Abstract
Increasing numbers of students with learning disability and attention deficit/hyperactivity disorder (ADHD) diagnoses are applying for accommodations in postsecondary education and employment settings. However, students’ documentation of these conditions is often substandard. One possible reason for this is that clinicians have failed to apply proper criteria when determining disability status. We surveyed 119 clinicians who diagnosed these conditions in students applying for accommodations to determine clinician levels of knowledge about appropriate diagnostic and legal standards. We found weak clinician knowledge on certain key issues, including the meaning of functional impairment and understanding of the different laws governing academic accommodation of children versus adults. The average respondent’s score on a 30-item true/false questionnaire was only 69% correct. Implications of these results for practice and future research are discussed.
Over the past two decades, there has been a considerable increase in the number of students requesting disability-related accommodations in postsecondary education settings (e.g., Ranseen & Parks, 2005). This includes applications for accommodations on classroom tests, college and graduate/professional admissions tests, certification and licensure tests, and, even, employment evaluations. The increase in accommodation requests parallels growth in the numbers of individuals with disabilities now attending college (College Committee on Disability Issues, 2004; Heiman & Precel, 2003; Mull, Sitlington, & Alper, 2001; Ontario Human Rights Commission, 2003; Sharpe & Johnson, 2001), and/or seeking professional employment (Katsiyannis, Zhang, Landmark, & Reber, 2009), and the growth in special resources available to students with disabilities in these settings (Madaus, 2011).
Students with disabilities are legally entitled to provision of appropriate accommodations, services, and supports in their postsecondary programs to ensure that their impairments do not unfairly interfere with their ability to participate equally and to demonstrate mastery of course material (Katsiyannis et al., 2009). Accommodations, however, must be individualized, determined based on the interaction between the nature of the task in question and the current impairments experienced by the individual (Roberts, 2012).
Most students with disability diagnoses in postsecondary settings report learning, cognitive, or psychiatric disorders rather than physical or sensory handicaps (e.g., Government Accountability Office, 2011; Ontario Human Rights Commission, 2003). Learning and attention problems are particularly common in these students (Ministry of Training, Colleges and Universities: Postsecondary Education Division, 2008). Therefore, one consequence of the growth in access for students with disabilities has been a market for psychoeducational evaluations that explicitly address accommodation needs in postsecondary contexts. This is especially important for the many students who were never diagnosed in childhood and who first receive diagnoses in college or after. However, even for students with earlier diagnoses, there is often a “documentation disconnect”; that is, the documentation that supported special education services does not sufficiently address someone’s needs after secondary school (Gormley, Hughes, Block, & Lendmann, 2005; National Joint Committee on Learning Disabilities, 2007; Sitlington & Payne, 2004).
The increase in formal evaluations is a positive development, increasing postsecondary access for students who need various accommodations. However, there are also several potential problems with this process. First, the dynamics of the evaluation process can lead to overdiagnosis of disabilities. Unlike school-based special education evaluations, those evaluations conducted by private diagnosticians are paid for directly by students and their families. This fact, combined with the client’s desired outcome (a positive diagnosis, access to accommodations and other services), may lead clinicians to make diagnoses with insufficient evidence or to assist students in obtaining accommodations (Wolforth, 2012). In Canada, the incentives for a diagnosis are especially high; for instance, students accessing government-sponsored bursaries to pay for an updated psychoeducational assessment will only receive a reimbursement for this expense if the assessment results in a learning disability (LD) diagnosis. Clinicians may discount the effects of these incentives, despite the large literature establishing the effects of financial incentives on diagnostic test performance (for discussion, see Chafetz, Prentkowski, & Rao, 2011).
