not all disabled individuals require accommodations€¦ · not all disabled individuals require...

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Ms.VanitaGupta

PrincipalDeputyAssistant

AttorneyGeneral

DepartmentofJustice

CivilRightsDivision

950PennsylvaniaAvenue

Washington,DC,20530-001

DearMs.Gupta:

The InterOrganizationalPracticeCommittee (IOPC) isa coalitionof theAmericanAcademyofClinicalNeuropsychology (AACN), the Society for Clinical Neuropsychology/Division 40 of the AmericanPsychological Association, the American Board of Professional Neuropsychology (ABN), the NationalAcademyofNeuropsychology(NAN),andtheAmericanPsychologicalPracticeOrganization(APAPO).Weare taskedwith coordinating national neuropsychology advocacy efforts, and represent thousands ofneuropsychologists in the United States. Our member organizations contain professionals who areexpertsincomprehensiveassessmentsthatdetermineanindividual'sfunctionalimpairmentsandrelatedaccommodationneeds.Neuropsychologistsoftenadvocateforindividualswithdisabilitieswhorequiretestingaccommodations.

TheIOPCiswritingtoexpressoursupporttotheDepartmentofJustice(DOJ)foritscommitmenttoestablishinglessburdensomeguidelinesforstudentstoobtaintestingaccommodations.Manyneuropsychologistshavehadtoappealdenialsofaccommodationsforcandidateswithwell-documentedhistoriesandcontinueddeficits.Forthisreason,theIOPCwouldliketoexpressoursupportfortheDepartmentofJustice’s(DOJ)'sintentiontoestablishguidelinesforobtainingtestingaccommodationsthatwillbelessburdensomeforstudents.Webelievethattheeffortstomakethedocumentationprocesslessonerousarestepsintherightdirection.However,wedonotbelievethatthisshouldbedoneattheexpenseofvalidityandfairness.ThisletteroutlinesourgraveconcernswiththeDOJGuidelinesonTestingAccommodations,releasedinSeptemberof2015.SomeoftheprinciplesoutlinedintheTechnicalAssistancedocumentarenotsupportedbyempiricalevidenceandclinicalexperienceandmayinadvertentlyleadtograntingofunnecessary,inappropriateorunhelpfulaccommodations.Suchaccommodationscanbeharmfultothosewhoreceivethem,unfairtoothertest

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takers,andposetheriskofmakingtestslessaffordableforlowincomestudents.WeexplainourconcernsandoffertoworkwiththeDepartmentofJusticeonthesechanges:

NotallDisabledIndividualsRequireAccommodations

TheTechnicalAssistancedocumentcorrectlystatesthat"individualswithdisabilitiesareeligibletoreceivenecessarytestingaccommodations."However, individualswithdisabilitiesvary inthedegreetowhichtheir disabilities affect their level of functioning, and as such, they may not require any testingaccommodations.Documentationofadisabilityaloneisthereforeinsufficienttodeterminethetypeanddegreeofnecessaryaccommodations;acomprehensiveevaluationisnecessarytoindividualizeandtailorthoseaccommodations.Blanketgrantingofaccommodationsbasedonprevioustestingcanultimatelyincreaseadministrativecostsifmanymorestudentsareprovidedwithaccommodationsthanshouldbeandhasthepotentialtoraisetestfeesandeliminatelower-incomeindividualswithoutdisabilitiesfromtesting,whichmaycreateasituationofreversediscrimination.

The Technical Assistance document states that if an individual has previously received testingaccommodations,theyshouldbegrantedaccommodationswhenevertheyrequestitinthefuture.Thisadvicedoesnottake intoaccountresearchonbrainplasticityandthefrequentpositivechanges inanindividual’s functional level over time. Some children with Attention Deficit Hyperactivity Disorder(AD/HD)willnotshowsignificantsymptomsasadults;astheirleveloffunctionalimpairmentdiminishes,sodotheiraccommodationneeds.Somechildrenwithreadingdisabilitiesundergoeffectiveremediativetraining/interventions,andthereforeastudentwhooncereceivedread-aloudaccommodationsmayonlyneedextendedtimeasanadult. Individualizedneuropsychologicalevaluationshelptodocumentwhatsomeone's current accommodation needs are whichmay be different than what was recommendedpreviously,astheremediativetrainingtheyreceivedinschoolhelpedthemovercometheirdisabilitiesovertime.

The‘BestPractices’documentacceptsassufficientdocumentationanevaluationcompletedatage13,without requiring an updated evaluation (ormore recent evaluation)much closer in time to the testadministrationinquestion.Thisisproblematicforseveralreasons.First,researchdoesnotsupportage13asadevelopmentalagewhendiagnosesoflearningdisabilitiesstabilize.Age13isanarbitrarynumberin this context. It iswellestablished thatconsiderablebrainmaturityoccurs in the teenageyearsandthrough the 20s. Thus, students’ cognitive profiles likely change over the intervening decade, withpotentialimprovementsinattentionandexecutivefunction,aswellasinotherareas(Antshel&Barkley,2011a). Furthermore, college work provides more practice in reading and writing, such that somestudents’readingandwritingspeedmarkedlyimprove.Thus,deficitspresentearlierinlifemaynotremainafter college.Changesoccur, necessitating reevaluation todetermine their nature and toensure thataccommodationsthatarenolongernecessaryarenotunfairlygranted.

