Attention Deficit & Hyperactive Disorder
Purdue University is required by Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 to provide effective auxiliary aids and services for qualified students with documented disabilities if such academic adjustments are needed to provide equitable access to the University's programs and services. Federal law defines a disability as "a physical or mental impairment that substantially limits one or more major life activities." Major life activities are defined as the ability to perform functions such as walking, seeing, hearing, speaking, breathing, learning, working, or taking care of oneself. It is important to note that a diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) does not necessarily constitute a disability. The degree of impairment must be significant enough to "substantially limit" one or more major life activities.
The mission of the Disability Resource Center (DRC) is to provide services that enable and encourage eligible students with disabilities to seek success in their intellectual and personal development at Purdue and elsewhere. The staff of the Disability Resource Center, in collaboration with the wider University community, ensures these students access to academic and extracurricular activities. The mission of the Disability Resource Center includes the provision of accommodations to qualified students with a ADHD. The documentation guidelines are designed to allow the Disability Resource Center to achieve these goals.
The Purdue University guidelines for documentation of ADHD were developed to aid professionals who assess Purdue students. The documentation must include a specific diagnosis of ADHD, account for other alternative diagnoses, be current, and be comprehensive. The documentation must establish the functional limitations of ADHD, how it impairs the person and how it may impact educational performance. The definition of a functional limitation is: A substantial impairment in the individual's ability to perform in the condition, manner or duration of a major life activity. Academic adjustments may be recommended; however, a clear and convincing rationale is required to identify the necessity of the adjustments to achieve access. (Note: there are additional guidelines that apply to the diagnosis of Learning Disorders (LD) or to the diagnosis of a Psychological Disability.)
The staff of the Disability Resource Center on a case-by-case basis makes the determination of whether a diagnosed ADHD disorder rises to the level of a substantial limitation of a major life activity. Further, they determine what reasonable adjustments in the academic activities are needed to provide access. If the quality or quantity of the documentation is inadequate, the options for Disability Resource Center staff are to deny eligibility, to deny a requested adjustment or to request additional documentation.
Information provided to the Disability Resource Center is considered confidential. Documentation and evaluation information will not be released outside of the academic community without the consent of the student or under compulsion of legal process. Generally, documentation and evaluation information is not shared within the academic community without the consent of the student.
FOR ATTENTION DEFICIT/HYPERACTIVITY DISORDERS
The guidelines follow the generally accepted criteria for diagnosing ADHD provided in the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS - Fourth Edition (DSM-IV). The diagnostic information will be reviewed using the criteria (See Supplemental Information - I.) provided in the DSM-IV. Professionals are not required to use the DSM-IV. Notwithstanding use or non-use of the DSM-IV, substantial information about the student's diagnosis is required. This need for substantial diagnostic information reflects the requirement upon Disability Resource Center staff to make judgments about eligibility and appropriate academic adjustments.
DIAGNOSIS OF ADHD
The documentation must clearly state a diagnosis of ADHD.
DOCUMENTATION MUST BE CURRENT
Because of developmental changes as an individual matures and because the provision of academic adjustments and other services is based upon an assessment of the current impact of the impairment on educational performance, recent documentation is required. Generally, this means that a diagnostic evaluation must have been completed within three years. If the documentation is older than three years, reevaluation may be required.
DOCUMENTATION MUST BE COMPREHENSIVE
An assessment report providing information and client history from the clinical interview and other assessment instruments (as appropriate) is required. All reports should be on letterhead and must be typed, dated, and signed.
(For a sample report see Supplemental Information - III.)
- CLINICAL INTERVIEW. Common components of the clinical interview are:
- Evidence of childhood impairment. (e.g., elementary school grade cards, discipline examples, etc.)
- Evidence of current impairment and the impact on education. (e.g., secondary school grade cards, discipline examples, etc.)
- Statements demonstrating the elimination of or ruling out of alternative diagnoses that might otherwise explain the symptoms of the impairment.
- Statements addressing the intensity and frequency of the symptoms. A comprehensive evaluation will address the challenge of distinguishing a clinically significant impairment from the 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 nonappearance).
- Statements articulating the impact of the impairment on one or more major life activities.
- Statements about the use and impact from medications and therapies. (A positive response to prescribed medications and therapies does not confirm a diagnosis nor does the use of medication support or negate the need for academic adjustments.)
- Interpretive Summary.
- OTHER ASSESSMENT INSTRUMENTS. Commonly several diagnostic instruments are used to provide a foundation of information upon which to base a diagnosis and to identify the student's functional status. (See Supplemental Information - II.) The information from the other assessment instruments which are used will include:
- The name of the assessment instrument(s) used.
- The scores obtained. (Standard scores, T-scores, percentiles, etc.)
- The interpretation of the scores.
QUALIFICATIONS OF THE EVALUATING PROFESSIONAL
Professionals conducting assessments, rendering diagnoses, and making recommendations for adjustments for students with ADHD, must have comprehensive training and relevant experience in differential diagnosis of ADHD and direct experience with the adolescent or adult ADHD population. Qualified professionals may include: psychologists, neuro-psychologists, psychiatrists, and other relevantly trained medical doctors. The name, title, and professional credentials of the evaluator should be clearly stated in the documentation. Information about license or certification, area of specialization, employment, and state in which the individual practices should also be included.
