Building Neurodiversity-Inclusive Postsecondary Campuses: Recommendations for Leaders in Higher Education

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UPDATED: September 28, 2022: In early May 2022, the Institutional Review Board (IRB) of University of California (UC)—Davis initiated an investigation into a potential issue with proper reference appropriation and author attribution for this article after receiving a complaint from an outside source. In September 2022, UC Davis informed the Publisher that the IRB concluded its inquiry and stated that “no additional action will be taken.” No further details were provided, but the Publisher considers the matter closed based on the decision of the UC Davis IRB. For questions, please contact eoconnor@ucdavis.edu Associate Dean for Graduate Students and Postdoctoral Scholars at UC Davis.

Abstract

Neurodivergent people are increasingly involved in postsecondary education, but they continue to face serious barriers and challenges on college campuses. These challenges are not only related to disability functional differences and accommodation needs, but also to stigma and prejudice toward neurodivergent people. Consequently, neurodivergent people are less successful than neurotypical peers; moreover, intersections between neurodivergence and other marginalized groups are associated with even greater inequities. This article was written by neurodivergent students and researchers, and their allies, who suggest a system-wide approach is needed to promote inclusion of neurodivergent students, staff, and faculty on postsecondary campuses. Specific recommendations, based on those the authors suggested to and that were endorsed by the University of California Academic Senate, are provided. These recommendations include diversity, equity, and inclusion (DEI)-oriented reforms (viewing neurodiversity through a DEI lens; establishing Disability Cultural Centers; providing campus-wide neurodiversity training; and fostering neurodivergent leadership in neurodiversity initiatives). Other recommendations address disability accommodations and supports (integrating disability accommodations in one place; making eligibility requirements less onerous; recognizing and accommodating sensory distress and distraction; establishing programs to facilitate transitions in and out of postsecondary; improving mental health support; and creating mechanisms to resolve issues where students are denied accommodations). Finally, further recommendations address accessibility of communication (respecting students' decisions to involve support people; and offering neurodivergent people the option to choose accessible modalities for communicating with instructors and staff and for taking classes). Institutions that embrace these reforms have an opportunity to position themselves as neurodiversity inclusion leaders and destination campuses for neurodivergent people.

Community brief

Why is this topic important?

Many neurodivergent people are, or want to be, students at college and university. However, neurodivergent people face many challenges and barriers at colleges and universities.

What is the purpose of this article?

This article recommends system-wide changes to make colleges and universities more inclusive for neurodivergent people, focusing on autistic and ADHD people.

What personal or professional perspectives do the authors bring to this topic?

The authors are neurodivergent people or parents of neurodivergent people. Most of the authors are members or allies of a community led by and for neurodivergent people at the University of California, Davis. The authors are all neurodiversity advocates and have personal experience of attending universities.

What is already known about this topic?

Previous studies show that neurodivergent people at colleges and universities face barriers and can require accommodations and supports in a number of areas. Moreover, neurodivergent people at colleges and universities can face stigma and prejudice.

What do the authors recommend?

First, the authors recommend changes to address prejudice and stigma toward neurodivergent people and to foster neurodivergent culture:

• The authors believe university and college offices for promoting diversity, equity, and inclusion should do more to help neurodivergent people.

• The authors suggest colleges and universities should create Disability Cultural Centers and provide neurodiversity training to everyone on their campuses.

• The authors recommend neurodivergent people should be leaders in neurodiversity programs and initiatives.

Next, the authors recommend changes to improve supports and accommodations for neurodivergent students:

• The authors recommend giving neurodivergent people a single contact person to set up their individualized accommodations.

• The authors recommend changes to make it easier for neurodivergent people to show they are eligible for accommodations.

• The authors recommend creating transition programs to support neurodivergent students as they arrive at college and as they leave college.

• The authors recommend providing better mental health supports and providing accommodations for sensory distress and distraction.

• The authors suggest that universities should establish mechanisms to help students who are denied accommodations.

Moreover, the authors recommend changes to help neurodivergent people communicate and study in ways they find accessible:

• The authors recommend that support people should be welcomed when neurodivergent people want them to be involved in their education.

• The authors recommend that neurodivergent people should be allowed to communicate with college/university staff in whatever way is most comfortable for them.

• The authors recommend that students should be able to choose to take classes online or in-person.

How will these recommendations help neurodivergent adults now or in the future?

The authors hope these changes will help neurodivergent people thrive at colleges and universities. Success at college could help neurodivergent adults achieve their personal employment and career goals.