The Technical Assistance document appears to base its recommendations on outdated evidence thatimpairmentfrompsychologicaldisordersispermanent.Manysuchdisordersinfactarenotpermanent.Forinstance,researchhasshowndiagnosesofAsperger'sDisorder(nowpartofDSM-5AutismSpectrumDisorder)tobequiteunstableandthereforesubjecttochangesthataffectwhataccommodationsareneeded (Helles,Gillberg,Gillberg&Billstedt,2015). Evenchildrenwithpriordiagnosesofautismcanrecovertothepointthataccommodationscanbereducedoreliminated(Helt,Kelley,Kinsbourne,Pandey,Boorstein,Herbert,&Fein,2008). AD/HDsymptoms frequently lessenorevendisappear/abate fromchildhoodtoadulthood(AntshelandBarkley,2011).Inaddition,learningdisorderschangeovertime,as

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indicatedontheNINDSDyslexiaandNINDSDysgraphiaInformationpages(2016).Tanner(2009)writesthat it is virtually impossible to provide a universal profile of an adult with dyslexia suggesting thatuniversalaccommodationsoraccommodationsmadeforahighschoolstudentwillnotbenecessarilythesameasforanadult. Forexample,Svensson&Jacobson(2006)foundthatsomeadultshavereachednormalwordidentificationskillsdespitebeingdyslexicaschildren,andwordidentificationis,ofcourse,acorefeatureofdyslexia.Inaddition,Lewinsohn,etal.(1994)reporthow,overtime,psychiatricdisordersalter.Thus,theseexamplesofpsychologicaldisorders/symptomsabatingovertimearefurtherevidencethat repeat neuropsychological evaluations are necessary for accurate diagnoses and appropriateaccommodations.

AccommodationNeedsDifferAccordingtotheTypeofExam

The DOJ Technical Assistance document assumes that different types of exams (college admissions,professional licensure, and high school equivalency) would all require the same type and degree ofaccommodations for a given individual. However, neuropsychologists help determine the appropriatetestingaccommodationsdependingonthenatureofthelearningdisabilityprofileandtheexaminationforwhichaccommodationsarebeingsought.Thus,forsometypesofexams(e.g.,licensingphysicians),amorerigorousstandardofreviewisrequiredthanforotherexams(e.g.,highschoolequivalency).Forexample,formerhighschoolstudentsweregrantedfairlyextensiveaccommodationstomeettheneedsoftheirdisabilityinhighschool,maynolongerneeditasmedicalstudentsbecausetheirdisabilityhaslessenedbutalsobecauseitwouldbeinappropriatetohavethisdegreeofaccommodationsinmedicalschool, and potentially create situations where substandard physicians are graduated from medicalschool.

InaccuracyofSelf-Report

TheTechnicalAssistancedocumentsuggeststhatself-reportsoflearningdisabledtest-takersshouldbeusedtoguidetheiraccommodationneeds.Asneuropsychologistsknowbothfromclinicalexperienceandresearch, self-reportsare frequentlyunreliable. The inaccuracy stems froma student’s lackofexpertunderstanding of what levels of functioning are typical and/or normal, as well as a motivation toexaggerateimpairmentstoobtainthegreatestaccommodationsrelatedtotheirdisability.Forexample,anindividualinahigh-performancesettingsuchasacompetitivecollegemayperceivethattheirskillsarerelativelyweakerthantheirpeers,eventhoughtheirskillsmaybewithinthenormalrange,andthustheymayunknowinglyreportadisabilitywherenoneexists.Tothatend,neuropsychologicalassessment iscriticaltoobtainobjectiveresultsandvalidateself-reports(Heilbronneret.al.,2009).Indeed,lawsrestrictdiagnosticpracticetocertifiedandlicensedprofessionalsforjustthisreason;askingindividualstoassesstheirownlevelofimpairmentseemstoviolatethespiritofthoselaws.

