ADABooklet

State of Florida

Department of Health

Information Booklet

Special Testing

Accommodations for

Examinees with Disabilities

Prepared by

Practitioner Reporting & Examination Services

Bureau of Operations

Division Of Medical Quality Assurance

Revised 02/2011

Introduction

How to Request Special Testing Accommodations: The Department of Health provides reasonable and

appropriate accommodations in accordance with the Americans with Disabilities Act of 1990 for

individuals with documented disabilities who demonstrate a need for accommodation. Examinees are

informed of the availability of special testing accommodations in the licensure application instructions or

the Special Testing Flyer, which is sent with all licensure applications from the Board office to which the

applicant applies for licensure. The individual requesting accommodations must personally initiate an

application for special testing accommodations. Applications made by a third party (such as an evaluator

or medical school) cannot be honored. Applications or requests for applications should be sent to:

Department of Health

Bureau of Operations,

Practitioner Reporting & Examination Services Unit

ATTN: Special Testing Coordinator

4052 Bald Cypress Way

BIN # C-90

Tallahassee, FL 32399-3290

(850) 245-4252

Fax (850) 487-9537

Application Submission Deadline: According to 64B-1.005(3)(a) F.A.C., applications for special testing

accommodations must be postmarked sixty (60) days prior to the test for which special testing

accommodations are required and should be accompanied by the required documentation. If the application

is submitted after that time, accommodations may not be made. Early requests are encouraged to speed up the

process.

Incomplete applications: If there is a need for further verification of the disability or the need for further

documentation, it is possible that the decision on providing the accommodation will be delayed until the

next scheduled test administration.

Reapplication for Special Testing Accommodations: An application must be submitted for each

examination for which special testing accommodations are required. When an application is requested,

one should indicate that special testing accommodations were provided in the past. An expedited

application will then be provided. Part II of the application will not be required if Part II is on file and is

complete. Send all application requests and applications to the Practitioner Reporting & Examination

Services Unit address at the top of this page.

Change in Disability or Accommodations Requested: Notification is required if there are any changes

in the nature or extent of a disability or if the accommodations will differ from previously provided

accommodation. Upon reapplication for special testing accommodations:

(1) submit a timely application.

(2) provide detailed documentation that explains any change.

(3) Provide an updated Part II of the application if changes are extensive. The Department will make the

request if a new Part II of the application is necessary

Confidentiality

To protect confidentiality, always send test accommodation information separately to the above address.

Do not include these materials with an examination application.

Test Accommodations:

Test accommodations include but are not limited to the following:

(1) Assistance in completing the answer sheet(s) - (Request a scribe).

(2) Reader.

(3) Extended testing time.

(4) Extra or extended breaks (without extended testing time for the examination).

(5) Large print examination.

(6) Printed copy of verbal instructions read by the proctor.

(7) Separate area for testing.

Purpose of the Document

The following information is provided for examinees, practitioners, evaluators, faculty and others

involved in the process of documenting a request for test accommodations. We strongly encourage

applicants requesting test accommodations to share these guidelines with their evaluator or with

therapists or treating physicians completing Part II of the application. This will help them

assemble the appropriate documentation to support the request for special testing accommodations.

The Americans with Disabilities Act of 1990 (ADA) and accompanying regulations define a

person with a disability as someone with a physical or psychological impairment that substantially

limits one or more of the major life activities. The purpose of documentation is to validate that

the individual is covered under the Americans with Disabilities Act as a disabled individual.

Functional limitation refers to the behavioral manifestations of the disability that impede the

individual’s ability to function, i.e., what someone cannot do on a regular and continuing basis as

a result of the disability. A special testing candidate's accommodation(s) should “match up” with

the identified functional limitation so that the area of impairment is alleviated by an auxiliary aid

or adjustment to the testing procedure. For example, a functional limitation might be described as

the inability to control fine motor movements so that the individual is unable to fill in computer

scanable answer sheets. An appropriate accommodation might be assistance with recording

answers. Therefore, it is essential that the documentation provide a clear rationale for the

identified functional impairment.

