Disabilities and Health-related Needs
ETS is committed to serving test takers with disabilities or health-related needs by providing services and reasonable accommodations that are appropriate given the purpose of the test. This abbreviated version of our documentation guidelines for autism spectrum disorder (ASD) is provided as a quick reference. For full details, please review the "ETS Policy Statement for Documentation of Autism Spectrum Disorder in Adolescents and Adults" below.
A documentation update for ASD is a brief report or a narrative by a qualified professional that includes a summary of the previous disability documentation findings as well as additional clinical and observational data to establish the candidate's current need for the requested testing accommodations. Reference Section III of the policy statement.
Office of Disability Policy
Educational Testing Service
Princeton, NJ 08541
The number of individuals with Autism Spectrum Disorder (ASD) pursuing higher education is increasing. Recent estimates suggest that as many as 1:88 children have ASD (Centers for Disease Control, 2012). Increased awareness on the part of parents, medical professionals and the educational system has resulted in an increased number of referrals of individuals with these profiles. Changes in the DSM-5 have also broadened this diagnostic category. Although the exact numbers of students with ASD in college are hard to predict, those numbers are on the rise. Many college-bound individuals with ASD have average to above-average cognitive capabilities; therefore, we can expect a portion of these individuals to pursue post-baccalaureate degrees.
The intention of this premier edition of ETS's Guidelines for the Documentation of Autism Spectrum Disorder in Adolescents and Adults is to synthesize current knowledge about ASD and to provide test takers and evaluators with clear guidelines for documenting this disorder and the need for reasonable accommodations. Finally, these guidelines may be useful to secondary and postsecondary disability services personnel as well as other testing agencies and licensing boards when considering accommodations for individuals with ASD.
"Autism Spectrum Disorder" (ASD) is a neurodevelopmental disorder ranging from mild to severe and characterized by core features of social/communication deficits, repetitive/restrictive behaviors and a lack of emotional reciprocity. The source for understanding the exact nature of ASD is the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 combines into one category previously distinct but overlapping subtypes (i.e., autistic disorder, Asperger's disorder and pervasive developmental disorder). While all people with ASD share the core features of the disorder, specific manifestations in developmental, cognitive, emotional and behavioral domains are unique to each individual.
ETS takes the confidential, private and sensitive nature of disability documentation very seriously. ETS will not release any information regarding an individual's diagnosis or condition without his or her informed consent or under compulsion of legal process. Information will be disclosed only on a "need to know" basis except where otherwise required by law. Furthermore, to safeguard the confidentiality of individuals with disabilities, evaluators may withhold or redact any portion of the documentation that is not directly relevant to ETS's criteria for establishing both (1) a disability as defined by the Americans with Disabilities Amendments Act (ADAAA) and (2) a rationale for all requested testing accommodations. If a section of a report has been redacted, the evaluator should provide an acknowledgement and rationale for this action.
This document provides individuals with ASD, secondary-school personnel, diagnosticians and postsecondary disability service providers with a common knowledge base regarding documentation necessary to support an ASD in adolescents and adults for the various Educational Testing Service programs, including the College Board®. Our intent is not to be overly burdensome but to provide test takers, as well as their evaluators, with guidance about the specific information that is needed to support requests for accommodations on high-stakes examinations.
Under the ADAAA of 2008 and Section 504 of the Rehabilitation Act of 1973, individuals with ASD are guaranteed certain protections and rights to equal access to programs and services. In order to receive testing accommodations, a test taker needs to provide ETS with current and comprehensive documentation. This documentation should support the need for reasonable accommodations that allow equal access to the testing environment without fundamentally altering any essential component of the test. According to the law, impairment due to a disability must "substantially limit a major life activity." Major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, working, concentrating, thinking, communicating and the operation of bodily functions.