Second, and relatedly, many clinicians do not use formal measures to detect clients who may be investing low effort or exaggerating symptoms to obtain a disability diagnosis. This occurs despite research conducted more than 20 years ago that showed that low effort or avoidance of disliked tasks could negatively influence children’s performance on achievement tests and result in inaccurate diagnoses (Adleman, Lauber, Nelson, & Smith, 1989). Moreover, symptoms of learning and attention problems can also be convincingly feigned—that is, students who are deliberately attempting to feign a LD or attention deficit/hyperactivity disorder (ADHD) can easily score in the “clinical” range on many tests used to diagnose these problems (e.g., Booksh, Pella, Singh, & Gouvier, 2010; Frazier, Frazier, Busch, Kerwood, & Demaree, 2008; Harrison, Edwards, & Parker, 2007, 2008; Jachimowicz & Geiselman, 2004), and clinicians are unable to identify suboptimal effort accurately using clinical judgment alone (Faust, Hart, & Guilmette, 1988; Faust, Hart, Guilmette, & Arkes, 1988). Even more worrisome, a substantial minority of those seeking assessments for learning and attention disorders in postsecondary settings are found, on closer inspection, to have been exaggerating their symptoms or purposely exhibiting poor effort during diagnostic testing (Harrison, 2006; Harrison & Edwards, 2010; Sollman, Ranseen, & Berry, 2010; Suhr, Hammers, Dobbins-Buckland, Zimak, & Hughes, 2008; Sullivan, May, & Galbally, 2007; see also Gordon, 2009, for a striking case of malingering in a testing accommodations case). Formal assessments of symptom credibility should be included in any such assessments (Harrison, Green, & Flaro, 2012); yet, in our own consulting work, the present authors see that fewer than 10% of applicants have documentation that includes formal assessments of symptom credibility.
Finally, clinicians may not understand the standards for certifying someone as legally disabled and needing accommodations at the postsecondary level. These standards are distinct from the standards for clinical diagnosis, because a person may meet diagnostic criteria for a disorder but not be sufficiently impaired in their activities to meet disability certification standards and require accommodations. Diagnosis concerns whether someone has a disorder; disability certification concerns how the disorder affects the person in real-world settings. In Canada and the United States, provision of academic accommodations and supports at the elementary and secondary school level is governed by specific legislation that applies only to publically funded educational systems. In the United States, the Individuals With Disabilities Education Act (IDEA) requires that special education services be given to students with certain kinds of disabilities, and accommodations are just a small part of those services. In Canada, each province has specific educational legislation that applies to the K-12 school system. For instance, in Ontario, provisions governing special education were introduced into the Education Act by the Education Amendment Act, 1980, more commonly known as Bill 82 (Government of Ontario, 1981). This legislation allows elementary and secondary schools to provide academic accommodations and supports to any student who is identified as “an exceptional learner”; this legislation was part of a worldwide movement toward providing all children with the opportunity for a publicly funded education, regardless of disabilities.
Special education laws do not apply to postsecondary studies; in Canada, Human Rights legislation (provincial and federal) applies. Eligibility for accommodations under this legislation requires, in part, a diagnosis of a disability, but that diagnosis, in and of itself, does not necessarily compel accommodation, even if that person was given special education services in the past (Roberts, 2012). Instead, at the postsecondary level, special education per se is not available, and accommodations are only provided when the impairments that flow from a disorder interfere with equal ability to access and use the educational system. Furthermore, Human Rights legislation does not guarantee the right to an education nor does it guarantee that accommodations will result in successful performance. It requires only that a student be given an equal opportunity to participate and that artificial barriers to such equal participation be removed or minimized. Unlike accommodations and supports at the K-12 level, postsecondary programs are also not obliged to provide accommodations that would undermine the essential requirements of a course or examination.
For students with learning or attention disorders to request accommodations at the postsecondary level, they must provide documentation that not only reports a diagnosis of a disability but also explains how impairments arising from that condition interfere with equal participation in the current setting. Determining impairment, however, is difficult. Unlike the United States, where there is a clearly defined demarcation (functioning substantially below the average person; Lovett, Gordon, & Lewandowski, 2009), Canadian human rights laws have focused on equality of opportunity to participate in society rather than on delineating a definition of how to determine who is disabled (Harrison & Holmes, 2012). For instance, the Canada Student Loans Program (CSLP) defines a permanent disability as a functional limitation caused by a physical or mental impairment that restricts the ability of a person to perform the daily activities necessary to participate in studies at a post-secondary school level or the labour force and is expected to remain with the person for the person’s expected life. (Government of Canada, 2009)
No parameters, however, help clinicians define at what specific level an individual must be performing to qualify as functionally limited. We return to this point below.
