When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria.

When should a university student be allowed academic accommodation For ADHD? A position statement for a unified procedure for use in Brazil.

OBJECTIVE: To identify under what circumstances a university student should be allowed academic accommodation for ADHD. To frame an evidence-based policy for use in Brazil based on a worldwide experience. METHODS: We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodation for ADHD is made (including malingering detection). We scrutinized the eligibility criteria of the best universities worldwide. Renowned experts in the field and national stakeholders were consulted. RESULTS: We found no international standard for the assessment of students with ADHD who request academic accommodation. Even renowned institutions worldwide differ from one another in their approaches to academic accommodation on the grounds of ADHD. We propose a national unified set of criteria for Brazilian universities, which could generalize internationally. DISCUSSION: Rigorous assessment is paramount for aiding students with disabilities while preventing ineligible students gaining an unfair advantage. Higher education institutions nationwide and beyond may benefit from adopting a unified set of criteria for eligibility to ADHD accommodation programs.

Sluggish Cognitive Tempo (SCT), Comorbid Psychopathology, and Functional Impairment in College Students: The Clinical Utility of SCT Subfactors.

BACKGROUND: Sluggish cognitive tempo (SCT) has been proposed to be either its own distinct disorder or a transdiagnostic process. OBJECTIVE: To examine SCT within ADHD (and its specific presentations) and internalizing disorders and its relationship with functional impairment, particularly when considered from a multidimensional perspective. METHOD: Undergraduate students (N = 2,806) completed self-report scales measuring SCT, ADHD, anxiety, depression, and functional impairment. The SCT scale consisted of three subfactors identified in prior research. RESULTS: Students with internalizing disorders were equally as likely as those with ADHD to report clinically significant SCT, and having multiple other disorders predicted especially high levels of SCT symptoms. Only sleepy/sluggish symptoms incrementally predicted impairment. CONCLUSIONS: These findings provide more support for SCT as a transdiagnostic process than as a distinct disorder. All areas of SCT symptoms are associated with ADHD, anxiety, and depression, but the sleepy/sluggish symptoms may be uniquely associated with problems in everyday living.

Systematic Review: Educational Accommodations for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often receive instruction and take tests using educational accommodations. This review aims to summarize and integrate the research literature on accommodations for this specific population. METHOD: Electronic databases in medicine (MEDLINE), psychology (PsycINFO), and education (ERIC) were systematically searched (last update January 13, 2020), with inclusion criteria selecting any document with a focus on accommodations in educational settings or on academic tasks for children or adolescents with ADHD. The search yielded 497 unique documents. Additional searches yielded 13 more documents. Of the 510 total potentially useful documents, 68 met criteria for topical relevance and age range, to be discussed in the narrative review. The wide range of document types led to a qualitative synthesis. RESULTS: Accommodations are by far the most common response to ADHD in educational settings, with testing accommodations such as extended time being particularly prevalent. However, most accommodations fail to show evidence of benefits that are specific to students with ADHD, and many of the more common accommodations have few or no experimental studies supporting them. An exception is read-aloud accommodations, which have two randomized experiments finding specific benefits for younger students with ADHD. Students and those who work with them often express ambivalence and dissatisfaction over the accommodations process. CONCLUSION: More empirical research is needed to examine the effects of these extremely common supports. In the absence of supportive evidence, health professionals should be hesitant to recommend accommodations immediately after a diagnosis. Even when such evidence exists, educational accommodations should only be provided along with evidence-based interventions, or after interventions have failed, as suggested by the "life course" model of managing ADHD.

Validation of curriculum-based reading passages and comparison of college students with and without dyslexia or ADHD.

