STRATEGIES FOR TEACHING UNIVERSITY STUDENTS WITH ADHD: SCOPE REVIEWABSTRACT
Objective: to map strategies for teaching university students with attention deficit hyperactivity disorder and identify recommended strategies for teaching these students pursuing a degree in nursing.
Method: this is a scoping review. Conducted in December 2023 in six databases and the catalog of theses and dissertations.
Results: the selection resulted in 14 studies. The mapped strategies were classified as general and active: extra time and flexible scheduling to conduct assessments and problem-based learning. In nursing, promoting better communication, organization, and prioritization of activities during clinical practice is necessary.
Conclusion: it is essential to recognize that attention deficit hyperactivity disorder may be present in university students. Therefore, higher education institutions must reflect on inclusive teaching strategies for this target audience.
KEYWORDS: Attention Deficit Disorder with Hyperactivity; Teaching; Universities; Nursing; Education
RESUMO
Objetivo: Mapear as estratégias para o ensino de estudantes universitários com transtorno do déficit de atenção com hiperatividade e identificar as estratégias recomendadas para o ensino desses estudantes que cursam a graduação em enfermagem.
Método: Trata-se de uma revisão de escopo, realizada em dezembro de 2023, em seis bases de dados e no catálogo de teses e dissertações.
Resultados: A seleção resultou em 14 estudos. As estratégias mapeadas foram classificadas em gerais e ativas, entre elas: tempo extra e flexibilização de horário para realizar avaliações; e, aprendizagem baseada em problemas. Já, no contexto da enfermagem, tem-se: promover melhor processo de comunicação, organização e priorização de atividades durante a prática clínica.
Conclusão: É fundamental reconhecer que o transtorno do déficit de atenção com hiperatividade pode estar presente no estudante universitário. Logo, é necessário que as instituições de ensino superior reflitam sobre as estratégias de ensino inclusivas para esse público-alvo.
DESCRITORES: Transtorno do Déficit de Atenção com Hiperatividade; Ensino; Universidades; Enfermagem; Educação
RESUMEN
Objetivo: mapear las estrategias para la enseñanza de estudiantes universitarios con trastorno por déficit de atención con hiperactividad e identificar las estrategias recomendadas para la enseñanza de estos estudiantes que cursan la licenciatura en enfermería.
Método: se trata de una revisión de alcance. Realizada en diciembre de 2023 en seis bases de datos y en el catálogo de tesis y disertaciones.
Resultados: la selección resultó en 14 estudios. Las estrategias mapeadas se clasificaron en generales y activas, entre ellas: tiempo extra y flexibilización de horario para realizar evaluaciones; y aprendizaje basado en problemas. Ya en el contexto de la enfermería: promover un mejor proceso de comunicación, organización y priorización de actividades durante la práctica clínica.
Conclusión: es fundamental reconocer que el trastorno por déficit de atención con hiperactividad puede estar presente en el estudiante universitario. Luego, es necesario que las instituciones de educación superior reflexionen sobre las estrategias de enseñanza inclusivas para este público objetivo.
DESCRIPTORES: Trastorno por Déficit de Atención con Hiperactividad; Enseñanza; Universidades; Enfermería; Educación
HIGHLIGHTS
Among the teaching strategies are extra time and schedule flexibility.
Prioritize clinical practice in teaching for nursing students with ADHD.
There is a noticeable lack of studies on ADHD in undergraduate nursing.
INTRODUCTION
Neurodevelopmental disorders are a group of conditions that arise in early childhood development and generally occur before the child enters the school environment. These conditions are characterized by the presence of developmental deficits, which can range from specific impairments and limitations in learning to general damage in social or intellectual skills1.
Among these conditions is Attention Deficit Hyperactivity Disorder (ADHD), which is defined by harmful and persistent levels of inattention, disorganization, and hyperactivity-impulsivity. The causes of ADHD are multifactorial, involving genetic, environmental, biological, and social aspects2,3.
