Health and Psychology

Testing for accommodations of health issues, learning disorders, or psychological issues is a complex process. This requires a knowledge of the law under the Americans with Disabilities Act, an understanding of the educations system and the laws pertaining to it involving such terms as a Free and Public Education (FAPE), Least Restrictive Environment, Individuals with Disabilities Education Act (IDEA), Individual Education Plans (IEP) and many other programs covered under education law.

The testing itself involves standardized psychological and educations testing instruments.  Everything that needs to be done in order for the individual to perform at an adequate level needs to be documented in detail.  In my practice this is approached as a research project with a single subject.  I have to document what happens if the person is in an ambient noise environment as opposed to an exceptionally quiet or private room environment.  What happens if the person is given 50% or 100% more time, does more time just make them anxious or does it substantially get them up to grade level.  What about technology?  If the questions are read by a computer does it help?  Does larger type help?  What about a computer program that writes for you?  What about a calculator on screen?  What if there's a sound cancellation program in the background to help the hyperacusis?  Does a break for exercise help?  Does a break for food help?  What happens to blood pressure in the person with heart disease during testing and can significant fluctuations be mitigated?  How about the diabetetic and their blood sugar levels?  What is the impact of asthma medication on testing?  If my asthmatic client has an asthma attack the night before an exam should they cancel or take the test anyway?

The big issue in documenting the need for accommodations for a classroom or for an exam, is the need to document clearly what the individual's functional limitations are, how the individual will function without accommodations, what accommodations are required to mitigate those functional limitations, and to document how the planned accommodations will improve the individual's functioning in the classroom or on examinations specifically.

When I work with doctoral level graduate students with a working familiarity of general psychological testing, they start to understand just how different the testing for accommodations process is from general psychological testing. General psychological testing involves the establishment of a diagnosis and a treatment plan.  Educational psychology involves establishment of factors that impact the educational performance of the student and clarification of any specific changes to curriculum, classroom, or teaching techniques that will allow the student to succeed.  Although some school districts do well at documenting the response to intervention (RTI) that is required, many school districts do not.  This is especially true with behavior plans also known as 504 plans.  There are limitations to the types of interventions conceptualized by the school district and often a lack of conceptualization of the requirement for accommodations.

Formal examinations are often different than a classroom quiz or exam.  They often start earlier in the day than most classrooms start examinations, and they often last far longer than a typical quiz or even a final class examination. Testing for accommodations needs to replicate the testing process to a large degree.   Seeing an individual in an office for 2 to 3 hours will simply not replicate the process of the formal examination they plan to take and will therefore fail to document the needed accommodations for the uniqueness of the examination.  This can be the difference between getting the needed accommodations or not.  School districts often only look at students being classified as disabled when they are several grades behind academically.  This process misses all the students that are very bright and do self accommodations for classwork but then perform poorly on complex multi-hour examinations like the SAT, PSAT,  or even STAR testing when they can no longer self-accommodate.  

For older students, they don't know they have been self accommodating until they face a much longer examination such as the GRE, GMAT, or other similar exams and are suddenly confronted with the fact they aren't passing the examination.  The initial step is to hire a tutor, or get a testing coach.  When that fails they may keep trying or they may seek testing to "see what's wrong."  In these cases it's necessary to carefully document what the student has been doing to self-accommodate.  For many of these students the amount of self-accommodation has been substantial.  I worked with a student with a reading disorder.  He had gone to great lengths to avoid reading.  He recorded all the lectures.  He hired a typist to transcribe his papers.  He had hired someone to read the textbook into a recorder "so he could listen to it" in his car.  The list of self-accommodations was quite extensive.  We documented what assistance he would require-a scribe, a screen reader, a text-to-speech-computer program, a speech-to-text-computer program, additional time, a private room, verbal not written instructions, noise cancellation headphones, and a note taker.  With accommodatins in place he has done well in graduate school and on the GRE.

Testing for accommodations can help students who need accommodations to perform adequately and to compete with other non-disabled students.   In some cases, the testing process uncovers underlying, previously undiagnosed medical conditions, like the student who had self-diagnosed ADHD and was found to have substantial changes in blood pressure and required treatment for an underlying heart condition that medication for ADHD may have worsened.

If you are struggling with testing and think you may benefit from accommodations, contact us so we can help evaluate you and see what your needs may be.