Introduction

Thanks to advances in diagnosis, awareness, and accessibility, increasing numbers of neurodivergent students are attending postsecondary institutions. Studies in the United States suggest that 0.3%–1.9% of postsecondary students are autistic.^1,2 Five percent of incoming American students report attention-deficit/hyperactivity disorder (ADHD),³ which does not include those whose ADHD is undisclosed/undiagnosed. However, despite often possessing important academic^4–6 and general strengths,^7–9 individuals with these disabilities face many barriers and challenges on postsecondary campuses. Autistic and ADHD students are less likely to complete their postsecondary studies than those in the general population.¹⁰

Despite the emergence of rich neurodivergent cultures and communities over the past several decades,^11–13 postsecondary administrations seem to view disability through predominantly medicalized, legalistic, and deficit-based lenses.^14,15 Many postsecondary students also appear to hold stigmatizing views of autism, ADHD, and associated behaviors.^16–19 Even a still image or brief video of an autistic person is enough for postsecondary students to judge them negatively.²⁰ Moreover, to date, most attention toward neurodiversity in higher education has focused on undergraduates, yet neurodivergent graduate students, faculty, and staff also face important challenges.²¹

We, the authors of this article, are a mixed group of neurodivergent undergraduate students, graduate students, and graduates, along with a parent ally. We believe that a system-wide approach to enhance postsecondary inclusion of neurodivergent students is necessary.²² Such an approach should consider not only disability-related functional barriers and accommodation needs, but also factors such as stigma, prejudice, identity, and culture.

Most of us are members or allies of the Aggie Neurodiversity Community, a neurodivergent-led peer support community and registered student organization based at UC Davis. Since its foundation in 2017 (at which time it was named the Autism and Neurodiversity Community), this group has primarily endeavored to provide a supportive social community for neurodivergent students, neurodivergent alumni, and other neurodivergent members of campus communities. In addition, Aggie Neurodiversity Community members have also given public presentations, including neurodiversity education workshops. After one of these workshops, we were invited to present recommendations for systemic change to enhance inclusion of neurodivergent students to the University of California's Academic Senate, which endorsed our recommendations.²³

The recommendations presented in the present article are an extended, elaborated, and edited version of these original recommendations. They are divided into three domains. First, insofar as neurodivergent people face stigma and discrimination in much the same way that other marginalized groups do,^14–20,24 we outline diversity, equity, and inclusion (DEI)-oriented steps to promote inclusion and acceptance of neurodivergent people on campuses. Second, as neurodivergent people can additionally face disability-related challenges and barriers in both academic and nonacademic aspects of postsecondary life,^25,26 we outline measures to improve the supports and accommodations available to neurodivergent people.

Finally, because some neurodivergent people may struggle to communicate using particular modalities or without support,^27,28 we provide recommendations to help campus actors better communicate with neurodivergent students and colleagues. Table 1 summarizes our recommendations, and we provide more detailed discussion and justification below.

Table 1.

Recommendations to Promote Inclusion of Neurodivergent Students, Staff, and Faculty in Postsecondary Institutions

