Key Research Questions to Support Neurodiversity in Higher Education: A Participatory Priority Setting Exercise

Abstract

The number of identified neurodivergent individuals in UK higher education, within both student and staff populations, is steadily increasing, yet there is limited evidence on how best to support them. In the context of financial pressures and sector-wide transformation, setting priorities for neurodiversity research is critical to make the most of limited resources. This study used an adapted James Lind Alliance methodology to identify the most pressing research questions concerning neurodiversity in higher education, gathering 385 ‘uncertainties’ (or possible research questions) from 135 students and staff across 37 UK universities. These were refined into 66 indicative research questions spanning 16 categories. Following interim prioritisation and a final consensus workshop, 10 top research priorities were identified. These reflect five key themes: staff knowledge, attitudes and practice; assessment; support; outcomes; and accessibility. This is the first study to systematically establish research priorities for neurodiversity in higher education, providing a foundation for evidence-based change that reflects the perspectives and needs of both neurodivergent students and staff.

1. Introduction

The construct of being neurodivergent, as opposed to neurotypical, emerged in the 1960s in relation to autism (Singer, 1999). Since that time, the neurodiversity movement advocating for equality, respect and inclusion of all neurodivergent individuals has flourished. Along with this movement, there has been an increase in the use of neuro-affirmative language as opposed to traditional medical language in public and academic spaces (Bottini et al., 2023). This language focuses on differences, not disorder. In the case of autism, identity first language (i.e., autistic person) rather than person first language (i.e., person with autism) may be preferred. In other cases, there is still a lack of consensus. Irrespective of the language used, neurodivergence now encompasses several conditions, most commonly Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Conditions (ASC) and dyslexia (Armstrong, 2010; Pollak, 2009). Neurodivergent people are estimated to represent around 15–20% of the worldwide population (Jurgens, 2020), and an increasing number of neurodivergent students have entered higher education in recent years (Farrant et al., 2022; Karalyte, 2024). However, there is limited research examining the university experience of neurodivergent individuals, both in student and staff roles. There is evidence to suggest that neurodivergent students are more likely to encounter difficulties adjusting to university (Shaw & Anderson, 2018) and less likely to successfully graduate (Dobson Waters & Torgerson, 2021; Sedgwick-Müller et al., 2022; Sedgwick et al., 2019; Stevens et al., 2022), but much of this research is focused on individual forms of neurodivergence or based on small-scale studies, limiting its generalisation. Furthermore, whilst universities strive to adopt inclusive education approaches and offer support to neurodivergent students and staff, there is limited evidence in which to ground practical strategies, potentially leaving a significant proportion of the university population with suboptimal support and unmet needs.

The need to generate robust evidence and use research-based practices in higher education is greater than ever before due to significant transformations within the sector in recent years, including digitisation, globalisation and widening participation (Choi et al., 2023; Vignoles & Murray, 2016). Research within higher education can be defined as original enquiry with rigorous data collection and analysis which enhances our knowledge of learning and education by examining experiences and outcomes (Hooper et al., 2018). The influence of such research should be felt at all levels, from individual students and teachers to higher level sector policy (Choi et al., 2023). However, it is critical that research is conducted in line with priorities for the organisation or sector. Despite this, research priority setting in higher education is rare, with few notable and recent examples (Choi et al., 2023; Sampson et al., 2022). The need to make use of priority setting for research in higher education is ever-growing because such prioritisation can also serve an important financial purpose by ensuring that limited resources are used effectively. This is particularly critical in the context of financial difficulties across the UK, with nearly one in four universities reportedly making redundancies (Adams, 2025). Priority setting is a lengthy process that is more commonly used in health settings, progressing from identification of needs, resource allocation, communications of decisions and management of feedback (Menon et al., 2007), with specific guidelines in place such as that provided by the James Lind Alliance (JLA), which details step-by-step directions to identifying priorities (National Institute for Health and Care Research, 2021).

Given the sparsity of evidence about the experiences of neurodivergent students and staff in higher education and the need for greater research in this area in a difficult financial climate and period of ongoing transformation for the sector, we aimed to conduct a research priority setting exercise within universities to ensure meaningful evidence for change can be established. This project therefore set out to consult key stakeholders (current and recent students, staff and parents) in the UK on their priorities for future research into neurodiversity within higher education. Critically, this had to include neurodivergent stakeholders to ensure that “experts by experience” were at the centre of the priority setting exercise, and we aimed to design the process in such a way that these experts could hold power with neurotypical respondents and researchers. Our aim was therefore to ensure that key members of the university community play an influential role in developing future research directions through a systematic priority setting process.

