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Guidelines for Attention Deficit Hyperactivity Disorder (AD/HD)

The Pennsylvania State University's Guidelines for Attention Deficit Hyperactivity Disorder (AD/HD)

I. Introduction

In order for AD/HD to be considered a disability, the student must demonstrate through documentation that their condition meets the definition of a disability under the Rehabilitation Act, 1973 and/or the ADA Amendments Act (ADAAA) of 2008. The ADAAA defines a disability as a physical or mental impairment that substantially limits one or more major life activity(s).

A clinical diagnosis is not synonymous with a disability. That is, evidence sufficient to render a clinical diagnosis might not be adequate to determine that an individual is substantially limited in a major life activity. The documentation must include the student's specific current functional impairment(s) and describe how the condition substantially limits a major life activity(s) in order for Penn State to fully evaluate the necessity for any of the following: academic adjustments, auxiliary aids, and/or auxiliary services

If the documentation submitted does not sufficiently address the student's current functional impairment or describe how the condition substantially limits a major life activity(s), additional information will be required.

It is the responsibility of the student to obtain appropriate documentation and present a copy to the Office for Disability Services (ODS) or to the Campus Disability Services Coordinator at other Penn State locations for review. Detailed information regarding reasonable academic adjustments, auxiliary aids and/or services, procedures for registration, documentation submission and determination of services, can be found on this website.

Individual Education Program (IEP) and Prior Academic Adjustments in Secondary Settings:

Secondary schools and post-secondary institutions are governed under different laws with regard to providing services to students with disabilities. A school plan such as an Individualized Education Program (IEP), a Comprehensive Evaluation Report (CER), or a 504 Plan are typically not considered sufficient documentation to establish the rationale for academic adjustments, auxiliary aids and/or services in the post-secondary setting. A possible exception would be an IEP, CER, or 504 Plan that meets all of the requirements defined by these guidelines.

II. Definition of Attention-Deficit/Hyperactivity Disorder:

Evaluators providing documentation to Penn State University should utilize the definition and diagnostic criteria for AD/HD from the current version of the Diagnostic and Statistical Manual of Mental Disorders. A specific diagnosis and corresponding DSM-IV code for an Attention-Deficit/Hyperactivity Disorder must be included in the report. The diagnostician should use direct language in the diagnosis of AD/HD, 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 AD/HD. 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 academic adjustments, auxiliary aids and/or services.

III. Evaluator Qualifications:

Professionals conducting assessment and rendering a diagnosis of AD/HD must be a licensed professional such as neuropsychologists or clinical psychologists. It is not appropriate for professionals to evaluate members of their family or others with whom they have personal or business relationships.

IV. Documentation Requirements:

Diagnostic reports for AD/HD must include the names, titles, and professional credentials of the evaluator(s) and include the signature of the professional(s) and the date(s) of testing. The reports must be typed and submitted on professional letterhead. Specific reporting format is left to the professional, but the required components must be clearly presented and easily discernable. Handwritten scores are not acceptable. In addition, assessment reports must include all of the following information (A through G) listed below:

A. Statement of Presenting Problem:

Describe the individual's presenting problem in terms of current academic functioning.

B. Evidence of Early Impairment:

Relevant historical information is essential because AD/HD is by definition, first exhibited in childhood (although it may not have been formally diagnosed) and manifested in more than one setting. The comprehensive assessment should include historical information establishing symptommatology indicative of AD/HD throughout childhood, adolescence, and adulthood (i.e., transcripts, report cards, teacher comments, tutoring evaluations, past psycho-educational testing, and third party interviews). Developmental information pertinent to the AD/HD diagnosis obtained from the student/student's parents/guardian must be included in the written report. Also, evidence of inattention and/or hyperactivity symptoms prior to age 7 must be included in the report submitted (e.g., daydreamer, spoke out of turn in class, was disruptive, had difficulty learning to read, had difficulty understanding directions, couldn't sit still, often misplaced things, etc.) Vague reports (from parents, student, family members or teachers) of childhood onset are insufficient.

