Guidelines for Documentation of a Disability in Adolescents and Adults

General Documentation Criteria
Qualifications of the Evaluator
Documentation
Appendix A
Appendix B
Appendix C

General Documentation Criteria

Documentation to support the need for requested accommodation(s) must  

• state the diagnosed disability
• be current, within the last 3 years, or 5 years for LD (does not apply to physical or sensory disabilities of a permanent or unchanging nature)
• include complete educational, developmental, and medical history relevant to the disability for which accommodations are being requested
• describe the functional limitations resulting from the disability and list the tests or techniques used to arrive at the diagnosis of the disability (include evaluation date[s] and test results with relevant subtest scores)
• describe the specific accommodations requested
• state why the disability qualifies the applicant for such accommodation(s) in a college environment
• be typed or printed on official letterhead and signed by an official evaluator qualified to make the diagnosis (include information about license or certification and area of specialization)

Qualifications of the Evaluator

For Medical Disabilities:

• Physicians

For learning disabilities and/or ADHD: (for more detailed information see Appendix A)

• Clinical or educational psychologists, school psychologists, neuropsychologists, learning disabilities specialists, physicians
• Additional training and experience in the assessment of learning problems and/or ADHD in adolescents and adults

Documentation(2)

•  Less than 3 years old for learning disabilities and current for medical disabilities

For learning disabilities: (for more detailed information see Appendix B)

• Diagnostic interview: a description of the present problem(s); developmental, medical, psychosocial and employment histories; family history (including primary language of the home and the student’s current level of English fluency); and a discussion of dual diagnosis where indicated
• Assessment of aptitude (intellectual assessment)
• Assessment of academic achievement (reading, mathematics, oral and written language)
• Assessment of information processing (short-and long-term memory, sequential memory, auditory and visual perception/processing, processing speed, executive functioning and motor ability)

For ADHD: (for more detailed information see Appendix C)

• Diagnostic interview (see description for learning disabilities above)
• Assessment of attention, hyperactivity, impulsivity, with evidence of some symptoms prior to age 7

For all disabilities:

• Specific diagnosis: specific language regarding evidence of a disability is required; terms such as "indicative of" or "suggests" a disability is not acceptable.
• Summary provides clear presentation of substantial limitation to learning or other major life activity presented by the disability.
• Recommendations for specific Accommodations are outlined, are clearly supported by test results and indicate how specific disability will be accommodated.
• Summary includes any record of prior accommodation or auxiliary aids and when such Accommodations were used.⁽³⁾

⁽¹⁾ Guidelines adapted from the Association on Higher Education and Disability (July 1997). AHEAD is an international, multicultural organization of professionals committed to full participation in higher education for persons with disabilities. The Association is a vital resource, promoting excellence through education, communication and training.

⁽²⁾ A school plan such as an individualized education program (IEP) or a 504 plan is insufficient documentation, but it can be included as part of a more comprehensive assessment battery.

⁽³⁾ Prior history of accommodation does not, in and of itself, warrant the provision of a similar accommodation.

APPENDIX A

1. For assistance in finding a qualified professional:

• contact the disability services coordinator at the institution you attend or plan to attend to discuss documentation needs; and
• discuss your future plans with the disability services coordinator. If additional documentation is required, seek assistance in identifying a qualified professional.

2. In selecting a qualified professional:

• ask what his or her credentials are;
• ask what experience he or she has had working with adults with disabilities; and
• ask if he or she has ever worked with the service provider at your institution or with the agency to which you are sending material.

3. In working with the professional:

• take a copy of these guidelines to the professional;
• encourage him or her to clarify questions with the person who provided you with these guidelines;
• be prepared to be forthcoming, thorough and honest with requested information; and
• know that professionals must maintain confidentiality with respect to your records and testing information.

4. As follow-up to the assessment by the professional:

•  request a written copy of the assessment report;
•  request the opportunity to discuss the results and recommendations;
•  request additional resources if you need them; and
•  maintain a personal file of your records and reports.