Although reading is an essential skill for college success, little is known about how college students with and without disabilities read within their actual college curriculum. In the present article, we report on two studies addressing this issue. Within study 1, we developed and validated curriculum-based oral reading fluency measures using a sample of college students without disabilities (N = 125). In study 2, we administered the curriculum-based measures to four groups (each with n = 25): college students without disabilities, college students with dyslexia, college students with ADHD, and a clinical control group. Study 1 results indicated that the curriculum-based measures demonstrated good reliability and criterion validity. Results from study 2 indicated that college students with dyslexia were substantially slower readers than all groups without dyslexia (ds > 1.8). The curriculum-based measures demonstrated high accuracy in classifying participants with dyslexia and with impaired oral reading fluency (area under the curve > .94). Implications for incorporating curriculum-based measures in postsecondary settings are discussed.

Assessing ADHD in college students: Integrating multiple evidence sources with symptom and performance validity data.

Prior research supports the use of multiple types of evidence from multiple sources when assessing ADHD in adults. However, limited research has examined how to best integrate the resulting set of data into a well-supported diagnostic conclusion. Moreover, clients sometimes overreport symptoms or display low effort on performance tasks, further complicating the interpretation of assessment data. The present study examined self-ratings and observer (e.g., parent) ratings of symptoms as well as performance task data from 514 postsecondary students assessed for ADHD at a university-affiliated clinic. Observer ratings were more reliable than self-ratings and were more likely to be corroborated by other data. The 2 types of ratings showed moderate to large relationships with each other as continuous variables (.32 < r < .52) while agreement around categorical symptom cutoffs was slight or fair (.12 < κ < .32). Both types of ratings showed only small relationships with a performance test designed to assess ADHD symptoms. Approximately half of the cases in the sample had at least 1 piece of potentially noncredible data (suggesting potential symptom overreporting, inconsistent responding, or inadequate effort). Requiring ratings from multiple informants (as opposed to a single informant) of clinically significant symptoms for a diagnosis substantially reduced the effect of noncredible data, while also reducing the number of diagnoses by approximately half. Implications of these and other findings for practice and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

How Is ADHD Assessed and Documented? Examination of Psychological Reports Submitted to Determine Eligibility for Postsecondary Disability.

Objective: To examine how ADHD evaluations are documented for postsecondary students requesting disability eligibility. Method: A total of 100 psychological reports submitted for eligibility determination were coded for documentation of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, methods and instruments used in the evaluations, and recommended academic accommodations. Results: Results showed that a minimal number of reports (≤1%) documented that students met all DSM criteria for ADHD. Psychologists rarely documented childhood impairment, symptoms across settings, or the use of rule-outs. Symptom severity was emphasized over current impairment. The majority of psychologists utilized a multi-informant, multi-method evaluation approach, but certain methods (e.g., symptom validity tests, record reviews) were limited in use. Most reports included recommendations for academic accommodations, with extended time being the most common (72%). Conclusion: This study raises awareness to the aspects of adequate ADHD evaluation and subsequent documentation that can be improved by psychologists. Recommendations are made regarding valid documentation of ADHD for disability determination purposes.

Anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD): Cross-informant, sex, and subtype differences.

OBJECTIVE: This study examined symptoms of anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD). PARTICIPANTS: Data were collected between March 2011 and March 2016 from 150 college students with ADHD and 150 college students without ADHD. METHOD: Participants with ADHD were compared to a sex- and ethnicity-matched control group. For the ADHD group, parent and self-report of anxiety and depression were also compared. RESULTS: College students with ADHD self-reported significantly higher anxiety and depressive symptoms than did students without ADHD. Scores on parent-report measures of anxiety and depressive symptoms were significantly higher than scores on self-report measures. Significant sex differences were found for participants with ADHD, with females showing higher depressive and anxiety symptoms than males. Parent-reported anxiety symptoms were higher for those with inattentive type ADHD compared to combined type ADHD. CONCLUSION: The current study highlights the importance of multi-informant assessment in ADHD evaluations for college-aged adults.

Socially Desirable Responding and College Students with Dyslexia: Implications for the Assessment of Anxiety and Depression.

