Disabilities and Health-related Needs
Guidelines for Documentation of Attention-Deficit/Hyperactivity Disorder (ADHD) in Adolescents and Adults, Third Edition
2016
Office of Disability Policy
Educational Testing Service
Princeton, NJ 08541
Introduction
ETS is committed to providing reasonable testing accommodations for candidates with documented disabilities or health-related needs as recognized under the ADA Amendments Act of 2008 (ADA AA). We treat requests for accommodations on a case-by-case basis and have established policies and procedures that ensure that people with disabilities or health-related needs have access to our tests. This document contains information to guide test takers in requesting accommodations for ADHD. It also includes information for evaluators to guide them in documenting ADHD and in providing rationales for their recommendations of appropriate testing accommodations.
To provide more information to your evaluators, direct them to our “For Evaluators” page.
You may refer to our "For Test Takers" page for helpful information on requesting accommodations, registering for a test and scheduling a test date. Also use this page for a list of common accommodations, information on where to find bulletins for the test(s) you plan to take, how to submit documentation to ETS in support of requested accommodations, and to register, pay for and schedule the test(s).
Please note that there are differences between the laws that govern accommodations in K–12 education and those that apply to postsecondary education, which emphasize equal access to educational opportunities. Because of these differences, you may not qualify for the same accommodations you received in the past in a different educational setting. Depending on the information you are able to provide after a collaborative process with ETS’s reviewers, ETS may approve some, all or none of the accommodations you request.
Confidentiality
ETS takes seriously its responsibility to maintain the confidentiality of your documentation and will not release any part of the information you provide without your informed consent or under compulsion of legal process. Visit Disabilities and Health-related Needs to read our confidentiality statement.
Definition and Diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD)
The current version of the Diagnostic and Statistical Manual of Mental Disorders (5th edition) defines ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has presented symptoms in two or more settings (e.g., at home, school or work; with friends or relatives; and in other activities) for at least the past six months, and has direct negative impact on social, academic or occupational functioning. The DSM-5 specifies that several symptoms must have been present before age 12 (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth edition, 2013).
Just having some of these symptoms, however, is not sufficient for diagnosis, as a large proportion of adolescents and adults report experiencing some of the ADHD symptoms listed in the DSM-5. Individuals who only report test anxiety or problems in particular situations with daily organization, timed testing, memory or concentration do not fit the diagnostic criteria for ADHD. Similarly, while executive function issues are commonly seen in students who have ADHD, students with executive function issues who do not meet the criteria for ADHD would not qualify under the ADHD classification. A positive response to medication by itself does not constitute a diagnosis, nor does the use of medication in and of itself either support or negate the need for accommodation(s).
Documentation Details
I. Who should conduct my evaluation?
A qualified professional should conduct the evaluation. The following professionals generally are considered qualified to evaluate and diagnose ADHD if they have comprehensive training in differential diagnosis and direct experience with an adolescent or adult ADHD population: psychologists, neuropsychologists, school psychologists, clinical social workers and psychiatrists. Supplemental information from other relevantly trained professionals may be helpful in support of requested accommodations.
The name, title and professional credentials of the evaluator — including information about licensure or certification, as well as the areas of specialization, employment and the state or province in which the individual practices — should be clearly stated in the documentation. All reports should be on letterhead, typed in English, dated, signed and otherwise legible.
II. What documents should I submit?
A. Document(s) addressing DSM-5 criteria
A diagnostic report to support the need for testing accommodations should include a specific diagnosis of ADHD (including the subtype) based on the current DSM diagnostic criteria and provide a rationale and supporting data to substantiate this diagnosis. It should rule out alternative explanations — such as medical conditions, other psychological disorders or noncognitive factors — for inattentiveness, impulsivity and/or hyperactivity and investigate and discuss the possibility of dual diagnoses. The report also should explore any educational and cultural factors potentially affecting ADHD diagnosis, and the ameliorative effects of medications, strategies and/or treatments.