Problems in the Diagnosis of High-Incidence Disabilities
Assessing learning and attention problems is especially vulnerable to the concerns raised above, because there are a variety of methods by which these problems are diagnosed. In the first study to examine documentation consistency, McGuire, Madaus, Litt, and Ramirez (1996) examined the documentation submitted by 415 college students to support their LD diagnoses. These investigators found “serious problems in the type and quality of documentation” submitted (p. 301). For instance, fewer than half of the psychological reports submitted mentioned the students’ academic achievement. Moreover, many reports that mentioned achievement did not administer any formal academic skills testing, instead contributing only vague and generic statements about students’ reported performance in school or on high-stakes tests. Finally, almost half of the reports contained no information about when an initial diagnosis of LD had been made, despite the importance of early history when assessing developmental disorders in college students.
More recent work suggests that problems of inadequate documentation continue. For instance, Harrison, Nichols, and Larochette (2008) reviewed the documentation submitted by 247 students, all seeking accommodations and related services at one of three Ontario postsecondary institutions under the LD classification. Fully, one quarter of students failed to submit any documentation, and other students only submitted special education documents or a physician’s letter. Although more than half of the students submitted a psychologist’s report, fewer than half of these reports even included a clear statement of a diagnosis, and not all of the clear diagnostic statements were for LD. These findings are similar to those reported by Reed, Lewis, and Lund-Lucas (2006), who found half of the students with LD who were surveyed arrived at their respective Canadian postsecondary institutions with inadequate disability documentation.
Even when the types of documentation are equivalent across applicants, marked variability in diagnostic standards is still found. Sparks and Lovett (2009) examined the diagnostic test scores (IQ and academic achievement scores) of 378 U.S. college students who had been diagnosed with LD and provided accommodations. Given that there is disagreement in the field over how to diagnose this disorder, these investigators applied five different sets of objective criteria for diagnosis of LD to these assessment reports (three sets based on IQ-Achievement discrepancies, one based on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. [DSM-IV], American Psychiatric Association [APA], 1994, and one requiring early onset and low achievement), and found that more than half of the students failed to meet any of the five sets of criteria even though they had already been diagnosed and provided with accommodations. Moreover, fewer than 10% of the students met sets of criteria that required academic impairment in an absolute sense (i.e., academic achievement test scores of 1 standard deviation below the mean or lower). Sparks and Lovett’s results have been replicated by a more recent study (Weis, Sykes, & Unadkat, 2012) finding that many diagnosed college students fail to meet objective criteria for LD.
Studies regarding diagnosis of ADHD have been just as disappointing. For instance, Joy, Julius, Akter, and Baron (2010) examined the files of 50 medical students with ADHD diagnoses who requested accommodations on the COMLEX exam (taken by osteopathic physicians for licensure). There are five official criteria required for diagnosing ADHD found in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000), and Joy et al. coded each applicant’s file to indicate whether each of the five criteria was met. Remarkably, only seven files (14%) had evidence demonstrating that the applicant met all five criteria, and most applicants’ files only met one or two of the criteria. In sum, studies of the diagnosis of learning and attention problems suggest that many clinicians make diagnoses without necessarily adhering to published or agreed-on diagnostic standards.
Clinician Understanding of Disability Law
Even when clinicians use evidence-based strategies for diagnosing disability conditions, it is unclear whether their determinations of legal disability status and their recommendations for accommodations are appropriately made. Indeed, a study of American clinicians suggests weak understanding of how to apply disability laws in diagnostic situations. Gordon, Lewandowski, Murphy, and Dempsey (2002) surveyed 147 diagnosticians who had performed evaluations used by students requesting accommodations on a law school entrance exam. In the United States, these issues are governed primarily by the Americans With Disabilities Act (ADA), which requires that “reasonable accommodations” be given to individuals who are substantially impaired, relative to the general population, in “major life activities” such as reading (Latham & Latham, 2011).