Academic adjustments may be recommended. Generally, academic adjustments are assisting devices, modifications or adaptations that serve to ease the current impact of the disorder on a particular activity. The rationale for a recommended adjustment must be clear and convincing as to the necessity of the adjustment to achieve access.
QUESTIONS/ DOCUMENTATION SUBMISSION
If you have questions regarding the nature of the information needed for students with ADHD disorders, please call the Disability Resource Center at (765) 494-1247, Monday through Friday from 8:00 a.m. to 5:00 p.m.
All documentation should be submitted to:
Disability Resource Center
Ernest C. Young Hall, Room 830
155 S Grant Street
West Lafayette, IN 47907
Fax: (765) 496-3759
- DIAGNOSTIC CRITERIA FOR ADHD
The following information is provided for the purpose of reference for professionals not using or not familiar with the DSM-IV.
The components of and criteria for a diagnosis of ADHD are outlined in the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS - Fourth Edition (DSM-IV). The current version of the DSM-IV states, "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). The DSM-IV specifies that the following criteria must be met when diagnosing ADHD.
- Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
- Often fails to give close attention to details or makes mistakes in schoolwork, work, or other activities.
- Often has difficulty sustaining attention in tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instruction).
- Often has difficulty organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
- Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
- Is often easily distracted by extraneous stimuli.
- Is often forgetful in daily activities.
- Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
- Often fidgets with hands or feet or squirms in seat.
- Often leaves seat in classroom or in other situations in which remaining seated is expected.
- Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
- Often had difficulty playing or engaging in leisure activities quietly.
- Is often "on the go" or often acts as if "driven by a motor".
- Often talks excessively.
- Often blurts out answers before questions have been completed.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
- Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
- Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
- There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
- The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Mental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, or a Personality Disorder)
DIAGNOSTIC CODES. The DSM-IV diagnostic code identifies several types of ADHD.
Attention Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: If Criteria A1 is met but Criterion A2 is not met for the past six months.
Attention Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: If Criterion A2 is met but Criterion A1 is not met for the past six months.
Attention Deficit/Hyperactivity Disorder, Combined Type: If both Criteria A1 and A2 are met for the past six months.
Coding Note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet the full criteria, "In Partial Remission" would be specified in the diagnosis.
OTHER ASSESSMENT INSTRUMENTS
The basic diagnostic instrument is the clinical interview. Commonly, several other diagnostic instruments are used to provide a broader foundation of information upon which to base a diagnosis and to identify the student's functional status. The following information is provided for the purpose of reference for professionals using other assessment instruments.
The common functional areas and the frequently used diagnostic instruments for each are:
Cognitive Functioning - provides a wealth of information on how the student copes with a variety of verbal and visual/spatial tasks. Using one instrument: Wechsler Adult Intelligence Scale, Third Edition with subtests (as appropriate); or Woodcock-Johnson Tests of Cognitive Ability - III.
Alternating and Divided Attention - provides information about mental flexibility (the ability to shift focus) and the ability to simultaneously attend to multiple demands. Using at least two instruments: Wisconsin Card Sort; Attentional Capacity Test (ACT); Paced Auditory Serial Addition Test (PASAT); Trail Making Tests, Parts A and B; or Kagen Matching Familiar Figure Test (KMFFT).
Target Focus - provides information about sustained and selective attention over time. Using one instrument: Tests of Variable Attention (TOVA); Connors' Continuous Performance Test (CPT); or Gordon Diagnostic System (GDS).
Executive Functioning - provides information about problem solving methods, frustration levels, restlessness, and distractibility. Using at least two instruments: Halstead - Reitan Category Test; Porteus Maze Test; Tower of London (sequencing and planning); Stroop Neurological Screening Test (SNST); Wisconsin Card Sort; Rey-Osterrieth Complex Figure Task; or Letter Cancellation Task.
Memory Functioning - provides information about long term and short term memory. Using one instrument: Wechsler Memory Scale - III (WMS-III); California Verbal Learning Test (CVLT); or the Verbal and Nonverbal Selective Reminding Tests.
Self and Other Reports - provides information about functioning from questionnaires. Using two instruments (one from a significant other [parent or sibling completing the checklists as it pertains to the student] and the other from the student: Wender Utah Rating Scale (WURS); Barkley Self-Rating Symptom Checklist for ADHD Adults; Copeland System Checklist for Adult Attention Deficit Disorders; Connors' Adult ADHD Rating Scales (CAARS); or Brown ADD Scales (Adult).
- Report Format (Sample) / Assessment Battery (Sample)
Name: Birth date: Sex: Ethnicity: Dates of Testing: Age at Testing: Date of Report: Referral: Examiner:
Referral and Presenting Problems:
Evaluation Instruments: (Sample Battery)
Parental History Questionnaire
Behavioral Rating Forms (DSM-IV)
Brown ADD Scales (Adult)
Connors' Adult ADHD Rating Scales (CAARS)
Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) or
Woodcock-Johnson III (WJ III) Tests of Cognitive Ability
Connors' Continuous Performance Test, Version 3.0
Review of Records (Specify, e.g.: conduct, grades and teacher comments on grade cards, previous testing, etc.)
Analysis of Test Results
Diagnosis (Use DSM-IV)
Recommendations: Address functional limitations, how will an adjustment impact the limitations, etc.)
(Note: attach all test scores or integrate the scores into the report.)
Name and degree(s)
Title/Area of Concentration
For more information regarding Attention Deficit & Hyperactivity Disorders please visit The Unabridged Student Counseling Virtual Pamphlet Collection.