Effects of the tendency of developing neurodevelopmental disorder on subjective evaluation of distance learning among university students

Owing to the coronavirus disease 2019 pandemic, our university implemented distance learning for all classes using information and communication technology (ICT) for the first semester of the academic year 2020. A previous study raised a concern that compared with face-to-face classes, distance learning may adversely affect students' mental health.1 In contrast, another study reported that the levels of satisfaction with distance learning were not unreasonably low among students.2 Despite the disadvantages of distance learning, such as anxiety and solitude, students highly appreciated the flexibility that allowed them to study at their own pace.3 Distance learning programs are conducted via ICT and are known to help patients with neurodevelopmental disorders adapt to society and improve their skills.4, 5 Attention-deficit hyperactivity disorder (ADHD) is highly correlated with Internet addiction among university students.4 Only a few studies have examined the impact of ICT-based distance learning on students predisposed to neurodevelopmental disorders. Therefore, this study aimed to characterize the subjective evaluation of ICT-based distance learning by students predisposed to neurodevelopmental disorders and to use these data to provide support. In September 2020, we sent emails twice to all second-, third-, and fourth-year students enrolled at our university and requested their participation. A questionnaire-based survey was conducted using a Google form linked to their email IDs, and 245 students (79 men, 165 women, and 1 nonbinary) responded to the questionnaire (valid response rate: 19%). Regarding online classes, the students were requested to score the following items on a five-point scale (Agree, Somewhat agree, Neutral, Somewhat disagree, and Disagree): (1) "I could relax"; (2) "I could concentrate"; (3) "I could learn at my own pace"; and (4) "I was motivated to learn." Moreover, they were asked to evaluate online classes as a whole as follows: Good, Somewhat good, Neutral, Not very good, or Not good. Further, to evaluate neurodevelopmental disorder, the Japanese versions of the Adult ADHD Self-Report Scale (ASRS-v1.1) and the 10-item Autism Spectrum Quotient (AQ-J-10) were used. Only six items in Part A of ASRS-v1.1 were used for assessing participants, and respondents who satisfied ≥4 of these items were considered predisposed to ADHD.5 Notably, the AQ-J-10 comprises 10 items, and the respondents who satisfied ≥7 of these items were considered predisposed to autism spectrum disorder (ASD).6 No identifiable information was collected. Logistic regression analysis was performed to adjust for age and sex, and the effects of ASD and ADHD tendencies on different items of subjective evaluation were investigated. The five-point subjective evaluation items were broadly divided into two groups: the first group included Agree, Somewhat agree, Good, and Somewhat good, whereas the second group included all other answers. The significance level was set at 5%. Overall, 32 students had ADHD tendency only, 11 students had ASD tendency only, and eight students had both tendencies (Supplementary table). Regarding the correlation between the tendency to develop neurodevelopmental disorder and subjective evaluation (Table 1), the responses to the "I could concentrate" item revealed that the ADHD group had lower concentration levels than the non-ADHD group. However, this finding was not noted in students with ASD tendency. A previous study reported the effectiveness of ICT-based smartphone applications in supporting the livelihoods of patients with ADHD,7 and the results seemed to be inconsistent with those of the present study. Notably, ADHD is partially characterized by the inability to concentrate.8 Because online classes at home allow students to learn in a familiar environment, students with ADHD tendency may find this type of learning more helpful in their studies. However, such an environment will have less coercive pressure from others and easy access to entertainment, including social media and online gaming. This could explain why they have more difficulty in concentrating. In contrast, this finding was not noted in students with a tendency to develop ASD. A previous study reported that some ASD symptoms can be relieved by tablet-based ICT applications,9 indicating that patients with ASD have a higher affinity toward ICT than those with ADHD. Moreover, ASD is characterized by hypersensitivity to visual and auditory stimuli.10 Accordingly, the home environment may be better suited for concentration among students with ASD than the classroom. This study has certain limitations. The valid response rate was low. Moreover, the participants were from the same university, making it difficult to generalize the results. Further, the participants with neurodevelopmental disorders were grouped based on subjective evaluation and not professional judgment. Finally, we did not directly compare our results with those from conventional face-to-face classes. A novel finding here is that students with ADHD tendencies find it difficult to concentrate during online courses at home, despite there being no influence of others and the environment being more easily adjustable, unlike in the classroom. While distance learning will continue to play a crucial role in enabling students to continue learning in emergency situations and diversifying learning experiences, sufficient consideration is needed to help students predisposed to neurodevelopmental disorder, particularly ADHD rather than ASD, to concentrate during distance learning at home. Conception and design of the study: E.I.; acquisition of data: E.I.; analysis of data: H.I.; drafting the manuscript and tables: E.I.; providing suggestions regarding the manuscript: H.I. and T.T. All authors reviewed the manuscript and approved it for submission. N/A. None The authors declare no conflicts of interest. This study was approved by the Human Rights Protection/Ethics Committee of Fukui Prefectural University (No. 2021007). The form was designed such that it could only be submitted if the respondent checked the box confirming "I have read and understand the instructions for this study and agree to participate." Therefore, the provision of responses was interpreted as the provision of informed consent. N/A. The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 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