Frequency and Mental Health Condition of Students with Developmental Disabilities Among First-Year Japanese University Students: A Cross-Sectional Survey

Abstract

Students with developmental disabilities are anxious about a change in environment when graduating from high school to college. Existing research, which is scarce, focuses on the mental health status of students with developmental disabilities entering university. This study investigated the frequency of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) among first-year Japanese university students and their mental health risks post-admission. We conducted a cross-sectional survey for university students within a month of admission, using the Autism Spectrum Quotient (AQ) and Adult ADHD Test (A-ADHD) to demonstrate the frequency of ASD and ADHD. The Counseling Center Assessment of Psychological Symptoms (CCAPS)–Japanese (depression, eating concerns, hostility, social anxiety, family distress, alcohol use, generalized anxiety, and academic distress) evaluated their mental health condition.Of 711 students (20.3 ± 2.1 years; 330 male, 381 female), the number of those showing either ASD or ADHD tendencies was 61 (8.58%). Twenty-three (3.23%) showed symptoms of only ASD, 34 (4.78%) of ADHD, and four (0.56%) of ASD and ADHD. No significant differences existed in the frequency of ASD and ADHD between each sex and major. The scores and frequency of high risk (over the cut-off points) students on all CCAPS-Japanese subscales (except alcohol use) were significantly higher among the ASD and ADHD groups than the control group, which showed no ASD or ADHD tendencies. The frequency of ASD and ADHD characteristics among first-year Japanese university students was 8.58%. They have a high risk of mental health problems when they enter university.

Introduction

The estimated global prevalence of autism spectrum disorder (ASD) has increased considerably in the recent years (Elsabbagh et al., 2012). In the U.S., between 0.7 and 1.9% of college students met the criteria for low support needs ASD (White et al., 2011). In Japan, the Maternal and Child Health Act stipulates that child in need of an appropriate treatment and support by child speech or communication specialists at health checkup at 3 years of age, needs special focus and care. This support includes sharing of student information between high school teachers and university, school doctors, professors, and the office for students with disabilities. However, not all students with ASD or Attention-deficit/hyperactivity disorder (ADHD) have good access to the system. “An appropriate therapeutic environment” can only be deemed as one where children can receive social, educational, and medical support after entering university; however, some students may not benefit from this. When students with ASD enter university with no access to an appropriate therapeutic environment, they might encounter problems related to interpersonal relationships, study procedures, and maladjustment (Elias and White, 2018; Elias et al., 2019; Lambe et al., 2019; Sturm and Kasari, 2019; White et al., 2011). Students with developmental disabilities are anxious and concerned about the change in environment from high school to college (White et al., 2011). In high school, students are divided as per classes and take classes according to a timetable. However, some universities offer selective courses after enrollment, and students have to make and manage their own timetables. Therefore, some students with developmental disabilities may feel bewildered by this change. In Japan, the university enrollment system is more confusing to students because it is upon them to make choices. Furthermore, there is a lack of coaching staff to support students, which can lead to maladjustment. Even though the number of college students with developmental disabilities is increasing with an increase in the percentage of students entering higher education institutions (Lambe et al., 2019), few studies have examined the exact epidemiological frequency of students with developmental disabilities with a scarcity of large-scale research on students’ psychological statuses in college. Although White et al. (2011) reported the prevalence of ASD in a U.S. university, the specific frequency of ASD in Japanese university students has not been elucidated. Although the estimated lifetime ASD frequency rate among Japanese children has been demonstrated as over 3% (Sasayama et al., 2021), the frequency of ASD and attention-deficit/hyperactivity disorder (ADHD) in Japanese university students is still unknown. The prevalence of ADHD varies by report, with the DSM-5 using a figure of 5% in childhood and 2.5% in adulthood (American Psychiatric Association and DSM-5 Task Force, 2013). If we could demonstrate the suspicious frequency of ASD/ADHD among university students in Japan, it would be greatly beneficial for the office for students with ASD/ADHD on campus.

