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Jeremy Cohen is a PhD candidate and instructor at McMaster University.

I wandered the cafeteria after hours, listening in as my seventh-grade English teacher spoke to my mom at an empty lunch table. My poor academic performance was likely owing to a learning disability, she told her, and future scholastic success was unlikely. It would take 17 years and several misdiagnoses before that disability was acknowledged and given a name: ADHD.

Students with ADHD are underrepresented in the university system, their symptoms poorly managed and their degree outcomes uncertain. This academic year may be the testing ground for the shape of higher education to come, and I worry that students with ADHD and other invisible disabilities will be placed at a particular disadvantage owing to a lack of social and institutional support as well as the realities of market-based higher education.

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My ADHD diagnosis at the age of 31 has come with its own complications, including the prohibitive cost of medication, social stigma and a greater awareness of the failure of universities to give due consideration to the unique needs of neurodiverse students.

Attention-deficit hyperactivity disorder (ADHD) is defined as a neurodevelopmental disorder characterized by either hyperactivity, inattentiveness or a combination of both. Some of the symptoms of ADHD include impulsive behaviours, poor organizational skills, impaired executive functioning, trouble multitasking, poor coping mechanisms and trouble focusing.

Individuals with ADHD are at a higher risk of depression and anxiety and of developing compulsive behaviours such as alcoholism, gambling and drug addiction. Up to 50 per cent of adult patients with ADHD have had comorbid substance-use problems, and a 2018 study estimated a reduced life expectancy of 13 years for individuals whose ADHD symptoms persisted into adulthood.

Educational outcomes for those diagnosed with ADHD are generally unfavourable. A 2009 study found that students with ADHD are 32.5 per cent more likely to drop out of high school. Although they account for up to 8 per cent of college populations, a 2013 study concluded that only 15 per cent of young adults diagnosed with ADHD graduated from university, compared with 48 per cent of the study’s control group. Over all, young adults with ADHD are 11 times more likely to be unemployed and not in school.

ADHD impairs executive functioning and presents unique barriers to developing basic life skills, let alone the skills needed to succeed in university. In graduate school, for example, students must balance seminars with dissertation writing and research, field work, publishing demands, grant writing, conference presentations and, hopefully, a life outside academia. No wonder researchers found that only 0.06 per cent of young adults with ADHD held a graduate degree.

Online course offerings have increased every year as universities look to cut costs and attract more students. In light of the pandemic, some opinion writers and media outlets have extolled the virtues of online education, arguing it will lower costs and remove traditional access barriers and that a postpandemic hybrid model of higher education will free up on-campus resources and make quality college education more accessible. Yet increased distance learning may contribute to an already-uneven educational experience, American economist David Deming argues. “On-campus learning will become an increasingly important quality differentiator, a luxury good that only students with means can afford,” he writes.

A 2015 Ashford University study found that classroom size creates a significant difference in student engagement and instructor participation – both predictive markers of educational success for all students but especially for those with learning disabilities. The optimum online class size? Fifteen to 20 students for undergraduate courses and 13 to 15 for graduate seminars.

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Having taught online undergraduate courses with as many as 250 students, I can attest to the challenges faced by my neurodiverse students, many of whom struggle with acute self-motivation and productivity issues and require individualized attention. Unfortunately, small classes are antithetical to the market model of higher education, where economic value guides administrative decision-making over the needs of faculty and students.

Beyond issues with the “fill the seats” model of higher education, distance learning risks discriminating against students from financially precarious households, who just so happen to be disproportionately affected by ADHD. Underprivileged students may have trouble accessing laptops, reliable WiFi and webcams, placing them at a disadvantage from the outset.

Research suggests that students with ADHD can achieve successful outcomes online as long as significant social and institutional support, including smaller classroom sizes, are factored in. Yet effective ADHD solutions such as counselling and medication are either unavailable or unaffordable for many university students in North America.

Instead, universities are increasingly relying on academic accommodations to support students with disabilities. But access to accommodations is not evenly distributed. Canadian ADHD organization CADDAC writes that “ADHD and its resulting impairments continue to be inadequately understood by postsecondary institutions. This has resulted in some of these institutions demanding that students with ADHD undergo unreasonable costly testing in order to be identified as having a disability.” A psycho-educational assessment in Ontario can cost as much as $3,500 and does not guarantee adequate accommodations.

Access to support systems may further diminish as universities distance themselves from offering ADHD diagnoses and prescription medication altogether. Afraid of contributing to the abuse of prescription medication, universities are outsourcing diagnostic and counselling services. However, outsourcing support services may exacerbate prescription abuse and discourage students from seeking appropriate mental-health services.

I am an instructor in the social sciences at McMaster University. The first full pandemic semester is now behind us, and my course’s failure rate is the highest it has ever been. By October, 10 per cent of my 120 students had stopped engaging with the course. This despite the pedagogical changes made to help all my students traverse this new reality.

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Without the physical barriers of traditional classrooms, online class size will certainly increase as postpandemic life and tight department budgets encourage more virtual course offerings. But in my experience as a neurodiverse student and instructor, online classroom environments can result in less accountability, provide more opportunities for plagiarism and offer less meaningful engagement owing to the impersonal nature of distance learning.

My academic discipline and methodology – heavy on reading and interviewing research subjects for hours at a time – are not well-suited to an ADHD brain. However, I owe my continued success as a graduate student to supportive professors, positive coping mechanisms, the CTRL-F e-book search function and expensive medication not covered by my university health insurance.

Navigating university with a learning disability adds to the increasing demands placed on students – and those we place on ourselves. In the before-time, individualized educational experiences and access to counselling services were already on the decline. As programs close and on-campus mental-health services are outsourced, postpandemic online learning environments will worsen the already-uneven educational experience for neurodiverse students.

Distance learning is the best option we currently have, and I do not want to discount the efforts made by universities as they continue to adjust to the new COVID-19 reality. But I fear that universities will take this opportunity to push even more of their curriculum online. Neurodiverse students do need a hand to hold as we navigate a system not prepared, or willing, to manage our needs. With universities already slashing budgets and raising tuition, I am not feeling optimistic about our place within the future of virtual higher education.

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