of us in academia (students, professors, coaches, staff) must embrace the belief that like those with physical disabilities, there is no shame in using appropriate support when one has academic challenges from ADHD. A student is simply getting what they need to participate equally in the academic setting.

What about those students who want to “try” college life without accommodations? There is certainly some merit to understanding that the brain continues to mature throughout young adulthood and that previous challenges students with ADHD experienced may improve with the maturation process. However, the applicable adage here is: Better safe than sorry. In other words, students who needed accommodation in the past or who aren’t sure if they will need accommodation in college are better off to register with the disabilities service office and go through the process to get them on board. It is better to have accommodations and not need them than to not have them at all. Waiting “to see” runs the risk of not getting accommodated in time. Too little, too late is a heartbreaking way to end a semester. Having accommodation in place is a student’s insurance policy.

Turning roadblocks into steppingstones

Stepping into college is like embarking on a thrilling adventure—full of fresh starts, new experiences, and the promise of growth. But with all the excitement comes the reality of new challenges, especially for students with ADHD, who may find the transition more complex.

Considering how ADHD intersects with the demands of college life, it’s important to acknowledge that sometimes, the journey might require a bit of extra support. Recognizing when to seek accommodations can be the key to turning potential roadblocks into steppingstones.

The good news? Colleges are more equipped than ever to support students facing challenges. The takeaway is simple: don’t wait until it’s too late. Seek the help you need early on, and turn “too little, too late” into “right on time.” Here’s to a college experience that’s not just survived but truly conquered. The next generation of students is ready to shine!

Jane Indergaard, DNP, RN, is an associate professor of nursing at Concordia College in Moorhead, Minnesota, and a licensed registered nurse in North Dakota and Minnesota. A recognized regional, national, and international speaker on ADHD, she has presented on the underdiagnosis of ADHD in women, the impact of hormonal fluctuations on ADHD symptoms across the lifespan, the impact of ADHD on siblings, and the enhanced impact of comorbidity with ADHD and family stress. Dr. Indergaard is a longstanding passionate provider of education, advocacy, training, and outreach for individuals living with ADHD. She provides consultation for multidisciplinary psychoeducational programming for providers treating individuals with ADHD. Her current research and clinical interests focus on the impact of hormonal fluctuations on women with ADHD, neurocognitive disorders and ADHD, clinical practice guidelines for adult ADHD, and the design and implementation of psychoeducational programming into provider treatment for ADHD. Dr. Indergaard is the co-founder of the award-winning Red River Valley CHADD, and she currently serves on CHADD’s board of directors and the editorial advisory board of CHADD’s Attention magazine.

ADDITIONAL READING

DuPaul G, Franklin M, Pollack B, Stack K, Jaffe A, Gormley M, AnastopouIos A, and Weyandt L. (2018). Predictors and trajectories of educational functioning in college students with and without attention-deficit/hyperactivity disorder. Journal of Postsecondary Education and Disability, 31(2),161-178. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586431/

Hallowell E and Ratey J. (2005). Delivered from Distraction: Getting the Most Out of Life with Attention Deficit Disorder. Ballantine Books.

Henning C, Summerfeldt L, and Parker J. (2022). ADHD and academic success in university students: the important role of impaired attention. Journal of Attention Disorders, 26(6) 893–901. https://journals.sagepub.com/doi/full/10.1177/10870547211036758

Lawrence D, Houghton S, Dawson V, Sawyer M, and Carroll A. (2021). Trajectories of academic achievement for students with attention-deficit/hyperactivity disorder. British Journal of Educational Psychology, 91(2), 755–774. https://doi.org/10.1111/bjep.12392

Sarkis S. (2022, March). College Accommodations for Teens with ADHD. ADDitude. https://www.additudemag.com/college-accommodations-for-adhd-teens

Thomas J and Barton P. (2024). Growing college success from first semester failure. ADHD College Success: Guidance Program. https://www.adhdcollegesuccess.com/growing-college-success-from-first-semester-failure/

*While this article addresses the challenges and needs of students with ADHD who pursue a college education, it in no way implies that future success is limited to a college degree. There are other viable avenues and options to secure economic success and achieve life goals. Nonetheless, this article will focus on academic functioning of college students with ADHD.

**The use of the term disability is used in this article to describe functional impairments associated with the disorder which qualify for accommodation. With due respect to concerns over ableism, it is necessary to understand that ADHD is considered a disability from both medical and legal perspectives and by federal law. This is critical to acknowledge in the context of accommodation and support in academic and occupational settings.