DEI recommendations  1. Recognize neurodiversity as a DEI issue     a. Ensure DEI personnel are adequately qualified to identify and address DEI issues affecting neurodivergent people     b. Ensure neurodiversity, and intersectionality with neurodiversity are considered in all DEI initiatives and programs     c. Collect data about representation of neurodivergent students, staff, and faculty, as well as intersectionality with neurodiversity     d. Collect data about challenges faced by neurodivergent students, staff, and faculty, including those with intersectional identities     e. Develop and implement strategies to increase inclusion and representation of neurodivergent students, staff, and faculty     f. Ensure mechanisms, such as remedial training and disciplinary processes, are in place and working effectively to address discriminatory behavior toward neurodivergent people  2. Provide campus-wide neurodiversity and universal design trainings to faculty, staff, and students  3. Establish Disability Cultural Centers     a. Place Disability Cultural Centers in accessible locations adjacent to other cultural and retention centers for marginalized student populations     b. Use Disability Cultural Centers as a base for institutional initiatives to promote neurodiversity and disability inclusion and acceptance     c. Use Disability Cultural Centers to provide support for neurodivergent-led clubs and initiatives, but without compromising the autonomy of these groups  4. Ensure neurodivergent people are meaningfully involved as leaders in neurodiversity initiatives     a. Involve neurodivergent students in oversight of neurodiversity initiatives and/or hire neurodivergent staff to execute programs     b. Provide appropriate remuneration     c. Ensure neurodivergent leadership is meaningful and nontokenistic Disability accommodations and supports recommendations  5. Integrate disability accommodations to enhance accessibility     a. Provide each disabled campus community member with a single primary contact to coordinate the accommodations, including accommodations in different domains (e.g., housing, classes)     b. Develop accommodations in a collaborative and person-centered manner to meet individuals' specific needs  6. Increase flexibility of disability documentation requirements     a. Do not require updated/recent documentation for permanent disabilities     b. Accept less expensive disability documentation, such as IEP disability classifications  7. Recognize and accommodate sensory discomfort, distraction, distress, and overload     a. Offer housing accommodations for sensory distress and overload, such as single rooms and quiet dormitory buildings     b. Offer dining accommodations for sensory distress and overload, such as alternatives to aversive foods and freedom to take food outside to avoid noise     c. Consider sensory accessibility in new construction and renovations of campus buildings and spaces     d. Establish sensory refuge areas around busy and overwhelming parts of campus     e. Ensure testing centers for disabled students are free of sensory distractions and allow opportunities for students to ask clarifying questions to instructors. Allow departments to use their own spaces (not the testing center) for accommodated examinations if their own space is suitable.  8. Establish supports to ensure a smooth transition into postsecondary     a. Provide summer transition programs     b. Offer staff check-ins     c. Develop mentorship programs and provide opportunities for neurodivergent students, staff, and faculty to be mentors, not just mentees  9. Establish supports to ensure a smooth transition out of postsecondary     a. Provide information about unwritten expectations of graduate school and employment     b. Offer career supports that address challenges neurodivergent people face, partnering with external agencies and programs if necessary to expand institutional capabilities     c. Partner with employers to develop customized job opportunities and programs for neurodivergent people     d. Ensure that career supports aim to support neurodivergent students' own long-term career goals and (if applicable) provide experiences that are competitively remunerated  10. Improve mental health supports for neurodivergent students     a. Offer sustained mental health support to neurodivergent students, rather than crisis model support     b. Hire counselors who have expertise supporting neurodivergent people and who have attitudes of flexibility of openness toward neurodivergent people     c. Offer mental health support groups targeted toward neurodivergent students  11. Establish mechanisms to swiftly provide remediation if neurodivergent people are prevented from receiving accommodations     a. Ensure that these mechanisms operate quickly and without imposing advocacy burdens on neurodivergent people     b. Ensure that neurodivergent people can easily and safely switch to a different accommodations case worker if required Communication recommendations  12. Respect neurodivergent people's preferences regarding advocates and support people     a. Make neurodivergent students' willingness to involve support people in their education a discussion topic in initial accommodations visits     b. Ensure that there is always a clear process for determining students' preferences that allows them to change their mind at any time     c. Ensure staff do not make students feel stigmatized for involving advocates and support people in their education  13. Offer flexibility of modalities to ensure accessibility of communication and instruction     a. Offer neurodivergent people the choice of communicating with university staff over a variety of communication modalities, such as the telephone, email, or using online systems to book in-person appointments or videoconferences     b. Provide students with multiple means of class engagement and evaluation     c. Provide students with the choice of taking classes in-person or remotely

DEI, diversity, equity, and inclusion; IEP, individualized education plan.

The recommendations in this article were developed, based on a combination of literature review and synthesis and the authors' expertise and experiences, with a focus on degree-seeking programs and with autism and ADHD in mind, as these are two diagnoses the authors have personal experiences with. Neurodivergent people with other diagnostic labels (such as dyslexia and dyscalculia) might benefit from some of the following recommendations, but might also require additional reforms to address the challenges and barriers they face. Furthermore, these recommendations are grounded in the Canadian and U.S. contexts; they may not generalize to all countries and regions.

DEI Recommendations

Recommendation 1: recognize neurodiversity as a DEI issue

DEI is receiving increasing attention at postsecondary institutions. A recent survey of American provosts indicates that all but 8% report implementing or considering changes to promote DEI in response to structural racism concerns.²⁹ However, in our experience, DEI initiatives seldom focus on neurodiversity. This neglect is surprising, as impacts of functional differences associated with neurodivergence and disability coexist alongside and blend into ramifications of societal barriers and discrimination.

Moreover, intersections between disability and other marginalized populations can bring further challenges. One-third to one-half of all police brutality victims in the United States are disabled.³⁰ Large income, race, and parental education disparities exist in autistic people's access to postsecondary education.³¹ For example, only 14% of American autistic people whose parents have no postsecondary background go on to attend postsecondary by their early twenties, compared with 44% of autistic people whose parents have some postsecondary: essentially a threefold gap.³¹

By contrast, 72% of general population students whose parents did not attend postsecondary nevertheless went on to attend postsecondary by age 26, compared with 84% of those whose parents have some college and 93% of those whose parents have a bachelor's degree or higher.³² Gender and parental education disparities also exist in postsecondary retention of autistic students,³³ and non-White ADHD students show slower progress toward graduation.³⁴

It is therefore essential to ensure that disability and neurodiversity are not only solely considered in terms of impairment and accommodation, but also through a DEI lens. Actions required to ensure this could include (but are not limited to):

• a. Ensuring that DEI office personnel are adequately qualified to identify and address DEI issues affecting neurodivergent students, staff, and faculty.