2. Materials and Methods

The methodology for this research was adapted from the James Lind Alliance (JLA) guidance, which provides a framework for how to conduct a priority setting exercise for healthcare (National Institute for Health and Care Research, 2021). Using this method, a steering group oversees the process of gathering uncertainties (i.e., possible research priorities), categorising and verifying these uncertainties, conducting an interim prioritisation, and then creating a final ranking to identify the top research priorities. This process is illustrated in Figure 1.

The steering group for this exercise consisted of the authors listed for this paper, which included university students and staff, including those who are neurodivergent and whose research focuses on neurodiversity. This group oversaw the steps outlined below. In all cases, participants gave informed consent prior to taking part, with ethical approval provided for all stages from the King’s College London institutional ethics committee (LRS-22/23-36250, MRA-24/25-46302). Due to the multi-stage nature of the research, individual ethical approval references are given in the specific methods sections. Online surveys were conducted using the Qualtrics platform, and the final workshop was completed using Microsoft Teams.

2.1. Stage 1: Gathering Uncertainties

According to the JLA guidance, uncertainties in healthcare research typically arise from four key sources: patients, clinicians, parents, and existing guidance or reviews. Adapting this to an educational context, our first stage focused on identifying uncertainties by consulting current students, recent university leavers, parents, and university staff. Participants completed an anonymous online survey in which they identified their role (e.g., student) and their neurotype (e.g., neurodivergent) to allow us to ensure sufficient representation of “experts by experience”. Where an individual identified as neurodivergent, they were asked to identify the condition(s) they had using their own preferred term, i.e., through free text (e.g., ADHD). Basic demographic data were also collected (age, gender, ethnicity), and students were asked to provide details of their studies (e.g., year of study and discipline). Recent university leavers were asked to indicate their qualification and whether it was successfully completed. All respondents were asked to provide up to three uncertainties that they considered to be priorities for research into neurodiversity in higher education. The survey was open from February 2023 to May 2024, with contributions from 135 participants (see results for detailed breakdown). Ethical approval was granted under reference LRS-22/23-36250 for this part.

2.2. Stage 2: Data Processing and Verifying Uncertainties

After the survey closed, responses were reviewed independently by four researchers to determine if they were in scope or out of scope for the exercise, based on our research aim. Items agreed to be in scope by at least three out of four reviewers were carried forward to the next round. Items where at least three out of four reviewers felt the question was out of scope were removed. Where views were more mixed, individual questions were discussed to arrive at a final decision.

In-scope items were then reviewed and assigned to categories by at least two researchers. Based on these categories, indicative questions were developed to capture key areas of research. These questions were closely based on the original uncertainties submitted by participants but were created to combine related questions and/or allow for removal of duplicates. Indicative research questions were then reviewed to check for validity as a research question, as opposed to service evaluation. Questions better aligned to service evaluation rather than research, i.e., those aiming to evaluate a service such as teaching or support services rather than derive new knowledge, were removed at this point.

Once all indicative research questions had been reviewed and agreed, literature searches were conducted to cross-reference the uncertainties with the existing evidence base. In line with the JLA guidance, this involved searching for existing evidence reviews (systematic, narrative and scoping) (National Institute for Health and Care Research, 2021). To ensure we identified up-to-date evidence, in line with JLA guidance, we focused searches on the last 5 years (starting at 1 January 2020) and utilised Web of Science as a cross-disciplinary database to identify literature across science and education. The categories were split between four researchers who conducted searches to verify uncertainties, recording hits and papers of note for each of their searches. Identified papers were then reviewed to examine the aim, methods and findings as well as markers of quality (e.g., systematic reviews following PRISMA guidelines and sample sizes of individual studies). Where a question could not be answered by existing evidence for more than one form of neurodiversity, the uncertainty was accepted. This meant that, for example, if literature was available only for ASC but not any other form of neurodiversity, it was considered a verified uncertainty. This stage was completed between June 2024 and November 2024.

2.3. Stage 3: Interim Priority Setting

The aim of this stage was to produce a short list of research questions from the long list of indicative research questions produced in Stage 2. JLA guidance suggests that this can be completed by asking people to choose and rank 10 questions from a long list of 60–70 questions (National Institute for Health and Care Research, 2021). The target participant groups were the same as for Stage 1 (uncertainty gathering). Participants completed an anonymous online survey in which they identified the 10 questions they considered most important. They were then asked to rank these 10 questions in order of importance. As in Stage 1, they also identified their role (e.g., staff or student) and neurotype to allow us to ensure “experts by experience” were adequately represented. This survey was open from November 2024 to December 2024.