Previously, it was mistakenly believed that ADHD was a diagnosis with few repercussions in the lives of patients and that it would disappear during puberty. However, it is observed that ADHD tends to persist into adulthood, affecting about 2.5% of this population, and with real possibilities of resulting in impairments in the social, academic, and professional functioning of these individuals1,2.
Among the academic difficulties pointed out by students with ADHD are reading and writing, lack of dynamism in classes, hyperactivity, taking non-adapted theoretical assessments, indiscipline, communication difficulties and relationships with other classmates, and low self-esteem4. Some of these difficulties are attributed to the teachers’ lack of knowledge about the disorder’s characteristics. Therefore, the need for meaningful teaching is evident, with innovative methods adapted for these students so they are not driven to seek during classes. These parallel activities release their energy and creativity4.
In the adult population with ADHD, low academic performance is commonly observed, and inattention prevails as the main symptom, which signals a possible focus on pedagogical actions. Individuals with elevated levels of ADHD symptoms generally exhibit lower academic success, something that is independent of gender5.
The presence of university students diagnosed with ADHD is a reality. Your identification by those involved in this process, especially by the teachers, is necessary and can occur through practical advice, guidance, and recommendations based on expert consensus. However, this alone is not enough; it is necessary to abandon the prevailing notions that ADHD is a specific learning difference (or difficulty) and enable these students to have timely access to inclusive and quality education, as well as treatment and support according to their needs6.
Inclusive education must support all students and strive for new educational strategies to allow students with special needs to be involved in the teaching-learning process6.
Given this context, it is noted that university students diagnosed with ADHD, including those pursuing a degree in nursing, the authors’ field of study, need innovative, meaningful, and adapted teaching strategies. These students need to be recognized to provide them, in the same way, with learning opportunities and active participation in their formative process, to increase the possibilities of personal, social, and professional success.
Thus, the study aims to map strategies for teaching university students with ADHD and identify recommended strategies for teaching these students pursuing a nursing degree.
METHOD
The research is a scoping review. This type of study aims to map and categorize the main concepts of certain areas of knowledge and analyze the extent, scope, and origin of the investigation, as well as select these studies, extract the data, summarize and disseminate the research data, and identify the research gaps existing in the literature7.
In an attempt to identify scope reviews that approached or equaled the objective of this study, a search was conducted in December 2023 on the following study platforms: International Prospective Register of Systematic Reviews (PROSPERO), Open Science Framework (OSF), The Cochrane Library, JBI Clinical Online Network of Evidence for Care and Therapeutics (COnNECT+) and Database of Abstracts of Reviews of Effects (DARE). The results showed the absence of research with a scope similar to this study’s aim.
This research was developed according to the recommendations of the Joanna Briggs Institute Review Manual7. It used the protocol Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)8. It was registered on the platform for registering scientific works OSF (https://osf.io/cfr4k/?view_only=5a9f20a7e2ee469c82267bbbd5186aeba).
The Population, Concept, and Context (PCC) research strategy was used. For the first guiding question, “P” students with ADHD, “C” strategies “C” university institutions were considered; therefore, the following question was elaborated on: What are the strategies for teaching students with ADHD in university institutions? As for the second guiding question, it was considered “P” students with ADHD, “C” strategies, and “C” nursing graduation, which allowed the construction of the following inquiry: what are the recommended strategies for teaching students with ADHD who are pursuing a nursing degree?
Six databases and the catalog of theses and dissertations were accessed through the federated academic community on the Portal de Periódicos of the Coordination for the Improvement of Higher Education Personnel (CAPES), including Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Web of Science, Scientific Electronic Library Online (SciELO), Cochrane Library and Catalog of Theses and Dissertations (CAPES).
The controlled descriptors selected through the Descritores em Ciências da Saúde/Medical Subject Headings (DECS/MeSH), were: Attention Deficit Disorder with Hyperactivity; Universities; Teaching; Nursing. The intersection between them occurred using the boolean operator AND, as shown below: 1) Attention Deficit Disorder with Hyperactivity AND Universities AND Teaching; 2) Attention Deficit Disorder with Hyperactivity AND Teaching AND Nursing; 3) Attention Deficit Disorder with Hyperactivity AND Universities AND Nursing. The search strategy for each selected database is described in Chart 1.