• b. Ensuring that all DEI initiatives and programs consider neurodiversity, and intersectionality with neurodiversity.

• c. Collecting data about representation of neurodivergent students, staff, and faculty, as well as regarding intersections between neurominorities and other marginalized populations.

• d. Collecting data about challenges faced by neurodivergent students, staff, and faculty, including challenges faced by neurodivergent people with intersectional marginalized identities.

• e. Developing and implementing effective strategies to increase inclusion and representation of neurodivergent students, staff, and faculty, as well as representation of intersections between neurominorities and other marginalized populations.

• f. Ensuring mechanisms, such as remedial training and disciplinary processes, are in place and working effectively to address discriminatory behavior toward neurodivergent people.

Recommendation 2: provide campus-wide neurodiversity and universal design trainings to faculty, staff, and students

Online and scalable training curricula not only increase knowledge of autism, but also diminish stigma toward autism, among both students³⁵ and faculty.³⁶ Thus, neurodiversity trainings could foster more inclusive attitudes toward neurodiversity on campuses. While the effectiveness of diversity training in general has been questioned,³⁷ members of campus communities often have limited knowledge and understanding of neurodivergent students and their needs,^5,38–43 let alone prior exposure to narratives aligned with the neurodiversity movement. It seems reasonable to assume that training is particularly important and effective when prior knowledge is minimal; this has certainly been our subjective impression when delivering autism- and ADHD-focused neurodiversity training in campus environments.

Among numerous other benefits, greater neurodiversity acceptance on campuses might help students feel safe to seek out supports when necessary; at present, many neurodivergent students are, partly due to fear of judgment and discrimination, reluctant to disclose their disabled identities to disability offices and other actors on campuses.^42,44

Furthermore, training for instructors and teaching assistants could provide information about universal design (UD). In postsecondary instruction, UD includes such strategies as providing material in multiple modalities and offering students multiple ways to demonstrate learning. Although prior studies have not rigorously tested whether UD improves academic success,⁴⁵ autism and UD training does improve faculty attitudes toward UD³⁶ and UD training can change instructors' practices and increase adoption of UD strategies.^46,47

One potential concern about UD is that an excessive number of choices can sometimes be overwhelming, but this depends greatly on the context, and having more choices is often beneficial.⁴⁸ If UD practices are implemented in instructional contexts in which increased flexibility and choice would be desirable, this might not only benefit neurodivergent students, but also neurotypical and nondisabled students. UD does not require instructors to diminish their expectations; UD can allow students to learn in the ways most effective for them, thereby permitting increased expectations.

Recommendation 3: establish Disability Cultural Centers

Establishing Disability Cultural Centers on postsecondary campuses is another DEI-oriented step toward inclusion. These centers can promote positive disability identities, culture, and community.^15,49,50 In this regard, Disability Cultural Centers have a different primary mission and purpose than postsecondary disability offices focusing on legal accommodations.

This is not to say that disability accommodation offices should not also try to promote positive disability identities—as stated above, we recommend that everyone on campuses, including staff in disability offices, should receive training to foster inclusive and positive attitudes toward neurodivergence. However, the power dynamics inherent in a disability accommodations office controlling access to accommodations and supports might make it difficult for seekers of those accommodations and supports to find it a truly comfortable environment.

In contrast to offices providing legal accommodations, Disability Cultural Centers would more closely resemble campus centers for other marginalized groups, such as LGBTQIA+ and racialized students. Indeed, in line with the approach taken at the University of Minnesota^50,51 and other institutions, we suggest that Disability Cultural Centers should be physically located alongside these other centers (to facilitate intersectionality-driven collaborations) in a central, accessible space on campus (to help students learn about and access the center).

Disability Cultural Centers can also provide an institutional base for initiatives promoting greater inclusion and acceptance of disability, including neurodivergence, in campus communities.^15,49 In addition to institution-initiated programs, these initiatives could include neurodivergent- and disabled-led student clubs similar to our own Aggie Neurodiversity Community. Not only can neurodivergent-led communities provide social connection, belonging, and mutual support for their members,^11,13 but they can also lead to advocacy and action.⁵² Disability Cultural Centers would be able to offer space to these groups and collaborate with them on shared goals, while respecting their autonomy.