Survey responses were organized by four participant groupings: neurodivergent learner (N = 46), neurotypical learner (N = 35), neurodivergent staff (N = 11), and neurotypical staff (N = 11). Current students and recent university leavers were grouped under the umbrella of ‘learner’. The 10 highest-scoring questions for each category were then identified. From these, a position score was calculated for each question by examining how many groups ranked the question at a particular position and whether this included neurodivergent groups. To be included in the final priority setting exercise (Stage 4), a question had to rank within the top 10 for three of the four groups. However, to ensure that questions prioritised by neurodivergent participants were not omitted, questions were re-reviewed, and any identified as part of the top 10 by a neurodivergent group were included (as recommended by the JLA). A score was calculated for each of the selected questions by participant group. This took place in January 2025 and was conducted and checked by two researchers. Ethical approval was given under code MRA-24/25-46302.

2.4. Stage 4: Final Priority Setting

The aim of this final stage was to rank the shortlisted research questions in order of priority to agree on the top 10 priorities. Following JLA guidance, this stage was conducted as a workshop with balanced participant groups—in this case, between staff and students. The JLA supports an adapted Nominal Group Technique (NGT) for this stage, and this was the approach we adopted. This approach ensures a consensus can be reached and that no one individual dominates the discussion. Ethical approval was provided by the institutional ethics committee for this stage (MRA-24/25-46302), which ran from January to March 2025.

Participants for this stage were recruited from those who had indicated willingness to participate from previous stages (1 and 3) and provided contact details. Additionally, advertisements were shared by members of the steering committee via institutional networks and social media. To ensure the voice of neurodivergent students was central to the conversation, we aimed to recruit 50% students (all neurodivergent) and 50% staff (who could be either neurodivergent or neurotypical). The final sample consisted of nine individuals (for breakdown, see results).

The NGT session followed a structured process adapted from McMillan et al. (2016) to ensure a balanced and systematic approach to priority setting. The session began with a 15-minute introduction, during which the facilitator (Author 1) provided an overview of the process, reiterated confidentiality protocols, and introduced the shortlisted research questions from the interim priority setting. Following the introduction, participants had 10 min to independently review the research questions in silence. This ‘silent generation phase’ allowed participants opportunity to form their own opinions, without external influence, before engaging in group discussion. The ‘group sharing phase’, which lasted for 30 min, was conducted in a structured round-robin format. Each participant took turns sharing their thoughts on specific research questions, explaining their reasoning for prioritising certain topics. At this point, discussion was not permitted; instead, all contributions were recorded verbatim on a Miro board, ensuring that every perspective was captured before further deliberation.

The next phase of the NGT session, clarification and discussion, lasted 30 min and provided participants the opportunity to seek clarifications, refine research questions, or suggest grouping together similar priorities where appropriate. After these discussions, participants were given 5 min to independently complete an online ranking form, where they selected their top 10 research priorities and ranked them from 1 (most important) to 10 (least important). The rankings obtained from this session were used to determine the final top 10 research priorities.

3. Results

A summary of the priority setting exercise, by each stage, is shown in Figure 2. Each stage is described in further detail below.

3.1. Stage 1 Findings: Initial Uncertainties

The first stage (Gathering Uncertainties) of this exercise gathered responses from 135 individuals. In the description that follows, where less than five people were within a group or category, specific numbers are not given to avoid compromising anonymity. Of the 135 respondents, 83 (61.5%) were current university students, 9 (6.7%) were recent university leavers, 41 (30.4%) were staff, and a small number (i.e., <5) had dual roles. Overall, 19 (14.1%) considered themselves neurotypical, whilst 20 (14.8%) were self-diagnosed as neurodivergent (most commonly ADHD), and 96 (71.1%) indicated that they had a formal diagnosis of a neurodivergent condition. For these individuals, the most noted diagnoses were ADHD, ASC, and dyslexia, and many reported multiple conditions. The average age of respondents was 33 years (SD = 11.8). Most respondents were female (N = 111, 82.2%), followed by males (N = 13, 9.6%) and non-binary (N = 9, 6.7%). Two respondents reported other genders or declined to answer. Most belonged to white ethnic groups (N = 104, 77.0%), with Asian or Chinese the next most common group (N = 19, 14.1%). There was little representation from Black ethnic groups or mixed groups. A few provided alternative details for ethnicity or declined to answer. Of the 72 students providing data on their studies, most were home students (N = 62, 86.1%). Thirty-nine (54.2%) were undergraduates studying for a BSc or BA, 17 (23.6%) were completing MSc or MA courses, and nine (12.5%) were completing PhDs. Five (6.9%) reported other types of qualification. Most (N = 53, 73.6%) were studying full time. Sixty-nine students provided details of their university, and 37 different institutions were recorded. Collectively, respondents identified 385 uncertainties.

