Examining How Students With ADHD Use an Extended Time Accommodation on a Low-Stakes Math Assessment

OBJECTIVE

Students with ADHD are often provided with an extended testing time accommodation due to various skill deficits. However, little empirical work has examined the ways in which students use their extra time, if at all, and how use relates to overall performance. Further understanding of how students use this accommodation in practice can help to inform accommodation decision-making procedures so that students with disabilities recieve the appropiate support to be able to demonstrate their underlying knowledge and skills on tests.

METHOD

The current study utilized the National Assessment of Educational Progress (NAEP) 2017 eighth-grade process data to examine the use and nonuse of extended time accommodations among students with ADHD as well as among comparison groups.

RESULTS

Less than half of students with ADHD who were eligible for an extended time accommodation used it. Access to the accommodation, rather than actual use, corresponded to higher rates of test completion. Those students who spent more time on the final five items of the test performed better overall when compared to their peers.

CONCLUSION

Findings raise questions about the underlying needs of students with ADHD during testing and whether mere access to extended time sufficiently addresses those needs. Additional critical analysis of the provision and use of extended time for students with attention problems appears warranted. Implications for future research and practice are offered.

Predictive value of performance validity testing and symptom validity testing in psychoeducational assessment

Using archival data from 2463 psychoeducational assessments of postsecondary students we investigated whether failure on either symptom or performance validity tests (SVTs or PVTs) was associated with score differences on various cognitive, achievement, or executive functioning performance measures or on symptom report measures related to mental health or attention complaints. In total, 14.6% of students failed one or more PVT, 33.6% failed one or more SVT, and 41.6% failed at least one validity test. Individuals who failed SVTs tended to have the highest levels of self-reported symptoms relative to other groups but did not score worse on performance-based psychological tests. Those who failed PVTs scored worse on performance-based tests relative to other groups. Failure on at least one PVT and one SVT resulted in both performance and self-reported symptoms suggestive of greater impairment compared with those who passed all validity measures. Findings also highlight the need for domain-specific SVTs; failing ADHD SVTs was associated only with extreme reports of ADHD and executive functioning symptoms while failing mental health SVTs related only to extreme reports of mental health complaints. Results support using at least one PVT and one SVT in psychoeducational assessments to aid in diagnostic certainty, given the frequency of non-credible presentation in this population of postsecondary students.

Identifying Feigned ADHD in College Students: Comparing the Multidimensional ADHD Rating Scale to Established Validity Measures

OBJECTIVE

There is increased concern for malingering in ADHD evaluations due to presence of incentives such as accommodations and medications. Although several validity tests are available to classify malingering in non-ADHD populations, there is no test with proven effectiveness to detect feigned ADHD. This study investigated the ability of the MARS Symptom Validity Index 4 (MARS SV-index 4) and two published validity tests (the Word Memory Test [WMT] and Clinical Assessment of Attention Deficit-Adult [CAT-A] Infrequency scale) to detect malingered ADHD.

METHOD

The participants consisted of 68 young adults, 34 with ADHD. Participants completed the MARS, CAT-A, and WMT validity measures.

RESULTS

The MARS SV index-4 demonstrated higher sensitivity rates for simulated malingering (61.8%) at close to optimal specificity (88.2%) compared to two published tests (which had sensitivity <42% at specificity >90%).

CONCLUSION

The MARS shows good ability to detect feigned ADHD and appears to be useful for adult ADHD assessments.

Accommodation Decision-Making for Postsecondary Students with ADHD: Treating the Able as Disabled

Students with attention-deficit/hyperactivity disorder (ADHD) may be entitled to academic accommodations in postsecondary education. Disability Services Offices (DSOs) in Canada say that objective evidence of functional impairment is required prior to providing academic accommodations. This study set out to determine if postsecondary disability service providers use objective, third-party data when making accommodation decisions. Providers were asked if they would grant extra time accommodations to a fictitious prospective student. The student self-reported attention and academic problems that emerged during COVID restrictions, and that extra time helped her earn better grades and reduced her anxiety. While her neuropsychological report suggested superficial similarity to ADHD and contained accommodation recommendations, it lacked any objective evidence supporting either an ADHD diagnosis or functional impairments that would support extra time accommodation. Despite the lack of current or historical functional impairment, 100% of all DSO decision makers confirmed that they would grant extra time accommodations to this student. Results suggest that DSOs’ accommodation decisions are not based on evidence of functional impairment but rely mainly on student self-report and the recommendations of a professional. As such, the current system of determining reasonable accommodations is flawed and inequitable, offering non-impaired individuals access to supports and services that may privilege them over their similarly abled peers. Postsecondary institutions must either develop more defensible methods of disability determination or provide all students with access to accommodations to create a more equitable learning environment.