Recommendation 4: ensure neurodivergent people are meaningfully involved as leaders in neurodiversity initiatives

Empirical research has shown that autism trainings developed in a participatory manner, that is, in collaboration with autistic people, are more effective in increasing knowledge, reducing stigma, and fostering inclusive attitudes than trainings developed by nonautistic people.⁵³ This reinforces the disability advocacy slogan, “Nothing about us without us”: disabled and neurodivergent people may be the best judges of what their communities need to thrive.

However, insofar as neurodivergent and disabled students already face barriers and stress in their lives, ensuring they do not face pressure to provide uncompensated volunteer support to campuses is imperative. Instead, campuses could facilitate meaningful involvement by financially compensating neurodivergent students for overseeing neurodiversity initiatives and/or by hiring neurodivergent employees.

Disability Accommodations and Supports Recommendations

Recommendation 5: integrate disability accommodations to enhance accessibility

At present, campus supports often require disabled people to work with multiple offices to obtain accommodations. For example, disabled student employees might need to approach the main disability office for class accommodations, human resources or the ADA/504 coordinator for job accommodations, and housing for housing accommodations. Each office might have separate points of contact and eligibility requirements, imposing considerable advocacy and executive function demands on neurodivergent people already facing substantial barriers—often including organizational and executive function difficulties^54–56—in their lives. Moreover, in some cases—for example, graduate programs, where employee and student responsibilities blend together—different offices might dispute who has responsibility for providing accommodations.

To ensure accommodations are accessible, we believe that a more centralized approach is needed. At a minimum, this should include a clear division of responsibility and coordinated frequent communication between different offices. Preferably, a single office should house all disability accommodations, and each disabled campus community member should have a single primary contact to coordinate the accommodations. In addition, the responsibilities of different offices and professionals should be clearly and accessibly outlined on institution websites. These accommodations should be developed in a collaborative and person-centered manner to meet specific individuals' needs.^41,57 A student or employee should not simply be offered a set of accommodations because they are typically given to people sharing the individual's diagnosis.

Recommendation 6: increase flexibility of disability documentation requirements

Proving one's eligibility for disability accommodations often presents challenges. Neurodivergent students can be required to provide recent documentation; for example, Canadian federal postsecondary disability funding demands documentation from within 3 to 5 years, or from adulthood.⁵⁸ However, a diagnostic, psychoeducational, or neuropsychological assessment can cost $2000 to $5000.^59–61 Importantly, any funding or health insurance postsecondary institutions provide to their current students cannot address this barrier; students must complete assessments substantially before classes begin to access accommodations as they commence their studies. This can be beyond many students' financial wherewithal,⁵⁷ especially given the high rates of poverty among disabled people.⁶²

Moreover, providers' practices can substantially influence the quality and utility of neuropsychological reports.⁶³ This suggests that relying on reports' recommendations to determine eligibility for accommodations may, rather than ensuring that those who most need accommodations receive them, instead risk introducing further inequities based on provider quality. This provides further reason to develop accommodations in collaboration with the student, as per recommendation #5.

Thus, in light of the barriers to accessing assessments and the inequity involved in using them to determine precise accommodation needs, we recommend that eligibility requirements for disability accommodations should be less onerous and more flexible. An essentially permanent disability, such as autism or ADHD, should not require recent documentation. Furthermore, so that individuals or families are not required to pay for expensive assessments, individualized education plans documenting a disability classification, and international equivalents, should be accepted. To the extent that onerous documentation requirements are mandated by government programs,⁵⁸ postsecondary institutions should advocate for reforms to these programs.

Recommendation 7: recognize and accommodate sensory discomfort, distraction, distress, and overload

The sensory experiences of neurodivergent people, such as autistic people, are related to sleep quality,⁶⁴ mental health,^65,66 and quality of life.^67,68 However, these sensory issues are poorly understood and accommodated by neurotypical postsecondary staff.^57,69

Sensory issues can become serious barriers in the housing domain.^69,70 We believe neurodivergent students vulnerable to sensory distress and overload need to be able to retreat to a space free from sensory bombardment, such as a single room with no roommate and/or a room in a “quiet” dormitory building with stringent noise limits. Furthermore, in North America, university dining commons are sometimes organized in inflexible ways that expose neurodivergent students to distressing noise or foods.⁷¹ Neurodivergent students should be free to take food outside to avoid noise and eligible to receive alternatives to sensory-aversive foods. If such sensory accommodations are unavailable, this could cause distress and burnout, impacting mental health and academic success.

Other areas on campus, such as libraries, hallways, and lecture halls, could potentially be inaccessible due to sensory experiences, such as discomfort or excessive distraction.^70,72 Considering sensory accessibility in new construction and renovations, including by providing sensory refuge spaces around busy overstimulating areas, could make campuses less stressful for many neurodivergent students.

