ADHD at School and University: For Students and Families

My report card was not bad. It was uneven, and nobody looked at the unevenness, everyone looked at the average.

I would get a very high mark on one exam and a very low one on the next. I could explain a subject flawlessly one week and not remember it three weeks later. In those years I gave this a name of my own: sometimes I study, sometimes I don't. As I approached thirty I learned that the real issue didn't end with studying; it ended with managing the studying.

The real indicator is inconsistency

The same student gets ninety on one exam and forty on another.

Reading this picture as "he doesn't study" is easy and wrong. Skill fluctuation is one of the most defining features of ADHD and for exactly that reason its most judged side: what someone has been seen to do once is assumed to be doable always.

The sentence that this assumption says to the student is always the same: "you can, but you don't." What that sentence does over the years I wrote about in the article on the "not living up to your potential" label.

Where the struggle is

• Long-term projects. If the deadline is far away, it is not real. He starts on the last night.
• Written exams. Misreading a question he knows, making a careless mistake, not being able to estimate the time.
• Taking notes. Listening and writing at the same time is a strain; one gets chosen and usually both end up incomplete.
• Keeping track of homework. Remembering that the homework exists is harder than doing the homework. A matter of prospective memory.
• Sitting in a quiet classroom. Especially in those where the inattentive type predominates, it is not visible from outside at all; the child quietly looks out of the window and nobody is bothered.
• Following what is being read. Reading the same paragraph three times, the eye on the line and the mind elsewhere.

For a diagnosis, symptoms are required to have started before the age of twelve (APA, 2022); so the school years are not only where the struggle is lived, they later become the most useful record in the diagnostic process.

I wrote separate guides for exam periods: LGS and YKS. I dealt with homework tracking, the everyday issue on the parents' side, in the article on homework.

Accommodations that help

In exams: extra time, a separate room with few stimuli, permission for breaks, questions read aloud.

In class: sitting close to the teacher, lecture notes provided in advance, permission to record, planned movement breaks.

In homework: staged submission, homework tracking that is written and through a single channel, splitting a big project into steps.

In Türkiye most of these supports are requested through the RAM (Guidance and Research Center) by way of an educational assessment. At school, the support education room and the BEP (Individualized Education Program) are common practices.

Being honest here

The list above is written in the same form everywhere and I did not question it for a long time. When I looked at the evidence side, the picture turned out more mixed.

A systematic review examining educational accommodations points to the scarcity of studies measuring the effect of these extremely common supports and reports that most of the accommodations did not show a benefit specific to students with ADHD. As an exception, reading questions aloud stands out for younger students. The authors' recommendation is that accommodations be given not alone but together with interventions whose effect has been shown (Lovett and Nelson, 2021).

On extra time there is an even more unexpected finding: in a study with university students, students with higher ADHD symptoms and executive function difficulty benefited less from extra time. Their perceptions of their own need also did not predict their actual performance (Lovett and Leja, 2015). It is a single study and it would not be right to generalize; but it says that the sentence "give extra time and the issue is solved" is not as safe as it looks.

I am not writing this so that you do not ask for accommodations. I am writing it to say this: an accommodation is a beginning, not a solution on its own. What the student really needs is support that teaches how to break the work into pieces and how to start.

The purpose of an accommodation is not to make the exam easier. It is for what the exam measures to be knowledge, not attention.

Why it gets harder at university

As soon as high school ends, the picture gets heavier for many people, and the reason is not that symptoms increase.

In high school there is a skeleton that comes from outside: a fixed schedule, attendance every day, a teacher chasing you, close deadlines, family at home. This structure takes the place of the executive functions that are lacking inside.

At university the skeleton is removed. The attendance requirement loosens, exams move further away, nobody chases you. What is underneath becomes visible.

The developmental review by Franke and colleagues shows that transition periods are a marked breaking point in ADHD (Franke et al., 2018). Many late-diagnosis stories begin right here; mine too began at one of those transitions.

A review examining university students reports that academic difficulty is consistently seen in this group (DuPaul et al., 2009). The same review also points to a gap: there is almost no controlled study measuring the effect of interventions specific to this group.

What is practical for the student

• Building the structure from outside. Fixed study hours, the same place, the same ritual. How to build the environment is in the article on the study environment.
• The library. The body doubling effect is free and strong.
• Spaced repetition. Studying the night before an exam works especially badly in ADHD; repetition at gradually widening intervals is one of the methods that makes the most difference. How to set it up is in the article on memorization and spaced repetition.
• Making up your own deadlines. A week before the real date, and by promising someone else.
• Dealing with exam anxiety separately. The attention problem and anxiety make each other bigger; the details are in the article on ADHD and exam anxiety.

Stop taking notes, try catching. Writing while listening always left both incomplete for me. What worked was catching only the keywords and the places I did not understand during the lesson, and completing the full notes in ten minutes right after the lesson. You are already making a selection during the lesson; making that selection on purpose is better than making it by accident.

How to request an accommodation

In Türkiye the process generally runs as follows, and knowing the steps shortens the wait.

Assessment first. The school guidance service refers the family to the Guidance and Research Center, and the educational assessment is done there. If a health board report is required, a separate visit to the hospital is made.

Then the school. When the report is delivered to the school, an individualized education program or a support education room comes onto the agenda.

At university there is a separate door. Most universities have a disabled student unit, and exam accommodations are requested from there. I see that most students do not know such a unit exists.

Ask in writing. An accommodation accepted verbally counts as never having existed when the teacher or the semester changes.

I explained the official steps on the school side separately in the articles on the RAM report, the BEP and talking to the teacher.

For families

Talking about grades does not work. Talking about the process does: when it starts, where it gets stuck, at which step it stays.

Behavioral parent training is one of the interventions with the strongest evidence in childhood ADHD and is built on consistent limits and immediate feedback (Faraone et al., 2021).

I also want to add this: if there is a separate difficulty with reading, writing or math, it may not be a result of ADHD. Learning disabilities often accompany ADHD and call for a separate assessment; I dealt with this in the article on ADHD and learning disabilities. The diagnosis and the medication decision are a physician's job.