Guide for Assessing Persons with Disabilities - How to determine and implement assessment accommodations - Attention Deficit Hyperactivity Disorder

What do you need to know about the disability?

Attention Deficit Hyperactivity Disorders (ADHD) are characterized by inattention, distractibility, disorganization and can be accompanied by restlessness and impulsivity when associated with hyperactive type characteristics.

• Attention Deficit Hyperactivity Disorder, predominantly inattentive type (also referred to as ADHD-H, or "ADHD minus Hyperactivity" or ADHD - Inattentive type or ADD). These individuals have difficulty in:
  • selecting appropriate information to which to attend (e.g., neglect important details or make careless errors, lose track of things);
  • sustaining attention for extended periods, including being easily distracted, following through on instructions, or forgetting; and
  • alternating attention between two or more tasks being done simultaneously (i.e., multitasking).
• Attention deficits accompanied by restlessness and impulsivity (also referred to as ADHD Hyperactive type). In addition to attention problems, individuals may have difficulty sitting still and working on a task without fidgeting, pacing, talking to others, or interrupting the task.

Functional limitations relatively to attending to information may also lead to problems similar to those seen with learning disabilities, in such areas as acquiring, organizing, retaining, understanding, and using verbal or non-verbal information. Thus, as with learning disabilities, the following abilities may be affected: oral language, reading, written language and mathematics. ADHD could also be associated with anxiety or depressive disorders.

What information or professional documentation is needed?

Persons with ADHD should be the first source of information regarding their limitations and the assessment accommodations that are useful to them. However, they will normally be required to provide professional documentation to clarify the nature and the extent of their functional limitations. In order to provide appropriate assessment accommodations, a report of an assessment conducted by a qualified professional in the field, accredited by the appropriate regulated professional association, is required to complement the information already provided by the applicant. Because the disability is not evident and is complex and subject to interpretation, it is of the most importance to have as precise a picture as possible as to the effect of the disability on a particular person's mode of functioning.

Documentation should reflect the person's current mode of functioning. While ADHD was previously thought to affect only children, it is now recognized that the impairment can sometimes continue into adulthood, although it may be expressed differently at this more mature stage. If the professional documentation presented dates from childhood or adolescence, the person may be asked to return to a specialist for a new and current assessment of their level of functioning. For a more general discussion on professional documentation requirements and standards, refer to the section on Standards for professional documentation.

Typically, the professional documentation should include:

• a clear description of the nature and extent of the functional limitations;
• an interpretative summary of test results;
• any means by which the applicant compensates for his or her functional limitations;
• a description of functional limitations that are not improved by the use of prescription medications (such as Ritalin) should also be included, as should any other side effects of medications, if applicable; and
• a description of accommodations that the person is using, has used or could benefit from.

Having this information in the professional report or document allows for a description of the person's current strengths and limits with implications for assessment accommodations. Specific accommodations may be suggested in the assessment report. While suggested accommodations from the report may not be directly transferable to the specific assessment situation, depending on the context for which they were intended, they may still provide useful information. When there is a difference between the professional's suggestions and the planned accommodations, it may be necessary to consult with the professional or another external expert familiar with both the applicant and the issues involved. The applicant must agree in writing to this further consultation (see step 3 of the section Determining and implementing assessment accommodations).

What are the key elements to consider?

When determining assessment accommodations for persons with ADHD, the following three elements should be considered:

1. The nature and extent of the person's functional limitations must be clearly understood. The following questions may help to gather useful information:

• What is the extent of the functional limitations imposed by the disability at the current time, taking into account effects of any medication used (mild, moderate, severe)?
• Does the person who has ADHD also have restlessness and impulsivity?
• What specific functions are affected in addition to attention? These functions could include oral language, reading, written language and mathematics. You may refer to the section on learning disabilities for information on determining accommodations for difficulties in these areas.
• Does the person who has ADHD also have another disability (for example, a learning disability)? If this is the case, this fact will normally be indicated in the report from the qualified professional, and you should refer to the appropriate section for examples of possible accommodations.
• What are the accommodations used by the person on the job to accomplish work tasks that are similar to the tasks to be accomplished during the assessment situation?

It is important to reiterate that persons with disabilities are the first source of information on the way their limitations affect them and on how to accommodate their specific needs. Consequently, although for the disability discussed here some documentation will have to be provided by a professional, information on functional limitations will also be gathered through exchanges with the person. To help you to gather these details in a discussion, you may wish to refer to the questionnaire available in appendix 2.