Moreover, the presence of distracting stimuli can disproportionately impact the test performance of ADHD students.⁷³ This emphasizes the importance of distraction-free testing centers; however, such centers must be of high quality. For example, air conditioning and lighting should be carefully designed to minimize distraction. Moreover, neurodivergent students in separate testing rooms are sometimes given incomplete directions and no opportunity to ask real-time questions to instructors⁵⁷; clear policies are needed to prevent this. Departments should not be forced to use an outside testing center if they can readily demonstrate they have an accessible location of their own.

Recommendation 8: establish supports to ensure a smooth transition into postsecondary

Postsecondary transition programs have traditionally targeted low-income or racialized populations, but are more recently emerging as a priority for neurodivergent students, such as autistic students.⁷⁴ Transition into adulthood can be challenging for autistic³¹ and ADHD^75,76 people, and autistic students who later drop out find transition particularly difficult.⁷⁷ Many transition programs models exist; for example:

• a. Summer transition programs.^78,79 Incoming neurodivergent students could arrive on campus early to acclimate to the campus environment and housing. Programs could offer information and discussion regarding academic expectations, relevant support centers, and other domains of campus life. Such programs could also build community among neurodivergent students.

• b. Check-ins, particularly during the first year. Neurodivergent students who drop out of postsecondary report previously becoming disengaged from their university.⁴⁰ Check-ins could help identify neurodivergent students who are struggling, disengaged, and not seeking support.

• c. Mentorship programs.^80–83 Mentorship offers a sustained scaffold to support students and prevent disengagement. Crucially, mentorship can be used to pursue individualized goals, ensuring relevance to students' needs.⁸⁴

Consistent with recommendation #4, recruiting neurodivergent people as peer mentors may provide key advantages.^85,86 For example, neurodivergent mentors might have, from their experiences navigating campuses as disabled people, more relevant knowledge and a greater appreciation for mentee perspectives.^87–89 Their presence may also reassure mentees that neurodivergent people can succeed in higher education. Similar benefits could come from mentorship provided by an increasing number of openly neurodivergent faculty and staff (as per recommendation #1); while it might be unfair to ask these faculty and staff to commit extra time to mentoring younger neurodivergent people, senior neurodivergent academics have nevertheless expressed interest in providing such mentorship.^90,91

Social skills training, which is sometimes included in transition programming for autistic students,^92,93 has been criticized,^94,95 and is not particularly desired or appreciated by many students.^80,96 Instead of learning how to fit in with students different from themselves, many students might prefer to find communities of like-minded students who will accept them as they are.

Although some institutions have developed autism programs that charge high fees to students,⁹⁷ we believe that imposing large additional costs on a marginalized group would violate principles of equity.

Recommendation 9: establish supports to ensure a smooth transition out of postsecondary

Just as the transition into university can be particularly challenging for neurodivergent students, the transition from postsecondary into employment or graduate school also presents obstacles.⁹⁸ Not only do neurodivergent people face discrimination in employers' hiring decisions,⁹⁹ but the social isolation faced by neurodivergent students may also make them vulnerable to missing important transition-related information transmitted by “word of mouth.” Furthermore, based on our experiences and observations, we believe that postsecondary career supports designed for neurotypicals do not address important challenges faced by neurodivergent students. However, many possible supports could help address these gaps, such as the following:

• a. Providing education about unwritten expectations. Information sessions could cover expectations regarding experiences necessary to be a competitive applicant, norms around cover letters and resumés/CVs, how to interpret job listings (e.g., that meeting all listed qualifications may be unnecessary), and other information often transmitted through word of mouth. Faculty mentorship could be offered to students interested in graduate school. As certain expectations may require early action, this information should be provided early.

• b. Providing work experience and career supports informed by the challenges neurodivergent people face. For example, students might require additional support navigating social norms of workplaces, additional practice with job interview skills, and assistance with executive function demands of a job search.^100,101 Postsecondary career services might be able to further develop their capacities in these areas by not only seeking training and developing programs internally, but also through partnerships with vocational rehabilitation programs and/or community-based agencies.

• c. Developing custom job opportunities and programs in partnership with employers. Although many employment interventions in the autism field focus on teaching skills to autistic people,¹⁰² such programs can only have limited effects, for they ignore employer-level factors disadvantaging neurodivergent people (e.g., hiring discrimination⁹⁹). However, programs that work with employers to develop job opportunities for neurodivergent people appear highly effective.

  For example, one study found, at follow-up, 73% employment in an intervention group, compared with 17% among controls.¹⁰³ Another program achieved 98% success in job placements.¹⁰⁴ Moreover, the programs cited above targeted neurodivergent students with higher support needs than most postsecondary students; should university and college career centers develop equivalent programs, perhaps in partnership with external agencies, they should be able to aspire to still-better outcomes.