While presumably the use of accommodations in the test activity will enable the individual to

better demonstrate his/her knowledge or mastery of the subject, accommodations are not a

guarantee of improved performance, test completion or a passing score.

I. General Guidelines

A. Purpose: The following guidelines are provided to assist in documenting a need for accommodation

based on an impairment that substantially limits one or more major life activities. Documentation

submitted in support of a request is referred to experts in the appropriate area of disability for a fair and

impartial professional review. The guidelines are to be shared with the practitioner who documents the

disability. To support a request for test accommodations, please submit the following:

1. a completed Part I of the Application For Special Testing Accommodation.

2. a detailed, written statement describing the disability, its

severity

and its impact on daily life and

educational functioning such as test taking.

3. documentation of the disability on Part II of the application by a qualified practitioner whose scope

of practice is relative to the disability and who is licensed pursuant to Chapters 490 (Psychological

Services), 458 (Medical Practice), 459 (Osteopathy), 461 (Podiatry), 463 (Optometry), or 468, Part

I (Speech Language Pathology and Audiology), Florida Statutes.

Documentation of the disability by a practitioner in the same field from another state may be made

if the practitioner is licensed in that state and was actively practicing the profession at the time the

diagnosis was made.

4. The evaluator's professional credentials, evidence of licensure/certification, area of specialization,

employment and the state in which the individual practices should be provided with Part II.

B. Guidelines

for use in documenting a disability.

Documentation submitted in support of a request for

special testing accommodations should be provided using Part II of the Special Testing Accommodation

Application and is expected to:

1. state a specific diagnosis of the disability.

The diagnostic taxonomies used in the most current edition of the Diagnostic and Statistical

Manual of the American Psychiatric Association (DSM-IV-TR) are recommended.

2. be current.

Because the provision of reasonable accommodations is based on assessment of the current

impact of the examinee’s disability on the testing activity, it is in the individual’s best interest to

provide recent documentation. As the manifestations of a disability may vary over time and in

different settings, in most cases an evaluation should have been conducted within the past three

years.

3. describe the specific diagnostic criteria and/or diagnostic tests used, including date(s) of

evaluation, test results and a detailed interpretation of the test results. This description

should include the specific results of diagnostic procedures and tests utilized and should

include relevant history. Where appropriate, specific test scores should be reported to support

the diagnosis. Diagnostic methods used should be current practice within the field and

appropriate to the disability. Informal or non-standardized evaluations should be described in

enough detail that other professionals could understand their role and significance in the

diagnostic process.

4. describe the individual’s limitations due to the diagnosed disability, i.e., demonstrated

impact on functioning and explain the relationship of the test results to the identified limitations

that result from the disability. The current functional abilities should be fully described.

5. recommend specific accommodations and/or assistive devices including an explanation of

why these accommodations or devices are needed and how they will reduce the impact of the

identified functional limitations. Recommendations should be tied to specific test results or

clinical observations when possible.

6. establish the professional credentials of the evaluator that qualify him/her to make the

particular diagnosis, including information about licensure and certification and specialization

in the area of the diagnosis. The evaluator should present evidence of training and direct

experience in the diagnosis and treatment of adults in the specific area of the disability.

C. Prior accommodations: A history of prior accommodation is helpful in documenting a

disability If no prior accommodations have been provided in testing situations, it is in the

candidates best interest for either the applicant or the qualified professional expert to

include an explanation as to why no accommodations were given in the past and why

accommodations are needed now.

II. Physical Disabilities

A. Purpose: Documentation of a physical disability is usually straight forward and less difficult than for

learning disabilities. A physical examination and a few tests are often sufficient to reach a diagnosis.

B. The basic steps

1. The general guidelines apply as they do for any disability.

2. Documentation must be based on objective evidence of a substantial limitation in physical function.

At a minimum, the comprehensive evaluation should include the following:

• A diagnostic interview and history taking.