C. Diagnostic Interview:

The information obtained in the diagnostic interview must consist of more than self-report. The diagnostic interview with information from a variety of sources must include, but not necessarily be limited to, the following:

  • History of presenting attentional symptoms, including evidence of ongoing inattention and/or hyperactive-impulsive behavior that has significantly impaired functioning over time.
  • Relevant developmental history.
  • Family history for presence of AD/HD and other educational, learning, physical, or psychological difficulties deemed relevant by the examiner.
  • Relevant medical and medication history.
  • Relevant psychosocial history.
  • A thorough academic history of elementary, secondary, and post-secondary education.
  • Review of prior psycho-educational test reports to determine whether a pattern of strengths or weaknesses is supportive of inattention/hyperactivity/impulsivity or learning problems.
  • History of prior academic adjustments including information about specific conditions under which the academic adjustments were utilized (e.g., standardized testing, final exams, licensing or certification examinations) and the extent to which they were beneficial.
  • Relevant employment history.

D. Testing:

1.- The assessment of the individual must not only establish a diagnosis of AD/HD, but must also demonstrate the current impact of AD/HD on an individual's ability to take standardized tests. Therefore, in addition to a full neuropsychological evaluation, psycho-educational testing is required in determining the current impact of the AD/HD on an individual's ability to function in an academic setting.

2.- Psycho-educational testing must be recent in order to accurately describe a student's current functional limitations and need for academic adjustments, accommodation and/or services.

3 - Tests utilized must be statistically reliable, statistically valid, and based upon the current version utilizing the most recent age based norms (grade based norms are not acceptable). These standards are defined by the current version of the "Standards for Educational and Psychological testing" jointly published by the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education.

4.- A full psycho-educational battery (series of tests) is required to meet the guidelines for AD/HD. A battery includes measures of aptitude test (IQ) and achievement. It is unacceptable to administer only one test or subtest for the purpose of a new diagnosis or with individuals with a previous diagnosis of a learning disorder and/or AD/HD. The following are recommended aptitude and achievement tests that are considered technically sound and standardized. However, other tests of aptitude or achievement can be utilized as long as they meet the quality and testing practices mentioned above.

5.- Short-form or abbreviated tests (i.e., WASI, WRAT, K-BIT) will not be acceptable as sole measures of ability or achievement.

a. Aptitude Tests:

A complete intellectual assessment with all subtests, cluster scores, standard scores, and percentiles reported is required. Examples of acceptable aptitude tests include the current  versions of:

  • The Wechsler Adult Intelligence Scale
  • The Stanford-Binet Intelligence Scale

b. Academic Achievement Tests:

A comprehensive academic achievement battery is required. Subtests, cluster scores, standard scores, and percentiles must be reported. The battery must include current levels of academic functioning including reading, writing, math, and other relevant areas.

Examples of acceptable achievement tests include the current versions of:

  • The Woodcock-Johnson Psycho-educational Battery, Tests of Achievement
  • The Wechsler Individual Achievement Test

6.- Objective Measures of Attention and Discrimination:

In addition to the above listed psycho-educational assessment, a current evaluation of the student's attention and discrimination must be obtained and provided in the report by using an objective measure of attention supporting the diagnosis of AD/HD (e.g., the Conners Continuous Performance Task, CPT; the Gordon Diagnostic System, GDS; the Intermediate Visual and Auditory, IVA, Continuous Performance Task; and the Test of Variables of Attention, TOVA/TOVA-A). The use of such measures assist in determining the level of functional impairment in attention, impulse control, and discrimination.

7.- Self-Reports and Observer Reports:

In addition to objective measures of attention and discrimination, information must be obtained and provided in the report utilizing self-reports and observer reports (e.g., the Conners Adult AD/HD Rating Scale, CAARS; the long version of the self-report form, CAARS-S:L; the observer form, CAARS-O:L; and the Brown Attention Deficit Disorder Scale).