3.2. Stage 2 Findings: Categorising and Verifying Uncertainties

Thirty-five uncertainties were removed at Stage 2 because they were out of scope. A further seven were removed because they were ambiguous. This left 343 uncertainties to be categorized in Stage 2. These were grouped into 16 categories, and indicative questions were created. Examination of those questions to remove any which aligned more closely with auditing or service evaluation resulted in a further reduction to 66 indicative research questions. This is summarised in

Table 1. Uncertainties were grouped into several categories, displayed alphabetically.

Category	Category Description	Initial Uncertainties	Indicative Questions	Indicative Research Questions
Accessing Support	These relate to accessing support for neurodivergent students rather than the experience or effectiveness of it, for example, who can access it and what steps are involved in doing so.	27	10	1
Alcohol, Substance Use, (Self-) Medication	These relate to use of substances in neurodivergent students (excluding medication used as prescribed) and the proportion who receive prescribed medication.	5	3	3
Assessment	These relate to the suitability of different forms of assessment neurodivergent students and the value of adjustments to assessment.	39	7	6
Campus Spaces	These relate to the suitability of physical and digital spaces within universities for neurodivergent individuals.	6	2	2
Careers support	These relate to support for employability of neurodivergent students, including during placements (i.e., as part of their degree) and through university career services.	5	4	3
Degree and University Choices	These relate to how neurodivergent students perceive subjects when selecting degrees and what factors impact neurodivergent choices about degree subjects and universities.	12	4	2
Diagnosis, Learning Performance and Success	These relate to how neurodivergent students compare to neurotypical students in terms of degree outcomes, dropout rates, and time taken to complete qualifications. This also includes the factors that impact these outcomes, e.g., support in place or disclosure.	44	6	3
Disclosure Experiences and Impact	These relate to experiences around disclosure of neurodivergent status and the impact it has on neurodivergent individuals.	5	3	2
Mental Health and Wellbeing	These relate to questions around the mental health and wellbeing of neurodivergent students and staff, including the impact of university work and access to mental health specific support.	14	7	5
Neurodivergent Staff	These relate to university staff who are neurodivergent and include topics such as support and career progression.	9	6	6
Prevalence Estimates	These relate to the number of neurodivergent individuals within universities (staff and students) and the proportion of students diagnosed during pursuit of their degree.	5	4	2
Staff Awareness of Neurodiversity	These relate to staff knowledge and understanding of neurodiversity.	16	3	3
Student Experience	These relate to the wider university experience for neurodivergent students, i.e., beyond teaching and learning, such as induction, social life and housing.	7	5	4
Support	These relate to how neurodivergent students experience university support and evidence for certain support approaches and effectiveness.	82	16	9
Teaching and Learning	These relate to teaching and learning practices for neurodivergent students, both in terms of preferences and effectively supporting learning.	41	14	7
The University Community	These relate to the wider community, e.g., attitudes of other students towards neurodiversity and sense of belonging.	26	13	8

Note: Initial uncertainties were proposed by respondents. These were then developed into indicative questions to remove duplication and combine questions as appropriate. Indicative questions aligning to service evaluation or auditing were then removed to give a final long list of 66 research questions.

, with all 66 indicative research questions detailed in Supplementary Material Table S1.

Literature searches were conducted for all indicative research questions on the long list, and none were deemed to be fully addressed by the existing research. An overview of the search results is provided below, by category, where research could be identified. We were unable to find any relevant reviews relating to the indicative research questions within the following categories: campus spaces, degree and university choices, career support, prevalence estimates, staff awareness, teaching and learning. As such, these were carried forward as confirmed uncertainties.

3.2.1. Accessing Support

There was little available evidence to address issues pertaining to accessing support. Indeed, only one systematic review was identified in this area, incorporating 24 studies, all of which were focused on ASC (Davis et al., 2021). This review aimed to examine academic and non-academic support made available to students with ASC. They noted that academic support was infrequently discussed, but is increasing, compared to non-academic support (e.g., social skills training or counselling). Furthermore, this support was available but often not fully used due to the requirement to disclose a diagnosis to access support in many cases. This review does therefore identify some issues around accessing support related to diagnosis disclosure but only for ASC, and subsequently, this area was deemed to be uncertain for neurodiversity more broadly.