Recently, it has been demonstrated that students in Japan with both ASD and ADHD tendencies often experience difficulties in university life, resulting in low academic performance and class attendance (Suzuki et al., 2020). Anderson et al. (2018) identified a risk of course failure of college students with ASD in Australia, as they did not or could not disclose their needs for special services, and hence, had less support and poor experiences. Furthermore, post-school options are still limited, and most adults with ASD struggle to find suitable and stable work opportunities (Laghi et al., 2020). Several studies have explored the mental health conditions psychological statuses of students in the U.S. (Sturm and Kasari, 2019; Vasa et al., 2018), with significant correlations with social anxiety, depression, and aggression being reported among university students with ASD (White et al., 2011). To the best of our knowledge, a survey of the mental health conditions of Japanese students with ASD and/or ADHD has not been conducted.

To address this gap in the literature, this study examines the epidemiological frequency of students with developmental disabilities, focusing on ASD and ADHD, and investigates their mental health conditions as they enter college, compared with students without ASD and/or ADHD tendencies.

Methods

Ethical Considerations

All study procedures complied with the ethical requirements of the national and institutional committees that oversee human studies and the 1964 Declaration of Helsinki and its later revisions. The study design was reviewed and approved by the Ethical Review Committee of the Graduate School of Medicine, Gifu University, Japan (No. 2021-B164). All the participants provided written informed consent to participate in this survey. They were notified that their responses would remain confidential and were completely unrelated to their academic performance. They were also notified that they could withdraw at any time. The participants were however not compensated for their participation.

Participants and Study Procedure

This study was conducted with first-year undergraduate students starting the academic year from April 1, 2022, at Gifu University—a national general university in Japan. The STROBE guidelines (Elm et al., 2014) were followed in this study.

The Japanese version of the Autism Spectrum Quotient (AQ) (Baron-Cohen et al., 2006), Adult ADHD Test (A-ADHD) (De Quiros and Kinsbourne, 2001), and Counseling Center Assessment of Psychological Symptoms–Japanese (CCAPS–Japanese) (Horita et al., 2023) were administered to 946 students who attended the “seminar for first-year undergraduate students 2022,” held within a month of entering university. The students were aged 18–47 and spoke Japanese as their mother tongue. All questionnaires were self-reported. Inclusion criteria were: (1) first-year students entering on April 1, 2022; (2) completion of the AQ, A-ADHD, and CCAPS-Japanese questionnaires; and (3) no missing responses. International students were excluded because the AQ, A-ADHD, and CCAPS-Japanese questionnaires were written in Japanese, and developed and validated among participants who spoke Japanese as their mother tongue. Finally, 711 of the 946 participants—20.36 ± 2.17 (range 18–47) years old (median = 18 years old); 330 male and 381 female—were eligible for analysis (Fig. 1.).

Fig. 1.

A flow diagram of the study. The 946 students attended the “seminar for first—year undergraduate students 2022”. The 907 students completed the AQ and A-ADHD and indicated their consent to participate in the study on the consent form. Students who did not complete AQ, A-ADHD, or CCAPS-Japanese were excluded from the study. Ultimately, 711 students participated in this study. AQ Autism Spectrum Quotient; A-ADHD Adult ADHD Test; CCAPS–Japanese Counseling Center Assessment of Psychological Symptoms–Japanese

The AQ is a brief self-administered rating scale used to measure the autistic traits/characteristics associated with the autism spectrum in adults (Baron-Cohen et al., 2006). We used the AQ to screen for ASD characteristics and classified students who exceeded its cutoff score of 33 or scored higher out of a total of 50 points as a group with strong ASD characteristics. The A-ADHD is a screening test for ADHD that comprises 43 items for self-assessment (De Quiros and Kinsbourne, 2001). We classified the groups whose scores on the A-ADHD exceeded the cutoff value (54 and 52 or higher for male and female respondents, respectively, out of a total 80 points) as students with particularly strong ADHD characteristics. A diagnosis cannot be made with the AQ and A-ADHD, because these are not diagnostic instrument. We used the tests in this study to determine if a student is more likely to have ASD or ADHD, regardless of whether these students received the diagnosis outside of the study or not.