Individuals with ASD may experience difficulties with remembering, learning, reading, concentrating and thinking, which may interfere directly with the test-taking process. In addition, the use of psychotropic medications has become increasingly common in the treatment of ASD. Therefore, it is important that documentation address possible medication side effects which may impact an individual's performance during clinical and standardized testing. Furthermore, individuals with Autism Spectrum Disorder may experience co-occurring psychiatric manifestations (e.g., anxiety, depression, etc.), learning disabilities (LD), and physical or chronic health conditions along with their primary diagnosis. Often, individuals with ASD exhibit behaviors affecting communication and social pragmatics. It is important that the documentation demonstrate need for accommodations for test-taking situations in which social engagement is minimal. In instances in which there may be multiple diagnoses, including LD or psychiatric disabilities, evaluators should consult the appropriate ETS companion documentation guidelines found at http://www.ets.org/disabilities/documentation
Qualified evaluators are defined as those licensed individuals who are competent to evaluate and diagnose ASD or who may serve as members of the diagnostic team. Professionals conducting evaluations, rendering diagnoses of ASD, and making recommendations for reasonable accommodations should have at least five years of clinical experience with this population. It is essential to provide ETS with information about the qualified professional's (1) comprehensive training and relevant expertise in the diagnosis of ASD, and (2) appropriate licensure/certification. The name, title and signature of the licensed qualified professional writing the evaluation report must be included. Information regarding the area of specialization, employment and state or province in which the individual practices must also be clearly stated in the documentation. All reports should be written in English, typed or printed on professional letterhead and dated.
Given the profound impact this disorder may have on daily life, documentation should be provided from more than one source, as this type of diagnosis warrants a clinical approach involving educational, medical and mental health professionals. A multidisciplinary assessment approach is often critical for the diagnosis and treatment of the individual with ASD. Optimally, the team should include a psychologist, a speech and language therapist, and an occupational therapist. Additionally, if psychiatric co-morbidity is involved, a psychiatrist should be part of the team. Team members may include any of the following:
A diagnosis of ASD by a family member will not be accepted due to professional and ethical considerations, even if the family members are otherwise qualified by virtue of their training and licensure/certification.
Documentation should be based on a comprehensive diagnostic protocol that includes objective as well as subjective data and adheres to the guidelines outlined in this document. It may be particularly relevant for the evaluator to conduct a clinical interview with parents or knowledgeable informants. This can help to document that manifestations of the disorder originated in early childhood, even if a formal diagnosis was not rendered at that time. The diagnostic report should include the following components:
In most cases, a neuropsychological or psycho-educational evaluation will be useful in clarifying the functional impact of the diagnosed disability and in supporting the underlying rationale for accommodations on a high-stakes test. For example, information that is solely concerned with social functioning and communication may have very little relevance to taking a standardized test and will usually be insufficient to support accommodations requests. Deficits in social functioning and communication should be directly tied to the high-stakes testing setting. Sections A and B provide more detailed information regarding historical and diagnostic information that may be helpful to evaluators.
Behavioral observations, combined with the clinician's professional judgment and expertise, are often critical in helping to formulate a diagnostic impression. The evaluator should specifically indicate the relevant test-taking behaviors that impact the examinee's performance. The evaluator should indicate if the behaviors noted during testing are consistent with the diagnosis, and if not, why not. This section of the diagnostic report should include the following:
The report must include a diagnosis, or diagnoses, of ASD as stipulated in the DSM-5* or the ICD-10* and of any co-morbid conditions, preferably with the accompanying numerical code(s). Evaluators are encouraged also to provide meaningful contextual information (e.g., associated medical diagnoses, current stressors and sociocultural factors), as well as statements regarding general level of functioning. The evaluators should avoid ambiguous wording such as "is consistent with," "has problems with," or "may indicate possibility of."
To the extent possible, the evaluator should investigate and rule out other potential diagnoses that may affect the expression of an autism spectrum disorder. These diagnoses, such as bipolar disorder, social anxiety disorder, reactive attachment disorder, generalized anxiety disorder or obsessive-compulsive disorder should be identified and ruled out as appropriate. If the co-morbid condition is relevant to the need for accommodations, this condition should be explored and discussed fully in the narrative report.
*DSM-IV and ICD 9 diagnostic criteria will be accepted through 2015.
The provision of reasonable accommodations and services is based upon ETS's assessment of the current impact of the individual's disability on his or her academic performance, particularly in testing situations. It is in a candidate's best interest to provide recent and appropriate documentation. As with many other developmental disorders and psychiatric diagnoses, ASD is an enduring disorder that exists across the lifespan. Functional limitations of the disorder, however, may change depending upon the test taker's age as well as on environmental demands. Therefore, documentation needs to be from within the last five years.