• A physical examination.

3. A report of assessment should be attached to Part II which usually includes:

• A description of the presenting problem(s).

• Notes on the physical examination.

• The tests or procedures used to support the diagnosis.

III. Psychological Disabilities

A. Purpose: Psychological disabilities are sometimes more difficult to document than physical disabilities.

In the interest of expediting your application, the following additional information is provided to clarify

the documentation process for applicants submitting a request for accommodations based on a learning

disability or other cognitive impairment. Not all the tests or evaluations may be necessary but this

information should be used as a guideline.

A. The basic steps:

1. The general guidelines apply as they do for any disability.

2. Documentation must be based on objective evidence of a substantial limitation in cognition or

learning must be provided. At a minimum, the comprehensive evaluation should include the

following:

• A diagnostic interview and history taking

Because Psychological disabilities are commonly manifested during childhood, though not

always formally diagnosed, relevant historical information regarding the individual’s academic

history and learning processes in elementary, secondary and postsecondary education should be

investigated and documented when possible. Such records as grade

reports, transcripts,

teachers’ comments and the like will serve to substantiate self-reported academic difficulties in

the past and currently.

• A report of assessment usually including:

(1) A description of the presenting problem(s);

(2) A developmental history;

(3) Relevant academic history including results of prior standardized testing, reports of

classroom performance and behaviors including transcripts, study habits and attitudes

and notable trends in academic performance;

(4) Relevant family history, including primary language of the home and current level of

fluency in English;

(5) Relevant psychosocial history;

(6) Relevant medical history including the absence of a medical basis for the present

symptoms which may include a dual diagnosis, alternative or co-existing mood,

behavioral, neurological and/or personality disorders along with any history of relevant

medication and current use that may impact the individual’s learning;

(7) Relevant employment history if it is related to the disability.

3. A psychoeducational or neuropsychological evaluation: A psychoeducational or

neuropsychological evaluation is required providing clear and specific evidence that a learning or

cognitive disability does or does not exist. This evaluation may include a comprehensive battery of

tests done so that the diagnosis can be based on the aggregate of test results, history and level of

current functioning. It is not acceptable to base a diagnosis on only one or two subtests. Minimally,

the domains to be addressed must include the following:

• Cognitive Functioning

A complete cognitive assessment is essential with all subtests and standard scores reported.

Acceptable measures include but are not limited to: Wechsler Adult Intelligence Scale-III

(WAIS-III); Woodcock Johnson Psychoeducational Battery-Revised: Tests of Cognitive

Ability; Kaufman Adolescent and Adult Intelligence Test.

• Achievement

A comprehensive achievement battery with all subtests and standard scores is essential. The

battery must include current levels of academic functioning in relevant areas such as reading

(decoding and comprehension) and mathematics. Acceptable instruments include, but are not

limited to, the Woodcock-Johnson Psychoeducational Battery-Revised: Tests of Achievement;

The Scholastic Abilities Test for Adults (SATA); Woodcock Reading Mastery Tests-Revised.

Specific achievement tests are useful instruments when administered under standardized

conditions and when interpreted within the context of other diagnostic information. The Wide

Range Achievement Test-3 (WRAT-3) and the Nelson-Denny Reading Test are not

comprehensive diagnostic measures of achievement and therefore neither is acceptable if used

as the sole measure of achievement.

• Information Processing

Specific areas of information processing (e.g., short- and long-term memory, sequential

memory, auditory and visual perception/processing, auditory and phonological awareness,

processing speed, executive functioning, motor ability) must be assessed. Acceptable

measures include, but are not limited to, the Detroit Tests of Learning Aptitude-Adult (DTLA-

A), Wechsler Memory Scale-III (WMS-III), information from the Woodcock Johnson

Psychoeducational Battery Revised: Tests of Cognitive Ability, as well as other relevant

instruments that may be used to address these areas.