Gordon et al. (2002) found widespread misunderstanding of ADA’s key provisions. For instance, more than half of the surveyed clinicians indicated that a client would be disabled under ADA with an average reading score, as long as the client’s IQ was well above average. Similarly, more than a third of the clinicians indicated that ADA provides for accommodations that will “guarantee that the individual . . . will perform at his or her best.” Indeed, although the 27 items on the survey had a true/false design (and therefore, respondents could get a 50% correct score through random guessing), the average correct score was only 75%. Gordon et al. concluded that their results indicated a need for increased training in disability evaluations, specifically focused on “current case law, guidelines for documentation, and the importance of providing valid, empirically based evidence of substantial impairment in real-life functioning” (p. 362).
In the present study, we aimed to extend Gordon et al.’s (2002) work to a Canadian sample, where the relevant disability-related laws are somewhat different. We expected that there might also be an effect of time, because approximately a decade had passed since Gordon et al. surveyed clinicians, and disability issues have become more prominent in the interim.
Method
Participants
Students seeking disability-related accommodations for LD or ADHD must present their Disability Services Office (DSO) at college or university with documentation from a professional diagnosing their disability. In the present ethics-approved study, a survey was mailed to all clinicians who had authored LD or ADHD-specific documentation that had been submitted between 2008 and 2011 either by Grade 12 students from across Ontario who were participating in an online transition program for students identified as having LD or ADHD, 1 or by students seeking academic accommodations at a major Canadian university. 2 This yielded a list of 119 individuals (45 male; 38%) who were registered psychological service providers. Apart from 3 clinicians who practiced psychology in British Columbia, clinicians to whom surveys were sent came from all regions of Ontario, and there was no one city or region that was disproportionally represented. Of the 119 surveys distributed (by either regular mail alone or mail and email), 12 envelopes were returned unanswered (5 clinicians had retired; 5 had moved with no forwarding address; 2 indicated that they no longer practiced in this area of psychology). In addition, 3 participants specifically indicated via email that they did not wish to participate in this survey, and 1 more indicated that she only assessed children in K-12 and so did not feel that she needed to understand the requirements for accommodation at the postsecondary level. This left 103 viable potential participants, and we received completed surveys from 58 of them (37.9% male), yielding a response rate of 56%.
Of the respondents, 37 were doctoral level psychological practitioners (see Table 1). The single largest group of professionals consisted of clinical psychologists (39.6%) followed by school/educational psychologists (22.4%), psychological associates (12.1%), and 25.6% either did not respond or represented other specialties. The mean age of the respondents was 56.4 years (SD = 8.2), the mean number of years in practice was 23.5 (SD = 9.8), and the mean number of LD and ADHD assessments conducted during the past year was 18.2. With few exceptions, individuals who returned the survey considered themselves to be experts in the diagnosis of LD and ADHD (see Table 3).
Respondent Characteristics (N = 58).
Materials
A questionnaire was developed, consisting of two parts. The first part comprised 30 true/false questions modeled after the survey by Gordon et al. (2002), examining respondents’ knowledge of diagnostic and human rights issues. The questions focused on several issues: the differential relevance of special education versus human rights laws in making disability determination for students at the postsecondary level; the appropriateness of diagnosing LD or ADHD when students exhibit only relative weaknesses (i.e., compared with their other skills); the relevance of early history in making diagnoses and accommodation decisions in postsecondary settings; the importance of using formal diagnostic criteria when assessing LD and ADHD; and the appropriateness of making diagnoses when a client only shows symptoms of a disorder in testing situations (e.g., test anxiety, or a history of poor performance only on timed exams).