3.2.2. Alcohol, Substance Use, Self-Medication

We were unable to identify any literature specifically related to neurodivergent students, as opposed to the general population of neurodivergent individuals. Research has demonstrated consistently that individuals with ADHD show a higher risk of drug and alcohol related difficulties (Huntley & Young, 2014; Ohlmeier et al., 2008), but there is less evidence for other forms of neurodiversity, and no work specifically focused on those in higher education. This area was, therefore, confirmed as an uncertainty.

3.2.3. Assessment

Indicative research questions related to assessment focused on the adjustments that aid equity, types of assessment that are preferred by students, and performance across different types of assessment and grading. Whilst some literature exists in this space, it is limited in scope both in terms of the assessment types considered and the neurodivergent conditions covered. For example, one review looked at the use of extra time for assessments and found that the research did not support this for those with ADHD, but that there was insufficient data to make any conclusions for ASC (Harrison et al., 2022). Another incorporated assessment within a wider review related to dyslexia and noted that high-pressure assessment, such as exams, may be particularly challenging for individuals who are dyslexic (Dobson Waters & Torgerson, 2021). An additional broad review, incorporating assessment, noted that what benefits dyslexic students may differ from those with ASC (Clouder et al., 2020). Given the breadth of assessments and the range of conditions, this was confirmed as an uncertainty.

3.2.4. Diagnosis, Learning Performance and Success

Although this topic has been examined in several systematic reviews, significant uncertainty remains. One of the largest reviews included ASC and ADHD and examined the factors that students attribute to success at university (Moriña & Biagiotti, 2022). This study identified internal factors such as self-advocacy, self-awareness, self-determination, self-esteem, and external factors such as disability offices, staff, and peers as influencing success. However, neurodivergent conditions were not separated from other conditions, making it hard to ascertain the role of neurodiversity. Another review focused just on individuals with ADHD and indicated poorer employment success in this group (Gordon & Fabiano, 2019). Therefore, it is unclear exactly what impact diagnosis of one or more neurodivergent conditions has on performance and success, and this was considered a confirmed uncertainty based on current evidence.

3.2.5. Disclosure Experiences and Impact

Two reviews were identified that had considered disclosure from the perspective of students. Firstly, a broad review into neurodiversity in higher education identified challenges around disclosure, with some students reluctant to disclose because of a potential negative impact, such as lack of supportive policies or stigma in ASC and dyslexia (Clouder et al., 2020). The second review confirmed the concerns around disclosure for ASC for fear of negative outcomes and stigma (Thompson-Hodgetts et al., 2020). A third review had examined the experiences of staff when disclosing neurodiversity (Mellifont, 2023) and noted that they too may have negative experiences, but also that the impact on students of staff disclosing was unknown. As such, this was also deemed an uncertainty.

3.2.6. Mental Health and Wellbeing

Only two reviews were identified relating to the indicative research questions in this area. The first review noted that neurodivergent students were more likely to encounter emotional difficulties and feel isolated or overwhelmed. This review covered ASC, ADHD, and dyslexia (Clouder et al., 2020). However, the review did not fully examine access to support for these difficulties, and so barriers or facilitators of access were unclear. The second review did map out different types of support, including challenges to these, but focussed exclusively on ASC (Nelson et al., 2023). Therefore, these questions were not deemed addressed by the current literature.

3.2.7. Neurodivergent Staff

Only one review article was found focusing on the indicative research questions within this category (Mellifont, 2023). This review identified that neurodivergent staff could experience difficulties with career progression but that positive relationships at work can be beneficial. The study also noted that accommodations could be helpful, as could specific support, such as access to a neurodivergent mentor. Given this review only partially addressed indicative questions in this area, this was carried forward as a verified uncertainty.

3.2.8. Student Experience: Beyond Studies

Questions in this area related to a broad range of elements of university life, from student induction to student accommodation and the impact of diagnosis during a degree. For most of the questions, no relevant reviews were identified. However, one review focusing on ASC and mentoring specifically did contain some relevant studies which revealed that mentoring may be beneficial in supporting students in areas such as social skills and belonging but that more research was needed (Duerksen et al., 2021). Given the sparsity of research and the focus exclusively on one form of neurodiversity, this was considered a confirmed uncertainty.