The frequency of ASD and ADHD tendencies were estimated and compared by each study major and participants’ sex. The participants were divided into two groups based on the AQ and A-ADHD scores; one was the control group (both AQ and A-ADHD scores were below the cutoff), and the other, the ASD or ADHD tendency group (either AQ or A-ADHD scores were above the cutoff). Additionally, the latter was divided into three groups: (i) ASD tendency group (only AQ score was over the cutoff); (ii) ADHD tendency group (only A-ADHD score was over the cutoff); and (iii) ASD and ADHD tendency group (both AQ and A-ADHD scores were over the cutoff). To elucidate the mental health condition of students with ASD and/or ADHD, the prevalence of high risk (over the cutoff points) and scores on each subscale of the CCAPS-Japanese were compared between the control and the ASD or ADHD groups, and also between groups (i), (ii), and (iii).

Originally created by the University of Michigan’s Counseling and Psychological Services in 2001 (Locke et al., 2011), the CCAPS measures university student’s psychological symptoms over the past two weeks. Horita et al. (2023) created the Japanese version of CCAPS, adapted and validated for Japanese university students with rigorous factor structure, good internal consistency, adequate convergent validity, and good test–retest reliability. Horita et al. (2022) used the CCAPS-Japanese to examine the psychological distress of first-year Japanese students involved in the COVID-19 pandemic. The CCAPS-Japanese comprises 55 items with eight factor-derived subscales: depression (11 items), eating concerns (8 items), hostility (7 items), social anxiety (6 items), family distress (6 items), alcohol use (5 items), generalized anxiety (9 items), and academic distress (3 items); and four critical items: thought disturbance, suicidal ideation, violent behavior, and homicidal behavior; items are rated on a five-point Likert scale ranging from 0 (not at all like me) to 4 (extremely like me). Higher scores relate to a high risk of mental health conditions with higher levels of distress, anxiety, and psychological symptoms (Horita et al., 2020, 2021). We used the CCAPS-Japanese to assess the university student’s mental health status for this study.

Statistical Analyses

The number of students with ASD and ADHD tendencies was summarized by frequency for categorical variables. The CCAPS-Japanese subscale scores were summarized by medians with interquartile ranges, and the Wilcoxon rank-sum test was used for comparisons in each group. The number of students with mentally high risk (over the cutoff of the CCAPS subscale) was also summarized and compared in each group using a chi-square test. All statistical analyses were performed using R version 4.2.2 (R Foundation for Statistical Computing, Vienna, Austria). All hypothesis tests were two-sided, and p-values < 0.05 were considered statistically significant. The findings should be interpreted as exploratory owing to the lack of correction for multiple comparisons.

Results

The characteristics of the 711 participants are shown in Table 1. There were 330 male and 381 female students, and there were no significant differences in sex distribution between each major.

Table 1.

Characteristics of participants

	(n)	Male/Female§ (n)	Mean Age (interquantile) (y.o.)
Total	711	330 / 381	18 (18, 18)
Faculty of Major ‡
Medicine (Medical, Nursing)	148	50 (33.8%) / 98 (66.2%)	18 (18, 18)
Applied Biological Sciences	157	65 (41.4%) / 92 (58.6%)	18 (18, 18)
Education	158	60 (38.0%) / 98 (62.0%)	18 (18, 18)
Engineering	170	123 (72.4%) / 47 (27.6%)	18 (18, 18)
Regional Sciences	78	32 (41.0%) / 46 (59.0%)	18 (18, 18)

Values are presented as a number

^§ There are no significant differences in sex distribution between each faculty of major

^‡ Medicine; Medicine, Nursing, Applied Biological Sciences; Applied Life Science, Agricultural science, Veterinary Medicine, Engineering; Civil Engineering, Mechanical Engineering, Electrical, Regional Culture. y.o. year-old

Of the 711 students, 61 (8.58%) students’ scores exceeded either the AQ or A-ADHD cutoff. Of these 61 students, 23 (3.23%), 34 (4.78%), and 4 (0.56%) students’ scores exceeded only the AQ, only the A-ADHD, and both the AQ and ADHD cutoffs, respectively, (Table 2). Although Gifu University has five majors: medicine, applied biological sciences, education, engineering, and regional science, no significant difference was observed in the frequency of students with ASD and/or ADHD tendencies in each major. There were also no significant differences in the frequency of male and female students with ASD and/or ADHD tendencies (Table 2).