A documentation update for ASD is a brief report or a narrative by a qualified professional that includes a summary of the previous disability documentation findings as well as additional clinical and observational data to establish the candidate's current need for the requested testing accommodations. Observational data gathered during the recent clinical interview, including affect, concentration, attentional fatigue, executive functioning, personal hygiene, and response to questions, may be helpful. The updated evaluation need not include a full battery of tests but should include selected neuropsychological and adaptive measures deemed appropriate, along with academic measures to support functional limitations and requested accommodations. A documentation update can be submitted if the candidate was diagnosed in childhood and their documentation exceeds our five-year currency policy.
ETS acknowledges that a clinical discussion of symptoms may be more valuable than a score on a standardized test. It is not uncommon for an ASD diagnosis to be supported by one or more evaluations by different evaluators. The domains described below frequently can provide vital information concerning the impact of ASD on daily life as well as on the types of accommodations needed in the testing environment. Not all of these domains need to be included in a diagnostic report, but it is hoped that noting them will help evaluators in selection of areas that are most relevant, depending on the individual. (See Appendix III – Tests for Assessing Adolescents and Adults with ASD)
Cognitive assessment refers to the portion of a psychological test battery that examines global skills, such as the way individuals process information and thought. This might include testing of intelligence (IQ), problem solving, concept formation and abstract reasoning.
Executive functioning refers to the cognitive aspects of behavioral control and is closely linked to self-regulation, the control over the social and emotional components of behavior (e.g., self-monitoring, frustration tolerance, etc.). This subset within the cognitive assessment battery focuses on the ability of an individual to plan, initiate and sustain actions and to evaluate and shift behavior to match intent. Executive functioning develops gradually from childhood well into early adulthood.
Expressive and receptive language and communication
Expressive language is the ability to use age-appropriate speech and prosody to communicate meaning, to speak coherently and cogently to get one's message across. Receptive language is the ability to comprehend speech, including attending in a developmentally appropriate manner, following directions and the pace of delivery, and understanding both literal and figurative aspects of language. Communication skills, in turn, cover a broad spectrum of skills, including the linguistic ones cited above as well as listening to, interpreting, and partaking in dialogue and exchange, which may involve both verbal and non-verbal communication (e.g., gestures and non-verbal expressions).
Social pragmatics is a key component of language and communication skill development and refers to our ability to (1) use language for different purposes such as to greet, make a promise or inform; (2) change language according to the needs of the listener (e.g., baby vs. adult) or the situation; and (3) follow rules of conversation and story-telling, such as taking turns, using facial expressions and eye contact, and so on.
Psychiatric, personality and behavioral assessments
Psychiatric, personality and behavioral assessments should address the impairment of social interaction and communication as they impact the individual's ability to adapt and be flexible in daily life activities. Assessment should include objective data as well as subjective observations. Secondary reporting of mood issues, such as depression and anxiety, is necessary to provide a fuller clinical picture. Most important, a summary is needed to explain how all of these individual vulnerabilities translate into a disabling condition that warrants accommodations for test taking in particular.
This refers to the way the nervous system receives messages from the senses and turns them into appropriate motor output and subsequent behavioral responses. Successful completion of activities such as reading a book, writing a class essay or giving a speech requires integration of input from multiple senses to process the information. Sensory integration refers to the brain's ability to interpret and use information from a variety of senses, including visual, auditory, tactile and olfactory. When the brain interprets sensory input inappropriately, an individual will find it difficult to process and act upon information received through the senses, which creates challenges in performing everyday tasks and possible disruptions to behavior. Sensory features are recognized in the revision of the Diagnostic and Statistical Manual (DSM-5) as part of autism spectrum disorders: hyper-sensitivity and hypo-sensitivity.
Attention is an aspect of mental control that involves the ability to maintain alertness, to focus selectively and to shift focus as needed.
In general, memory refers to the brain's ability to store or hold onto information that it receives through the senses. Three primary categories of memory have been identified: short-term, long-term and working memory. Even if information is stored appropriately, there may be difficulty with on-demand retrieval.
In psychological assessment, learning tasks are typically those in which information, such as a list of words, is presented several times to measure how quickly and how well an individual remembers them. A comprehensive assessment of memory gives an impression of the full range of memory skills.
Visual-perceptual motor skills
Visual-perceptual motor skills enable one to make sense of visual information and then use it appropriately for a variety of motor tasks, including handwriting, playing sports and using tools or utensils.