The search strategy was carried out in December 2023, and according to the objective of this review, the following inclusion criteria were adopted: scientific articles, documents, booklets, and manuals that are available in full, without time limit, in any language, and address the research theme. Scientific articles that did not answer the guiding questions of the research, duplicate articles, abstracts, conference proceedings, and letters to the editor were excluded.
The selection of publications included in the research was carried out by two reviewers independently and blinded by them, who conducted the entire analysis process on the same day and at the same time using different electronic devices based on the information available in the title and abstract. Two independent reviewers selected the final sample, with the full text read in full. In case of disagreement about including any article in the final list, the reviewers analyzed the full version of the works until they reached a consensus; therefore, there was no need for a third reviewer.
The study variables were: 1- year of publication; 2- country of origin; 3- objective of the study; 4- strategies for teaching university students with ADHD; 5- strategies for teaching university students with ADHD who are pursuing a degree in nursing. A data collection instrument was developed to extract data from the studies, and these variables were entered into a spreadsheet and analyzed using simple descriptive statistics. A descriptive analysis of the selected studies was also carried out, which made it possible to construct a synthesis of the main evidence and summarize these results in response to the guiding questions.
RESULTS
The initial search resulted in 4,846 scientific articles. Next, after filtering according to the inclusion criteria, 4,690 studies were obtained, which were read for titles and abstracts. After this initial reading, 26 articles were selected for full eligibility evaluation. In this way, the final selection consisted of 14 scientific articles, as shown in Figure 1.
Flowchart of search and selection of studies for the scoping review. Natal, RN, Brazil, 2024
The 14 selected studies, identified by the letter “E,” met the previously established inclusion criteria for the development of this scoping review, as they dealt with strategies for teaching university students with ADHD. Table 1 presents the description of the articles included, organized by study, year of publication, country, and objective.
It is observed that in this scope review, studies conducted in the United States were most prevalent (42.8%), followed by Canada, the United Kingdom, and Brazil (14.2% each), and finally, Australia and Japan (7.1% each). The articles included in the study were published between 2008 and 2023.
In mapping strategies for teaching university students with ADHD, the following topics were established when analyzing scientific articles: 1) General strategies for teaching college students with ADHD; 2) Active strategies for teaching college students with ADHD. These are represented in Chart 2.
In the undergraduate nursing scenario, there were only two studies, E13 and E17, published in Canada and Japan, respectively, which referred to the education of university students with ADHD within the reality of the course, which highlights a scarcity of research on this topic at the international and, mainly, national level.
DISCUSSION
In higher education, the number of students entering with learning difficulties associated with neurodiversity, such as ADHD, is increasing, which represents a common and shared challenge among teachers and institutional leaders22. However, many higher education institutions (HEIs) seem to be “cold” towards neurodiversity because, despite having support services, low levels of staff awareness and traditional/inflexible teaching and assessment approaches are observed22.
When considering the academic journey of university students with ADHD, it becomes essential that all professionals involved in the education of these individuals, especially teachers, seek to gain knowledge about the disorder, that is, what it is and how it can negatively impact the academic life of students23. In a survey conducted with teachers, this need was recognized. Most of them stated that it is necessary to study the characteristics of ADHD and the impacts of the disorder on academic life. Additionally, they expressed interest in possible professional training on the subject, which could be addressed through workshops sponsored by HEIs or support services18.
Subsequently, it becomes necessary to understand that, given the learning difficulties presented by students with ADHD, teaching needs to be meaningful, participatory, and questioning to motivate and engage students during classes. These strategies include simultaneous activities that stimulate creativity and the release of energy since people with ADHD in adulthood have difficulties adhering to sedentary and routine activities and avoid taking on jobs and roles that are not flexible or do not allow free movement, which consequently leads them to change jobs frequently23.
Among the available strategies to ensure that the education of university students with ADHD has the qualities suggested above, one can consider the use of active learning methodologies, such as problem-based learning, simulation, cases, teams, and flipped classroom11, described in the results of this review.