Table 2.

Frequency of students with ASD and/or ADHD tendencies in each major and sex

	Total n = 711 (100%)	Control n = 650 (100%)	ASD or ADHD tendency n = 61 (100%)	ASD tendency only n = 23 (100%)	ADHD tendency only n = 34 (100%)	ASD and ADHD tendency n = 4 (100%)
Faculty of Major‡
Medicine	148 (20.8%)	134 (20.6%)	14 (23.0%)	3 (13.0%)	10 (29.4%)	1 (25.0%)
Applied Biological Sciences	157 (22.1%)	138 (21.2%)	19 (31.1%)	7 (30.4%)	10 (29.4%)	2 (50.0%)
Education	158 (22.2%)	152 (23.4%)	6 (9.8%)	2 (8.7%)	4 (11.8%)	0 ( 0.0%)
Engineering	170 (23.9%)	157 (24%)	13 (21.3%)	6 (26.1%)	6 (17.6%)	1 (25.0%)
Regional Sciences	78 (11.0%)	69 (10.6%)	9 (14.8%)	5 (21.7%)	4 (11.8%)	0 (0.0%)
Sex Female	381 (53.6%)	351 (54.0%)	30 (49.2%)	11 (47.8%)	17 (50.0%)	2 (50.0%)
Male	330 (46.4%)	299 (46.0%)	31 (50.8%)	12 (52.2%)	17 (50.0%)	2 (50.0%)

Values are presented as a number (percentage). ASD Autism Spectrum Disorder; ADHD Attention-Deficit/Hyperactivity Disorder

The prevalence of students with a high score on the CCAPS-Japanese was compared between the ASD or ADHD tendency group and the control group (Table 3). The prevalence of students with a high score in the ASD and ADHD tendency groups were significantly higher for all CCAPS-Japanese subscales, except that related to alcohol use, compared to the control group (Table 3).

Table 3.

Differences in prevalence of high-scored students among CCAPS-Japanese subscales between the controlgroup and the ASD or ADHD tendency group

	Cutoff point	Number of high-scored students (exceeded cutoff)
		Control group (n = 650)	ASD or ADHD (n = 61)	p-value
Subscales
Depression	1.7	89/650 (13.6%)	30/61 (49.2%)	< 0.001***
Generalized anxiety	1.7	115/650 (17.7%)	33/61 (54.1%)	< 0.001***
Social anxiety	2.5	195/650 (30.0%)	37/61 (60.7%)	< 0.001***
Academic distress	2.4	28/650 (4.3%)	9/61 (14.8%)	< 0.001***
Eating concerns	1.8	93/650 (14.3%)	17/61 (27.9%)	< 0.01**
Hostility	1.43	59/650 (9.1%)	25/61 (41.0%)	< 0.001***
Family distress	1.83	70/650 (10.8%)	14/61 (23.0%)	< 0.01**
Alcohol use	1.4	7/650 (1.1%)	1/61 (1.6%)	0.69
Suicidal ideation item	4	11/650 (1.7%)	6/61 (9.8%)	< 0.001***

Suicidal ideation item was also validated because it is a particularly important clinical question in the CCAPS-Japanese. CCAPS-Japanese: The Counseling Center Assessment of Psychological Symptoms-Japanese. ASD, Autism Spectrum Disorder; ADHD, Attention-Deficit/Hyperactivity Disorder. The number of students with high-scored (exceeded cutoff) in CCAPS-Japanese subscales are compared between the control group and the ASD or ADHD group using a chi-square test. *p < 0.05,**p < 0.01,***p < 0.001

The median scores with interquartile range of subscales of the CCAPS-Japanese in each group are summarized and shown in Table 4. The group of students with ASD or ADHD had significantly higher scores than the control group on all subscales except alcohol use, with the most significant differences observed for social anxiety (2.8 (2.0–3.5) vs 2.0 (1.3–2.7), p < 0.001) and generalized anxiety (2.0 (1.4–2.6) vs 1.0 (0.6–1.6), p < 0.001). The group of students with only ADHD tendency had the same trends as the ASD or ADHD group; however, in the group with only ASD tendency, there were no significant differences in scores of not only alcohol use but also academic distress and eating concerns compared with the control group. There were no significant differences on the CCAPS-Japanese subscales between the group with only ASD tendencies and that with only ADHD tendencies (Table 4).