Academic achievement refers to school-related areas such as reading, writing and math. Proficiency in an academic domain typically involves mastery of basic skills, applied skills and fluency or automaticity of skills. Achievement scores are usually obtained by comparing an individual's performance to that of others of the same age and the same educational level.
It is important that clinical impressions and test results from each of the relevant domains be communicated in a clear and straightforward manner in the report. Standard scores and percentile ranks should be reported for all measures. Findings should be integrated into a narrative that provides an interpretive summary along with relevant recommendations for accommodations specific to the test taker.
In conclusion, many of the core features of ASD are not captured easily in test scores. In some instances this occurs because an individual reaches the ceiling on certain cognitive, academic and neuropsychological tests. In other cases, individual tests were not designed to capture subtle but relevant aspects of social communication or social-emotional regulation. Therefore, it is useful to have an interpretative summary that goes beyond the test scores and provides a flavor of the way an individual approaches tasks, the quality of their thought processes, and their motivation as they approach the task. An interpretive summary might also provide important historical or observational data that would not be reflected in standardized test scores alone. Information about psychiatric symptoms that are ongoing during the assessment or in the individual's current life is important as well. Anxiety, lack of motivation and social withdrawal certainly merit discussion, both as potential factors affecting the testing and as separate domains that might warrant accommodation.
The evaluator must describe the degree of current impact of the diagnosed ASD on a specific major life activity as well as the degree of impact on the individual in a testing situation. A link must be established between the requested accommodations and the manifested symptomatology of the disorder that is pertinent to the anticipated testing situation. Accommodations can be provided only when a convincing rationale is made for their necessity to provide equal access. A diagnosis of ASD in and of itself does not automatically warrant approval of requested accommodations. For example, if there is a prior history of accommodations without demonstration of current need, the provision of accommodations needs further support. Also, the manifestation of specific characteristics such as poor oral communication skills, repetitive motor behaviors and lack of social or emotional reciprocity is insufficient to support requests for testing accommodations. However, characteristics of co-morbid conditions, such as OCD or ADHD, may be used in support of the need for accommodations if fully documented in the narrative report.
Also, since ASD is typically recognized and accommodated at an early age, a strong rationale is needed if there is no history of accommodations. The evaluator and the test taker must include a detailed explanation of why accommodations were not needed in the past and why they are currently being requested.
Other sources of documentation can be used to corroborate symptoms of the disorder and support the need for the requested accommodation(s). Relevant information from these sources should be summarized by the evaluator in the current disability documentation and included as an attachment by the applicant. Depending on the degree and scope of the information it contains, a school-based document such as an Individualized Education Program (IEP), a Section 504 Plan, a Summary of Performance or transition documentation can be included as part of a more comprehensive documentation packet. Prior evaluation reports should be reviewed by the evaluator and summarized in the history section or attached to the documentation packet. Teachers' comments from any of these documents may be relevant to the need for accommodations. Such documents may provide useful supplemental information about a test taker's educational history as well as her or his history of eligibility for services, limitations to academic achievement and accommodation use.
Other supplemental forms of documentation may include evidence of a reduced course load or the number of incompletes or dropped courses in school, a copy of an accommodation letter to faculty, a letter from a content area teacher, and official scores on national standardized tests (e.g., SAT® or ACT®) taken with or without accommodations. A detailed letter from a college disability services provider, a vocational rehabilitation counselor or a human resources professional describing current limitations and use of accommodations also can be helpful to supplement comprehensive documentation.
A personal letter from the applicant in his/her own words explaining academic difficulties and coping strategies may be helpful. The applicant's personal letter should highlight any relevant additional information that further supports the current need for accommodations. The personal letter should not exceed one page and may include information regarding the date of the initial diagnosis, accommodations history in a variety of settings, a statement explaining the need for the accommodations that are presently requested, and any additional supporting information for the requested accommodations. In some instances additional insights regarding the students' disability and use of accommodations could be provided by the disability services coordinator at their campus.
For additional information contact:
|Mail:||ETS Disability Services; P.O. Box 6054; Princeton, NJ 08541-6054|
||1-866-387-8602 — Toll free from the United States, American Samoa, Guam, Puerto Rico and U.S. Virgin Islands. and Canada
1-609-771-7780 — All other locations
The following diagnostic criteria for ASD are specified in the DSM-5:
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for ASD, should be evaluated for social (pragmatic) communication disorder.
