Guidelines for Documentation of ADD/ADHD

Please note that AD/HD is commonly referred to as Attention Deficit Disorder (ADD) and for the purpose of these guidelines, these terms are interchangeable.

Introduction
Students requesting accommodations or services because of AD/HD at the University of Kansas Medical Center are required to submit documentation to determine eligibility in accordance with the Federal Rehabilitation Act of 1973, and/or the Americans with Disabilities Act of 1990 (ADA) and/or the Americans with Disabilities Act Amendments Act of 2008 (ADAAA). A diagnosis of AD/HD does not necessarily qualify a student for accommodations under the law. To establish that an individual is covered under the Rehabilitation Act and/or the ADA and/or the ADAAA, the documentation must indicate that the condition substantially limits some major life activity and/or major bodily function. For individuals previously diagnosed who have not continuously received medical, educational or employment support, a comprehensive evaluation may be necessary to determine whether academic or job accommodations are appropriate.

The following guidelines are provided in the interest of assuring that documentation of AD/HD is complete and supports the request for accommodations. The University of Kansas Medical Center will determine eligibility and appropriate accommodations, case-by-case, based on the quality, recency and completeness of the documentation submitted. The following requirements provide students, schools, and qualified professionals with a common understanding of the components of documentation that are necessary to validate a diagnosis of AD/HD, the impact on the individuals educational or job performance, and the need for academic or job accommodations for the purpose of the ADA, the ADAAA or the Rehabilitation Act.

Documentation Requirements

A Qualified Professional Must Conduct the Evaluation
The assessment must be administered by a trained and qualified (i.e., certified and/or licensed) professional, who has had direct experience with adults with AD/HD. A qualified professional may include but is not limited to a medical doctor, psychologist, or student clinician who is being supervised by a professional. The evaluator's name, title and professional credentials and affiliation should be provided. The professional completing the evaluation should not be a family member. All reports should be on letterhead, typed, dated, signed, and otherwise legible.

Documentation Must Be Current
Reasonable accommodations are based on the current impact of the disability on academic or job performance. In most cases, this means that a diagnostic evaluation should be age appropriate and relevant to the individual's learning or working environment, and show the individual's current level of functioning. If documentation does not address the individual's current level of functioning, a re-evaluation may be required.

Documentation Must Include a Specific Diagnosis
The report must include a specific diagnosis of AD/HD based on the DSM-IV diagnostic criteria. It is recommended that the clinician report the diagnostic criteria used to support the diagnosis. The diagnostician should use direct language in the diagnosis of AD/HD, avoiding the use of terms such as "suggests," "is indicative of" or "attentional problems."

 

Documentation Must be Comprehensive
The documentation must include a summary containing relevant historical information, instructional interventions, related services, and age of initial diagnosis. The documentation must also include objective data regarding aptitude, achievement and information processing. Test scores (standard scores, percentiles, and grade equivalents) must be included in the documentation.

Co-existing Conditions
The diagnostic assessment should examine the possibility of co-existing conditions including medical and psychiatric disorders as well as a possible learning disability. The evaluator should determine and discuss the possibility of alternative disorders that may mimic AD/HD.

Documentation Must Include Evidence of Current Impairment
Statement of Presenting Problem
A history of the individual's presenting attentional symptoms should be provided, including evidence of ongoing hyperactive-impulsive or inattentive behaviors that significantly impair functioning in an academic setting.
Diagnostic Interview
Information from a structured interview should be thorough and may include:

  • Family history
  • Educational history
  • Developmental history
  • Medical history
  • Social history
  • Review of prior psycho-educational reports
  • Description of current functional limitations pertaining to an educational setting 
  • Relevant history of therapeutic treatment


Documentation Must Include Relevant Testing Information
Psycho-educational assessments are important in determining the current impact of the disorder on the individual's ability to function in an academic or employment setting. The report must include objective data, which might include, but not be limited to psychological assessments, educational assessments, rating scales, memory function tests, attention or tracking tests, or continuous performance tests. A score report page(s), which presents the test, sub test, standard scores, and percentiles, should accompany the report.

Current Plan for Treatment and Effects of Medication
The current plans for treatment, including the use of medications, should be summarized. Whether or not the individual was evaluated while on medication and whether the use of medications mitigates the impact of the disorder on the individual's ability to function in an academic or employment setting should be indicated.

Recommendations for Accommodations
A diagnostic report should include specific recommendations for accommodation(s). A prior history of an accommodation, without a demonstration of a current need, does not in and of itself warrant the provision of a like accommodation. Each accommodation recommended by an evaluator should include a rationale. The evaluation should support the recommendations with specific test results or clinical observations. If an accommodation is not clearly identified in the diagnostic report, the University of Kansas Medical Center will seek clarification and, if necessary, more information, and will make the final determination as to whether appropriate and reasonable accommodations are warranted and can be provided. The University of Kansas Medical Center reserves the right to request reassessment when questions regarding previous assessment or previous service provision arise.


Examples of Typical Measures Used in Adult Assessment of AD/HD
(this is not intended to be a complete list, but rather serve as a guide for clinicians)

Rating Scales

  • Wender Utah Rating Scale
  • Brown Attention-Activation Disorder Scale
  • Beck Anxiety Inventory
  • Hamilton's Depression Rating Scale

Neuro-psychological and psycho-educational testing:
For Aptitude/Cognitive Ability

  • Wechsler Adult Intelligence Scale - III (WAIS III)
  • Woodcock-Johnson Psycho-educational Battery - Revised: Tests of Cognitive Ability
  • Kaufman Adolescent and Adult Intelligence Test

For Academic Achievement

  • Scholastic Abilities Test for Adults (SATA)
  • Stanford Test of Academic Skills (TASK)
  • Woodcock-Johnson Psycho-educational 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

For Information Processing

  • Detroit Tests of Learning Aptitude - 3 (DTLA-3) or Detroit Tests of Learning Aptitude - Adult (DTLA A)
  • Information from subtests on WAIS IV or Woodcock Johnson Psycho educational Battery - Revised: Tests of Cognitive Ability

 

 


Revised: September, 2013

Last modified: Nov 19, 2013
ID=x15146