Self-reported functional impairment in college students: relationship to noncredible reporting, ADHD, psychological disorders, and other psychological factors

INTRODUCTION

Both symptoms and functional impairment should be assessed in college students seeking evaluations for Attention Deficit Hyperactivity Disorder (ADHD). However, impairment is not specific to ADHD. Although it is well documented that self-reported symptoms can be reported noncredibly, there is less research examining credibility of self-reported impairment, and few clinicians rule out alternative causes for impairment.

METHOD

Participants (N = 428) completed self-report measures of functional impairment, sleep, perceived stress, and in an ADHD symptom measure with embedded validity indicators.

RESULTS

Noncredible reporters endorsed greater functional impairment than credible reporters in several domains, but impairment was reported at a high rate even in credible responders (N = 323) in several domains. Participants who reported prior ADHD and participants who reported prior psychiatric diagnoses reported greater impairment and higher rates of clinically significant impairment than those who reported no prior diagnoses. Few differences in reported impairment emerged between those who reported ADHD and psychiatric diagnoses. Sleep and stress accounted for significant variance in impairment, and the ADHD group reported greater impairment than the psychiatric diagnosis and no diagnosis groups after controlling for these variables.

CONCLUSIONS

Results reinforce the importance of considering the validity of, and alternative sources for, self-reported impairment in college students with ADHD concerns.

Examining academic confidence and study support needs for university students with dyslexia and/or developmental coordination disorder

Higher education providers are seeing a shift from externally funded support for students with specific learning difficulties (SpLD), to a need to develop more inclusive practices generally. However, the precise needs of students with different SpLD diagnoses is unknown. A total of 367 students in England and Wales (163 students with dyslexia, 50 students with developmental coordination disorder [DCD/"dyspraxia"], 62 students with dyslexia and DCD, and 92 non-SpLD students) completed an online questionnaire to determine: (a) how confident they are with their study-related capabilities, (b) the types of support they access, and (c) their views on current inclusive practices. Students with dyslexia and students with dyslexia/DCD reported lower confidence in their grades and studying than non-SpLD students, and accessed more technology-related support than students with DCD only. Examination accommodations supporting writing were common for all SpLD students. Inclusive practices were perceived positively, although different priorities were seen across groups. The findings demonstrate the complexities inherent in providing effective support for all students at university, with the varied profiles across and within SpLD groups suggesting that an individualized approach is necessary. Practical implications are discussed.

The Implementation of Extended Examination Duration for Students With ADHD in Higher Education

OBJECTIVE

Recently, research indicated that extended examination duration was perceived as effective by students with ADHD. However, the objective effectiveness of this accommodation has not been researched extensively. This study addresses this gap in literature.

METHOD

A total of 30 students with ADHD and 30 matched typically developing controls (TDC) participated in a simulation of a real-life examination. They filled in three parallel versions of a paper-and-pencil test in three time conditions: 1 hr (+0%), 1 hr 20 min (+33%), and 1 hr 30 min (+50%).

RESULTS

When granted extended examination duration, students with ADHD and TDC use extra time but their performance does not increase. In addition, test-taking strategies were altered to a limited extent, and strategies that are perceived as effective (e.g., marking key words) were rarely used by the students.

CONCLUSION

It is concluded that extended examination duration is not objectively effective in an experimental design. Limitations and guidelines for future research are formulated.

ADHD Assessment in College Students: Psychologists’ Adherence to DSM-5 Criteria and Multi-Method/Multi-Informant Assessment

The evidence-based assessment of attention-deficit/hyperactivity disorder (ADHD) depends on adherence to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) diagnostic criteria and reliance on multi-method/multi-informant data. Although nearly all psychologists endorse these practices, college students with ADHD may lack documentation supporting their diagnoses. We reviewed the documentation submitted by 214 undergraduates diagnosed with ADHD and receiving academic accommodations for this condition. Their clinicians also completed a checklist that described their assessment procedures. Relatively few psychologists assessed all DSM-5 criteria, based on either the psychologist’s self-reported assessment procedures (23.4%), written documentation (14.0%), or multi-method/multi-informant data (10.3%) such as educational/medical records, results of rating scales, or interviews with other informants. Psychologists were least likely to assess students’ areas of impairment or to rule out alternative causes for students’ self-reported symptoms. This lack of adherence to DSM-5 criteria and overreliance on students’ self-reports can threaten the reliability of diagnosis and the appropriateness of medication and accommodations that follow.