APPENDIX B

Students who are seeking services from the College of the Holy Cross on the basis of a learning disability are required to submit documentation to verify eligibility under Section 504 of the Vocational Rehabilitation Act of 1973.

The following guidelines are provided in the interest of assuring that evaluation reports are appropriate to documentation eligibility. The Director of Disability Services is available to consult with diagnosticians regarding any of these guidelines.

When selecting a battery of tests, it is critical to consider the technical adequacy of instruments including their reliability, validity and standardization on an appropriate norm group. The professional judgment of an evaluator in choosing tests is important. Testing must be comprehensive. It is not acceptable to administer only one test for the purpose of diagnosis. Minimally, domains to be addressed must include (but are not limited to) aptitude, academic achievement, and information processing.

The following list is provided as a helpful resource, but it is not intended to be definitive or exhaustive.

Aptitude 

•  Wechsler Adult Intelligence Scale - III (WAIS-III)
•  Woodcock-Johnson Psychoeducational Battery - Revised: Tests of Cognitive Ability
•  Kaufman Adolescent and Adult Intelligence Test
•  Stanford-Binet Intelligence Scale (4th ed.)

The Slosson Intelligence Test - Revised and the Kaufman Brief Intelligence Test are primarily screening devices that are not comprehensive enough to provide the kinds of information necessary to make accommodation decisions.

Academic Achievement 

•  Scholastic Abilities Test for Adults (SATA)
•  Stanford Test of Academic Skills
•  Woodcock-Johnson Psychoeducational Battery - Revised: Tests of Achievement
•  Wechsler Individual Achievement Test (WIAT)

or specific achievement tests such as:

•  Nelson-Denny Reading Skills Test
•  Stanford Diagnostic Mathematics Test
•  Test of Written Language - 3 (TOWL-3)
•  Woodcock Reading Mastery Tests - Revised

Specific achievement tests are useful instruments when administered under standardized conditions and interpreted within the context of other diagnostic information. The Wide Range Achievement Test - 3 (WRAT-3) is not a comprehensive measure of achievement and therefore is not useful if used as the sole measure of achievement.

Information Processing

Acceptable instruments include the Detroit Tests of Learning Aptitude - 3 (DTLA-3), the Detroit Tests of Learning Aptitude - Adult (DTLA-A), information from subtests on WAIS-R, Woodcock-Johnson Psychoeducational Battery Revised: Tests of Cognitive Ability, as well as other relevant instruments.

(1) AHEAD - Guidelines for Documenting LD - July  

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APPENDIX C

Students who are seeking services from Holy Cross on the basis of Attention Deficit/Hyperactivity Disorder are required to submit documentation to verify eligibility under Section 504 of the Vocational Rehabilitation Act of 1973.

The following guidelines are provided in the interest of assuring that evaluation reports are appropriate to document eligibility. The Director is available to consult with diagnosticians regarding any of these guidelines.

1. A Qualified Professional Must Conduct the Evaluation. Professionals conducting assessments and rendering diagnoses of ADHD must have training in differential diagnosis and the full range of psychiatric disorders. The name, title, and professional credentials of the evaluator, including information about license or certification as well as the area of specialization, employment, and state or province in which the individual practices should be clearly stated in the documentation. The following professionals would generally be considered qualified to evaluate and diagnose ADHD provided they have comprehensive training in the differential diagnosis of ADHD and direct experience with an adolescent or adult ADHD population: clinical psychologists, neuropsychologists, psychiatrists, and other relevantly trained medical doctors. It may be appropriate to use a clinical team approach consisting of a variety of educational, medical, and counseling professionals with training in the evaluation of ADHD in adolescents and adults. Use of diagnostic terminology indicating an ADHD by someone whose training and experience are not in these fields is not acceptable. It is also not appropriate for professionals to evaluate members of their own families. All reports should be on letterhead, typed, dated, signed, and otherwise legible. The receiving institution or agency has the responsibility to maintain the confidentiality of the individual's records.

