Attention Deficit Disorder with or without hyperactivity (ADD/ADHD) is a neurological disorder causing difficulties with sustained focus and concentration. The absence of proper treatment and intervention designed to help a person learn how to manage this disorder can result in chronic frustration, discouragement, and academic underachievement. The College of William and Mary responds with a team of professionals whose number one goal it is to help students diagnosed with ADD/ADHD avoid pitfalls that could impede successful academic progression. This system of checks and balances is intended to acknowledge the psychological, the neurological, as well as the behavioral aspects of the disorder.

All William and Mary students seeking evaluation, treatment, and/or assistance for ADD/ADHD are expected to follow the protocol outlined below:

I. Medicinal Treatment/Medication Monitoring by Student Health Center

The following are clinical guidelines to be followed on all patients seeking treatment at the Student Health Center, College of William and Mary, for the evaluation and treatment (new or ongoing) of ADD and ADHD.

Students who have been diagnosed with ADD/ADHD prior to coming to William and Mary (or diagnosed off campus) who are requesting prescriptions to be written for ADD/ADHD medications must provide the following:

1. Psychiatric/psychological records, to include all summaries of psychological testing batteries used to support the diagnosis. These records must be provided for review prior to the ADD/ADHD consultation appointment. If the health center is not in receipt of these records two working days before the scheduled appointment, the appointment may be cancelled. Documentation should clearly support the diagnosis of ADD/ADHD, and response to any treatment.

2. If review of these records reveals no psychological testing has ever been done, the patient will be referred for same. Prescriptions can be written for up to three months pending conclusion of this assessment. Patients will be notified of the need to have the evaluation/testing completed within this time period.

1. A detailed interview addressing criteria for the diagnosis of ADD/ADHD as outlined in the DSM IV. Details of this interview will be documented in the medical record to include the "DSM IV Criteria" form. Attempts to interview spouses, parents, should be pursued.

2. Patient history should support the existence of symptoms of this diagnosis in childhood. The development of this disorder during college is exceedingly rare (per review of the literature): if history supports this, consideration for psychiatrist consultation should be entertained.

3. ALL patients should be referred for psychological testing, ideally to a psychologist with extensive experience with this diagnosis.

4. ADD/ADHD is extremely difficult to diagnose in the face of a concomitant untreated, or inadequately treated, mood or psychotic disorder. If diagnosis is considered under these circumstances, the patient will be referred for a psychiatric consultation.

1. Class II stimulant agents will not be prescribed at the Student Health Center. Patients seeking these medications will be referred to an outside psychiatrist.

2. All patients receiving ongoing care for ADD/ADHD at the Student Health Center will be advised of the services offered by the Disability services office, and encouraged to meet with the Assistant Dean of Students for Disability Services. The patient must agree to follow through on all study skills assessment/classes/follow-up as recommended by the Dean of Students Office.

1. The patient must maintain an updated Release of Information (ROI) form allowing exchange of information between the Student Health Center and the Dean of Students office.

2. The student must maintain an updated ROI allowing exchange of information between the Student Health Center and the physician prescribing stimulant therapy.

A. The student must register as a student with a disability by providing documentation of ADD/ADHD to the Disability Services Office. A comprehensive psycho-educational or neuropsychological assessment demonstrating the significant impact of ADD/ADHD upon academics is expected and must meet the following guidelines:

a. Evaluation must be conducted by a qualified diagnostician: The diagnostician must have comprehensive training and direct experience in working with adult populations. Diagnosticians should describe the academic credentials and qualifications that allow them to diagnose the disability and recommend accommodations. Documentation from professionals who are blood relatives of the student cannot be accepted.

b. Accommodations based upon assessment of the current impact of disability: Documentation verifying learning disabilities and physical or medical disorders that could be compensated for over time should not be older than three years from the date of submission.

c. Evaluation must be comprehensive and include the following:

• Diagnostic Interview: Objective evidence of a substantial limitation in cognition/learning must be provided. Minimally, the written summary must include a description of presenting problem, developmental history, academic history, family history (including primary language of the home and current fluency of English if relevant), psychosocial history, medical history (including the absence of a medical basis for the present symptoms), discussion of dual diagnosis, alternative or coexisting mood/ behavioral/neurological/personality disorders, along with a history of relevant medication and current use that may have an impact upon learning.
• Neuropsychological or Psycho-educational Evaluation: Neuropsychological or psycho-educational evaluation for the diagnosis of a cognitive disability should be presented on the letterhead of a qualified professional and should provide clear and specific evidence that a cognitive disability does exist. It is not acceptable to diagnose on the basis of a single test, a clinical interview, or response to medication alone. Domains to be addressed include the following: Aptitude/Cognitive Ability, Academic Achievement, and Information Processing.

d. Test scores must be provided: Standard scores must be provided for all normed measures. There must be evidence of intra-individual differences in cognition/achievement and in information processing that demonstrates a substantial limitation for which an accommodation is recommended. The particular profile of the individual’s strengths and weaknesses must be shown to relate to functional limitations that necessitate the recommended accommodations. All tests used in assessment must be reliable, valid, and standardized for use with an adult population. Test findings must document both the nature and severity of the disability. Informal inventories, surveys, and direct observation may be used in tandem with formal tests to further develop a diagnosis and support accommodation requests.

e. Report of assessment must include a specific diagnosis: "Learning styles", "learning differences", and "academic problems" are not cognitive disabilities for which accommodations will be granted. An explicit diagnosis must be supported by test data, academic history, anecdotal and clinical observations which may include comments about the student’s level of motivation, study skills, and other non-cognitive factors. Findings must demonstrate that the functional limitations are due to the diagnosed disability. The diagnostician will also be expected to rule out alternative explanations for problems in learning such as emotional or attention that may interfere with learning, but do not, in and of themselves, constitute a disability in learning.

f. Report of assessment must recommend specific accommodation(s): The diagnostician must include a detailed explanation as to why each recommended accommodation is necessary. Such requests must reference test results or clinical observations that support the need for accommodation.

B. The student then should schedule an appointment to discuss individual learning needs and to identify appropriate accommodations with the Assistant Dean of Students for Disability Services by calling 757-221-2510 (757-221-2302 TDD). Disability Services is located in the Dean of Students Office, 109 Campus Center. Office hours are 8:00 a.m. to 5:00 p.m. Monday through Friday. As part of the registration process, students will be expected to sign a Release of Information Form giving consent to the sharing of information with the Student Health Center, the Counseling Center, and the professional that has diagnosed ADD/ADHD.

III. Learning Assistance Assessment

The Dean of Students Office provides students with individual counseling on skill-enrichment topics including time management, reading and note taking techniques, test taking strategies, and others. In addition, a series of campus-wide workshops and residence hall presentations are offered throughout the year. Please call 757-221-2510 (757-221-2302 TDD) to obtain more information or to schedule an appointment to meet with a learning assistance counselor.

IV. Counseling Center (optional, but strongly recommended)

Students may wish to address issues related to their ADD/ADHD diagnosis through counseling. The following individual and group counseling options are available:

• Adjustment issues/coping skills
• Possibility of co-existing conditions (e.g., depression)
• Anxiety/stress reduction workshops
• Behavior modification
• Personal success strategies

Call the Counseling Center at 221-3620 to schedule an appointment or to inquire about other workshops that are being offered.