*Note. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013). American Psychiatric Association. All rights reserved.
1. For assistance in finding a qualified professional:
2. In selecting a qualified professional:
3. In working with the professional:
4. As follow-up to the assessment by the professional:
When selecting a battery of tests, it is critical to consider the technical adequacy of instruments, including their reliability, validity and standardization on an appropriate norm group. The professional judgment of an evaluator in choosing tests is important. Whenever feasible, the most recent version of the test should be used. The following list includes a variety of popular standardized measures for diagnosing ASD. It is meant to be a helpful resource to evaluators, but is not a definitive or exhaustive listing.
Tests of Intellectual Functioning
The Slosson Intelligence Test - Revised, Wechsler Abbreviated Scale of Intelligence (WASI) and the Kaufman Brief Intelligence Test (K-BIT-2) are primarily screening devices and are not comprehensive enough to provide the kinds of information necessary to make accommodation(s) decisions.
Executive Functioning (EF)
Language and Communication Skill Assessment
Psychiatric, Personality and Behavioral Assessments
Sensory Processing and Integration
Clinical observations and previous sensory history will be highly relevant in providing insight into patterns of documented or suspected sensory-motor integrative dysfunction.
Specific achievement tests are useful instruments when administered under standardized conditions and when the results are interpreted within the context of other diagnostic information. Results from these instruments must include standard scores, at a minimum, and may be supplemented by percentiles; however, age and grade equivalents are not appropriate. The Wide Range Achievement Test - 4 (WRAT-4) is not a comprehensive measure of achievement and therefore should not be used as the sole measure of achievement.
Advancing Futures for Adults with Autism (AFFA)
AFAA is a national consortium of organizations working together, led by the vision of individuals with autism and their families, to promote a collaborative spirit and develop both public and private sector support that improve the lives of adults living with autism.
Association on Higher Education and Disability (AHEAD)
|Mail:||107 Commerce Center Drive, Suite 204; Huntersville, NC 28078|
An excellent organization to contact for individuals with disabilities who are planning to attend college training programs, workshops and conferences.
|Mail:||4340 East-West Hwy, Suite 350; Bethesda, Maryland 20814|
1-800-328-8476 — Toll free
The Autism Society is the leading voice and resource of the entire autism community in education, advocacy, services, research and support. The Autism Society is committed to meaningful participation and self-determination in all aspects of life for individuals on the autism spectrum and their families. The Autism Society accomplishes its ongoing mission through close collaboration with a successful network of affiliates, members and supporters.
|Mail:||1 East 33rd Street; 4th Floor; New York, NY 10016|
1-888-288-4762 — Toll free
At Autism Speaks, our goal is to change the future for all who struggle with autism spectrum disorders. We are dedicated to funding global biomedical research into the causes, prevention, treatments and a possible cure for autism. We strive to raise public awareness about autism and its effects on individuals, families and society; and we work to bring hope to all who deal with the hardships of this disorder.
|Mail:||233 South Wacker Drive, Suite 2400; Chicago, IL 60606|
|Phone:||1-800-221-6827 — Toll free|
Easter Seals is the leading nonprofit provider of services for individuals with autism, developmental disabilities, physical disabilities and other special needs. For more than 85 years, we have been offering help and hope to children and adults living with disabilities, and to the families who love them. Through therapy, training, education and support services, Easter Seals creates life-changing solutions so that people with disabilities can live, learn, work and play.
National Autism Resources & Information Center
|Mail:||1825 K Street NW, Suite 1200; Washington, DC 20006|
|Phone:||1-855-828-8476 — Toll free|
The Autism NOW Center provides high quality resources and information in core areas across the lifespan to individuals with Autism Spectrum Disorders (ASD) and other developmental disabilities, their families, caregivers and professionals in the field.
*References cited can be found at the following link: https://www.ets.org/disabilities/documentation/asd/references.
Grateful acknowledgment to Manju Banerjee, Arunas Kuncaitis, Kathleen Monagle, Lori Muskat, Christine O'Dell, Stuart Segal, Jane Thierfeld Brown and Lorraine Wolf for their contributions to this document.
If you have questions or need additional information, contact disability services at the following link: http://www.ets.org/contact/additional/disabilities