Adult Learners with ADHD
by Althea Need Kaminske
Cover Image by Robin Higgins from Pixabay
As of last October, the CDC estimates that approximately 1 in 16 adults in the United States have been diagnosed with ADHD (1). Despite the high prevalence of ADHD in adults, there are few resources for adult learners with ADHD. Many resources online are designed for parents of children with ADHD or are personal anecdotes of adult learners’ experiences with ADHD. As such, I often struggle to provide evidence-based advice and guidance for the adult learners that I work with who are struggling with ADHD. In this post I will provide an overview of ADHD in adult learners and how it impacts memory and learning.
ADHD in Adults
Adults with ADHD may experience a range of symptoms, including (2):
lack of concentration
inattention
forgetfulness
distractability
erratic mood changes
unhappiness caused by emotional overload
If you are familiar with ADHD then this list of symptoms is probably not surprising. However, I want to take a minute to highlight what these symptoms might look like in an educational or professional context. Arriving late to meetings, forgetting material that was covered in the last lecture, and sometimes showing up with high energy and lots of questions to sometimes showing up somewhat withdrawn and distant. These behaviors can easily be misinterpreted as a lack of motivation, caring, or professionalism. ADHD learners often report difficulties navigating learning environments that are not designed for ADHD learners. For example, medical students with ADHD report feeling isolated and alienated during medical school, expressing fears of ableism, fears of being accused of being unprofessional, and exhaustion from masking ADHD symptoms (4). Additionally, adults with ADHD also have an increased risk of also dealing with substance abuse, anxiety, and mood disorders (3).
ADHD and Memory in Adults
Skodzik, Holling, and Pedersen (2017) conducted a meta-analysis to better understand how adult ADHD affects memory (5). They searched through both English- and German-language literature to find research on adult ADHD learners. They found 19 studies that examined adults who had been diagnosed with ADHD, included at least one measure of long-term memory, and included a comparison group to adults without an ADHD diagnosis. Across these studies the found that adults with ADHD:
performed moderately, but significantly, worse on measures of delayed free recall of both verbal and visual memory. However, further analysis revealed that this effect was largely driven by one outlier. So I would say that the evidence here is mixed.
performed significantly worse on acquisition, or encoding, of verbal memory
The authors did some additional analyses to see if this initial difficulty in encoding could account for some of the variance in the delayed free recall mentioned above. The answer? YES. “Hence, long-term memory performance deficits in adults with ADHD are strongly influenced by deficits already present in the stage of memory acquisition.” (p. 275)
did not perform differently on measures of recognition memory
The negative impacts of ADHD on memory appear to be due to issues with encoding verbal memory, as opposed to issues of retrieval. This pattern is similar to what is found in children with ADHD.
The authors note that while this pattern is well described, they don’t quite know why it happens. They discuss theories about how ADHD affects working memory. Working memory acts as sort of an interface between attention and memory; a working space where attention to the cues and context of what is happening in the present can interact with retrieval of relevant information from the past. Within one of the more prominent models of working memory (6), working memory is broken into three parts: a visuo-spatial sketch-pad that helps us process visual information, a phonological loop that helps us process verbal information, and an executive (or attention) control function that helps to allocate attention and resources. The authors suggest with ADHD struggle to control attention related to the phonological loop, specifically.
ADHD and Learning in Adults
Understanding how ADHD affects memory is incredibly helpful when working with adult learners. Many of the students I work with already know the value and importance of retrieval practice, and their learning strategies center around using flash cards and practice questions. However, if you were never able to encode the information in the first place, then these retrieval practice strategies are substantially less effective. If the learner I work with mentions substantial difficulty with attention, or substantial difficulty with retaining information after a learning session, then I work with them to find ways to optimize their attention and encoding strategies. I am still working through the literature to find evidence-based best practices for adult learners with ADHD, but understanding that these learners are experiencing difficulties with encoding is already a big help.
References
Staley, B.S., Robinson, L.R., Claussen, A.H., et al. (2023). Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment, and Telehealth Use in Adults. National Center for Health Statistics Rapid Surveys System, United States, October–November 2023. MMWR Morb Mortal Wkly Rep 2024;73:890–895. DOI: http://dx.doi.org/10.15585/mmwr.mm7340a1
Barkley, R.A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. New York, NY: Guilford Press
Wilens, T. E., Biederman, J., & Spencer, T. J. (2002). Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 53, 113-131.
Godfrey-Harris, M., & Shaw, S. C. K. (2023). The experiences of medical students with ADHD: A phenomenological study. PloS one, 18(8), e0290513. https://doi.org/10.1371/journal.pone.0290513
Skodzik, T., Holling, H., Pedersen, A. (2017). Long-term memory performance in adult ADHD: A meta-analysis. Journal of Attention Disorders, 21(4), 267-283. http://doi.org/10.1177/1087054713510561
Baddeley, A. D., & Hitch, G. J. (1994). Developments in the concept of working memory. Neuropsychology, 8(4), 485–493. https://doi.org/10.1037/0894-4105.8.4.485