However, it is necessary to understand that for these methodologies to be effective, it is advisable to plan them considering the use of universal design for learning11, which is guided by three guiding principles: (1) provide multiple means of engagement, (2) provide multiple means of representation, and (3) provide multiple means of action and expression. Although it was created to make classrooms more accessible to elementary and high school students with some disability25, universal learning design is now considered beneficial to many students, regardless of whether they have disabilities or not24.
Attention is drawn to the fact that if the teacher, even when adopting active teaching methodologies, chooses to provide students with extensive texts or only a single source of information, they will still contradict the principles of universal learning design. Thus, the chosen methodology may act not as a facilitator but as a barrier to the learning of all students, including those with ADHD11.
The act of not selecting extensive texts for preparation or conducting classroom activities, as presented in the results of this research, fits into the general strategies for teaching university students with ADHD, that is, which involves accommodations for these students, which also includes allowing extra time in assessments, flexible schedules for conducting assessments, negotiating extensions of deadlines for activities, separate room for writing assessments, among others. The extra time for conducting assessments has proven to be the most effective strategy used by HEIs that have students with ADHD.
It is noteworthy that learning problems among these students in higher education may also be related to the teaching methods and assessments used. However, reasonable adaptations are necessary for this target audience, which need to be selected taking into account the student’s personal characteristics and the institution’s environmental characteristics26.
In general, the entire academic community needs to understand that students diagnosed with ADHD may show impairment in executive function. This human function is responsible for time management, action planning, personal organization, focus, and short-term memory27.
Another highlight of this review’s results was the identification of recommended strategies for teaching university students with ADHD in the context of clinical nursing practice.
Implementing these strategies requires structural modifications to the nursing undergraduate course, not only regarding clinical practice but also concerning all the support provided to students with ADHD enrolled in the course. It also clarifies the need for better preparation of clinical instructors, who sometimes feel uncomfortable and unable to adequately assist students with special needs.
In clinical nursing practice, it is observed that the most difficult learning situations involving students with ADHD are typical care activities in the professional area and communication with other team members. However, what causes the most fear among nurse educators are serious medical errors. However, despite the risks, it is possible to prevent these errors through the meticulous attention of clinical instructors and educators during the internship19.
Finally, it is emphasized that nursing educators are also among those responsible for identifying students with a high possibility of making medical errors and, from there, planning and providing activities such as extra training or appropriate professional guidance19.
The study presented as a limitation the scarcity of research on the education of university students with ADHD inserted within the reality of the nursing undergraduate course, both nationally and internationally, highlighting the need for more efforts and interest from researchers in this professional area on the topic in question.
CONCLUSION
This scope review mapped strategies for teaching college students with ADHD, which were classified as general and active. These strategies included allowing extra time and flexible schedules for assessments, helping to manage and organize study and activity time, problem-based learning, simulation, and cases.
It was also possible to identify the recommended strategies for teaching university students with ADHD who are pursuing a degree in nursing, such as promoting a better communication, organization, and prioritization of activities during clinical practice, providing additional preparation time for clinical practice, and offering extra training for practical activities.
The development of this study seeks to draw the attention of HEIs to the need to recognize that ADHD is a disorder that may be present in university students. From this emerging and global reality, it becomes necessary to reflect on teaching strategies for this target audience, to practice inclusive education and increase the possibilities of personal and professional success.
It is suggested that studies be conducted with a higher level of evidence to evaluate the effectiveness of strategies for teaching university students with ADHD, as mapped and identified in this review.
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HOW TO REFERENCE THIS ARTICLE:
Ferreira LB, Gonçalves RG, Menezes RMP de, Medeiros SM de. Strategies for teaching university students with ADHD: scope review. Cogitare Enferm. [Internet]. 2024 [cited “insert year, month and day”]; 29. Available from: https://doi. org/10.1590/ce.v29i0.96179.
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Publication Dates
-
Publication in this collection
20 Sept 2024 -
Date of issue
2024
History
-
Received
28 Jan 2024 -
Accepted
04 June 2024
Source: Page et al.