The original questions used in the Gordon et al. (2002) survey were developed by expert consensus. All items relevant to Canadian postsecondary practices were retained. For those that addressed American legislation regarding accommodation of students with disabilities, items were revised to reflect relevant Canadian or provincial legislation. In addition, three new questions were developed for inclusion. These items were created based on the experience of the lead author and dealt with issues identified as problematic in disability documentation at Canadian postsecondary institutions. These items were then provided to a group of six Canadian Disability Services experts for review and revision prior to being included in the survey. In addition, to minimize the possibility of respondents answering questions in a biased manner (e.g., all true or all false), items were written so that correct responses varied between true and false.
The second part of the questionnaire asked about demographic information. In addition to typical demographic questions (age, gender, number of years in practice, etc.), respondents were asked whether they considered themselves to have expertise in diagnosing ADHD and LD, how often they assess students for these conditions, and how often their evaluations result in positive diagnoses of these conditions. We were interested in determining whether clinicians’ understanding of legal standards and best practices in clinical diagnosis were related to their self-reported expertise and diagnostic record.
Procedure
Contact information for each assessor was obtained from the letterhead of the provided assessment report. In this way, the DSO could decouple the identity of the assessor from the diagnostic report provided and, thus, protect the identity of the students in question. The method of soliciting participation for this survey followed an approach recommended by Dillman (1991), which purports a success rate of 75%. This method involves sending waves of invitations. Thus, one advance-notice letter/email and three waves of letter/email surveys were sent to potential participants. These professionals were told that completion of the questionnaire would be taken as consent to participate. Paper copies were sent to all participants and included a self-addressed stamped envelope in which to mail the completed survey, and the participants were provided with a separate self-addressed envelope in which they could return a ballot to win one of eight prizes (three $CDN 100 gift certificates for purchase of psychological test materials, five $10 gift certificates to a popular coffee company). In this way, the identity of the individuals was protected while also offering an incentive to participate.
In the letter of introduction, participants were informed that they could complete the survey either on paper or by email, and an anonymous survey link was provided if they preferred to complete the survey online. In addition, email addresses for 64 of the assessors were also obtained. These individuals were also sent an email invitation using an online survey provider (SurveyMonkey). The introductory letter soliciting participation via email was identical to the paper version with the exception that it also included a link on which recipients could click if they did not wish to receive any further emails regarding this survey. SurveyMonkey has the advantage that it can track response rate and automatically resend a second and third email to nonresponders, while keeping the actual names of respondents confidential. Online participants were offered the option of being redirected to a separate location after completing the survey where they were asked to enter their names into the prize draw electronically.
Results
Table 2 presents the results of the survey, ordered by the proportion of respondents who answered each item correctly. We computed a total score for each respondent, simply their proportion of correct answers. 3 The average correct score of respondents was 69.2% (SD = 14.8), with the scores ranging from 23.3% to 96.7% correct. No respondent answered every item correctly, and fewer than 15% of them obtained a score of 85% or above, which might be taken to signal mastery.
Knowledge Survey Items and Results.
Note. ADHD = attention deficit/hyperactivity disorder; LD = learning disability; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994); OHRC = Ontario Human Rights Code. The letter ‘T’ refers to ‘True’ and ‘F’ refers to ‘False’.
We were also interested in the knowledge levels of different groups who participated in the survey. However, many groups (e.g., physicians) were too small to perform meaningful statistical tests comparing the groups, and several respondents chose not to respond to the optional demographic questions. An exception was respondents’ level of education; we found that there was no difference between the knowledge of evaluators trained at the master’s level (n = 13, M = 68.26, SD = 14.4) and those trained at the doctoral level (n = 36, M = 68.71, SD = 15.4), t(47) = .09, ns.