We investigated self-reported depressive and anxiety-related symptoms among college students with dyslexia, with emphasis on the role of socially desirable responding (SDR) in understanding these reports. Analyses included examination of differences in self-reported depressive symptoms, anxiety-related symptoms, and SDR. We also examined the relationships among SDR, depressive symptoms, anxiety-related symptoms, and reading skills. Participants with dyslexia demonstrated significantly higher SDR than did participants without dyslexia, and higher SDR was significantly associated with lower self-reported depressive and anxiety-related symptoms. Moreover, higher SDR was significantly associated with lower reading skills. There was no group difference on anxiety-related symptoms, but participants with dyslexia had higher depressive symptoms than did participants without dyslexia when SDR was controlled. Implications for the assessment of anxiety and depression among college students with dyslexia are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Auditory and Visual Working Memory Functioning in College Students with Attention-Deficit/Hyperactivity Disorder and/or Learning Disabilities.

OBJECTIVE: We investigated the auditory and visual working memory functioning in college students with attention-deficit/hyperactivity disorder, learning disabilities, and clinical controls. We examined the role attention-deficit/hyperactivity disorder subtype status played in working memory functioning. The unique influence that both domains of working memory have on reading and math abilities was investigated. METHOD: A sample of 268 individuals seeking postsecondary education comprise four groups of the present study: 110 had an attention-deficit/hyperactivity disorder diagnosis only, 72 had a learning disability diagnosis only, 35 had comorbid attention-deficit/hyperactivity disorder and learning disability diagnoses, and 60 individuals without either of these disorders comprise a clinical control group. Participants underwent a comprehensive neuropsychological evaluation, and licensed psychologists employed a multi-informant, multi-method approach in obtaining diagnoses. RESULTS: In the attention-deficit/hyperactivity disorder only group, there was no difference between auditory and visual working memory functioning, t(100) = -1.57, p = .12. In the learning disability group, however, auditory working memory functioning was significantly weaker compared with visual working memory, t(71) = -6.19, p < .001, d = -0.85. Within the attention-deficit/hyperactivity disorder only group, there were no auditory or visual working memory functioning differences between participants with either a predominantly inattentive type or a combined type diagnosis. Visual working memory did not incrementally contribute to the prediction of academic achievement skills. CONCLUSION: Individuals with attention-deficit/hyperactivity disorder did not demonstrate significant working memory differences compared with clinical controls. Individuals with a learning disability demonstrated weaker auditory working memory than individuals in either the attention-deficit/hyperactivity or clinical control groups.

Naming Speed of Adolescents and Young Adults with Attention Deficit Hyperactivity Disorder: Differences in Alphanumeric Versus Color/Object Naming.

This study investigated the performance of adolescents and young adults with Attention Deficit Hyperactivity Disorder (ADHD), Reading Disorder (RD), and ADHD/RD on measures of alphanumeric and nonalphanumeric naming speed and the relationship between naming speed and academic achievement. The sample (N = 203) included students aged 17-28 years diagnosed with ADHD (n = 83), RD (n = 71), or ADHD/RD (n = 49). Individuals with ADHD performed significantly faster on measures of alphanumeric naming compared with RD and comorbid groups and, within group, demonstrated significantly quicker naming of letters/digits compared with colors/objects. Both alphanumeric rapid naming scores and processing speed scores variably predicted academic achievement scores across groups, whereas nonalphanumeric rapid naming only predicted reading comprehension scores within the ADHD group. Results support findings that older individuals with ADHD show relative weakness in rapid naming of objects and colors. Implications of these findings in regard to assessment of older individuals for ADHD are discussed.

Examination of the double-deficit hypothesis with adolescents and young adults with dyslexia.

