Criteria for Documenting Attention Deficit/Hyperactivity Disorder (ADHD)
This describes the required criteria for documenting Attention Deficit/Hyperactivity Disorder, with or without hyperactivity (ADHD) for students seeking to receive prescriptions from a Counseling and Psychological Services psychiatrist. These criteria are adapted from the Educational Testing Services’ document that synthesizes current knowledge about ADHD and explains diagnostic criteria for documenting ADHD.
Evaluators providing this documentation must be properly licensed/certified in the area of adult attention deficit disorders, including psychiatrists, neuro-psychiatrists/psychologists and or psychologists trained in treatment and diagnosis of adult ADHD.
Evaluators must provide a typed report on official letterhead that includes their credentials related to diagnosis and treatment of persons with ADHD.
A. Relevant Testing Information Must Be Provided
Neuropsychological or psycho-educational assessment is important in determining the current impact of the disorder on an individual's ability to function in academically related settings. Such assessments might include testing of intelligence, achievement, processing speed, fluency, executive functioning, language, memory and learning, attention, etc.
In-depth, comprehensive ADHD evaluations must include:
Two or More Objective Assessment Instruments such as:
- Conners Continuous Performance Test - CPT
- Test of Variables of Attention (TOVA-A/TOVA-R)
B. Evidence of Early Impairment
ADHD is exhibited in childhood or early adolescence (although it may not have been formally diagnosed) and manifests itself in more than one setting. Relevant historical information is essential.
C. Evidence of Current Impairment
In addition to providing evidence that the symptoms interfere with the quality of functioning, the following areas must be investigated:
Statement of Presenting Problem: What are the individual's current ADHD symptoms?
Relevant Diagnostic Information: The documentation should include a summary of the diagnostic interview conducted by a qualified evaluator. The diagnostic information obtained from the interview should consist of more than self-report, as information from third party sources is critical in the diagnosis of ADHD.
D. Documentation Must Include a Specific Diagnosis
The report must include a specific diagnosis of ADHD (including the subtype) based on the current DSM diagnostic criteria. The qualified professional should provide a rationale and supportive data to substantiate this diagnosis. It is not sufficient for a current evaluation report to simply refer to a prior diagnosis as confirmatory evidence of ADHD. The current assessment needs to reconfirm the diagnosis with supportive clinical data and an updated rationale for any accommodations being sought.
E. Alternative Diagnoses or Explanations Must Be Ruled Out
Given the high rate of co-morbidity, it is recommended that evaluators investigate and discuss the possibility of dual diagnoses and alternative or coexisting mood, behavioral, neurological, personality disorders, etc. and/or other health issues that may confound the diagnosis of ADHD (e.g., substance abuse, sleep management, etc.). This process should include exploration of possible alternative diagnoses and medical and psychiatric disorders, as well as educational and cultural factors potentially affecting the diagnosis of ADHD.
F. Documentation Must Include Interpretation and Discussion of Diagnostic Findings
An interpretation of findings based upon a comprehensive evaluative process is a necessary component of the documentation. This interpretation should be developed along the following guidelines.
Evaluators should rule out alternative explanations for inattentiveness, impulsivity, and/or hyperactivity resulting from medical conditions, other psychological disorders, or non-cognitive factors. The evaluator must describe the manner in which the possible alternatives were considered and ruled out (e.g., historical information, observation, or test results).
Evaluators should demonstrate how patterns of inattentiveness, impulsivity, and/or hyperactivity have affected the individual across the life span and across developmentally appropriate settings (e.g., school, playground, and home discipline for children; occupational, interpersonal, financial, civic adjustment/responsibility for adults) in making a diagnosis of ADHD.
Evaluators should specifically describe how ADHD substantially limits learning and to what degree the disorder affects the individual in testing contexts when the candidate is requesting accommodations.
Evaluators should describe whether or not the candidate was taking psychoactive medication at the time of the evaluation, and indicate the extent to which any and all of the treatment provides a positive response and/or negative side effects.
G. Alternative Documentation
If a student has been diagnosed with ADHD and does not have a comprehensive ADHD evaluation, a letter substantiating their symptoms and diagnosis is required from a prescribing psychiatrist or neurologist. The student should have a recent treatment history for ADHD (within one year). Counseling and Psychological Services psychiatrist may determine that they will prescribe medication to the student in the event that a recent treatment history has been documented. However, an appointment with our psychiatrist will not be scheduled until after documentation of the ADHD diagnosis has been reviewed and approved.