ADHD Documentation Guidelines
(available in PDF format: Attention-Deficit/Hyperactivity Disorder Documentation Guidelines)
Cornell University requires the following information to make informed decision concerning academic accommodations for students with Attention Deficit Hyperactivity Disorder (ADHD or ADD).
Qualification of the Evaluator
Documentation
Evidence of Early Impairment
Evidence of Current Impairment
Diagnostic Interview
Alternative Diagnoses or Explanations
Specific Diagnoses
Recommendations for Accommodations
Qualifications of the Evaluator
Professionals conducting assessments and rendering diagnoses of ADHD and making recommendations for accommodations must be qualified to do so. Comprehensive training and relevant experience in differential diagnosis and the full range of psychiatric disorders are essential. The name, title, and professional credentials of the evaluator should be clearly stated in the documentation. All reports should be on letterhead, typed, dated, and signed.
Documentation
Cornell University requires current documentation of disabilities using well-known diagnostic criteria that are valid for adult populations.
Evidence of Early Impairment
Because ADHD is, by definition in the DSM-IV, first exhibited in childhood (although it may not have been formally diagnosed) and manifests itself in more than one setting, relevant historical information is essential. A comprehensive assessment should include a clinical summary of objective historical information that establishes symptomatology indicative of ADHD throughout childhood, adolescence, and adulthood as garnered from transcripts, report cards, teacher comments, tutoring evaluations, and past psycho-educational testing, and third party interviews when available.
Evidence of Current Impairment
Statement of Presenting Problem-A history of the individual's present attentional symptoms should be provided, including evidence of ongoing impulsive/hyperactive or inattentive behaviors that significantly impair functioning in two or more settings.
Diagnostic Interview
The information collected for the summary of the diagnostic interview should consist of more than self-report, as information from third party sources is critical in the diagnosis of ADHD. The diagnostic interview with information from a variety of sources should include, but not necessarily be limited to, the following:
- History of presenting attentional symptoms, including evidence of ongoing impulsive/hyperactive or inattentive behavior that has significantly impaired functioning over time
- Developmental history
- Family history for presence of ADHD and other educational, learning, physical, or psychological difficulties deemed relevant by the examiner
- Relevant medical and medication history, including the absence of a medical basis for the symptoms being evaluated
- Relevant psychosocial history and any relevant interventions
- A thorough academic history of elementary, secondary, and post secondary education
- A review of prior psychoeducational test reports to determine whether a pattern of strengths or weaknesses is supportive of attention or learning problems
- Relevant employment history
- Description of current functional limitations in an educational setting that are a direct result of problems with attention
- Relevant history of prior therapy
Alternative Diagnoses or Explanations
The evaluator must investigate and discuss the possibility of dual diagnoses and alternative or coexisting mood, behavioral, neurological, and/or personality disorders that may confound the diagnosis of ADHD. This process should include exploration of possible alternative diagnoses and medical and psychiatric disorders as well as educational and cultural factors affecting the individual that may result in behaviors mimicking an Attention-Deficit/Hyperactivity Disorder.
Specific Diagnoses
The report must include a specific diagnosis of ADHD based on the DSM-IV diagnostic criteria. The diagnostician should use direct language in the diagnosis of ADHD, avoiding the use of such terms as "suggests," "is indicative of," or "attention problems." Individuals who report only problems with organization, test anxiety, memory or concentration in selective situations do not fit the prescribed diagnostic criteria for ADHD. Given that many individuals benefit from prescribed medications and therapies, a positive response to medication by itself does not confirm a diagnosis, nor does the use of medication in and of itself either support or negate the need for accommodation.
Recommendations for Accommodations
The evaluator must describe the impact, if any, of the diagnosed ADHD on a specific major life activity as well as the degree of impact on the individual. The diagnostic report must include specific recommendations for accommodations that are realistic at post secondary institutions. A detailed explanation as to why each accommodation is recommended must be provided and should be correlated with specific functional limitations determined through interview, observation, and/or testing.
Although prior documentation may have been useful in determining appropriate services in the past, current documentation must validate the need for services based on the individual's present level of functioning in the educational setting. A school plan such as an Individualized Education Program (IEP) or a 504 plan is insufficient documentation in and of itself but can be included as part of a more comprehensive evaluative report. The documentation must include any record of prior accommodations or auxiliary aids, including information about specific conditions under which the accommodations were used (e.g., standardized testing, final exams, licensing or certification examinations) and whether or not they benefited the individual. However, a prior history of accommodations without demonstration of a current need does not in itself warrant the provision of like accommodations.
If no prior accommodations were provided, the qualified professional and/or the candidate must include a detailed explanation of why no accommodations were needed in the past and why accommodations are needed at this time. Because of the challenge of distinguishing normal behaviors and developmental patterns of adolescents and adults (e.g., procrastination, disorganization, distractibility, restlessness, boredom, academic under-achievement or failure, low self-esteem, chronic tardiness or inattendance) from clinically significant impairment, a multifaceted evaluation should address the intensity and frequency of the symptoms and whether these behaviors constitute an impairment in a major life activity.
If the requested accommodations are not clearly identified in the diagnostic report, Student Disability Services will seek clarification, and, if necessary, more information. Student Disability Services will make final determination of whether appropriate and reasonable accommodations are warranted and can be provided to the individual.