Accommodation Decision Making for Postsecondary Students With Learning Disabilities: Individually Tailored or One Size Fits All?

Clinicians uniformly recommend accommodations for college students with learning disabilities; however, we know very little about which accommodations they select and the validity of their recommendations. We examined the assessment documentation of a large sample of community college students receiving academic accommodations for learning disabilities to determine (a) which accommodations their clinicians recommended and (b) whether clinicians' recommendations were supported by objective data gathered during the assessment process. In addition to test and instructional accommodations, many clinicians recommended that students with learning disabilities should have different educational expectations, standards, and methods of evaluation (i.e., grading) than their nondisabled classmates. Many of their recommendations for accommodations were not supported by objective evidence from students' history, diagnosis, test data, and current functioning. Furthermore, clinicians often recommended accommodations that were not specific to the student's diagnosis or area of disability. Our findings highlight the need for individually selected accommodations matched to students' needs and academic contexts.

When Average Is Not Good Enough: Students With Learning Disabilities at Selective, Private Colleges

Adolescents with learning disabilities disproportionately come from lower socioeconomic status backgrounds, show normative deficits in academic skills, and attend 2-year, public colleges instead of 4-year institutions. However, students with learning disabilities are well represented at the United States' most expensive and selective postsecondary institutions. We examined the psychoeducational functioning of students receiving accommodations for learning disabilities at a private, selective, liberal arts college. We also determined whether students had objective evidence supporting their disability diagnoses and academic accommodations. Most students showed above-average cognitive abilities, average academic skills, and no evidence of impairment. Although nearly all students reported academic problems, most lacked objective evidence of academic difficulties prior to college as well as relative or normative deficits in broad academic skills or fluency. Results indicate a need for greater reliance on objective, multimethod/multi-informant data in the diagnostic process. Results also highlight limitations in the current professional guidelines for documentation decision making in higher education.

Feasibility of School-Based ADHD Interventions: A Mixed-Methods Study of Perceptions of Adolescents and Adults

OBJECTIVE

Little is known about perceptions surrounding academic interventions for ADHD that determine intervention feasibility.

METHOD

As part of a longitudinal mixed-methods research project, representative school district samples of 148 adolescents (54.8%), 161 parents (59.4%), 122 teachers (50.0%), 46 health care providers (53.5%), and 92 school health professionals (65.7%) completed a cross-sectional survey. They also answered open-ended questions addressing undesirable intervention effects, which were analyzed using grounded theory methods.

RESULTS

Adolescents expressed significantly lower receptivity toward academic interventions than adult respondents. Stigma emerged as a significant threat to ADHD intervention feasibility, as did perceptions that individualized interventions foster inequality.

CONCLUSION

Findings suggest that adolescents' viewpoints must be included in intervention development to enhance feasibility and avoid interventions acceptable to adults, but resisted by adolescents.

Examining accommodation effects for equity by overcoming a methodological challenge of sparse data

BACKGROUND

As accommodation itself is an equity issue in varied contexts in and beyond education (e.g., the provision of assistive technology, extended time, or read-aloud), it is critical to examine the equitability of accommodation policies and practices by examining their effects on student performance.

AIMS

This study sought to assess the effectiveness of thirty-one bundled accommodations for students with learning disabilities, emotional or behavioral disorders, or multiple exceptionalities writing a provincial literacy test in Ontario, Canada.

METHODS AND PROCEDURES

We employed quantitative methods of log-linear analysis and odds ratio to examine the data. To analyze sparse data, we compared three different adjustment methods to meet this methodological challenge.

OUTCOMES AND RESULTS

Our findings suggest that the problems with sparse data can be overcome by an adjustment method. We also found that the likelihood of achieving the provincial standards may differ among students with special needs depending on whether they did or did not receive certain combinations of accommodations for the literacy test.

