Does anybody really know who qualifies as disabled?

1. Does anybody really know who qualifies as disabled? Allyson G. Harrison, Ph.D., C.Psych Regional Assessment & Resource Center, Queen’s University Canada

2. What exactly is a disability? • The definition of what constitutes a disability is a moving target. • No clear agreement regarding how to determine • Boundaries on definition seem to be widening • Culture where everyone expects to succeed and if not then there must be a “cheat code”

3. What exactly is a disability? Ontario Human Rights Commission definition is circular & based on discrimination rather than identification. • “any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness ….includes diabetes mellitus, epilepsy, a brain injury, any degree of paralysis, amputation, lack of physical co-ordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment, or physical reliance on a guide dog or other animal or on a wheelchair or other remedial appliance or device,

4. OHRC continued • a condition of mental impairment or a developmental disability, • a learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language, • a mental disorder, or • an injury or disability for which benefits were claimed or received under the insurance plan established under the Workplace Safety and Insurance Act, 1997

5. OHRC • NOTE: “believed to have or have had”clause • This does not mean that anyone who has ever believed s/he has a disability is automatically afforded rights as a person with a disability • Only means you cannot discriminate against because of perceived or implied disability. • NOTE, too: Disability label alone does not compel accommodation- IMPAIRMENT or UNEQUAL opportunity to participate does (unless essential requirement)

6. American’s with Disabilities Act (Amended) • ADA gives a rough benchmark for determining who is disabled. • “An impairment is a disability if it substantially limits the ability of an individual to perform a major life activity as compared to most people in the general population”

7. Is a DISORDER a DISABILITY? • According to DSM, a DISORDER is NOT necessarily a Disability. • DSM-5, pg. 25. "In most situations, the clinical diagnosis of a DSM-5 disorder does not imply than an individual with such a condition meets legal criteria for the presence of a disability…Additional information is usually required beyond that contained in the DSM-5 diagnosis, which might include information about the individual's functional impairments and how these impairments affect the particular abilities in question….assignment of a particular diagnosisdoes not imply a specific level of impairment or disability." 

8. Who is disabled? Scenarios 1. White matter damage 2. Unilateral deafness 3. Congenital hand and foot malformation 4. I have to work hard to get A’s 5. Working memory lower than IQ 6. IQ and academic skills that are low average

9. What accommodations must be provided? • Dx alone does not mean person requires accommodation. • Nexus of impairment and task demands • Should be reasonable and not give unfair advantage • Purpose is to provide equal opportunity to participate

10. What accommodations are reasonable? 1. White matter damage 2. Unilateral deafness 3. Congenital hand and foot malformation 4. I have to work hard to get A’s 5. Working memory lower than IQ 6. IQ and academic skills that are low average

11. Accommodations are not meant to ensure success • Human Rights Tribunal has made clear that there is no requirement that academic standards be reduced or ignored in order to provide accommodation. • Aim of accommodation is to provide students with an equal opportunity to meet legitimate academic standards. • http://www.canlii.org/en/on/onhrt/doc/2012/2012hrto715/2012hrto715.html • http://www.canlii.org/en/on/onhrt/doc/2011/2011hrto1229/2011hrto1229.html • Accommodations ensure ACCESS not SUCCESS

12. Is it fair? • Some colleges provide double time to ALL students with disabilities for ALL classes • Ontario High School’s motto is student success- so anyone who is not succeeding can get an IEP • HS curriculum can be modified to ensure success & Principal can authorize regular credit. • Some boards have 1/3 students on IEPs • Clinicians give diagnosis that is wanted rather than diagnosis that is warranted

13. Is it fair? • Many studies show that anything over time & a quarter provides an advantage vs regular time (e.g. Lewendowski, Cohen & Lovett, 2013). • Evaluations of those getting extra time on SAT show majority come from upper class neighbourhoods and attended private schools, while those in low SES neighbourhoods comprised very small % of disabled test takers (e.g. Abrams, 2005; California State Auditor Board, 2000; Mitchell, 2012; Rado, 2012) . • Unlike physical or medical disabilities, studies show proportion of those labeled LD correlates with parental income and education (e.g. Lester & Kellman, 1997)

18. Do Professionals know how to dx a disability?

19. Recent survey of 110 Psychologists (partial) 1. Evidence that an individual reads slowly is sufficient to justify extra time as a disability accommodation.

20. Recent survey of 110 Psychologists (partial) 1. Evidence that an individual reads slowly is sufficient to justify extra time as a disability accommodation. Answer: Only 72% knew this was FALSE

21. Recent survey of 110 Psychologists (partial) 2. An individual can be considered disabled even if performance on timed, multiple choice exams is their only area of weak functioning?