Finally, we were interested in which areas of information were known to more respondents. None of the 30 questions were answered correctly by all respondents. Twelve items were answered correctly by at least 85% of the respondents, and most of these items concerned diagnostic standards for LD and ADHD. However, 4 questions were answered correctly by fewer than one third of respondents; these items concerned the purpose of accommodations, the distinction between K-12 and postsecondary legislation, the assessment of effort in diagnostic testing, and choosing appropriate norms for determining disability status in postsecondary settings. The item with the lowest proportion of correct responses queried whether the purpose of accommodations is to “allow a disabled individual to perform at his or her best”; only 12.3% of respondents recognized this to be false.
Table 3 presents the results of the supplemental questions; we note several trends here. Fewer participants chose to respond to these optional questions, but of those who did, most considered themselves to be experts in the assessment of LD and ADHD. In addition, most reported doing a significant number of LD/ADHD evaluations each year (at least approximately one each month) and that most of their clients qualified as disabled. Finally, almost all respondents indicated that they needed at least some additional training in these issues.
Respondents’ Supplemental Question Percent Endorsements (N = 58).
Note. LD = learning disability; ADHD = attention deficit/hyperactivity disorder.
Discussion
In this study, we surveyed clinicians who provided evaluations and supportive documentation to students seeking accommodations related to LD or ADHD at a major Canadian university. The survey concerned best-practice standards for diagnosis of these disabilities, as well as relevant legal standards concerning disability status and the determination of appropriate accommodations. Although the survey’s items were presented in a true/false format, allowing a 50% chance of getting the correct answer by guessing, the average score of respondents was only 69.2, and none of the respondents answered all items correctly.
Our average score of 69.2 is slightly lower than the average score of “approximately 75” reported by Gordon et al. (2002). The similar scores suggest that Canadian evaluators are not more knowledgeable than American evaluators about these issues, nor has knowledge increased in the decade since Gordon et al.’s study. In any case, given the response format of the survey, our average score is disappointingly low.
An item-level analysis reveals areas of stronger and weaker knowledge. Knowledge of best-practice standards for assessing ADHD was an area of relative strength; the vast majority of respondents understood that ADHD cannot be diagnosed using either psychological test scores or self-reported symptoms alone and that other disorders must be ruled out prior to making this diagnosis. Another area of relatively strong knowledge was the process of applying for accommodations; the vast majority of respondents understood the importance of recent and comprehensive documentation, as well as the need to consider the appropriateness of accommodations even when an applicant has indicated a desire for them. In contrast, respondents had a particularly weak understanding of certain general issues in clinical assessment; fewer than half of respondents understood the importance of using general population (or age-based) norms when making judgments about disability, or the importance of using formal tests of response effort (e.g., the Word Memory Test; Green, 2003), when judging whether a client was putting forth full effort during an assessment.
We also call out for special attention to three items concerning issues that were of particular interest. Although 86% of respondents recognized that it was inappropriate to make a diagnosis of LD or ADHD when clients failed to meet official criteria, 14% felt that this was appropriate. Even more respondents (31%) seemed to endorse the existence of a test-taking disability, indicating that a person could qualify as having a disability even if his or her only area of impairment was on timed, multiple-choice tests. Finally, almost half (44.6%) of the respondents reported that the purpose of a psychoeducational evaluation is to help the client secure those accommodations. It appears, then, that many clinicians see their role as advocates rather than as objective evaluators.
Finally, if we ignore the accuracy of answers, we can examine respondents’ answers in terms of agreement or consensus. On approximately half of the survey items, fewer than 75% of the respondents gave the same answer (i.e., “true” or “false”). This either indicates a general lack of professional consensus on these matters, or else guessing due to ignorance. Many of the survey items in this group dealt with issues of impairment—how to determine whether someone with symptoms of LD or ADHD is actually impaired in real-world settings, and who should serve as the comparison for impairment standards.
