There are a broad range of conditions that impact an individual’s ability to concentrate or think, process and retain information, and use judgment to make decisions. These conditions are considered cognitive disabilities and are represented below.
Attention Deficit Hyperactivity Disorder (ADHD)
Definition
The Diagnostic and Statistical Manual of Mental Disorders (5th edition) defines ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has presented symptoms in two or more settings (i.e.., at home, school or work; with friends or relatives; and in other activities) for at least the past six months, and has direct negative impact on social, academic or occupational functioning. The DSM-5 specifies that several symptoms must have been present before age 12.
Documenting ADHD
Many adolescents and adults report experiencing some of the ADHD symptoms listed in the DSM-5, but those with only test anxiety or specific issues in daily organization, memory, or concentration do not meet the diagnostic criteria. Similarly, students with executive function issues who do not meet ADHD criteria are not classified as having ADHD. A positive response to medication alone does not confirm a diagnosis, nor does medication use alone support or negate the need for accommodations.
A diagnostic report for testing accommodations should confirm an ADHD diagnosis (including subtype) based on DSM criteria, provide supporting data, and rule out alternative explanations like medical conditions, other psychological disorders, or noncognitive factors. It should also consider the possibility of dual diagnoses.
Distinguishing normal behaviors from clinically significant impairment in adolescents and adults (e.g., procrastination, disorganization, distractibility) requires evaluating symptom severity, frequency, and impact on major life activities.
Learning Disabilities
Definition
Learning disability is a general term that refers to a group of disorders characterized by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. Problems in self-regulatory behaviors, social perception and social interaction may exist with learning disabilities, but do not by themselves constitute a learning disability.
Adopted from the National Joint Committee on Learning Disabilities (2016).
The Diagnostic and Statistical Manual of Mental Disorders (5th edition) uses the term Specific Learning Disorder (SLD) which is defined as persistent difficulties in reading, written expression, and / or mathematical reasoning; academic skills significantly below what is expected for the individual's age; and difficulties that persist for at least 6 months despite targeted intervention.
Documenting Learning Disabilities
A comprehensive evaluation by a qualified professional should address the presenting problem and evaluate intelligence, achievement, listening, speaking, reading, writing, reasoning, and math. Standardized tests are administered and data is collected in the form of history, interviews, self-rating measures, and clinical observations.
Traumatic Brain Injury and Concussion
Definition
The Diagnostic and Statistical Manual of Mental Disorders (5th edition) defines TBI as a form of nondegenerative acquired brain injury associated with changes in levels of consciousness, memory disturbances, confusion, and neurological signs such as brain injury observable on neuroimaging, new onset or worsening of seizure disorder, visual field deficits, and hemiparesis. TBI's are classified as mild (applies to concussions), moderate, or severe.
Documenting TBI
Documentation of this complex condition may be medically, psychologically, or vocationally oriented. In most cases, a neuropsychological or psychoeducational evaluation will be useful in clarifying the functional impact of the diagnosed disability and in supporting the underlying rationale for accommodations.
Examples of assessment instruments include but are not limited to:
- Automated Neuropsychological Assessment Metrics (ANAM)
- Brief Test of Head Injury
- Coma Recovery Scale – Revised
- Glasgow Coma Scale
- ImPACT (Immediate Post-concussion Assessment and Cognitive Testing)
- Military Acute Concussion Evaluation (MACE)
- Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI)
- SCAT-3 (Sports Concussion Assessment Tool-3)
- VA Traumatic Brain Injury Screening Tool
A complete psychoeducational or neuropsychological assessment is recommended to determine the degree to which the condition impacts a student relative to the academic setting. The assessment must include an individualized, standardized, and norm-appropriate battery demonstrating the functional limitations necessitating accommodation. Assessment areas may include intellect, achievement, processing speed, fluency, executive functioning, language, memory, and attention.