Guidelines for Documentation of Neurodevelopmental Disorders and Need for Accommodation

Please provide these guidelines to your diagnosing/treating professional.

Note: These guidelines are applicable to requests for accommodation of a neurodevelopmental disorder, as defined in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including but not limited to specific learning disorders, Autism Spectrum Disorder, and ADHD.

Introduction: To Students

In order to fully evaluate your request for accommodation, W&L will need adequate documentation of your disability and your need for accommodation by virtue of the specific functional limitations of your disability.

Note: a diagnosis of any impairment, though required, does NOT in and of itself automatically mean that you have a "disability" under the ADA or that you qualify for a reasonable accommodation under the ADA. While a neurodevelopmental impairment may be a source of discomfort or stress, a student who has an impairment, even one that constitutes a "disability" under the ADA, may not necessarily require accommodation.

You should refrain from taking medication during testing that might alter your performance on tasks. You should consult with your evaluator about testing on or off medication. Testing off medication will increase the possibility that the testing will show current functioning more accurately.

W&L has developed these guidelines to help your diagnosing/treating professional(s) prepare the documentation needed to support your accommodation request. The designated administrator (as specified in the University's disability accommodations policies) will maintain all documentation received in a confidential file, separate from your academic record, and will disclose the documentation only in accordance with law or your consent.

Information for Diagnosing/Treating Professionals

Definitions Applicable To All Student Accommodation Requests

Guidelines For Documentation Of A Neurodevelopmental Disorder And Need For Accommodation

In order to verify eligibility for academic accommodation under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act, students should provide documentation that their neurodevelopmental impairment currently substantially limits some major life activity and that they need accommodation by virtue of the specific functional limitations of the neurodevelopmental impairment. The following documentation guidelines are provided in the interest of assuring that documentation of neurodevelopmental disorders, including specific learning disorders (LD) and Attention-Deficit/Hyperactivity Disorder (ADHD), is appropriate to verify eligibility and to support requests for reasonable accommodations. These guidelines apply to both LD and ADHD, as well as other disorders that affect neurodevelopmental abilities, except where indicated to relate exclusively to ADHD. W&L reserves the right to request additional documentation as necessary to fully evaluate individual requests for accommodation.

I. A Qualified Professional Must Conduct a Current Evaluation

Professionals conducting assessments and rendering diagnoses of neurodevelopmental disorders must have comprehensive relevant training in differential diagnosis of neurodevelopmental disorders and experience with adults. The following professionals would generally be considered qualified to evaluate and diagnose neurodevelopmental disorders: clinical psychologists, neuropsychologists, and educational psychologists, psychiatrists (ADHD).

Because the provision of reasonable accommodations is based on assessment of the current functional impact of the student's disability on academic performance, it is in a student's best interest to provide documentation of recent testing. This generally means that a comprehensive evaluation should have been conducted within the past three years using the adult version of assessment tools. If documentation is inadequate in scope or content, or does not address the individual's current level of functioning, reevaluation and/or additional testing will be required. If the impairment is one that is episodic or has been in remission, the designated administrator may require documentation describing the functional impact of the impairment at the time it recurs.

Note: a psychiatric evaluation without the relevant testing is not acceptable.

II. Documentation Must Be Comprehensive
  1. Evidence of Impairment: A Diagnostic Interview
  2. Relevant Testing
  3. Evidence of DSM-5 Criteria (ADHD)

Note: For documentation of LD, all elements of Subparts A and B must be provided. For documentation of ADHD, all elements of Subparts A, B, and C must be provided.

A. Evidence of Impairment: A Diagnostic Interview

The report of assessment should include a comprehensive diagnostic interview that includes relevant background information from a variety of sources to support the diagnosis. The report of assessment should include, but not necessarily be limited to, all of the following areas as relevant to the disability and the current request for accommodation(s):

B. Relevant Testing: Neuropsychological/Psychoeducational Evaluation in Unmitigated State

The neuropsychological or psychoeducational evaluation for the diagnosis of a neurodevelopmental disorder should provide clear and specific evidence that a neurodevelopmental disorder does or does not exist. The data should logically connect the specific substantial limitation to learning or other major life activity for which the student requests accommodation. The test findings must document both the nature and severity of the neurodevelopmental impairment(s) involved.