Implications for Practice
One practice implication involves the training of clinicians with respect to diagnostic assessment of LD and ADHD in postsecondary contexts and related training in making recommendations for educational accommodations. These topics are not covered in great detail in the training of most clinical psychologists (the most common background of the evaluators in our sample). Indeed, nowhere in Canada except perhaps in British Columbia is specific training required to arrive at a diagnosis of LD or ADHD, apart from registration with a provincial licensing body (Philpott & Cahill, 2008). Although psychologists and other professionals have an ethical duty to obtain whatever further training is needed to perform in their chosen areas of practice, the clinical issues covered by our survey constitute particularly neglected areas in which it is difficult for clinicians to find adequate instruction. Given the growth in diagnosis of LD and ADHD in postsecondary settings, relevant training programs (in clinical, school, and educational psychology) must address these issues and direct students toward research-based resources for further training including discussion of the psychologist’s role as an objective evaluator in diagnostic contexts. Although the advocate is a recognized role that psychologists can play at times, there are times where the psychologist is instead expected to provide objective information to educational institutions and testing agencies, and at these times, advocacy can interfere with appropriate practice.
This problematic nature of the advocacy role relates to a second, larger implication: Many respondents consistently endorsed diagnostic practices that would lead more people to be diagnosed than meet official criteria. Therefore, we must conclude that concerns expressed, in scholarly and popular venues, about the overdiagnosis of LD and ADHD in high-functioning populations (e.g., Lerner, 2004; Tapper, Morris, & Setrakian, 2006; Vickers, 2010) have a rational basis. Although some such concerns have clearly been overblown (for discussion, see Cook, Gerber, & Murphy, 2000; Englandkennedy, 2008), the results of the present study suggest that many evaluators endorse practices that may lead to overdiagnosis.
As another implication for practice, DSOs interested in ensuring that appropriate standards are being followed must conduct their own thorough review of documentation rather than relying on diagnosticians’ conclusions. Admittedly, some DSO staff may not feel able to interpret psychoeducational assessment reports, but in fact many staff without clinical background can be trained to identify certain common flaws in documentation. When difficult cases arise, it is helpful to have consulting psychologists who have not only clinical training but also expertise in relevant research and legal standards.
There may be an additional benefit to review by outside consultants, beyond the expertise that they will have when well-chosen. Wolforth (2012) argued that clinicians who make diagnoses and recommend accommodations are often in a position with a conflict of interests. On one hand, the clinicians are being asked to provide an objective evaluation of the student, but on the other hand, they are advocating for a client who is paying for their services. In an effort to help their clients, some clinicians may err on the side of overdiagnosis and unnecessary accommodation recommendations. More research must be done to evaluate how serious and problematic this potential conflict of interest is, but an advantage of outside consultants is that they lack such a conflict.
Finally, it would also be appropriate for postsecondary institutions to post clear guidelines for incoming students on their websites outlining exactly the type of documentation that is required for accommodation at the postsecondary level. This proactive step would put the onus on the student and on his or her clinician to ensure that evidence is available to make appropriate accommodations.
Limitations and Future Research Needs
Our study had expected limitations, each of which prompts needed future research. Our sample was fairly small, and we surveyed only clinicians who authored reports submitted by applicants seeking disability-related accommodations in one province; it is possible that clinicians in different provinces are more aware of these postsecondary-specific accommodation issues than are those in Ontario. Given the number of assessments each clinician in our survey estimated she or he performs for students in general, however, we believe that our sample was representative of evaluators who conduct such assessments for students seeking accommodations at the postsecondary level, at least in Ontario; nonetheless, more research is needed at other institutions in other provinces, and also by testing agencies. Larger samples would also allow more refined analyses relating knowledge to specific evaluator characteristics. Although many such institutions and agencies have shown reluctance to engage with the evaluators who provide documentation submitted by students, such engagement is needed to ensure that the diagnoses and recommendations can be trusted.
Another expected limitation involved the format of our survey; although the response format allowed for easy coding of responses, it did not permit nuanced responses. We intentionally designed items to be statements that could be reasonably scored simply as true or false, but respondents may have had more complex views that led their knowledge to be underestimated. Interviews, focus groups, or other research methods with open-ended survey items would produce richer narrative information about evaluators’ perspectives on these issues, and we would encourage such work.
Footnotes
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors of this article have served as external consultants to educational and testing entities, reviewing disability documentation.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.