The double-deficit hypothesis (DDH) of the developmental dyslexias (Wolf and Bowers, Journal of Educational Psychology, 91, 415-438, 1999) was investigated with 149 adolescents and young adults (age range = 16 to 24 years) with dyslexia. Confirmatory factor analysis indicated that a two-factor model with separate naming speed (NS) and phonological awareness (PA) constructs was superior to a one-factor model, supporting the assumption within the DDH that NS is a source of reading dysfunction separable from PA. Hierarchical multiple regression analyses resulted in findings that were only partially supportive of the DDH. NS was predictive of word reading, spelling, and reading fluency beyond PA and verbal intellectual ability, but not pseudoword reading and timed and untimed reading comprehension. Examination of DDH subtypes did not support the core assumption of the DDH that the double-deficit subtype would have more impaired reading skills than both of the single-deficit subtypes. The NS deficit subtype was found to be more prevalent than the double-deficit and PA deficit subtypes within the subgroup of dyslexics with impairment in reading fluency. Overall results provided mixed support for the DDH and pointed to the need for the inclusion of additional abilities within theories of the underlying mechanisms disrupted in dyslexia.

Postsecondary ADHD Documentation Requirements: Common Practices in the Context of Clinical Issues, Legal Standards, and Empirical Findings.

OBJECTIVE: To evaluate the information postsecondary institutions require when determining disability service eligibility for students with reported ADHD. METHOD: ADHD documentation requirements of 200 U.S. institutions were surveyed by reviewing guidelines posted on disability services websites. RESULTS: Whereas virtually all institutions required documentation, findings revealed significant variability in requirements across institutions. Required variables most often included a qualified evaluator (80%), diagnostic statement (75%), and identification of substantial limitations (73%), but only 5 of 46 evaluated variables were required by at least 50% of institutions. Supportive data such as diagnostic criteria, standardized assessment results, and rationale for accommodations were rarely required. CONCLUSION: The majority of institutions required little to verify ADHD as a disability. Furthermore, there was little agreement on what components are essential for verification. When integrated with research, a large portion of guidelines failed to address identified weaknesses in ADHD diagnosis and disability determination.

Test Anxiety Among College Students With Specific Reading Disability (Dyslexia): Nonverbal Ability and Working Memory as Predictors.

Test anxiety and its correlates were examined with college students with and without specific reading disability (RD; n = 50 in each group). Results indicated that college students with RD reported higher test anxiety than did those without RD, and the magnitude of these differences was in the medium range on two test anxiety scales. Relative to college students without RD, up to 5 times as many college students with RD reported clinically significant test anxiety. College students with RD reported significantly higher cognitively based test anxiety than physically based test anxiety. Reading skills, verbal ability, and processing speed were not correlated with test anxiety. General intelligence, nonverbal ability, and working memory were negatively correlated with test anxiety, and the magnitude of these correlations was medium to large. When these three cognitive constructs were considered together in multiple regression analyses, only working memory and nonverbal ability emerged as significant predictors and varied based on the test anxiety measure. Implications for assessment and intervention are discussed.

Structural and incremental validity of the Wechsler Adult Intelligence Scale-Fourth Edition with a clinical sample.

Structural and incremental validity of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV; Wechsler, 2008a) was examined with a sample of 300 individuals referred for evaluation at a university-based clinic. Confirmatory factor analysis indicated that the WAIS-IV structure was best represented by 4 first-order factors as well as a general intelligence factor in a direct hierarchical model. The general intelligence factor accounted for the most common and total variance among the subtests. Incremental validity analyses indicated that the Full Scale IQ (FSIQ) generally accounted for medium to large portions of academic achievement variance. For all measures of academic achievement, the first-order factors combined accounted for significant achievement variance beyond that accounted for by the FSIQ, but individual factor index scores contributed trivial amounts of achievement variance. Implications for interpreting WAIS-IV results are discussed.

Self-concept of college students with ADHD: discordance between self- and parent-reports.

OBJECTIVE: To investigate the self-concept of college students with ADHD. METHOD: College students with ADHD and their parents completed self-report and observer-report measures of self-concept, respectively. RESULTS: Results indicated that college students with ADHD did not report problems with self-concept but their parents did for them. This difference was statistically significant and large in magnitude (d = .84). CONCLUSION: Perceptions of the self-concept of college students with ADHD appear to vary by informant source. Hypotheses for the discordance between self- and parent-reports are discussed. Multi-informant assessment is recommended as a way to obtain a more complete clinical picture than reliance on self- or parent-report alone.