2. Documentation Should Be Current. Because the provision of all reasonable Accommodations and services is based upon assessment of the current impact of the disability on academic performance, it is in an individual's best interest to provide recent and appropriate documentation. In most cases, this means that a diagnostic evaluation has been completed within the past three years. Flexibility in accepting documentation which exceeds a three-year period may be important under certain conditions if the previous assessment is applicable to the current or anticipated setting. If documentation is inadequate in scope or content, or does not address the individual's current level of functioning and need for accommodation(s), re-evaluation may be warranted. Furthermore, observed changes may have occurred in the individual's performance since previous assessment, or new medication(s) may have been prescribed or discontinued since the previous assessment was conducted. In such cases it may be necessary to update the evaluation report. The update should include a detailed assessment of the current impact of the ADHD and interpretive summary of relevant information (see Section 3, G) and the previous diagnostic report.

3. Documentation Should Be Comprehensive.

A. Evidence of early impairment. Because ADHD is, by definition, first exhibited in childhood (although it may not have been formally diagnosed) and manifests itself in more than one setting, relevant historical information is essential. The following should be included in a comprehensive assessment: clinical summary of objective, historical information establishing symptomology indicative of ADHD throughout childhood, adolescence, and adulthood as garnered from transcripts, report cards, teacher comments, tutoring evaluations, past psychoeducational testing, and third party interviews when available.

B. Evidence of current impairment. In addition to providing evidence of a childhood history of an impairment, the following areas must be investigated:

1) Statement of presenting problem. A history of the individual's presenting attentional symptoms should be provided, including evidence of ongoing impulsive/hyperactive or inattentive behaviors that significantly impair functioning in two or more settings.
2) Diagnostic interview. The information collected for the summary of the diagnostic interview should consist of more than self-report, as information from third party sources is critical in the diagnosis of ADHD. The diagnostic interview with information from a variety of sources should include, but not necessarily be limited to the following:
a. history of presenting attentional symptoms, including evidence of ongoing impulsive/hyperactive or inattentive behavior that has significantly impaired functioning over time;

a) developmental history;
c) family history for presence of ADHD and other educational, learning, physical, or psychological difficulties deemed relevant by the examiner;
d) relevant medical and medication history, including the absence of a medical basis for the symptoms being evaluated;
e) relevant psychosocial history and any relevant interventions;
f) a thorough academic history of elementary, secondary, and postsecondary education;
g) review of prior psychoeducational test reports to determine whether a pattern of strengths or weaknesses is supportive of attention or learning problems;
h) relevant employment history;
i) description of current functional limitations pertaining to an educational setting that are presumably a direct result of problems with attention;
j) relevant history of prior therapy.

C. Rule out alternative diagnoses or explanations. The evaluator must investigate and discuss the possibility of dual diagnoses, and alternative or co-existing mood, behavioral, neurological, and/or personality disorders which may confound the diagnosis of ADHD. This process should include exploration of possible, alternative diagnoses, and medical and psychiatric disorders as well as educational and cultural factors impacting the individual which may result in behaviors mimicking an attention-deficit/hyperactivity disorder.

D. Relevant testing. Neuropsychological or psychoeducational assessment is important in determining the current impact of the disorder on the individual's ability to function in academically related settings. The evaluator should objectively review and include with the evaluation report relevant background information to support the diagnosis. If grade equivalents are reported, they must be accompanied by standard scores and/or percentiles. Test scores or subtest scores alone should not be used as a sole measure for the diagnostic decision regarding ADHD. Selected subtest scores from measures of intellectual ability, memory functions tests, attention or tracking tests, or continuous performance tests do not in and of themselves establish the presence, or absence of ADHD. Checklists and/or surveys can serve to supplement the diagnostic profile but in and of themselves are not adequate for the diagnosis of ADHD and do not substitute for clinical observations and sound diagnostic judgment. All data must logically reflect a substantial limitation to learning for which the individual is requesting the accommodation.