3.2.9. Support

This was one of the larger categories, containing nine indicative research questions pertaining to the breadth and effectiveness of support. Perhaps unsurprisingly, most research had been conducted in this area, with several reviews identified. Most of these reviews focused on individual conditions, with the largest number focused on ASC. One review in this area noted that academic and non-academic support were available, although access could be hindered by the need for disclosure (Davis et al., 2021). A second review focusing specifically on support for executive functioning in ASC identified that these interventions could have positive effects, but that outcomes are typically measured subjectively and that objective measures to support effectiveness were lacking (Stark & Lindo, 2023). This work included mentoring as one form of support, the effectiveness of which was also noted in another review (Duerksen et al., 2021). A larger review, also focused on ASC, looked at multiple forms of post-secondary education, including university, and focused on the role parent participation could have in terms of support, but noted that more research is needed (Widman & Lopez-Reyna, 2020). One review focused exclusively on dyslexia and included eight studies examining a range of interventions for this group, from phonetic approaches to the pause procedure. However, the overarching conclusion was that more high-quality research was needed in this area (Dobson Waters & Torgerson, 2021). A second review focused on ADHD, albeit partially in combination with learning disability (Stevens et al., 2022). Rather than examining specific support interventions, this review examined the areas which could be incorporated into support approaches and noted that academic regulation, self-efficacy, and integration along with emotional regulation, ADHD symptoms, and social integration should be included in support. Only one identified review looked across conditions and identified a range of support services and technologies available for neurodivergent students but noted a disconnect between needs and support (Clouder et al., 2020). Although this is the most researched area, no indicative question was fully addressed by the existing literature for all neurodivergent conditions and, as such, we considered these indicative questions to be verified uncertainties.

3.2.10. University Community

Indicative research questions in this area related to inclusion within the community and the attitudes of other members of the university towards neurodiversity. Only two reviews were identified with relevant content for these questions, and both noted experiences of stigma from others within the community (O’Connor et al., 2022; Thompson-Hodgetts et al., 2020). Based on this lack of research, this was considered a verified uncertainty.

3.3. Stage 3 Findings: Interim Priority Setting Results

Given that no single indicative research question had been adequately addressed in the literature for more than one form of neurodiversity, all 66 questions were carried forward into the next stage. The interim priority setting survey was completed by 103 individuals. Of these, 72 (69.9%) were current students, nine (8.7%) were recent university leavers, and 22 (21.4%) were university staff. Overall, 57 (55.3%) identified as neurodivergent, and 46 (44.7%) as neurotypical, with neurotypes split quite evenly across the different participant groups. After scoring those 66 indicative research questions as outlined within the methods section, the 17 research questions shown in

Table 2. The research questions rated within the top 10 either by consensus (i.e., three out of the four groups) or by a neurodivergent group (learners or teachers).

Interim Priority Setting Top Ranked Questions	Rationale
How much do university staff understand about neurodivergence, the challenges it may bring for students, and the accommodations that may help, and therefore adjust their practice?	Consensus
What barriers exist to accessing mental health support at universities for neurodivergent students?	Consensus
How do factors such as diagnosis, disclosure, treatment, and support impact degree outcomes for neurodivergent students?	Consensus
Do neurodivergent graduates have different employment prospects compared to neurotypical students?	Neurodivergent
What teaching methods are most effective for neurodivergent students?	Consensus
What adjustments to assessment (e.g., coversheets, extensions) help neurodivergent students and ensure equity?	Consensus
Should neurodivergent and neurotypical students be graded against different criteria?	Neurodivergent
What interventions or supports are most useful for neurodivergent staff?	Neurodivergent
Are neurodivergent students more likely to drop out of study, require resits or interrupt their studies compared to neurotypical students?	Neurodivergent
Do neurodivergent students perform better or worse than neurotypical students on certain types of assessment?	Neurodivergent
What types of assessment and/or adjustments to assessment are preferred by neurodivergent students?	Neurodivergent
To what extent do neurodivergent staff and students feel that their university is accessible, and what factors impact this?	Neurodivergent
What are staff attitudes towards neurodivergent students and how do these impact student outcomes?	Neurodivergent
What are neurodivergent student experiences of support systems within universities, including both advantages and disadvantages of received support?	Neurodivergent
Are university wellbeing and mental health support services trained in supporting neurodivergent students?	Neurodivergent
What is the impact of neurodivergency on access to careers and career progression for university staff?	Neurodivergent
How does time blindness impact adherence to deadlines in neurodivergent students?	Neurodivergent

were identified for the final stage.