22. Recent survey of 110 Psychologists (partial) 2. An individual can be considered disabled even if performance on timed, multiple choice exams is their only area of weak functioning? Only 69% knew this was FALSE

23. Recent survey of 110 Psychologists (partial) 3. An adult can be classified as having ADHD even if he had no significant childhood impairment, never required accommodations prior to graduate school, and had no history of brain injury.

24. Recent survey of 110 Psychologists (partial) 3. An adult can be classified as having ADHD even if he had no significant childhood impairment, never required accommodations prior to graduate school, and had no history of brain injury. Answer: Only 63% knew this was FALSE

25. Recent survey of 110 Psychologists (partial) 4. The purpose of a clinical evaluation for patients seeking accommodations is to help secure those accommodations.

26. Recent survey of 110 Psychologists (partial) 4. The purpose of a clinical evaluation for patients seeking accommodations is to help secure those accommodations. Answer: Only 55% knew that the answer was FALSE

27. Recent survey of 110 Psychologists (partial) 5. To demonstrate the need for accommodations, clinicians should determine impairment by comparing a patient’s test score with norms for students at similar education levels

28. Recent survey of 110 Psychologists (partial) 5. To demonstrate the need for accommodations, clinicians should determine impairment by comparing a patient’s test score with norms for students at similar education levels Answer: Only 29% knew this was FALSE

29. Recent survey of 110 Psychologists (partial) 6. Studies show that clinicians are unable to reliably determine if a student is answering honestly or investing good effort in testing without aid of specific effort tests.

30. Recent survey of 110 Psychologists (partial) 6. Studies show that clinicians are unable to reliably determine if a student is answering honestly or investing good effort in testing without aid of specific effort tests. Answer: Only 29% knew this was TRUE

31. Recent survey of 110 Psychologists (partial) 7. The purpose of accommodations is to allow a disabled individual to perform at his/her best

32. Recent survey of 110 Psychologists (partial) 7. The purpose of accommodations is to allow a disabled individual to perform at his/her best Answer: Only 12% knew the answer was FALSE

33. Recent survey of 110 Psychologists (partial) 8. To assist a student in obtaining test accommodations it is appropriate to make a diagnosis of LD or ADHD even if clinical data do not completely meet agreed upon diagnostic criteria such as those in DSM-IV

34. Recent survey of 110 Psychologists (partial) 8. To assist a student in obtaining test accommodations it is appropriate to make a diagnosis of LD or ADHD even if clinical data do not completely meet agreed upon diagnostic criteria such as those in DSM-IV Answer: A whopping 14% actually said TRUE!!!!!

35. Common problems with documentation • Don’t use appropriate tests • Don’t employ appropriate norms • Use significance as a diagnosis • Fail to take good history • Forget to use all of DSM criteria • Fail to show how person is impaired • Fail to use common sense • Recommend ++accommodations, many of which unrelated to persons strengths & weaknesses

36. Misinterpretation of normal variability in performance • All people have variability in cognitive functioning. • Higher you go in IQ, greater that variability is. • Less formal education you have, larger number of below average scores.

37. Table 3. Percentages of normative participants with 10 or more, 15 or more, 20 or more, and 25 or more point discrepancies between WAIS-IV Index scores byIQ level Binder et al., 2009

38. Prevalence of low subtest scores on the WAIS-III/WMS-III across different cutoffs. Prevalence of low subtest scores on the WAIS-III/WMS-III across different cutoffs. Iverson & Brooks, 2008 Brooks, 2008

39. Clinical vs statistical significance • Lots of reports note that two scores are “significantly different” • That does not mean it is clinically meaningful. • Statement only means that the difference between the two scores did not occur by accident- i.e. it is a real difference. • Does not mean it is diagnostic

40. Conclusion? • Having a few subtest scores on any flexible test battery that fall within the impaired range is neither unusual nor unexpected, and certainly not diagnostic of any type of disability. Binder et al., 2009; Iverson & Brooks, 2008; Brooks & Iverson, 2010

41. Regression to mean • Difference between IQ and achievement increases as IQ increases due to regression to mean. (Reynolds & Wilson, 1984; Sternberg & Grigorenko, 2002) • Normally find much lower achievement than IQ when IQ above average. • Correlation between IQ and achievement test influences effect

42. Effects of Correlation Regression to the Mean

43. Increasing numbers • Explosion in number of postsecondary students requesting accommodations. • Unclear if all institutions apply same criteria for identification of disability. • New DSM may increase # labeled with a disorder • Huge rise in mental health disorders in teens • Huge rise in # IEPs at HS • Financial incentives to be labeled as disabled • At what point will a disability label become the norm? • Learning from history