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Duke University/Health System
Disability Management System, 402 Oregon Street, Suite 102, Box 90142, Telephone: (919) 668-6213, Fax: (919) 668-3977, http://www.access.duke.edu
Documentation Guidelines
Attention Deficit/Hyperactivity Disorder
Duke University/Duke University Health System is committed to providing equal employment opportunities to qualified
employees with disabilities for purposes of Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities
Act (ADA) of 1990 and the ADA Amendments Act of 2008. To establish that an individual is covered under these
laws, employees must submit current documentation confirming that a disability substantially limits one or more
major life activities as compared to the average person in the general population.
The following guidelines are designed to provide employees and professional diagnosticians with a common
understanding and knowledge base of the components of documentation which are necessary to validate the
existence of an Attention Deficit Hyperactivity Disorder, its impact on the individual’s employment performance,
and accommodation(s) that are necessary in the workplace.
These guidelines contain information regarding:
I.
Qualifications of the Evaluator
II.
Current and Age Appropriate Evaluation Data
III.
History of Impaired Functioning
IV.
Records and Information that Support a History of Impaired Functioning
V.
Important Considerations
A. Evaluation/Diagnostic Report should build a case for and provide sufficient evidence
of the ADHD diagnosis.
B. Test scores, checklists and/or ADHD symptom rating scales alone are not sufficient to
establish an ADHD diagnosis
C. Alternative diagnosis or explanations must be ruled out
VI.
Documentation must include a specific diagnosis
VII.
Rationale & Justification for Each Requested Accommodation
The final determination of disability status and necessary accommodations rests with the University/University
Health System and is based on an interactive process including, but not limited to, a review of supporting
documentation and records submitted by the employee as outlined below. Accommodations are not granted on the
basis of a diagnosis; they must be tied to current functional impairment(s).
Qualifications of the Evaluator
The professional conducting the evaluation and making the diagnosis must be qualified to make the diagnosis,
make recommendations as to necessary accommodations and have direct experience working with an adult
population. The documentation must include the name, title, and professional credentials of the evaluator,
including information about licensure and/or specialization.
In general diagnoses documented by family members will not be accepted even when the family members are
otherwise qualified by virtue of training and licensure/certification. All reports should be in English, typed or
printed on professional letterhead, dated, and signed.
II.
Current and Age Appropriate Evaluation Data is Required
Since reasonable accommodations are based upon the assessment of the current impact of the disorder on the
essential functions of a particular position; evaluation/diagnostic reports must address the individual’s current level
of functioning and the need for accommodations. If the documentation is inadequate in scope or content, or is not
relevant to the individual’s current functional impairments and need for accommodations, additional information
may be required. It is the employee’s responsibility to obtain additional documentation, as necessary.
III.
History of Impaired Functioning
Since developmental disorders such as an Attention Deficit Hyperactivity Disorder are commonly manifested
during childhood (though not always diagnosed), historical information regarding the individual’s history should
be documented and provided. Self-report alone, without any accompanying objective historical records and
information that validate developmental learning problems, are generally not sufficient.
IV.
Records and Information that Support a History of Impaired Functioning
Examples of historical records include, but are not limited to, previous psycho-educational evaluation reports,
written comments from present and past teachers, documentation from past tutors and/or learning specialists,
Individualized Education Plans (IEPs), 504 Plans, report cards from kindergarten, elementary, junior high, and
high school, college transcripts, job performance evaluations and the like.
V.
Important Considerations
A. Evaluation/Diagnostic Report should build a case for and provide sufficient
evidence of the ADHD diagnosis.
An ADHD evaluation is primarily based on an in-depth history reflecting a chronic and pervasive history of
ADHD symptoms and associated impairment beginning during childhood and persisting to the present day.
The evaluation should provide a broad, comprehensive understanding of the individual’s relevant background
including academic, behavioral, family, social, vocational, medical, developmental, employment and psychiatric
history. There should be an emphasis on how the ADHD symptoms have manifested across various settings over
time, how the individual has coped with the problems, and what success the individual has had in their coping
efforts. Any past or current treatments for ADHD and the impact of those treatments should be discussed
(including medications, accommodations, tutoring, classroom modifications, counseling, etc). Providing narrative
documentation from collateral informants who know the individual well (such as parents, spouses, siblings,
teachers, professors, supervisors, tutors, coaches, employers, etc.) can also help to illuminate and establish a
credible history of significant functional impairment relating to ADHD.
B. Test scores, checklists and/or ADHD symptom rating scales alone are not
sufficient to establish an ADHD diagnosis
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), Scholatistic Achievement Test for Adults
(SATA), memory function tests, attention or mental tracking tests or continuous performance tests do not in and of
themselves establish the presence or absence of ADHD. However, test and subtest scores provide useful additional
evidence of attentional problems that support the past and current functional impairments of the individual. A
neuropsychological or psycho-educational assessment can be helpful in identifying the individual’s pattern of
strengths and weaknesses and whether there are patterns supportive of attention problems. A comprehensive
testing battery alone, without illuminating a pattern of real world functional impairment, will not be sufficient to
establish an ADHD disability. Standard scores must be provided for all normed measures.
C. Alternative diagnosis or explanations must be ruled out
The evaluator must investigate and discuss the possibility of dual diagnoses and alternative or co-existing mood,
behavioral, neurological, and/or personality disorders that may confound the diagnosis of ADHD. This process
should include an exploration of possible alternative explanations for substantially limiting problems resulting
from educational, language and cultural factors impacting the individual that may result in behaviors mimicking an
Attention-Deficit/Hyperactivity Disorder.
VI.
Documentation must include a specific diagnosis
 The report must include a specific subtype diagnosis of ADHD based on the diagnostic criteria of the
Diagnostic and Statistical Manual - Fourth Edition (DSM-IV).

It must be demonstrated that the individual exhibits a sufficient number of
symptoms (listed in DSM-IV) of Inattention and/or Hyperactivity/Impulsivity
that have been persistent and maladaptive over time.

Objective evidence demonstrating that symptoms resulting from the current
impairment are currently and were in the past, present in two or more settings.
Since ADHD tends to affect people over time and across situations in multiple life
domains, it is necessary to show that the impairment is not confined to only the
employment setting or to only one circumscribed area of functioning.
VII. Rationale & Justification for Each Requested Accommodation
Accommodations are not granted on the basis of a diagnostic label: they must be tied to the individual’s
specific history and current functional impairment that supports their use. The diagnostic report should include
specific recommendations for accommodations that flow logically from the history and current functional
impairment. A link must be established between the requested accommodations and the current functional
limitations of the individual that are pertinent in the workplace.
02/10/2009