3.4. Stage 4 Findings: Final Priority Settings

These 17 questions were used in the final stage of the priority setting exercise. A total of 14 potential participants expressed interest in completing this stage, and nine participated. This stage included four students, all of whom were neurodivergent, and five staff members, three of whom were also neurodivergent. The remaining two staff members were experts through neurodiversity research. Although efforts were made to recruit equal numbers of neurodivergent students and staff, the final breakdown ensured that the perspectives of neurodivergent students remained central to the discussion. The session was facilitated online, with all discussions recorded for analysis.

During the round-robin discussion, participants shared their reasoning behind prioritising certain research questions. A key theme was the recognition that neurodivergence is not a singular experience but rather a diverse spectrum of conditions with varying support needs. Participants discussed that effective teaching methods are likely to differ across neurodivergent students, suggesting that personalised educational approaches may be more beneficial than a standardised set of accommodations. This led to reflections on whether institutions should focus on flexibility in learning and assessment rather than rigid adjustments that may not work for all students.

Another theme that emerged from discussing the research questions was the framing of neurodivergence within higher education. Some participants highlighted that much of the existing discourse is shaped by a deficit-based perspective based on the medical model of neurodiversity instead of addressing structural barriers within the university environment. This prompted discussion about whether research priorities should focus more on institutional change rather than individual-level adjustments.

Participants also reflected on the language and intent behind certain research questions. Some noted that specific phrasing (e.g., “time blindness”) could unintentionally reinforce a remedial view of neurodivergence or be offensive to certain communities. This led to discussions on how future research should centre neurodivergent voices to ensure that studies are aligned with the lived experiences and priorities of neurodivergent students and staff.

Throughout the discussion, participants engaged with these themes in ways that shaped the final ranking of research priorities, ensuring that the final list of research priorities reflected not only individual preferences, but also collective insights gained through dialogue. The final rankings produced 10 research priorities for neurodiversity research in higher education, as detailed in

Table 3. The final priorities for neurodiversity research in higher education, shown in order of importance. C = consensus item for interim stage, N = neurodivergent item from interim stage.

Priority	Research Priority
1	How much do university staff understand about neurodivergence, the challenges it may bring for students, and the accommodations that may help, and therefore adjust their practice? (C)
2	How do factors such as diagnosis, disclosure, treatment, and support impact degree outcomes for neurodivergent students? (C)
3	What are staff attitudes towards neurodivergent students, and how do these impact student outcomes? (N)
4	Are university wellbeing and mental health support services trained in supporting neurodivergent students? (N)
5	What adjustments to assessment (e.g., coversheets, extensions) help neurodivergent students and ensure equity? (C)
6	What teaching methods are most effective for neurodivergent students? (C)
7	To what extent do neurodivergent staff and students feel that their university is accessible, and what factors impact this? (N)
8	Are neurodivergent students more likely to drop out of study, require resits or interrupt their studies compared to neurotypical students? (N)
9	Do neurodivergent students perform better or worse than neurotypical students on certain types of assessment? (N)
10	What are neurodivergent student experiences of support systems within universities, including both advantages and disadvantages of received support? (N)

.

4. Discussion

The aim of this study was to engage key stakeholders to identify research priorities for future research into neurodiversity within higher education using an adapted James Lind Alliance approach (National Institute for Health and Care Research, 2021). This study therefore represents the first step in priority setting, by identifying the needs of key stakeholders (Menon et al., 2007).

During the multi-stage process, we received 385 uncertainties from key stakeholders. These formed 66 indicative research questions, which were utilised in an interim priority setting exercise. This resulted in 17 questions being used for the final priority setting workshop. Of these 17, five progressed through consensus (i.e., three of the four groups had the item in their top 10), and the remaining 12 progressed to the final stage because they were in the top 10 for either neurodivergent learners or neurodivergent staff. This approach ensured “experts by experience” were central. It is unclear why these items important to neurodivergent stakeholders were not also highly valued by neurotypical participants. However, we speculate that they arose simply because of the expertise, i.e., a neurotypical student may not consider whether mental health services need to be suited to a neurodivergent student, as they may not have recognised this could be an issue.

After the final stage, we identified 10 key priorities, as listed in Table 3. It is noteworthy that four of these progressed to this stage through consensus, but six progressed through “expert by experience” priority. This supports the validity of these priorities as important to those they are designed to support. These can be broadly grouped into five areas. First, three questions related to staff knowledge, attitudes and practices regarding neurodiversity (Q1, Q3 and Q6). Second, two questions related to assessment (Q5 and Q9) focused on understanding which types of assessment neurodivergent students tend to perform better on, and which approaches promote greater equity between neurodivergent and neurotypical students. Third, there were two questions related to support (Q4 and Q10), with one focusing exclusively on mental health support. Fourth, there were two questions related to outcomes (Q2 and Q8) and the factors that impact these. The remaining question related to whether neurodivergent staff and students felt their university was accessible (Q7). It should be noted that the questions related to outcomes showed overlap with other areas (e.g., support), reflecting the interconnectedness of different aspects of the student experience.

