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Documentation Guidelines

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ADHD Documentation Guidelines

These guidelines outline what information is necessary in order to obtain academic accommodations for Attention Deficit Hyperactivity Disorder. As Attention Deficit Hyperactivity Disorder or ADHD is the correct and complete name of the disorder based on psychiatric nomenclature, ADHD will be used throughout this document. However, the guidelines also refer to other terms sometimes used for the same disorder including "Attention Deficit Disorder" and "Attention Deficit Disorder without Hyperactivity."

In determining eligibility for accommodations under Section 504 of the Rehabilitation Act of 1973 and the American's With Disabilities Act (ADA) the student must demonstrate that a qualified professional has established a formal diagnosis of a disability. However, the diagnosis alone is not enough to establish eligibility for accommodations under the ADA. There must also be evidence of a "substantial limitation" in a major life activity, such as learning. These guidelines are provided to help the evaluating professional document his/her findings in a manner that meets requirements of the ADA and supports the request for accommodations.

All information obtained in diagnostic and medical reports will be maintained and used in accordance with applicable confidentiality requirements.

Documentation Guidelines

I. Qualifications of the Evaluator

The professional conducting the evaluation and making the diagnosis must be qualified to make the diagnosis of an Attention Deficit Hyperactivity Disorder and to recommend appropriate academic accommodations. Experience with diagnosing ADHD in adolescents and young adults is essential. The evaluator must also have training in differential diagnosis of the full range of psychiatric and learning disorders. Professionals typically qualified to make this diagnosis include:

  • Clinical psychologists
  • Neuro-psychologists
  • Psychiatrists
  • Other relevantly trained medical doctors.
  • A clinical team approach to diagnosis may also be appropriate.

The documentation must include the name, title, and professional credentials of the evaluator, including information about licensure and/or specialization. All evaluation reports must be typed on letterhead, signed, dated, and legible.

II. Documentation

The provision of all reasonable accommodations and services is based upon the assessment of the current impact of the disability on academic functioning. Therefore, it is in the student's best interest to provide documentation of an evaluation completed within the last three years. If the documentation is inadequate in scope or content, or is not relevant to the individuals current functioning and need for accommodations, then an updated evaluation may be warranted. Since the purpose of the update is to determine the student's current need for accommodations, the update, conducted by a qualified professional, should include a rationale for ongoing services and accommodations.

III. Comprehensive Evaluation and Diagnostic Report

The comprehensive evaluation should include review of a diagnostic interview, psychological assessment data, clinical interpretation and recommendations as described below.

Evidence of Early and Current Impairment
ADHD by definition is first exhibited before age seven, although it may not have been formally diagnosed. Therefore, the documentation must include historical information establishing symptomology indicative of ADHD during childhood, adolescence and young adulthood. The documentation must also include a statement of the current symptoms, including evidence of ongoing impulsive/hyperactive or inattentive behaviors that significantly impair functioning in two or more settings (e.g. home, school, work). There should also be a summary of a diagnostic interview that includes both self-report and 3rd party report, as information from 3rd party sources is often critical in the diagnosis of ADHD.

Medical, Developmental and Psycho-social History
The diagnostic interview should also include developmental, school, and psycho-social history; family learning/psychiatric history; relevant medical information; and history of mental health and pharmacological intervention.

Evidence that alternative diagnoses or explanations have been ruled out
The evaluator should have considered possible alternative diagnoses including medical and psychiatric disorders as well as educational or cultural factors that could account for behaviors that appear like ADHD symptoms. The evaluator should also assess for dual diagnoses and co-existing mood, behavioral, neurological, or personality disorders that confound the diagnosis of ADHD.

Psychological Assessment Data
Norm-referenced checklists and surveys, computerized continuous performance tests, and attention/tracking tests can be used to supplement the diagnostic profile, but are not in and of themselves sufficient. Neuropsychological or psychoeducational assessment is required in order to determine the current impact of the disorder on the individual's ability to function in the academic setting. All data must logically reflect a substantial limitation to learning for which the individual is requesting accommodations.

In order to support the diagnosis of ADHD and substantiate the need for accommodations there should be an assessment of intellectual functioning, academic achievement, and information processing as detailed below:

Aptitude/Intellectual Assessment
An intellectual assessment including sub-test and standard scores. Appropriate measures may include:

    • Wechsler Adult Intelligence Scale Revised(WAIS-R)
    • Kaufman Adolescent and Adult Intelligence Test
    • Stanford-Binet Intelligence Scale (4th edition)
    • Woodcock-Johnson Tests of Cognitive Ability
    • Psychometrically-sound short forms of these instruments may be acceptable.

Academic Achievement
A comprehensive academic achievement battery is essential with all sub-test and standard scores reported, and should include current levels of academic functioning in such relevant areas as reading (decoding and comprehension), mathematics, and oral and written language. Appropriate measures may include:

    • Woodcock Johnson Psycho-educational Battery - Revised Tests of Achievement
    • Wechsler Individual Achievement Tests
    • Scholastic Abilities Test for Adults

Information Processing
There should also be evidence of assessment of short and long term memory, auditory and visual perception and processing, executive functioning, and/or motor ability. These results may come from the aptitude measures or additional measures of information processing. All test scores must be included in the report including sub-test scores, standard scores, and percentile ranks. Age/grade equivalent scores are not sufficient in the absence of standard scores or percentile ranks.

Test Scores
Standard scores and/or percentiles should be provided for all normed measures. Grade equivalents are not useful unless standard scores and/or percentiles are also included. The data should logically reflect a substantial limitation to learning for which the student is requesting the accommodation. The particular profile of the student's strengths and weaknesses must be shown to relate to functional limitations that may necessitate accommodations.

Specific Diagnosis based on DSM-5 / 5th edition Criteria
The evaluator should include a review of the presence or absence of specific diagnostic criteria for ADHD based on the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition. The evaluator should include in the report an explicit statement about the presence of the diagnosis.

Clinical Summary
The report should include an integrative interpretative summary that is based on the comprehensive evaluation. Professional judgment should be used to interpret and integrate historical information, clinical observations, and test data including self-report measures, 3rd party report measures, computerized assessment, and psycho-educational assessment in order to arrive at a summary of the evaluation and a specific diagnosis. The summary should also include evidence of the disorder across childhood, adolescence, and adulthood, evidence that there is an impact of the disorder in multiple settings, evidence that the ADHD limits learning or other life activity, and discussion of the anticipated impact of the ADHD in the higher education environment.

IV.  Recommendations for Accommodations

The diagnostic report should include specific recommendations for accommodations as well as a rationale for why each accommodation is recommended. The recommendations should be correlated with the specific, identified functional limitations. However, the final determination of appropriate accommodations rests with James Madison University, Disability Services.

It is important to recognize that accommodation needs can change over time and are not always identified through the initial diagnostic process. Conversely, a prior history of accommodation does not, in and of itself, warrant the provision of a similar accommodation.

In instances where a request for accommodations is denied, a written grievance or appeal procedure is in place and may be obtained from Disability Services.