The documentation provided by a professional will ensure a precise understanding of the multifaceted functional limitations associated with the disability. For more information on professional documentation requirements please refer to Standards for professional documentation.

2. A thorough knowledge of the assessment tool to be used is required. Depending on the assessment tool's characteristics, accommodations which are necessary for one tool may be unnecessary for another. Here are some considerations to help you identify the characteristics of your assessment tool.

For an interview:

• Are written documents provided before or during the interview? If so, how much reading is involved? Is the applicant allowed to bring these documents into the interview to refer to?
• Is there time to prepare responses prior to the interview? If so, how long is it?
• Is the applicant allowed to make notes of his or her planned responses and refer to them throughout the interview?
• How long is the interview?
• Is there a written component? If so, how much writing is involved?
• Is the interview room free from visual and/or auditory distractions?

For a written test:

• Is it an essay-style exam or a multiple choice test?
• Is it a case study, an in-basket exercise?
• Is the test an open book test?
• How many questions are there?
• How much reading and writing are involved?
• What is the time allotted?
• What is the expected length of responses to be provided?
• Is the assessment room free from visual and/or auditory distractions?

For an interactive situation:

• Is it a group interactive situation? If so, how many participants are there?
• Is written documentation provided before or during the situation? If so, how much reading is involved?
• What is the expected length of exercise to happen orally?
• Is there a written component? If so, how much writing is involved?
• What is the time allotted?

3. Knowledge of the qualification being assessed is essential. This information will help you ensure that accommodations do not modify the nature or level of the qualification being assessed. Considerations include:

• What qualification(s) is (are) assessed by the instrument? It is knowledge, abilities/skills, aptitude or personal suitability? How is it defined?
• Is there a speed requirement?
• Does the level of the qualification assessed reflect the job requirement?

Determining appropriate assessment accommodations necessarily requires research and analysis of all three elements above; of the impact they have one another, and the application of the Principles for assessment accommodations. This analysis is the foundation of the rationale for the accommodations. This rational has to explain how the accommodations are enabling the demonstration of the person's qualifications, preventing his or her functional limitations from being a disadvantage. It also has to explain how the person is not being given an advantage compared to others in the appointment process, therefore, that merit is preserved.

Examples of assessment accommodations and considerations

The following are examples and considerations that may be helpful in determining assessment accommodations. It also includes a number of specific examples of assessment accommodations relative to possible functional limitations.

While reviewing these examples, keep in mind that accommodations are determined on a case by case basis and their appropriateness will depend on the nature and extent of the individual's functional limitations, the assessment tool to be used and the qualification to be assessed. Also, accommodations must resemble, if possible, the usual way in which the person would perform the task requested as if he or she was on the job, and must not alter the nature or level of the qualification being assessed. For more details, please refer to Determining and implementing assessment accommodations.

Individual session: An individual assessment session in a quiet room free from distracting noises, and where the person may move about or talk aloud, if needed, is particularly important for persons with ADHD.

Additional time: Additional time may be required to accommodate difficulties attending to the task at hand, following instructions and concentrating on the important elements.

Short test sessions: Break longer test sessions into shorter segments, providing for extra breaks, when this change can be done without disrupting attention. These breaks are not counted in the test's administration time.

Use of assessment accommodations suggested for those with learning disabilities: ADHD may affect many of the abilities also affected by learning disabilities, such as oral language, reading, written language and mathematics. Thus, many of the accommodations previously described in the section on learning disabilities may be appropriate depending on the identified functional limitations. Particularly important are accommodations that aid the person to:

• reduce distractions;
• concentrate on important elements in a assessment procedure by simplifying information and presenting it in small chunks;
• organize information; and
• follow instructions and work within time limits.

For primarily attention difficulties

• use of sound-suppression earphones or earplugs;
• use of white noise or environmental sound machines;
• allow the person to play soothing music (e.g., with a cassette player and headset);
• have the person verbalize test instructions, test questions, or interview questions in his or her own words to aid in maintaining attention and to monitor comprehension; and
• provide choice in the scheduling of examination sessions to take into account the individual's best working periods.

For attention deficits accompanied by restlessness and impulsivity

• allow the person to bring in beverages or food if this helps to concentrate and focus on the task at hand;
• allow frequent breaks, not counted in the administration time, to enable the person to walk around for a few minutes to discharge excess energy.