Table 4.

Differences in scores of CCAPS-Japanese sub-scale between the control and the ASD or ADHD tendency group

	Control	ASD or ADHD tendency	p-value (vs control)	ASD tendency only	p-value (vs control)	ADHD tendency only	p-value (vs control)
Sub-scale
Depression	0.7 (0.3—1.4)	1.8 (1.2—2.4)	< 0.001***	1.9 (1.4—2.5)	< 0.001***	1.6 (1.1—2.3)	< 0.001***
Generalized anxiety	1.0 (0.6—1.6)	2.0 (1.4—2.6)	< 0.001***	2.0 (1.2—2.6)	< 0.001***	1.9 (1.4—2.4)	< 0.001***
Social anxiety	2.0 (1.3—2.7)	2.8 (2.0—3.5)	< 0.001***	3.2 (2.6—3.5)	< 0.001***	2.7 (1.9—3.2)	< 0.01**
Academic distress	1.0 (0.7—1.7)	1.7 (1.0—2.0)	< 0.001***	1.3 (1.0—2.0)	0.13	1.7 (1.3—2.2)	< 0.001***
Eating concerns	0.9 (0.5—1.5)	1.3 (0.6—1.9)	< 0.05*	0.9 (0.6—1.9)	> 0.999	1.4 (0.8—1.9)	< 0.05*
Hostility	0.3 (0.0—0.9)	1.3 (0.7—1.9)	< 0.001***	1.1 (0.5—1.6)	< 0.001***	1.3 (0.7—1.9)	< 0.001***
Family distress	0.5 (0.2—1.2)	1.2 (0.7—1.8)	< 0.001***	1.0 (0.5—1.7)	< 0.05*	1.2 (0.7—1.8)	< 0.001***
Alcohol use	0.0 (0.0—0.0)	0.0 (0.0—0.0)	> 0.999	0.0 (0.0—0.0)	> 0.999	0.0 (0.0—0.0)	0.995
Suicidal ideation item	0.0 (0.0—1.0)	1.0 (0.0—3.0)	< 0.001***	1.0 (0.0—3.0)	< 0.001***	1.0 (0.0—2.8)	< 0.001***

Values are presented as a median score (interquartile range). Suicidal ideation item was also validated because it is a particularly important clinical question in the CCAPS-Japanese. CCAPS-Japanese: The Counseling Center Assessment of Psychological Symptoms—Japanese. ASD: ASD, Autism Spectrum Disorder; ADHD, Attention-Deficit/Hyperactivity Disorder. To compare the scores of CCAPS-Japanese subscale in each group, the Wilcoxon rank-sum test was used. *p < 0.05,**p < 0.01,***p < 0.001. These were no differences in scores of each sub-scale between the ASD traits only and the ADHD traits only groups

Discussion

This study demonstrated the epidemiological prevalence of students with ASD and ADHD characteristics among first-year Japanese university students as 3.23% and 4.78%, respectively. In total, the prevalence of students with either ASD or ADHD was 8.58%.

The prevalence of ADHD was highly heterogeneous among various international reports because it is influenced by various factors, including demographics and diagnostic methods (Polanczyk et al., 2007). However, a systematic review of 102 studies revealed a global pooled prevalence of ADHD as 5.29% (Polanczyk et al., 2007). Thus, our result of 4.78% for ADHD prevalence is acceptable compared to this review data.

Sasayama et al. (2021) reported an estimated national 5-year cumulative lifetime incidence rate of 2.75% for ASD in children born during 2009 to 2014 in Japan. Comparatively, our result of 3.23% for ASD prevalence in university students is also acceptable. Previously, the prevalence of ASD was estimated to be as low as 0.02–0.05% in Japan. The reason why the prevalence of ASD in Japan was lower than in the West may be due to the low level of awareness in the medical community and in society. Recently, ASD and ADHD prevalence in Japan has increased (Sasayama et al., 2021, 2022). However, the biases in understanding ASD and ADHD may affect the data (Miyasaka et al., 2018). In a paper by Miyasaka et al. (2018), Japanese experts found that children are more likely to attribute behavioral problems to ASD compared to other disorders. Japanese therapists may be more sensitive to and more likely to diagnose ASD compared to therapists in other countries. These findings suggest that cultural biases may influence clinician’s diagnoses of ADHD and ASD. Knowledge of cultural differences in subjective judgments, communication styles, and social norms may contribute to understanding clinical diagnoses.