AccommodationswithoutDisability

Related, school evaluators sometimes award academic accommodations to students even when thestudentisnotdisabled,basedonextenuatingcircumstance(e.g.,theschool’scurriculumischallenging,orunfamiliaritywithdisabilitypoliciesandlaws(seeCrawfordandKetterlin,2013).Thus,historyofprioraccommodationsthatwerenotbasedonformaldiagnosticevaluationsshouldnotbesufficienttojustifyfuturetestingaccommodations.Forexample,inNewYorkCityindependentschools,twentypercentormore of the students are receiving accommodations. A story from the NY Times from 2002 reportsparents'gaming'thesystem(Gross,2002).Perthatsamearticle,aCaliforniastateauditfoundelevated

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figuresforuseofaccommodationsinprivateschools.Grantingunnecessaryaccommodationstostudentsisalsoaconsumerprotectionandfairnessissue.Inflatedtestscoresmayleadtoadmissionintoprogramswherethereisnotagoodfitbetweenthestudent’sactualabilitiesandthedemandsoftheprogram.Inthosecases,studentconsumersareatriskofacademicfailure,whichisparticularlytroublingifthestudenthaslargestudentloandebt.Suchunjustifiedaccommodationsarealsounfairtootherstakingthesameexam.

ProblemswithProvidingUnnecessaryAccommodations

Students require updated periodic neuropsychological evaluations to minimize the problem ofunnecessaryaccommodations,whichcanbeproblematic.First, studentswhoreceive theunnecessaryaccommodationsaregivenanunfairadvantage.Researchhasshownthatwhenhighachievingstudentswithdisabilitiesareprovidedwith50%additionaltime,theycompletemorequestionsthantheirnon-disabledpeersdowiththestandardamountoftime(Lewandowskietal.,2013).Second,ifstudentsareprovidedwithaccommodationsthattheydonotneedtobesuccessful,theymaybegintorelyonsuchaccommodationsratherthandeveloptheskillsandcopingmechanismstheywillneedintheircareersandlives.Third,notallstudentswithAD/HDarethesameandalthoughsomeworkmoreslowlyandneedadditionaltime,manydonot(Lewandowskiet.al.,2013).Similarly,althoughsomestudentswithlearningdisabilitiesmayneedadditionaltimeacrossallaspectsofatest,othersmayonlyneeditforonlyaspecificportion(e.g.,reading,problem-solving,orwriting).Ifdecisionsarebasedonpasthistory,thisislikelytoresultinunnecessaryandinappropriateaccommodationsandpotentiallyunfairadvantagesascomparedtoclassmateswhoarenotreceivingaccommodations.

NeedtoDefineWhoisa“QualifiedProfessional”

WeagreewithTechnicalAssistancedocument indirectingtestingentities to"defer todocumentationfromaqualifiedprofessional."Documentationfromthird-partydiagnosticevaluationsisoftencrucialinmakingaccommodationdecisions.Butdeficient/inexpertdocumentationbysomeprofessionalsmakesessentialthattheTechnicalAssistancedocumentclearlydefinewhoisa“qualifiedprofessional”.Someparaprofessionals or professionals (e.g., pediatricians, family physicians) who can diagnose but notconducttestingmaynotadheretoofficialformaldiagnosticcriteria,theymaynotproperlyapplythelegalstandardoftheADA(substantial limitationscomparedtomostpeople inthegeneralpopulation),andmay fail to make specific and individualized accommodations (see Harrison et. al, 2013). Someprofessionalsmayalsofailtoincludemeasuresassessingaclient'slevelofmotivation/effort/performanceconsistency, even though neuropsychologists have shown these measures to be critical to properinterpretations. Some adolescents and adults furthermore have been diagnosed using a discrepancymodel(comparingIQtoreadingskills),whichiswidelyconsideredadiscreditedmodelthatisusedasthebasisofevidence.Thus,individualsmaybereceivingaccommodationsbaseduponanoutdatedclinicalmodel. In light of these problems, "qualified professional" should be defined to clarify whatprocedures/typesofevaluationsarenecessaryandsufficienttoproduceareasonablediagnosisandsetof accommodations. These professionals, at a minimum, need to have training in both psychiatricdiagnosisandneuropsychological/psychoeducationalassessment.

Summary

Insum,theIOPCstronglyrecommendsthattheseguidelinesbeimprovedtoaddresstheconcernsthatwehaveidentified.WegladlyofferourassistanceinrewritingtheseguidelinessosupportDOJ’sgoalof

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makingaccommodations lessburdensomeforstudents,withtheaddedaimofmaximizingthevalidityandutilityofdisabilityevaluations.

Respectfully submitted on behalf of the American Academy of Clinical Neuropsychology, NationalAcademyofNeuropsychology,Division40(Neuropsychology)oftheAmericanPsychologicalAssociation,theAmericanPsychologicalAssociationPracticeOrganization,andtheAmericanBoardofProfessionalNeuropsychology,

Karen Postal, Ph.D., ABPP-CN President, American Academy of Clinical Neuropsychology

Katherine Nordal, Ph.D. Executive Director, American Psychological Association Practice Organization

Laura Lacritz, Ph.D., ABPP-CN President, National Academy of Neuropsychology Jennifer J. Vasterling, Ph.D. President, Society for Clinical Neuropsychology (APA Division 40)

Karen L. Wilhelm, Ph.D., ABN President, American Board of Professional Neuropsychology

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