Psychological Disabilities Documentation Guidelines
(available in PDF format: Psychological Disabilities Documentation Guidelines)
Cornell University recognizes that "psychiatric disabilities" is a generic term used to refer to a variety of conditions involving psychological, emotional, and behavioral disorders and syndromes. The two official sources designed to outline the criteria used in making these diagnoses are the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the International Classification of Diseases Manual, Tenth Revision (ICD-10). For the purpose of determining eligibility for accommodation, the symptoms must meet the Americans with Disabilities Act (ADA) definition of a disability.
Qualifications of Evaluator
Current Documentation
Comprehensive Evaluation
Historical Information
Specific Diagnosis
Alternative Diagnoses or Explanations
Recommendations for Accommodations
Adults with Psychological Disabilities
Qualifications of Evaluator
Professionals conducting assessments, rendering diagnoses of psychiatric disabilities, and making recommendations for accommodations must be qualified to do so. It is essential that professional qualifications include:
- comprehensive training and relevant expertise in differential diagnosis of psychiatric disorders
- appropriate licensure/certification
Current Documentation
Due to the changing nature of psychiatric disabilities, it is essential that a student provide recent and appropriate documentation from a qualified evaluator. Since reasonable accommodations are based upon the current impact of the disability, the documentation must address the individual's current level of functioning and the need for accommodations (e.g., due to observed changes in performance or medication changes since previous assessment). If the diagnostic report is more than one academic year old the test taker must also submit a letter from a qualified professional that provides an update of the diagnosis, a description of the student's current level of functioning during the preceding twelve months, and a rationale for the requested academic accommodations.
Comprehensive Evaluation
In most cases, documentation should be based on a comprehensive diagnostic/clinical evaluation that adheres to the guidelines outlined in this document. The diagnostic report should include the following components:
- a specific diagnosis
- a description of current functional limitations in the academic environment as well as across other settings
- relevant information regarding medications
- relevant information regarding current treatment
Historical Information
The information collected for the summary of the diagnostic interview should include, but is not limited to, the following:
- history of presenting symptoms
- duration and severity of the disorder
- relevant developmental, historical, and familial data
- relevant medical and medication history, including the individual's current medication regimen compliance, side effects (if relevant), and response to medication
- a description of current functional limitations in different settings with the understanding that a psychological disorder usually presents itself across a variety of settings other than just the academic domain and that its expression is often influenced by context-specific variables (e.g., school-based performance)
- if relevant, a description of the expected progression or stability of the impact of the condition over time
- if relevant, information regarding kind of treatment and duration/consistency of the therapeutic relationship
Specific Diagnosis
The report must include a specific diagnosis based on the DSM-IV or ICD-10 diagnostic criteria and include the specific diagnostic section in the report with a numerical and nominal diagnosis from DSM-IV or ICD-10. Evaluators are encouraged to cite the specific objective measures used to help substantiate the diagnosis. The evaluator should use definitive language in the diagnosis of a psychiatric disorder, avoiding such wording as "suggests," "has problems with," or "may have emotional problems."
Alternative Diagnoses or Explanations
The evaluator must also investigate and rule out the possibility of other potential diagnoses involving neurological and/or medical conditions or substance abuse, as well as educational, linguistic, sensorimotor, and cross-cultural factors that may result in symptoms mimicking the purported psychiatric disability.
Recommendations for Accommodations
The evaluator must describe the degree of impact of the diagnosed psychiatric disorder on a specific major life activity, as well as the degree of impact on the individual. A link must be established between the requested accommodations and the functional limitations of the individual that are pertinent to the anticipated academic setting. Accommodations will be provided only when a clear and convincing rationale is made for the necessity of the accommodation. A diagnosis in and of itself does not automatically warrant approval of requested accommodations. A prior history of accommodations, without demonstration of current need, does not in and of itself warrant the provision of accommodations. If there is no prior history of accommodations, the evaluator must include a detailed explanation of why accommodations were not needed in the past, and why they are now currently being requested. Psychoeducational or neuropsychological testing may help to support the need for accommodations based on the potential for psychiatric disorders to interfere with cognitive performance.
Adults with Psychological Disorders
If psychological instruments are used, all tests used should be current and have sufficient reliability, validity, and utility for the specific purposes for which they are being employed. All tests should also be normed on relevant populations, and the results should be reported in standard scores and/or percentile ranks. Tests that have built-in validity scales or indicators are preferred over those that do not. No single test or subtest should be used solely to substantiate a diagnosis.