There are few reports about the prevalence of ASD and/or ADHD in Japanese university students. Takahashi et al. (2016) reported the prevalence of ASD and ADHD among Japanese university students as 1.1% and 2.72%, respectively. These data were different from that of ours (3.23% and 4.78%, respectively). As the participants in Takahashi et al. (2016) were 375 female college students in Japan, our results may be considered to be more general and representative of university students’ real data in Japan.

Although the prevalence of ASD and ADHD is generally higher in males than in females, our report found no significant gender differences between students with ASD and ADHD characteristics. Sasayama et al. (2022) reported ADHD prevalence in Japan from 2010 to 2020, with 19.2% females and 80.8% males in the 0–6 age group, 24.1% females and 76.0% males in the 7–19 age group, and 47.8% females and 52.2% males after age 19, with gender differences changing. Bonney et al. (2022) suggested that females were diagnosed with ASD later than males in the Ugandan context; Wodka et al. (2022) found that female children with ASD were at risk for underestimation of autism-related symptoms, including underestimation of symptoms outside the core features of ASD (motor skills). They stated that they were most at risk. It can be assumed that developmental characteristics tend to become apparent later in women, possibly delaying diagnosis. With an increase in the prevalence of ASD and ADHD, and epidemiological studies of gender differences will continue to be an important issue.

In this study, we demonstrated that the frequency of high mental health risks and the level of worsening mental health conditions separate from psychological condition, or diseases are significantly higher among students with ASD and ADHD than those without such tendencies in Japan. Although various mental health problems including anxiety and depression and comorbid disorders among college students with developmental disorders have been demonstrated in European countries (Lambe et al., 2019; Sturm and Kasari, 2019; Vasa et al., 2018; White et al., 2011), our study is the first to report on characteristics of mental health conditions among Japanese university students with ASD and/or ADHD.

Suzuki et al. (2020) found that sickness, presenteeism, and poor student performance were related to difficulties with social skills, attention-switching, and inattention among Japanese university students with ASD and ADHD. As we elucidated on the specific mental health conditions of Japanese university students with ASD and/or ADHD, we suspect that poor academic performance in students with ASD and/or ADHD may be closely explained by the CCAPS-Japanese results. For example, in the current study, academic distress in the CCAPS-Japanese was significantly higher in the group with only ADHD and not in the group with only ASD tendencies. Thus, we suspect that students with ADHD tendency might often have difficulty managing their schedules and tend to procrastinate on assignments, which may lead to increased academic distress. Additionally, the group with only ADHD had a significantly higher score on the eating behavior subscale compared to the control group, however which was not evident in the group with only ASD characteristics in this study. Impulsive behavior, a characteristic of ADHD (Bleck et al., 2015; Nazar et al., 2016; Steadman et al., 2016), may induce over-eating or impulsive picky-eating, which may affect the eating behavior score. The social anxiety scores in the ASD and ADHD groups were particularly higher than the control group. This might be because students with ASD tendencies are at a disadvantageous position regarding social skills, particularly in interpersonal relationships and communication. Therefore, they are more likely to experience anxiety in their social lives, as demonstrated by White et al. (2009). Although Suzuki et al. (2020) reported that students with both ASD and ADHD were more likely to exhibit poor academic performance, no significant differences were found in the CCAPS-Japanese subscale scores between the groups with only ASD or ADHD and the group with both in this study.