Students should refrain from taking medication during testing that might alter their performance on tasks. Students should consult with their evaluator about testing on or off medication. Testing off medication will increase the possibility that the testing will show current functioning more accurately.

It is not acceptable to administer only one test, nor is it acceptable to base a diagnosis on only one of several subtests. The tests used must be reliable, valid, and standardized for use with an adult population.

Actual test scores must be provided. Age norms should be used unless not available for that specific test. In addition to test scores, interpretation of results is required. Test protocol sheets or scores alone are not sufficient.

Domains to be addressed should include the following:

  1. Cognitive Ability

    A complete aptitude assessment is required with all subtests and standard scores. The preferred instrument is the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV). Other acceptable instruments include, but are not limited to, the Woodcock - Johnson Psychoeducational Battery -IV: Tests of Cognitive Ability; the Stanford-Binet Intelligence Scale: Fifth Edition.

  2. Achievement

    A complete achievement battery, with all subtests and standard scores, must be provided. The battery should include current levels of academic functioning in reading (decoding and comprehension), mathematics, and written language. If an accommodation request includes extended time for tests, timed measures of relevant academic skills should be included. Accommodation recommendations based on an ADHD diagnosis require evidence from a full psychoeducational evaluation that the student has deficits directly related to each accommodation request. For instance, if extended time for tests is being requested, testing should include academic fluency measures and other timed measures of academic skills showing that the student is substantially impaired in his/her ability to complete the work in a timely manner.

    Recommended instruments include, but are not limited to, the Woodcock - Johnson Psychoeducational Battery-IV: Tests of Achievement; the Nelson - Denny Reading Skills Test; the Gray Oral Reading Test - Fifth Edition; and the Wechsler Individual Achievement Test - III. The Wide Range Achievement Test - 4 (WRAT-4) is not a comprehensive measure of achievement and therefore is not acceptable if used as the sole measure of achievement. Note: if the student is requesting accommodation of a foreign language course requirement, the Modern Language Aptitude Test (MLAT) or an alternate instrument designed to measure skills relevant to language learning should be included in the battery. For some foreign language course substitution requests, auditory processing assessment is also indicated (see below). The results of any language learning testing will be reviewed in the context of other testing scores, academic history, past language attempts, and level of motivation.

  3. Information Processing

    Specific areas of information processing (e.g., short and long term memory; sequential memory; auditory and visual perception/processing; processing speed; executive functioning; motor ability) must be assessed, including the nature and extent of all processing deficits, in addition to other information provided regarding functional impairment.

    Acceptable instruments include, but are not limited to, the Detroit Test of Learning Aptitude - 4 (DTLA-4), the Wide Range Assessment of Memory and Learning - 2 (WRAML2), Wisconsin Card Sort, Trails A and B, Rey-Osterrieth Complex Figure Drawing (REY-O). Information from subtests on the WAIS-IV, or the Woodcock - Johnson Psychoeducational Battery-IV; Tests of Cognitive Ability, Wechsler Memory Scale - IV, Luria-Nebraska Neuropsychological Battery, Halstead-Reitan Neuropsychological Battery, as well as other instruments may be used to address these areas. For students with ADHD, computerized assessment of attentional functioning, (e.g., Continuous Performance Test (CPT)), is strongly encouraged. Weaknesses in Processing Speed or Executive Functions do not automatically qualify a student for extended time; rather, an accommodation for extended time must be supported by data that clearly shows work pace deficits on timed measures specifically related to academic skills, such as reading, writing, and/or math.

  4. Other Assessment Measures

    Other standard and formal assessment measures (e.g., personality, clinical, or behavior inventories) may be integrated with the above documents to help support a dual diagnosis, or to disentangle the neurodevelopmental disorder from coexisting mood, behavioral, neurological, and/or personality disorders. In addition to standardized test batteries, it is also very helpful to include informal observations of the student during the test administration. Nonstandard measures and informal assessment procedures may be helpful to determine performance across a variety of domains.