E. Identification of DSM-IV criteria. According to the DSM-IV, "the essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development". A diagnostic report should include a review and discussion of the DSM-IV criteria for ADHD both currently and retrospectively and specify which symptoms are present. In diagnosing ADHD, it is particularly important to address the following criteria:
1. symptoms of hyperactivity/impulsivity or inattention that cause impairment which must have been present in childhood;
2. current symptoms that have been present for at least the past six months;
3. impairment from the symptoms present in two or more settings (for example, school, work, and home);
1. clear evidence of significant impairment in social, academic, or occupational functioning; and
2. symptoms which do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

F. Documentation and a specific diagnosis. The report must include a specific diagnosis of ADHD based on the DSM-IV diagnostic criteria. The diagnostician should use direct language in the diagnosis of ADHD, avoiding the use of terms such as "suggests," "is indicative of", or "attention problems". Individuals who report only problems with organization, test anxiety, memory and concentration in selective situations do not fit the prescribed diagnostic criteria for ADHD. Given that many individuals benefit from prescribed medications and therapies, a positive response to medication by itself does not confirm a diagnosis, nor does the use of medication in and of itself either support or negate the need for Accommodations (s).

G. An interpretative summary. A well-written interpretative summary based on a comprehensive evaluative process is a necessary component of the documentation. Because ADHD is in many ways a diagnosis which is based upon the interpretation of historical data and observation, as well as other diagnostic information, it is essential that professional judgment be utilized in the development of a summary, which should include:
1) demonstration of the evaluator's having ruled out alternative explanations for inattentiveness, impulsivity, and/or hyperactivity as a result of psychological or medical disorders or non-cognitive factors;
2) indication of how patterns of inattentiveness, impulsivity, and/or hyperactivity across the life span and across settings are used to determine the presence of ADHD;
3) indication of whether or not the student was evaluated while on medication, and whether or not there is a positive response to the prescribed treatment;
4) indication and discussion of the substantial limitation to learning presented by the ADHD and the degree to which it impacts the individual in the learning context for which Accommodations are being requested; and
5) indication as to why specific Accommodations are needed and how the effects of ADHD symptoms, as designated by the DSM-IV, are mediated by the accommodation(s).

H. Each accommodation recommended by the evaluator should include a rationale. The evaluator(s) should describe the impact, if any, of the diagnosed ADHD on a specific major life activity as well as the degree of impact on the individual. The diagnostic report should include specific recommendations for Accommodations that are realistic and that postsecondary institutions, examining, certifying, and licensing agencies can reasonably provide. A detailed explanation should be provided as to why each accommodation is recommended and should be correlated with specific functional limitations determined through interview, observation, and/or testing. Although prior documentation may have been useful in determining appropriate services in the past, current documentation should validate the need for services based on the individual's present level of functioning in the educational setting. A school plan such as an Individualized Education Program (IEP) or a 504 plan is insufficient documentation in and of itself but can be included as part of a more comprehensive evaluative report. 

The documentation should include any record of prior Accommodations or auxiliary aids, including information about specific conditions under which the Accommodations were used (e.g., standardized testing, final exams, licensing or certification examinations) and whether or not they benefited the individual. However, a prior history of Accommodations, without demonstration of a current need, does not in itself warrant the provision of a like accommodation. If no prior Accommodations were provided, the qualified professional and/or the individual should include a detailed explanation as to why no Accommodations were used in the past and why Accommodations are needed at this time.

Because of the challenge of distinguishing normal behaviors and developmental patterns of adolescents and adults (e.g., procrastination, disorganization, distractibility, restlessness, boredom, academic underachievement or failure, low self-esteem, and chronic tardiness or inattendance) from clinically significant impairment, a multifaceted evaluation should address the intensity and frequency of the symptoms and whether these behaviors constitute an impairment in a major life activity.

 Reasonable accommodation(s) may help to ameliorate the disability and to minimize its impact on the student's attention, impulsivity, and distractibility. The determination or reasonable
accommodation(s) rests with the designated disability contact person working in collaboration with the individual with the disability and when appropriate, college faculty. The receiving institution or agency has a responsibility to maintain confidentiality of the evaluation and may not release any part of the documentation without the individual's informed consent.

(1) AHEAD - Guidelines for documenting ADHD

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