Can testing benefit students with ADHD more than studying?

For individuals with learning disabilities, there is no one-size-fits all solution.

Two recent studies illustrate this point perfectly, as both investigated the benefits of a common technique-the testing effect-with different results.

The testing effect-a first line therapy for individuals with attention-deficit/hyperactivity disorder (ADHD)-involves initial teaching or learning followed by self-testing to increase the recall of information.

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An estimated 3% to 7% of school-aged children are diagnosed with ADHD, and it was previously believed that children “grow out” of the disorder as they age. Recent research, however, suggests that as many as 2% to 4% of college students and adult learners struggle with ADHD, which can decrease academic focus and performance.

College students with ADHD often don’t utilize effective study strategies, resulting in lower grades and graduation rates compared to their peers, according to Laura E Knouse, PhD, assistant professor of psychology and a licensed clinical psychologist at the University of Richmond in Virginia. Previous research that has evaluated the testing effect on information recall has not specifically looked at the benefits to learners with ADHD.

Although 2 recent studies examined the benefit of this intervention on students with and without ADHD, the results are conflicting, resulting in a call for further research into learning tools that could be applied to help students overcome their learning disabilities.

In one study out of the University of Richmond, 100 college students were challenged to memorize 2 sets of 48 words. A quarter of the students involved in the study had ADHD. Researchers introduced the students to the words on a computer screen, then 1 cohort restudied the list while the other were tested on how much of the list they could recall after initial teaching without restudying. An exam was given 2 days later, and the students who learned the words initially then restudied were able to recall 35% of the words, while students that learned the words then tested themselves recalled 45% of the words.

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Knouse says the testing effect is not often used in learners with ADHD, but her team found that the testing effect did produce benefits for those students.

“Taking tests and trying to recall as many words as possible resulted in remembering more words after 2 days than simply getting to see the words again. The test-taking effect was just as strong for students with ADHD,” Knouse says. “However, we need to conduct additional studies to see if the testing effect holds up for students with ADHD outside the lab. We also need to address the possibility that people with ADHD might have more difficulty using the strategy consistently. So the problem might not be that the strategy doesn’t work, but perhaps people with ADHD are less likely to use it without support.”

Knouse says her results lead her to the conclusion that clinicians should consider working with children with ADHD on better organizational skills, time-management techniques, and study strategies to improve academic performance.

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“These OTMP (organization, time-management, planning) interventions can give people with ADHD the skills they need to better manage their symptoms and the challenges that those symptoms pose to self-management in academic settings,” Knouse says. “There’s accumulating evidence that children, adolescents, and adults with ADHD can learn and use specific strategies to improve their functioning-especially in academic settings. For college students, they might consider recommending the strategies that are typically most effective for students in general-repeated studying in short sessions over time (so-called ‘distributed practice’) and practice testing. Even asking adolescent or college-aged patients some simple questions about how they study and structure their time and having some informational resources ready to recommend might point some patients in a productive direction.”

Knouse points to supporting research for her theories, with guidance for organization skills training in children from the American Psychological Association and Expert Review of Neurotherapeutics, for middle school students from School Psychology Review and the American Psychological Association, and in adult learners from the Journal of Attention Disorders and the Journal of the American Medical Association.

In the second study, conducted by psychologists at Trinity College in Hartford, Connecticut, 36 students-half with ADHD-were given 2 essays. One cohort read and restudied the essays while the other read the essays then were asked to recall and retype as much of the essay as they could after reading it just once from memory. Two days later, both groups were tested on the content of the essays, and study authors say there were only minimal differences in results between the 2 study methods. No difference was noted in the individuals with ADHD compared to the other study participants.

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“Although participants without ADHD did not show a significant benefit of testing over restudying, testing did produce recall benefits relative to not taking a test,” according to the study. “These testing benefits were diminished in participants with ADHD, who did not show any advantage of testing over either restudying or no test. The absence of testing benefits in the ADHD group is likely due in part to decreased recall on the initial test. These findings have implications for improving educational practices among individuals with ADHD and also speak to the need to examine individual differences in the effectiveness of testing as a learning strategy.”

Nichole Dudukovic, MA, PhD, now a psychology professor at the University of Oregon in Eugene, was one of the authors of the Trinity study. She says self-testing or early testing by an instructor has been shown in the past to be a very effective study technique, but in her study it was revealed that students with ADHD were less likely to benefit from the strategy than their counterparts.

“This suggests that there may be individual differences in terms of the effectiveness of a studying technique, like testing, and that other study strategies may be more effective in ADHD,” she says.

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Acknowledging that the University of Richmond study had conflicting results, Dudukovic says more research needs to be done to identify the most effective study strategies for learners with ADHD.

“Until more research has been done, I'm not sure that this work should necessarily impact clinical practice. Pediatricians should be aware that not much is known about effective studying techniques in ADHD, but unless we establish that there are significant differences in the ways in which individuals with ADHD learn and remember, one should continue to promote established learning strategies in this group,” she says.

The Trinity study also notes that learners with ADHD may have failed to benefit from the testing effect because initial recall performance, or the amount they could learn from memory retrieval, was low. Additionally, the study suggests that students with ADHD may benefit more when corrective feedback is paired with testing.