The Regents Centers for Learning Disorders The University System of Georgia Model for the Assessment and Accommodation of Cognitive Disorders in College Students September 10, 2010

Presenters Anne Imhoff, Ph.D. – Director, Regents Center for Learning Disorders at Georgia State University George Shaver, Psy.D. – Director, Regents Center for Learning Disorders at Georgia Southern University Will Lindstrom, Ph.D. – Director, Regents Center for Learning Disorders at The University of Georgia

Eligibility and Academic Accommodations: Transition from HS to College High School (K-12) – Guided by IDEA (Individuals with Disabilities Education Act) – School is responsible to identify and evaluate – Accommodation decisions implemented by IEP team and provided by school – Parents advocate for students College – Guided by ADA-AA and Section 504 (extends to the workplace) – Individual must self identify and provide documentation – Accommodations based on documentation and specific evaluation data – Students become self advocates

So what is a disability? Under Section 504 & ADA a physical or mental impairment which substantially limits one or more of the major life activities of such individual – Walking, breathing, seeing, hearing, learning, working, performing manual tasks, caring for oneself eating, sleeping, standing, lifting, bending, reading, concentrating, thinking & communicating

DSM vs. ADA? Note the diagnostic/clinical definition of a disorder is not exactly the same as a legal definition, which puts more emphasis on the documentation of functional impairment. The explication of the student’s functional impairment is critical in guiding accommodations. Post secondary institutions note the degree of impairment and set guidelines for documentation criteria that is consistent with contemporary research.

Evaluating Documentation and Determining Accommodations Post-secondary institutions must – Review documentation – Identify functional impairments – Determine reasonable accommodations With 35 institutions in the University System of Georgia, how can this be done equitably across all colleges and universities?

RCLD History and Mission Board of Regents (BOR) for the University System of Georgia (USG) sought to standardize disability documentation requirements and accommodations across 35 institutions by establishing three Regents Centers in 1993 Regents Centers are housed at three “host institutions” and are responsible for three geographical areas of the state – The University of Georgia (Athens) – Georgia State University (Atlanta) – Georgia Southern University (Statesboro)

RCLD Mission – Review “outside” documentation and make accommodation recommendations – Conduct psychological evaluations for USG students (at a subsidized rate) that meet BOR criteria for disability documentation – Training doctoral students in clinical, counseling, educational, school psychology – Research in learning disorders – Community outreach

Areas of Cognitive Disability Learning Disabilities Attention Deficit/Hyperactivity Disorder Acquired brain impairment (e.g. TBI; systemic illness) Psychological disorders (e.g. anxiety disorders; mood disorders) Pervasive Developmental Disorders (e.g. Asperger's and High Functioning Autism)

Psychoeducational Evaluations Case History Clinical Interview Assessment – Socioemotional – Intellectual/Aptitude – Achievement – Cognitive Processing

Board of Regents Criteria for Disability Documentation: General Requirements ADA 1990 / ADA-Amendments Act 2008 Substantial limitations as compared to “most people” Identify disability, describe diagnostic criteria, detail progression of condition Diagnosis made by a qualified individual Adequate representation of the student's current functional abilities/impairments Current evaluation (within 3 years) or as adult (>18 years old at time of evaluation) Professional judgment must be used in accepting older documentation of conditions that are permanent or non-varying, or in requiring more recent documentation for conditions for which the functional impact may change over time.

ADHD Documentation of developmental history of symptoms (past evaluations; school records; teacher’s reports; doctor’s notes) List of specific symptoms consistent with DSM-IV diagnostic criteria Behavioral observation rating forms for childhood and adulthood Comparison to age-based normative data Corroboration of symptoms across two settings by two independent observers Documentation of functional impairment in the academic setting Differential Diagnosis (Rule outs)

Learning Disability Documentation Clear identification of LD (No “Learning Styles” or “Learning Differences”) Documentation of developmental and educational history consistent with a learning disability Information from standardized assessment instruments with age-appropriate norms is essential.

Learning Disability Documentation Discrepancy between IQ score and academic achievement score(s) no longer required; looking also for intra-cognitive and intra-achievement discrepancies that correlate in a “meaningful way.” Documentation of both academic and cognitive strengths and weaknesses is required on multiple measures. Documentation that alternative explanations for the academic and cognitive limitations have been considered and ruled out (i.e, low cognitive ability, lack of adequate instruction, emotional factors).

Cognitive Process Deficits for LD in Basic Reading Skills Basic Reading Skills Phonological Awareness/Phonemic Processing Double Deficit (Alphabetic Mapping) Orthographic/Rapid Automatized Naming Birch & Chase (2004); deGelder & Vrooman (1996); Elbro (1998), Hugdahl et al. (1995); Lovrich et al. (1997); Katz et al. (2001), Paulesu et al. (2001); Shaywitz & Shaywitz (2005); Shaywitz et al. (2006); Velluntino et al. (2004); Vukovic & Siegel (2006)

Profile Example

Accommodations: Introduction Goal of accommodations: equal access to information and equal opportunity to demonstrate knowledge. Vast majority of disability service providers use report recommendations to decide which accommodations to implement. At postsecondary level, documentation stands as only evidence of student’s eligibility/service needs. Comprehensiveness and quality of documentation are critical to student success.

Accommodation: Individualized services Individuals with the same diagnostic label frequently demonstrate varying profiles of cognitive, linguistic, and academic strengths and weaknesses. Accommodations should be recommended based on unique individual profiles, not on diagnostic category. Should be selected through a careful analysis of the functional impact of the condition.

Accommodations: Defensible recommendations Increases in: – litigation regarding postsecondary accommodation determination – the numbers of students requesting accommodations Examiners encouraged to link each recommended accommodation to justifying data from evaluation. Essential that recommendations are defensible.

Accommodations: Sample report section The reasons for each accommodation are indicated by the following abbreviations: PA = phonemic awareness; OA = orthographic awareness; NS = naming speed; ALL = combination of deficits. Test Accommodations – extended time (1.5x) for all tests (ALL) – speech-to-text technology (PA, OA) – screen reading software (PA, OA, NS) Course Accommodations – books in digital/tape format (PA, OA, NS) – use of a notetaker and/or digital recorder during lectures (OA) – screen reading software (PA, OA, NS)

Accommodations: LD (reading, writing) Test Accommodations – Extended time (1.5x or 2x) – Speech-to-text technology – Screen-reading software – Spellcheck Course Accommodations – Note-taking assistance – Textbooks and required readings in alternate formats

Accommodations: AD/HD Test Accommodations – Quiet/private testing room with few distractions – Scheduled breaks during tests that do not count against test time – Use of a word processor Course Accommodations – Note-taking assistance (e.g., notetaker; digital recorder) – Priority seating

References Gormley, S., Hughes, C., Block, L.,& Lendman, C. (2005). Eligibility assessment requirements at the postsecondary level for students with learning disabilities: A disconnect with secondary schools? Journal of Postsecondary Education and Disability, 18, 63–70. Gregg, N. (2009). Adolescents and adults with learning disabilities and ADHD. New York: The Guilford Press. Gregg, N., Heggoy, S., Stapleton, M., Jackson, R., & Morris, R. (1994). Eligibility for college learning disabilities services: A system-wide approach. Learning Disabilities, 7, Gregg, N., & Scott, S. (2000). Definition and documentation: Theory, measurement, and the courts. Journal of Learning Disabilities, 33(1), cesDH/ Ofiesh, N., & McAfee, J. (2000). Evaluation practices for college students with LD. Journal of Learning Disabilities, 33(1),