• Other Assessment Measures

Other formal assessment measures or nonstandard measures and informal assessment

procedures or observations may be integrated with the above instruments to help support a

differential diagnosis or to disentangle the learning disability from co-existing neurological

and/or psychiatric issues. In addition to standardized test batteries, nonstandardized measures

and informal assessment procedures may be helpful in determining performance across a

variety of domains.

Tests must be appropriately normed for the age of the patient and must be administered in the

designated standardized manner.

4. A differential diagnosis must be reviewed and various possible alternative causes for the identified

problems in academic achievement should be ruled out. The differential diagnosis must demonstrate

that:

• Significant difficulties persist in the acquisition and use of listening, speaking, reading, writing,

reasoning or cognitive skills.

• The problems being experienced are not primarily due to lack of exposure to the behaviors

needed for academic learning or to an inadequate match between the individual’s ability and

the instructional demands.

5. A clinical summary must be provided. A well-written diagnostic summary based on a

comprehensive evaluative process is a necessary component of the report. Assessment instruments

and the data they provide do not diagnose; rather, they provide important data that must be

integrated with background information, historical information and current functioning. It is

essential then that the evaluator integrates all information gathered in a well-developed clinical

summary. The following elements must be included in the clinical summary:

• Demonstration that alternative explanations for the identified academic problems as a result of

poor education, poor motivation and/or study skills, emotional problems, attention problems

and cultural or language differences have been ruled out;

• Indications of how patterns in cognitive ability, achievement and information processing are

used to determine the presence of a psychological disability;

• Indication as to why specific accommodations are needed and how the effects of the specific

disability are mitigated by the recommended accommodation(s);

• The impact the diagnosed psychological disability has on a specific major life activity as well as

the degree of significance of this impact on the individual.

6. Problems such as test anxiety, English as a second language, slow reading without an

identified underlying cognitive deficit or failure to achieve a desired academic outcome are not

learning disabilities and therefore are not covered under the Americans with Disabilities Act.

IV. Attention-Deficit/Hyperactivity Disorder (ADHD)/ Attention

Deficit Disorder (ADD)

A. Purpose: For those applicants submitting a request for accommodations based on Attention-

Deficit/Hyperactivity Disorder (ADHD) or Attention Deficit Disorder, the following additional

information is provided to clarify the documentation process:

B. The basic steps

1. A qualified diagnostician must conduct the evaluation. Professionals conducting assessments and

rendering diagnoses of ADHD/ADD must be qualified to do so. Comprehensive training in the

differential diagnosis of ADHD/ADD and other psychiatric disorders and direct experience in diagnosis

and treatment of adults is necessary. The evaluator’s professional credentials, including information

about licensure or certification, the area of specialization, employment and state in which the individual

practices should be clearly stated in the documentation.

2. Testing/assessment must be current. A history of presenting attentional symptoms, including

evidence of ongoing impulsive/hyperactive or inattentive behavior that has significantly impaired

functioning over time should be provided.

3. Developmental history should be ascertained and reported:

• Family history for presence of ADHD/ADD and other educational, learning, physical or

psychological difficulties deemed relevant by the examiner;

• Relevant medical and medication history, including the absence of a medical basis for the

symptoms being evaluated;

• Relevant psychosocial history and any relevant interventions;

• A thorough academic history of elementary, secondary and postsecondary education;

4. Relevant Assessment Batteries. A neuropsychological or psychoeduational assessment may be

necessary in order to determine the individual’s pattern or strengths or weaknesses and to

determine whether there are patterns supportive of attention problems. Test scores or subtest

scores alone should not be used as the sole basis for the diagnostic decision. Scores from subtests

on the Wechsler Adult Intelligence Scale - III (WAIS-III), memory functions test, attention or

tracking tests or continuous performance tests do not in and of themselves establish the presence or

absence of ADHD. They may, however, be useful as one part of the process in developing clinical

hypotheses. Checklists and/or surveys can serve to supplement the diagnostic profile but by

themselves are not adequate for the diagnosis of ADHD. When testing is used, standard scores

must be provided for all normed measures.