Overall, transition programs should not aim to simply place students in any job, nor to push students into fields in which a neurominority is stereotypically considered to perform well,¹⁰⁵ but to facilitate experiences that support neurodivergent individuals' personal long-term goals and (if applicable) are competitively remunerated.

Recommendation 10: improve mental health supports for neurodivergent students

Autistic postsecondary students experience elevated rates of anxiety, depression, and mental health challenges in comparison with neurotypical peers,^5,106,107 as well as high rates of lifetime (75%) and current (54%) suicidality.¹⁰⁸ ADHD students also experience elevated rates of depression¹⁰⁹ and are four times more likely than comparison students to attempt suicide.¹¹⁰ To address this crisis, we believe that the following steps are necessary:

• a. Offer neurodivergent students an adequate number of appointments with a preferred counselor. Autistic college students require more counseling appointments than nonautistic students to experience similar improvements to mental health.¹¹¹ This may partly reflect the complexity of neurodivergent students' mental health challenges; experiences of trauma are more common among autistic and ADHD people.^112,113 Thus, policies limiting the number of counseling appointments students can receive—or preventing students from consistently seeing a single preferred counselor—could decrease mental health supports'effectiveness for neurodivergent students.

• b. Hire counselors with expertise in supporting neurodivergent students. An emerging but rapidly growing literature documents the challenges autistic people face in finding supportive clinicians and counselors, most commonly due to lack of therapist expertise in autism or therapists' unwillingness or inability to modify their practices to support autistic people.¹¹⁴

  In one study, only 1 of 44 clinicians learned about autism in their professional training,¹¹⁵ but 98% of autistic people view whether a clinician understands autism as important.¹¹⁶ Indeed, autistic people often find clinical mental health supports unhelpful and not tailored to their needs,¹¹⁷ and therapists' lack of experience with autism can prevent autistic people from receiving support.¹¹⁸ In one study, 20 of 22 autistic people reported negative therapy experiences.¹¹⁵ Some ADHD individuals report finding mental health supports overly deficit-focused, or believing they should be more accessible and engaging.^119,120 Hiring counselors who have experience with neurodivergent people, and with open, flexible attitudes toward individual needs of neurodivergent clients, is essential.

• c. Offer mental health support groups for neurodivergent students. These formal groups would be distinct from and complementary to both individual counseling supports and the informal communities found in disability cultural centers.

Recommendation 11: establish mechanisms to swiftly provide remediation if neurodivergent people are prevented from receiving accommodations

If a neurodivergent member of the campus community is not receiving adequate accommodations, we believe a swift accessible process must exist to determine if further accommodations are needed. If so, the institution must ensure rapid implementation of accommodations and institute changes to prevent similar future incidents. Waisman proposes a mediation panel as one example of such a process.²² Whatever the mechanism's exact form, it should remove the burden of advocacy from the neurodivergent person's shoulders.

In addition, if a neurodivergent student or employee has a poor relationship with their disability case worker, a clear and safe process for switching case workers is necessary. In the United States, the presence of an ADA/504 coordinator can potentially be helpful. An ADA/504 coordinator is tasked with ensuring that the university follows disability laws,¹²¹ including the Americans with Disabilities Act (ADA) and sections 503–504 of the Rehabilitation Act of 1973. These professionals are often tasked with a variety of duties, including making sure that accommodations are in place. The ADA/504 coordinator can be housed in many different offices on campus, such as DEI departments and offices that ensure Title IX protections.

However, we believe it is likely most beneficial for these professionals to be housed in or near disability service offices, so that they could easily work with disability service professionals and ensure accommodations are in place, in accordance with the law.

Neurodivergent leadership in roles such as disability case workers or ADA/504 coordinator may further enhance this process by ensuring equity and inclusion as well as by creating a sense of belonging for neurodivergent students, staff, and faculty.

Communication Recommendations

Recommendation 12: respect neurodivergent people's preferences regarding advocates and support people

Autistic²⁵ and ADHD^76,122 students can find many complexities of managing college life challenging and overwhelming. Furthermore, many neurodivergent people have a history of significant advocacy support from parents who have come to understand the individual's challenges and support needs.¹²³ Indeed, autistic^28,124,125 and ADHD⁷⁶ students frequently seek out parental support, even to the extent that the parent can assume the leading role in advocating for their adult child's needs.¹²⁶ However, in our experience, postsecondary personnel can react negatively to the involvement of parents and support people. Creating a more welcoming environment for supporters could help neurodivergent students collaboratively advocate for their needs and eliminate some of the stigma they may feel about involving an advocate.