C. Identification of DSM-5 Criteria (ADHD only)

According to the Diagnostic and Statistical Manual of Mental Disorders: (DSM-5) (2013), 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-5 criteria for ADHD and specify which symptoms are present from those specified in the criteria. The following diagnostic criteria for ADHD are specified in the DSM-5 (American Psychiatric Association, 2013):

  1. Either (1) or (2):

    1. Five (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Note: for individuals under the age of 17, at least six symptoms are required:

      Inattention (Note: symptoms not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions).

      1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (e.g., overlooks or misses details, work is inaccurate)
      2. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading)
      3. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction)
      4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily side-tracked)
      5. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficult keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
      6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; in older adolescents or adults, preparing reports, completing forms, reviewing lengthy papers)
      7. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools. wallets, keys, paperwork, eyeglasses, mobile telephones)
      8. Is often easily distracted by extraneous stimuli (in older adolescents or adults may include unrelated thoughts)
      9. Is often forgetful in daily activities (e.g., doing chores, running errands; in older adolescents or adults, returning calls, paying bills, keeping appointments)

    2. Five (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Note: for individuals under the age of 17, at least six symptoms are required:

      Hyperactivity (Note: symptoms not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.)

      1. Often fidgets with or taps hands or feet or squirms in seat
      2. Often leaves seat in situations when remaining seated is expected (e.g., leaves place in the classroom, office or other workplace)
      3. Often runs about or climbs in situations in which it is inappropriate (in adolescents or adults, may be limited to feeling restless)
      4. Often unable to play or engage in leisure activities quietly
      5. Is often "on the go" acting as if "driven by a motor" (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)
      6. Often talks excessively

      Impulsivity

      1. Often blurts out an answer before a question has been completed (e.g., completes people's sentences; cannot wait for turn in conversation)
      2. Often has difficulty waiting his/her turn (e.g., while waiting in line)
      3. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people's things without asking or receiving permission; in adolescents or adults, may intrude into or take over what others are doing)
  2. Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  3. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school or work; with friends or relatives; in other activities).
  4. There is clear evidence that the symptoms interfere with, or reduce the quality of social, academic, or occupational functioning.
  5. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
The DSM-5 specifies a code designation based on presentation
III. Documentation Must Include a Specific Diagnosis and Demonstrate a Substantial Limitation to a Major Life Activity as Compared to the Average Person in the General Population

The report must include a specific diagnosis of a neurodevelopmental disorder. For example, "individual learning styles," "learning differences," "attention problems," "foreign language disability" and "test anxiety" are not by themselves neurodevelopmental disorders for which accommodations will be granted. The specific diagnosis must be supported by test data, academic history, anecdotal and clinical observations that may include comments about the candidate's level of motivation, study skills, and other non-neurodevelopmental factors. These findings must demonstrate that the candidate's functional limitations are due to the diagnosed disorders.

It is important that the diagnostician demonstrate having ruled out alternative explanations for academic problems, such as emotional, medical, or psychological disorders, or motivational or study skill problems that may interfere with learning or another major life activity, but which do not, in and of themselves, constitute a neurodevelopmental disorder.

IV. Recommended Accommodations with Rationale

The comprehensive report must recommend specific accommodations. The diagnostician must include a detailed explanation as to why each recommended accommodation is necessary and must reference specific current functional limitations (determined through test results and clinical observations) that support the need for the accommodation. The report may also include an explanation of current treatments, medications, or other accommodations and/or self-accommodations, including any patient-reported information on effectiveness of such measures. An Individualized Education Program and/or 504 Plan can be included as part of a comprehensive report, but is insufficient by itself to establish the rationale for a recommended accommodation.

Note: It is important to note that no specific accommodation suggested by an evaluator is guaranteed by Washington and Lee University. The University's obligation is to provide a reasonable accommodation to an otherwise qualified person with a disability, not necessarily to provide particular accommodations requested or recommended.