Checklists and/or surveys can serve to supplement the diagnostic profile, but are not adequate for the diagnosis of AD/HD and do not substitute for clinical observations and sound diagnostic judgment.

E. Summary and Significant Functional Impairment:

1. - Test protocol sheets or scores alone are not sufficient. A well-written interpretative summary based on a comprehensive evaluative process is required (i.e. interpretation of historical data, observation, and objective diagnostic measures).

2 - The evaluator must investigate and discuss the possibility of dual diagnoses, and alternative or co-existing mood, behavioral, neurological, physical health, and/or personality disorders, which may confound the diagnosis of AD/HD. 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 AD/HD.Â

3 - A discussion of the current functional limitations must be contained within the report including ongoing inattention and/or hyperactive-impulsive behaviors that significantly impair functioning in two or more settings that are a direct result of problems with inattention / hyperactivity / impulsivity.

4 - When specifying the symptoms of inattention and/or hyperactivity-impulsivity, the diagnostic report should include a review and discussion of the DSM-IV criteria for AD/HD. This review should include current and past symptoms; must specify which symptoms of inattention and/or hyperactivity-impulsivity are present; the degree of severity of the symptom(s); and the supporting evidence for each symptom.

5 - A discussion of how these symptoms significantly impair the individual's functioning in a classroom setting and other settings is necessary to determine eligibility for services. A diagnosis of AD/HD is not enough to indicate functional limitation(s) in an academic setting. The evaluator must include the specific functional limitations of the student being evaluated in order for ODS to fully evaluate the necessity of accommodations.

F. Recommended Academic Adjustments, Auxiliary Aids and/or Services:

1. - The evaluator should describe the impact, if any, of the diagnosed AD/HD on a specific major life activity. A multifaceted evaluation should address the intensity and frequency of the symptoms and whether these behaviors constitute impairment in a major life activity. The student's functional limitations from the AD/HD specifically in a classroom setting must be discussed.

2. - The diagnostic report should include specific recommendations for academic adjustments, auxiliary aids and/or services that are realistic for a post-secondary institution that include the degree to which the condition and symptoms impact the student in a learning environment (i.e., the classroom) for which the academic adjustments, auxiliary aids and/or services are being requested.

3. - A rationale for each requested academic adjustment, auxiliary aid, and/or service and how the effects of the AD/HD symptoms (DSM-IV) are mediated by the requested academic adjustment, auxiliary aid and/or service.

4. - A statement of whether or not the student was evaluated while on medication, and whether or not there is a positive/negative response to the prescribed treatment.

5. - Records of prior academic adjustments, auxiliary aids, and/or services including information about specific conditions under which they were used (e.g., standardized testing, final exams, licensing or certification examinations) and whether or not the individual benefited from them.

G. ADHD Verification Form:

In addition to the evaluation described above, evaluators and providers will need to complete a Verification Form for Attention Deficit/Hyperactivity Disorder if the report does not sufficiently address current functional impairment(s) or reflect current treatment response (e.g., medication changes, life changes, changes in symptomatology, etc.). The verification form is not to be utilized in place of the documentation requirements above; rather, it is supplemental to a full report. The Verification of Attention-Deficit/Hyperactivity Disorder form can be obtained from ODS located in Room 116, Boucke Building, University Park, PA or call 814- 863-1807 (Voice or TTY) to have a copy sent via fax or mail. Also, this verification form can be found on this website. The student must complete Page 1, and the student's provider must complete Pages 2-8. This verification form (pages 1-8) should be returned to ODS at University Park or to the appropriate Campus Disability Services Coordinator office.

For a more detailed description of the documentation guidelines, please contact the Office for Disability Services at 814 863-1807 (V/TTY).

The Pennsylvania State University's Guidelines for Attention Deficit Hyperactivity Disorder (AD/HD)