Some of the areas identified align with trends already developing in education and neurodiversity research. For example, knowledge, attitude and practice (KAP) research is increasingly commonplace in universities (Powell, 2023), and in clinical settings including in relation to neurodiversity (Kovshoff et al., 2013). The importance of this research is supported by the current study, which identifies the role of staff as critical to neurodivergent student experience. This is perhaps unsurprising, given the established importance of teacher effectiveness in student experiences and outcomes (Devlin & Samarawickrema, 2010; Ding & Sherman, 2006). Similarly, the emphasis on assessment is to be expected, given its role in allowing students to demonstrate their achievement of learning outcomes, as well as its function as both a motivator and a component of the learning process (Fischer et al., 2024). It is also proposed to be the means by which students become ‘known’ and develop a sense of self (Nieminen & Yang, 2024), further underpinning its importance. The presence of support within the priorities is also unsurprising. Indeed, when verifying uncertainties, this was the area which had received the most prior research attention and had been discussed in several reviews (Clouder et al., 2020; Davis et al., 2021; Dobson Waters & Torgerson, 2021; Duerksen et al., 2021; Stark & Lindo, 2023; Stevens et al., 2022; Widman & Lopez-Reyna, 2020), albeit often as drawing on smaller studies with a focus on a single condition. The focus on mental health specifically for one of these priorities is perhaps also to be expected, as neurodivergent individuals are more likely to experience depression and anxiety, including at university (McKenney et al., 2023; Otu & Sefotho, 2024). Furthermore, this could reflect growing concern around student mental health in general (Auerbach et al., 2018) and increasing demand for support services on university campuses (Gyimah, 2018). The priorities related to outcomes can be considered overarching questions that ultimately link to the students’ degree classifications and, therefore, it is understandable that these are important to those within the university community, as student outcomes impact not only the individual, but also staff and university.

Given the consistency of our priorities with existing and emerging research within higher education, these findings can be used to directly support the development of higher education research strategies related to neurodiversity. To our knowledge, this is the first study to adopt a robust multi-stage priority setting approach to suggest research into neurodiversity within higher education. Whilst this work is an important first step in directing research within this area, it is not without limitations. Firstly, we identified four key stakeholder groups at the start of the process (current students, recent university leavers, staff, parents), but we were unable to engage parents in the process, meaning only three of the four intended groups were represented. Although this group is arguably the furthest removed from the university experience, the role of parents is still important (Meurlin & Senko, 2025; Wintre & Yaffe, 2000), potentially even more so for neurodivergent students, and so, future work should aim to reach them. Secondly, this is a UK-focused study. This decision was made because different countries have different structures within universities, including fee structures which could impact priorities. However, this means that these research priorities may not generalise to other countries. Thirdly, although we went to great efforts to ensure “experts by experience”, i.e., those who have ASC, ADHD, dyslexia or other forms of neurodivergence were consulted throughout, we cannot be sure of their level of knowledge of individual forms of neurodivergence, and therefore, a more nuanced approach may be helpful in future.

5. Conclusions

This study represents the first structured research priority setting exercise focused on neurodiversity within higher education, conducted using an adapted James Lind Alliance methodology. Through three rounds of consultation with staff, current students, and recent university leavers across the UK, we identified 10 key research priorities that reflect the lived experiences, needs, and aspirations of neurodivergent individuals within the university context. These priorities span themes such as staff understanding and attitudes, assessment practices, mental health and academic support, accessibility, and student outcomes. The resulting priorities highlight a clear call for more inclusive, evidence-based practices and institutional change. Notably, the findings emphasise that research must move beyond individual-level accommodations and address the structural and cultural barriers that shape neurodivergent experiences in higher education. This echoes wider critiques of deficit-based approaches and underlines the need for participatory, co-produced research that centres neurodivergent voices. While this study provides a critical foundation for guiding future research, its scope is inherently shaped by its UK focus and the underrepresentation of parent perspectives. Nonetheless, it provides an initial direction for institutions and researchers who seek to align their work with the priorities of neurodivergent communities. As higher education continues to evolve, this research will contribute to shaping more inclusive academic environments.