Meta-analysis on the effectiveness of extra time as a test accommodation for transitioning adolescents with learning disabilities: more questions than answers.

The accommodation of students with learning disabilities (LD) on mandatory high stakes tests continues to heighten concern over the equity and effectiveness of current practices. As students transition from high school, they are required to complete timed graduation tests and postsecondary entrance examinations. The most common accommodation accessed by transitioning adolescents with LD is extended time. In order to inform test accommodation practices, a meta-analysis was conducted to address whether test scores from accommodated (i.e., extended time only) and standard test administrations are comparable for transitioning adolescents with LD as compared to their normally achieving peers. The results of the meta-analyses raised more questions than answers and highlighted the need for future research in this area.

Depression and anxiety among transitioning adolescents and college students with ADHD, dyslexia, or comorbid ADHD/dyslexia.

OBJECTIVE: To investigate depressive and anxious symptomatology among transitioning adolescents and college students with ADHD, dyslexia, or comorbid ADHD/dyslexia. METHOD: Transitioning adolescents and college students with these disorders along with a non-ADHD/dyslexia college sample completed self-report measures of depression and anxiety. RESULTS: Results indicated no differences between the college-level groups, although a main effect for gender was found and trended toward females with dyslexia reporting more symptoms of depression and anxiety than did males with dyslexia. Internalizing symptomatology differences were not found for subtypes of ADHD. Transitioning high school students with ADHD, dyslexia, or ADHD/dyslexia reported fewer symptoms of anxiety and depression than did college underclassmen with these disorders. CONCLUSION: The unique characteristics and experiences of the college population of individuals with ADHD and/or dyslexia are discussed relative to the general adult population with these disorders.

Examination of the structural, convergent, and incremental validity of the Reynolds Intellectual Assessment Scales (RIAS) with a clinical sample.

Empirical examination of the Reynolds Intellectual Assessment Scales (RIAS; C. R. Reynolds & R. W. Kamphaus, 2003a) has produced mixed results regarding its internal structure and convergent validity. Various aspects of validity of RIAS scores with a sample (N = 521) of adolescents and adults seeking psychological evaluations at a university-based clinic were examined. Results from exploratory factor analysis indicated only 1 factor, and confirmatory factor analysis (CFA) indicated that the 1-factor model was a good fit and a better fit than the 2-factor model. Hierarchical factor analysis indicated the higher order, general intelligence factor accounted for the largest amount of variance. Correlations with other measures of verbal/crystallized and nonverbal/fluid intelligence were supportive of the convergent validity of the Verbal Intelligence Index but not the Nonverbal Intelligence Index. Joint CFA with these additional measures resulted in a superior fit of the 2-factor model compared with the 1-factor model, although the Odd-Item-Out subtest was found to be a poor measure of nonverbal/fluid intelligence. Incremental validity analyses indicated that the Composite Intelligence Index explained a medium to large portion of academic achievement variance; the NIX and VIX explained a small amount of remaining variance. Implications regarding interpretation of the RIAS when assessing similar individuals are discussed.

Learning disabilities and anxiety: a meta-analysis.

This article presents the results of a meta-analysis of the empirical literature on anxious symptomatology among school-aged students with learning disabilities (LD) in comparison to their non-LD peers. Fifty-eight studies met inclusion criteria. Results indicate that students with LD had higher mean scores on measures of anxiety than did non-LD students. The overall effect size was statistically significant and medium in magnitude (d=.61) although substantial heterogeneity of results was found. Moderator effects were examined for informant type, gender, grade, publication status, and identification source. Informant type (i.e., self-, parent, or teacher report) explained a significant amount of variability in the sample of studies, and identification source (i.e., school identified or special school and clinic/hospital identified) approached statistical significance. Implications for assessment and intervention are discussed.