We demonstrated that poor mental health condition was associated with students with ASD and/or ADHD even in the early phase—within a month of entering university. Several students with ASD showed difficulties in the transition from high school to university (Elias and White, 2018; Elias et al., 2019; Lambe et al., 2019; Sturm and Kasari, 2019). These difficulties might influence their mental health condition when they start higher education; therefore, there was a significantly higher risk of mental health issues among students with ASD and/or ADHD, even soon after starting campus life. Miyasaka and Nomura (2022) reported worsening subsequent psychological distress in groups with developmental disabilities 8.5 month after entering college; we demonstrated these psychological issues at a very early stage of higher education. Previously, students with ASD were less likely to enroll in college than those with language or specific learning disabilities, even without intellectual disabilities (Wei et al., 2016); however, the number of students with ASD and/or ADHD might increase proportionately according to the increased number of students entering higher education. Students with ASD and/or ADHD have been associated with greater academic disengagement (Suzuki et al., 2020). Students with both ADHD and ASD characteristics are more likely to have difficulties with social skills, be judged by teachers as underachieving, and have higher rates of absences due to illness (Sturm and Kasari, 2019). Therefore, for students with ASD, participating in college transition planning while still in high school and early goal setting are required to increase their likelihood of attending an institution of higher education successfully (Capriola-Hall et al., 2021; White et al., 2017). While rates of degree completion and postsecondary job retention are still lower for youth with ASD than in the general population, there is growing evidence that actively involving students with ASD in transition planning meetings and teaching self-determination skills can improve outcomes (Chandroo et al., 2018). It is thus, possible to prepare an environment in which the individual and those around them can comfortably disclose their disability and its characteristics so that appropriate action can be taken at an early stage. It is also important to prevent them from becoming socially isolated and to improve peer acceptance (Nevill and White, 2011). Having a support meeting with all parties involved in the student’s university life as early as possible after their enrollment is effective in creating a positive learning environment for students with disabilities. We believe that this will help students with disabilities easily consult experts about problems related to their disabilities in their future university life (Vanbergeijk et al., 2008).

We also demonstrated that the CCAPS screening is useful in detecting anxiety, worry, and problem behaviors in students with ASD and/or ADHD who are pursuing higher education. Based on our CCAPS-Japanese results, it can be deducted that by focusing on the level of mental health as seen in the daily lives of students after their enrollment, it is possible to initiate support for their obstacles or problems as early as possible.

This study has three limitations. First, our CCAPS-Japanese survey was conducted only once after admission. As the CCAPS reflects mental health levels in the past two weeks, periodic and continuous assessment using it will depict the transition of mental health of students with ASD and/or ADHD after college admission. This is a possible direction for future research. Second, while we observed differences in terms of sex regarding ASD and/or ADHD, we did not analyze sex differences for specific mental health conditions among students with ASD and/or ADHD. As a previous study showed that women with ASD and any comorbid disorders often self-reported poor psychological health (Sturm and Kasari, 2019), this also entails a direction for future research. Third, this study describes developmental characteristics based on the results using the AQ and A-ADHD, so it cannot address whether the participants meet the diagnostic criteria for ASD or ADHD.

Higher education settings must consider students with latent developmental disorder characteristics. Reasonable accommodations and appropriate environmental adaptations should be created in a way that is acceptable to all campus members in the field of higher education so that students with ASD or ADHD do not drop out of courses.

Conclusion

The present study demonstrated that 8.58% of first-year Japanese university students had ASD and/or ADHD tendencies. Furthermore, those with ASD or ADHD characteristics were found to have high risks of mental health conditions like anxiety when they entered college. Reasonable accommodations should be thus prepared for students with ASD and/or ADHD entering universities to avoid associated mental health risks.

Author Contributions

All authors performed substantial contributions to the conception and design of the article and to the acquisition, analysis, and interpretation of data. All authors reviewed the manuscript for important intellectual content and approved the final version for publication. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are investigated and resolved.

Funding

This work was supported by [JSPS KAKENHI] (Grant Number [JP22K02709].

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Competing Interests

The authors have no competing interests to declare that are relevant to the content of this article.

Research Involving Human Participants and/or Animals

All study procedures complied with the ethical requirements of the national and institutional committees that oversee human studies and with the 1964 Declaration of Helsinki and its later revisions. The study design was reviewed and approved by the Ethical Review Committee of the Graduate School of Medicine, Gifu University, Japan (No. 2021-B164).

Informed Consent

All participants provided written informed consent to participate in this survey.

Consent to Publish

Not applicable.