Because of the challenge of distinguishing the range of normal behaviors and developmental patterns of adolescents and adults — e.g., procrastination, disorganization, distractibility, restlessness, boredom, academic underachievement or failure, low self-esteem, chronic tardiness or non-attendance — from clinically significant impairment, an evaluation should address the severity and frequency of the symptoms and whether these behaviors constitute an impairment in a major life activity. A current evaluation report should not simply refer to a prior diagnosis as confirmatory evidence of ADHD. The current assessment needs to reconfirm the diagnosis with supporting clinical data and an updated rationale for accommodations.
B. Evidence of early impairment and current impact
By definition in the DSM-5, ADHD is exhibited in childhood or early adolescence, although it may not yet be formally diagnosed. The provision of reasonable accommodations and services is based upon clear evidence of the current impact of the disability on your academic performance. In most cases, this means that a diagnostic evaluation has been completed within the past five years.
The documentation should include a summary of the diagnostic interview conducted by a qualified evaluator. This interview, with information from a variety of sources, may include, but not necessarily be limited to, the following:
- history of presenting ADHD symptoms, including evidence of ongoing inattentive and/or impulsive/hyperactive behavior that has significantly impaired functioning over time and across settings
- developmental, psychosocial, and vocational history
- family history, specifically for incidence of ADHD
- educational history (including previous standardized test scores, group-administered test scores, IEPs, 504 Plans, report cards and/or listings of previously obtained accommodations and evidence of their effectiveness)
- relevant medical and medication history; effects of medication (either positive or negative), including whether the typical medical regimen was in effect at the time of the evaluation
- for each requested accommodation, a rationale related to how your disability affects you in the testing situation
Please note that a complete psycho-educational or neuropsychological assessment is often recommended for determining the degree to which the ADHD currently impacts you relative to taking standardized tests. Such assessments might include testing of intellect, achievement, processing speed, fluency, executive functioning, language, memory and learning, attention, etc. Depending on the type of accommodations you request, academic achievement testing may be necessary. For example, if you request a reader as an accommodation, achievement measures pertinent to reading may be required.
Please report complete test scores, not selective or partial scores. If you report grade equivalents, we prefer standard scores and/or percentiles to accompany the grade equivalencies. Selected subtest scores from measures of intellectual ability, memory function tests, attention or tracking tests or continuous performance tests do not in and of themselves establish the need for accommodations. Checklists and/or surveys can serve to supplement the diagnostic profile but may not, in and of themselves, be adequate for identifying functional limitations and are not a substitute for clinical observations and sound diagnostic judgment. All data and documents you provide should logically reflect a substantial limitation on learning and/or attention to the test(s) for which you are requesting an accommodation.
III. What if my documentation is more than five years old?
If your documentation is more than five years old, you have the option of submitting either new documentation or a documentation update. A documentation update is a report by a qualified professional that includes a summary of the original disability documentation findings as well as additional clinical data necessary to establish your current eligibility and the appropriateness of the requested testing accommodation(s).
We recommend that the summary in a documentation update include:
- a restatement of the current diagnosis, including date(s) for all prior diagnoses and data that were used to establish each diagnosis
- verification of continuing weaknesses in those areas identified in prior evaluation(s)
- a statement about current functional limitations due to your disability
- observational data, gathered during the evaluation, of behavior such as affect, concentration, attentional fatigue, executive functioning and fluency
- a history of the accommodations you have received and the consistency and circumstances of their use (e.g., type of test for which accommodations were most helpful), or an explanation of why accommodations have not been used previously, but are needed now
- a discussion of the appropriateness of the requested accommodations for ETS tests
Additional evaluation data for an ADHD update may include achievement measures that substantiate the ongoing impact of the disability on academic performance. Assessment of cognitive functioning is necessary only if the existing documentation does not contain adequate and age-appropriate information to establish the current functional limitations. Finally, the extent of retesting required for a documentation update is applicant-specific and will be evaluated individually.
Conclusion
ETS is committed to providing equal access to our assessments for all test takers. If you have been diagnosed with ADHD and believe you need accommodations for equal access during the standardized testing process, ETS will evaluate, individually, the information that you provide and will work with you to identify any additional documents we require to make a timely determination of your eligibility for accommodations. Of the many thousands of applicants who request accommodations every year, over 80 percent ultimately receive accommodations. We welcome the opportunity to engage in discussions with test takers who have disabilities to determine reasonable accommodations on a case-by-case basis.