Children with attention deficit disorder may not grow out of it by 18. So don't assume that students who can't focus are lazy, says Harriet Swain

Exams are more stressful for Jack, a maths and philosophy student, than for most undergraduates. Often it is only shortly before an exam that he realises he hasn't done any work and, in his case, this is not panicked exaggeration. Jack (not his real name) has attention deficit disorder, which makes organising his time - never easy for any student - a particular struggle. And if exams are bad, dealing with essays is worse.

Being asked to read around a subject and answer an open-ended question to a long-term deadline is not suited to someone with his condition, diagnosed when he was at school. But worst of all is having nothing to do. "If I'm just stuck in my room doing nothing, I will go insane," he says. His solution, like that of many young people with ADD, has been to take up extreme sports. He seeks out this adrenalin rush at least twice a week.

Jack has done well to get to university. Many of those with ADD or ADHD, whose symptoms additionally include hyperactivity, have so many problems at school that they do not continue studying post-16. Quite a few are expelled. But with an expanding student population and better treatment of people with the disorder early in their educational career, students such as Jack are more common. "We are increasingly having to address this as an issue," says Mike Adams, director of the National Disability Team, which supports disabled students in ÖйúAƬ.

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But ADD in adulthood is a neglected area. While substantial research has been carried out in schools, where between 2 and 5 per cent of pupils are thought to have the disorder, very few researchers have looked beyond the early teenage years. Only recently has ADD in adults been recognised. This issue will be addressed at a conference - The Challenges of ADHD in Adolescents and Adulthood: They do Grow Out of it, Don't They? - held this week by the National Attention Deficit Disorder Information and Support Service.

Most children grow out of ADD but not necessarily at 16 or 18. David Coghill, senior lecturer in child and adolescent psychiatry at Dundee University, says that the parts of the brain related to organisational skills are still developing in the mid to late twenties.

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The work that has been done on students with ADD has usually been connected with other conditions, such as dyslexia or dyspraxia, which those with the disorder often experience. Helen Whiteley, principal lecturer in psychology at the University of Central Lancashire, carried out an assessment of 578 undergraduate psychology students in which more than 30 per cent scored highly enough on recognised check lists for dyslexia, ADD or both to cause concern. Of these, only 24 per cent reported receiving learning support.

The higher students scored on the ADD spectrum, the less likely they were to ask for help with their work. They also tended to have a shallower approach to learning, reduced organisational and time-keeping skills, and were less able to monitor their own effectiveness. ADD does affect performance, says Whiteley, who is carrying out a larger survey of more than 1,000 students from four universities. In this, she has found a lower incidence of ADD than her original survey (14 per cent of those assessed), but has again identified a lack of support.

"It isn't something you either have or don't have," Whiteley says. "It's a continuum. Maybe we should explore this more as students arrive at university, follow through those who score highly, talk to them and put appropriate support in place."

Many institutions are now focusing on diagnosis, Adams says. Check lists are being developed and training given to staff to help identify students who may need support.

The impact of ADD on a student is different from that of more traditional disabilities, he says, since it affects behaviour, rather than being an obvious physical impairment. Some medical and educational professionals simply do not believe it exists. Whiteley admits that it is tempting to think that if students do not pay attention to detail or produce sloppy work, they are lazy. "That could well be the case, but it could also be that they do have a specific disorder," she says.

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Philip Asherson, senior lecturer and consultant psychiatrist at the Maudsley Hospital in London, is one of the few people in the UK researching adult ADD. He says that while the disorder is generally recognised by child psychiatrists, adult psychiatrists are split over whether or not it exists.

And even if they believe it exists, they often do not know how to manage it. Moreover, young people who have had help managing their condition as children find support withdrawn when they fall under adult services, particularly if they move location to go to university. This can include being taken off medication, which for some can be disastrous, says Andrea Bilbow, director of the National Attention Deficit Disorder Information and Support Services (Addiss). The irony is that the disorder is recognised enough to qualify sufferers for a disabled student's allowance.

Some young people with ADD, bright enough to have coasted through school and well supported by parents, experience difficulties only when they leave home and face the more complicated organisation involved in university life. Carol Youngs, policy director of the British Dyslexia Association, says some get as far as their thesis before experiencing difficulties.

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Finton O'Regan, education director at Addiss, says that often ADD students can be very successful in ÖйúAƬ because they have discarded subjects they found boring at school. "But the other side of it is that ADD students need a lot of structure, and with the freedom given in ÖйúAƬ it can go very wrong too."

Take money. "Keeping track of money is probably the biggest problem I have," Jack says. "Certainly more than most people. I have no idea where it is and impulsively spending money is one of the things I do."

Then there is getting to the right lectures at the right time. He has a calendar on his wall and a diary, and constantly has to remind himself to note dates down. Often people with ADD find note-taking difficult because of poor short-term memory and need to take in a tape recorder or get others to take notes for them. "The college setting is particularly demanding on their ability to sit and focus for a standard length of time," Asherson says. Often, people with the condition will do something that grabs their attention, flitting from one thing to another.

Adults with ADD are also likely to have problems interacting socially with their peers, he says, because of difficulty focusing on conversations or because they come across as irritable or overbearing.

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Working knowledge, page 50