CONCLUSIONS AND IMPLICATIONS

We recommend that education stakeholders review the accommodations that produced significant differential effects to address the concerns regarding whether the test results were interpreted validly and fairly for students with special needs.

The Extra-Examination Time Granting Policy

Differential granting of extra-examination time (EET) is commonly based on learning disabilities (LD) status: EET is granted to LD examinees and is denied to nondisabled examinees. We argue that LD serves as a proxy for the extent to which time limitation affects the examinee’s test score ( e). Hence, the validity of the LD-based EET granting policy depends on how well LD status serves as a proxy for e. Reanalysis of 11 comparative experimental studies of the effect of EET shows that LD status is a poor proxy for e. The proportion of nondisabled examinees who benefit from EET roughly equals the corresponding proportion among LD students. Implications of these results for the validity and fairness of this policy are discussed.

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.

Effects of Extended Time for College Students With and Without ADHD

OBJECTIVE

The number of students with a disability requesting test accommodations has been steadily increasing in higher education settings. The present study examined the effects of extra time on the reading comprehension performance of college students with and without ADHD.

METHOD

A modified version of The Nelson-Denny Reading Test was completed by 38 college students with ADHD and 38 matched controls under three conditions: standard time, time and one half, and double time.

RESULTS

Groups did not differ in the number of items attempted or correctly answered at standard time, time and one half, or double time. Comparing the ADHD group at extended time to non-ADHD peers at standard time, the ADHD group attempted and answered significantly more test items.

CONCLUSION

Extra time conferred an advantage to the ADHD group, suggesting that extended time accommodations are not specific and perhaps not necessary for all college students with an ADHD diagnosis.

Community college students with learning disabilities: evidence of impairment, possible misclassification, and a documentation disconnect

Recent research suggests that most 4-year college students diagnosed with specific learning disability (SLD) do not meet objective criteria for the disorder, show normative deficits in academic skills, or have childhood histories of SLD. The purpose of this study was to examine the functioning of students diagnosed with SLD attending community college. We reviewed SLD documentation for 359 community college students previously diagnosed with SLD and receiving academic accommodations. Most students met objective criteria (82.3%) and were first diagnosed in childhood (93.3%). Most students also showed average intellectual functioning and below-average to borderline academic achievement. However, 27.3% showed uniformly low ability and achievement scores, suggesting possible misclassification. Students who failed to meet objective criteria for SLD often submitted test data that lacked current, adult-normed standardized test scores; many were diagnosed based on response to intervention and submitted only an individualized education program or summary of performance. This finding provides initial evidence of a disconnect between the qualitative documentation that secondary schools provide and the quantitative documentation that postsecondary institutions require for SLD classification.

Effects of Extended Time Allotments on Reading Comprehension Performance of College Students With and Without Learning Disabilities

Students with disabilities often receive test accommodations in schools and on high-stakes tests. Students with learning disabilities (LD) represent the largest disability group in schools, and extended time the most common test accommodation requested by such students. This pairing persists despite controversy over the validity of extended time as a test accommodation. The current study examined the effects of 50% and 100% time extensions on the reading comprehension performance of college students with and without LD. Results indicated that typical students actually benefited more than the LD group when given extra time, indicating that extended time is not a test accommodation that is specific to those with a disability. Moreover, when only students with LD were given extended time, especially double time, they outperformed nondisabled peers. We discuss implications of these findings for future research as well as accommodation decisions in educational settings.

Test-Taking Skills in College Students With and Without ADHD

College students with attention deficit hyperactivity disorder (ADHD) often request and receive extended time to complete high-stakes exams and classroom tests. This study examined the performances and behaviors of college students on computerized simulations of high-stakes exams. Thirty-five college students with ADHD were compared to 185 typical peers on measures of reading decoding, speed, vocabulary, comprehension, test strategies, time management, and test anxiety. Results indicated no differences between students with and without ADHD on various reading (decoding, speed, vocabulary, and comprehension) and test-taking variables (time utilization, navigation style, or strategy use), yet significant differences were present regarding their perceptions of, and anxiety during, test taking. It appears that students with ADHD perform similarly to peers on timed reading tests, although they think they perform less well and worry more about their performance.