However, autistic^28,124,125 and ADHD¹²⁷ students can also resent perceived parental overreach and interference. Neurodivergent people's family relationships may become especially complex when intersectional LGBTQIA+ identities, prevalent among neurodivergent people,^128–131 enter the picture. Power dynamics and financial dependence on parents could also complicate matters.

To prevent either denial or unwanted imposition of support people, we recommend making questions about how to involve an advocate part of initial conversations about accommodations. We believe that a simple, swift, and nonjudgmental process is needed to determine students' preferences; this process should remain open for neurodivergent students to revise their choices at any time.

Recommendation 13: offer flexibility of modalities to accessibility of communication and instruction

Many neurodivergent people find communication using certain modalities inaccessible, which presents barriers to interacting with instructors and support services. For example, telephones are often inaccessible for autistic people.^27,132 Moreover, some nonspeaking or minimally speaking autistic people can be academically capable of postsecondary education,⁸⁵ and even “speaking” autistic adults can experience intermittent or unreliable speech.¹³³ Because different neurodivergent individuals can have varying communication accessibility needs, offering a wide variety of communication modalities—for example, telephone or email, online systems to schedule in-person or videoconference appointments—is essential for accessible communication.

Similar issues arise in teaching. Autistic and ADHD students have shown to have difficulties with completing course tasks and evaluation methods in college. Students with ADHD often struggle with classical course evaluation methods, including writing articles or completing examinations.¹³⁴ Autistic students often face challenges completing group work and participating in class discussions.^69,135 Furthermore, given the heterogeneity of both neurotypes, individual autistic and ADHD people might face still other barriers when accessing various modalities for demonstrating their learning. A more flexible approach, offering multiple modalities of engagement and evaluation, could help eliminate some of these barriers. Such flexibility would be consistent with UD principles, as per recommendation 2.

These challenges in course instruction have been amplified during the COVID-19 pandemic. Several authors are members of the Aggie Neurodiversity Community at UC Davis, a peer-support group for neurodivergent students. While some members found online learning inaccessible during the COVID-19 pandemic, other members who prefer online education are now stressed and concerned about returning to in-person classes. In keeping with UD principles and the flexibility they require, we suggest that a choice between in-person and online instruction should be offered to both neurodivergent and neurotypical students whenever possible.

Limitations

As previously noted in the introduction, the recommendations in this article have a limited scope, one circumscribed by the limits of our own knowledge and expertise as authors. We focus here on postsecondary programs in Canada and the United States, not other countries. We focus here on autism and ADHD, not other neurominorities. We also focus on degree-seeking programs; we expect that these recommendations will generalize quite well to 2-year (community) college programs, but the growing movement toward establishing nondegree-seeking postsecondary programs for the inclusion of students with intellectual and developmental disabilities^136,137 is outside our expertise.

Further work is needed to develop recommendations for neurodiversity inclusion in postsecondary education in domains left unexplored by this article. We believe such recommendations should—such as the recommendations in this article—not only take into account research evidence but should also be developed by or in partnership with neurodivergent people with lived experiences in the relevant postsecondary domains.

Conclusions

This article not only recommends actions postsecondary administrators can take to increase the accessibility of their programs to neurodivergent people through better accommodations, supports, and communication, but also recommends ways in which campuses can apply a DEI lens toward representation of neurodivergent people in the academy. We hope that implementation of these recommendations will improve the postsecondary inclusion and success of neurodivergent people, particularly those with multiple marginalized identities.

If institutions take actions to not only better support neurodivergent people facing accessibility barriers, but also to combat stigma and discrimination against neurodivergent and disabled members of the campus community, we hope a virtuous cycle will ensue. If representation of neurodivergent people expands across all multiple levels of academia, including leadership roles, neurodivergent people would then be better positioned to educate their colleagues, mentor younger neurodivergent generations, and promote neurodiversity acceptance and inclusion.

Positionality Statement

P.D., A.G., E.M., and T.C.W. identify as autistic. K.M. identifies as ADHD. C.L. is the parent of an autistic college alumnus. All authors are currently attending or have previously attended postsecondary programs as undergraduate students. In addition, P.D. and A.G. are currently attending graduate school and T.C.W. has completed graduate studies. All authors are advocates for increasing neurodiversity inclusion on postsecondary campuses.

Authorship Confirmation Statement

P.D. drafted the present article, which all authors read, edited, and approved.

Author Disclosure Statement

P.D., K.M., and E.M. have entered into a relationship with the UC Davis Student Disability Center that will result in financial compensation for the provision of neurodiversity education to the campus community.

Funding Information

Open access publication costs were funded by the Autism Intervention Research Network for Physical Health (AIR-P), supported by the United States' Health Resources and Services Administration (HRSA; award UT2MC39440).