5. A Review of psychoeducational test reports to determine if a pattern of strengths or weaknesses is

supportive of attention or learning problems must be prepared by the evaluator and should include:

• Evidence of impairment in several life settings (home, school, work, etc.) and that the disorder

significantly restricts one or more life activities.

• Relevant employment history;

• Description of current functional limitations relative to an educational setting and to the Department

in particular that are presumably a direct result of the described problems with attention;

• A discussion of the differential diagnosis, including alternative or co-existing mood, behavioral,

neurological and/or personality disorders that may confound the diagnosis of ADHD; and

• Exploration of possible alternative diagnoses that may mimic ADHD.

6. A Clinical Summary Must Be Provided. A well-written diagnostic summary based on

comprehensive evaluative process is a necessary component of the assessment. The clinical

summary must include:

• Demonstration of the evaluator’s having ruled out alternative explanations for inattentiveness,

impulsivity, and/or hyperactivity as a result of psychological or medical disorders or

noncognitive factors;

• Indication of how patterns of inattentiveness, impulsivity and/or hyperactivity across the life

span and across settings are used to determine the presence of ADHD/ADD;

• Indication of the substantial limitation to learning presented by ADHD/ADD and the degree to

which accommodations are being requested (e.g., impact on the program); and

• Indication as to why specific accommodations are needed and how the effects of ADHD/ADD

symptoms, as designated by the DSM-IV, are mediated by the accommodation(s).

C. Identification of DSM-IV Criteria

A diagnostic report must include a review of the DSM-IV criteria for ADHD/ADD both currently and

retrospectively and specify which symptoms are present (see DSM-IV for specific criteria). According

to DSM-IV, “the essential feature of ADHD/ADD is a persistent pattern of inattention and/or

hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a

comparable level of development.” Other criteria include:

1. Symptoms of hyperactivity-impulsivity or inattention that cause impairment that were present in

childhood.

2. Current symptoms that have been present for at least the past six (6) months.

3. Impairment from the symptoms presents in two or more settings (school, work, and home).

D. Documentation Must Include a Specific Diagnosis

The report must include a specific diagnosis of ADHD/ADD based on the DSM-IV diagnostic criteria.

Individuals who report problems with organization, test anxiety, memory and concentration only on a

situational basis do not fit the prescribed diagnostic criteria for ADHD/ADD. Given that many

individuals benefit from prescribed medications and therapies, a positive response to medication by

itself is not supportive of a diagnosis, nor does the use of medication in and of itself either support or

negate the need for accommodation.

E. Each accommodation recommended by the evaluator (practitioner) must include a

rationale. The evaluator must describe the impact of ADHD/ADD (if one exists) on a specific

major life activity as well as the degree of significance of this impact on the individual. The

diagnostic report must include specific recommendations for accommodations.

1. A detailed explanation must be provided as to why each accommodation is recommended

and should be correlated with specific identified functional limitations.

2. Former documentation may have been useful in determining appropriate services in the

past. However, documentation should validate the need for accommodation based on the

individual’s current level of functioning .

3. The documentation should include any record of prior accommodation or auxiliary aid,

including information about specific conditions under which the accommodation was used

(e.g., standardized testing, final exams, subject exams, etc.). However, a prior history of

accommodation without demonstration of a current need does not in itself warrant the

provision of a similar accommodation.

4. If no prior accommodation has been provided, the qualified professional and/or individual

being evaluated should include a detailed explanation as to why no accommodation was used

in the past and why accommodation is needed

at this time.

F. Because of the challenge of distinguishing ADHD/ADD from normal developmental patterns and

behaviors of adults, including procrastination, disorganization, distractibility, restlessness, boredom, academic

underachievement or failure, low self-esteem and chronic tardiness or inattendance, a multifaceted evaluation

must address the intensity and frequency of the symptoms. Indicate these behaviors which constitute

impairment in a major life activity.

DH 4000, 2/2011