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Verification
for Attention-Deficit /Hyperactivity Disorders in Adults
I.
Documentation Requirements
| A. |
A Qualified Professional Must Conduct the Evaluation |
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| 1. |
Professionals
conducting evaluations and rendering diagnoses or diagnostic
impressions of and making recommendations for accommodations
must be qualified to do so. Generally, psychologists,
psychiatrists, relevantly trained physicians and relevantly
trained licensed professional counselors are considered
qualified. Finally, the name, title, and credentials of
the qualified professional writing the report should be
included. Information about license or certification,
as well as the area of specialization, employment, and
state or province in which the individual practices, should
also be clearly stated in the documentation. All reports
should be in English, typed or printed on professional
letterhead, dated, and signed.
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| B. |
Documentation
Must Be Current |
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| 1. |
Reasonable
accommodations and services are based on the assessment
of the current impact of the disability on academic performance.
In most cases an evaluation must have been completed within
the last three years. There is some flexibility in accepting
documentation that is older if the previous assessment
is applicable to the current or anticipated situation.
More recent documentation may be required if changes have
occurred in the individual’s performance or medication
since the previous assessment.
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| C. |
Documentation
must be consistent with the Diagnostic and Statistical Manual,
Fourth Edition (DSM-IV-TR) criteria for diagnosis of the
disorder(s), substantiates the diagnosis, and be comprehensive.
The following should be included iin a comprehensive assessment: |
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| 1. |
Evidence
of Early Impairment - 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, and past psycho-educational testing; and
third party interviews when available.
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| 2. |
Evidence of Current Impairment - 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.
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| 3. |
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:
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| a) |
history
of presenting attentional symptoms, including evidence
of ongoing impulsive/hyperactive or inattentive
behavior that has significantly impaired functioning
over the lifespan |
| b) |
developmental history
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| 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) |
a
review of prior psycho educational 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 |
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| 4. |
Alternative
Diagnoses or Explanations Should Be Ruled Out -The evaluator
must investigate and discuss the possibility of dual diagnoses
and alternative or coexisting mood, behavioral, neurological,
and/or personality disorders that 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 affecting
the individual that may result in behaviors mimicking
an Attention-Deficit/Hyperactivity Disorder.
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| 5. |
Relevant
Testing Information Must Be Provided -The assessment of
the individual must not only establish a diagnosis of
ADHD, but must also demonstrate the current impact of
the ADHD on an individual's ability to function in the
academic setting. In addition, neuropsychological or psycho
educational assessment is important in determining the
current impact of the disorder on an individual's ability
to function in academically related settings. The evaluator
must objectively review and include with the evaluation
report relevant background information to support the
diagnosis and its impact within the current educational
environment. If grade equivalents are reported, standard
scores and/or percentiles must accompany them. 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.
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| 6. |
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"
(p. 78). 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.
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| 7. |
Documentation
Must Include 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 such terms
as "suggests," "is indicative of,"
or "attention problems."Individuals who report
only problems with organization, test anxiety, memory
or 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 accommodation(s).
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| 8. |
An
Interpretative Summary Must Be Provided - A well-written
interpretative summary based on a comprehensive evaluative
process is a necessary component of the documentation.
The summary will indicate whether the candidate was evaluated
while on medication and what response the treatment produced;
will discuss the limitation and degree to which the condition
affects learning in the academic setting as related to
accommodations requested; will specify what accommodations
are needed: and how the accommodations will mediate the
effects of the ADD/HD symptoms.
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| 9. |
Each
Accommodation Recommended by the Evaluator Must Include
a Rationale - The diagnostic report must include specific
recommendations for accommodations that are realistic
and that postsecondary institutions can reasonably provide.
An explanation as to why each accommodation is recommended
must be provided and should be correlated with specific
functional limitations determined through interview, observation,
and/or testing. 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. |
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(Adapted
from Educational Testing Service Disability Guidelines for Documentation,
Princeton, New Jersey, 2001)
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