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.

Accommodation decision-making for postsecondary students with ADHD: Implications for neuropsychologists

Neuropsychologists are often asked to evaluate students for attention-deficit/hyperactivity disorder (ADHD) and to provide documentation to support their requests for academic accommodations in college. Research points to the importance of multi-method, multi-informant data when evaluating ADHD and determining the need for accommodations. However, the Association on Higher Education and Disability (AHEAD) directs disability service providers to give primacy to students' self-reports and their own impressions of students' narratives over objective, third-party data when rendering accommodation decisions. The organization asserts that in many cases information from parents, teachers, and psychologists is not needed to confirm the existence of a disability or students' need for accommodations. In this article, we describe the way disability service providers are directed to evaluate accommodation requests, the limitations of these procedures, and the dangers of well-intentioned, but indiscriminate accommodation-granting. We then provide recommendations for neuropsychologists who conduct ADHD evaluations for college students in light of these professional guidelines.

The impact of depression and anxiety on speed of academic performance and retrieval fluency in postsecondary students

OBJECTIVE

This study evaluated the functional effects of severe mental health symptoms on speed of academic performance to assist clinicians and educators in determining whether extra time accommodations are evidence-based for students with such diagnoses. Method: Using archival data from 1476 post-secondary students, we examined the performance of students with existing mental health diagnoses who were also reporting extremely high levels of symptoms. Their performance on timed academic achievement and cognitive processing measures was compared with performance of students with learning disabilities, Attention Deficit Hyperactivity Disorder, and clinical controls. Students failing stand-alone performance validity and/or symptom validity measures were excluded from this investigation. Results: Students diagnosed with anxiety and/or depression did not differ from clinical controls on any timed performance measure, typically performing academic tasks within a normal amount of time. By contrast, those with reading disabilities were typically the slowest on all academic tasks. Conclusion: Across the range of timed tests, students with mental health diagnoses did not show functional impairments in tests with a speed component. As such, they would not typically require increased time to perform speeded academic tasks, but they might require alternative accommodations in their post-secondary programmes in order to participate equally.

Using the Woodcock-Johnson IV tests of cognitive abilities to detect feigned ADHD

Research has suggested that many young adults can successfully feign ADHD, reporting clinically significant symptom levels and displaying deficits on cognitive tasks when asked to do so. Standalone performance validity tests (PVTs) have shown some success in identifying feigned ADHD, but these tests are rarely used in typical ADHD evaluation batteries. The present study attempted to develop embedded PVT indices from the Woodcock-Johnson IV Tests of Cognitive Abilities (WJ-IV). College students (N = 150) completed a battery including tasks from the WJ-IV, as well as an established standalone PVT and a rating scale measuring ADHD and related symptoms. Thirty of the students had been professionally diagnosed with ADHD; of the remaining 120 students, half were asked to perform honestly and to the best of their ability on the battery, whereas the other half were asked to try to simulate ADHD. Several processing speed and working memory scores from the WJ-IV effectively identified students feigning ADHD, detecting at least 50% of those students at score cutoffs that also maintained specificity of 90% or more, close to the efficiency of the standalone PVT. In addition, students with ADHD diagnoses generally did not show deficits on the WJ-IV. Implications for practice and future research are discussed.

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.

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.

Test Anxiety and the Americans With Disabilities Act

Test anxiety leads to requests for accommodations under the Americans With Disabilities Act (ADA), but many testing entities have expressed skepticism about whether test anxiety qualifies as a disability. This article addresses three legal issues raised by the inclusion of test anxiety under ADA: whether test anxiety is a mental impairment, whether test-taking is a major life activity, and whether test anxiety substantially limits test-taking. The article then turns to questions of policy: How should ADA claims for test anxiety be handled by educational institutions, independent testing agencies, and employers? A review of scientific research and legal authorities are used to answer these questions. Most individuals with high test anxiety levels will not qualify as disabled under ADA, although there will be exceptions to that general rule, and testing entities should always conduct an individualized inquiry into each claim.

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.

Test-Taking Speed: Predictors and Implications

Students often feel time pressure when taking tests, and students with disabilities are sometimes given extended time testing accommodations, but little research has been done on the factors that affect students’ test-taking speed. In the present study, 253 students at two colleges completed measures of processing speed, reading fluency, and self-reports of their reading and test-taking skills, as well as a standardized paper-and-pencil reading comprehension task. The time taken to complete the reading comprehension task was not significantly related to students’ accuracy on the task, but it was predicted by students’ reading fluency and by their self-reports of problems with timed reading/test-taking. Students’ processing speed did not significantly predict comprehension task completion time or accuracy when reading fluency and self-reports were held constant. We discuss the implications of these and other results for making determinations about extended time testing accommodations, as well as for future research studies.