Pre-Screening and Testing for Possible Cognitive Disabilities

Background
“Cognitive disabilities” refers to various neurologically-based impairments that significantly affect learning and perhaps other major life activities. Some cognitive disabilities result from head injuries. Some are lifelong circumstances experienced from childhood. They can be diagnosed as “cognitive disorders,” “learning disorders,” “Attention Deficit/Hyperactivity Disorder” (AD/HD), or “post-traumatic head (or ‘brain’) injuries". Commonly used and less clinical terms include “learning disabilities,” “dyslexia,” “Attention Deficit Disorder” and “head injuries.”

Students with cognitive disabilities may need disability-related academic adjustments, services, or program modifications (often referred to as “academic accommodations”). Each student’s circumstances are unique. Thus, accommodations are determined on an individualized basis. Some of the more common accommodations include extended time and/or a separate venue for timed in-class tests, note-taking support, document conversion, use of adaptive technology, reduced course loads, speech-to-text captioning, and development of advocacy skills.

Service eligibility is based in large part on the quality and comprehensiveness of a student’s disability documentation and degree of current functional need. A record of prior accommodation, in and of itself, is usually insufficient to support academic accommodations in higher education. A physician’s, psychologist’s or other practitioner’s determination/ recommendation/assertion about appropriate accommodations is valued, but there are many factors to consider and the ultimate judgment rests with a college or university.

Generally, it is the student’s responsibility to provide current and comprehensive documentation that substantiates a student’s disability-related need for services at a college or university (this is different from K-12 in the United States, where schools/school districts may be required to arrange and fund certain kinds of disability assessments). In order to ensure that we have appropriate information that allows us to best respond to students’ needs, Dartmouth College specifies documentation guidelines for various disabilities (see http://www.dartmouth.edu/~accessibility/policies/). These are consistent with those at other U.S. institutions of higher education.

The testing initially needed to fully substantiate the disability-related need for students with cognitive disabilities is commonly referred to as “psychoeducational” or “neuropsychological” assessment. It can cost from $600 to over $5,000. Much of this wide range, the extremes of which are very rare, is based on location: generally, testing in large metropolitan areas seems to be more expensive than in more suburban or rural areas. Other variables include: array of testing needed, local supply-demand environments, degree of a practitioner’s reputation/established practice, and comprehensiveness of the report. In the Upper Valley area local to Dartmouth College, the range is $1,500 to $2,400 as of Fall, 2012.  There is also a clinical education program training doctoral-level psychology students to do assessments under clinical supervision where assessments are only $600.

Pre-screening at Dartmouth College’s Student Accessibility Services Department

Although Dartmouth College has no legal responsibility to arrange, facilitate, or provide psychoeducational or neuropsychological assessment, we have chosen to (1) provide “pre-screening” to undergraduate students exploring the possibility that they have a cognitive disability and, for students who have been referred by Student Accessibility Services (SAS) or Dick’s House, (2) assess whether “provisional” services are needed, and (3) provide funding to help pay for psychoeducational or neuropsychological testing for some students. We have chosen to do so mostly because of the following factors:

• Anecdotally, selective schools experience a noticeable number of students who have unidentified cognitive disabilities – particularly the so-called “learning disabilities” – that significantly impede their performance at the post-secondary level. This has certainly been true at Dartmouth College.
• Unlike the support for diagnosis and assessment for many other types of disabilities, psychoeducational and neuropsychological assessments are expensive and often not funded by health insurance or other public services. This, of course, has a disproportionate effect on students with limited financial resources.
• The nature of most cognitive impairments is such that no other effective “short-cut” diagnostic tool is available.
• Pre-screening helps students make better decisions about whether and when to pursue expensive and time-consuming testing.
• Pre-screening helps SAS advocate for potentially important “provisional” academic adjustments, services, and program modifications before the lengthy psychoeducational/neuropsychological assessments are completed.
• Pre-screening can be helpful in a student’s adjustment to the notion that s/he may have a “disability” and lay the groundwork for a comfortable, private place to discuss related struggles, emotions, concerns, and so forth. Ideally, it sets up a more comfortable and constructive relationship with SAS in the event that the student is indeed diagnosed with a cognitive disability and needs SAS support.

SAS pre-screening services are designed for students who believe that may be experiencing technical difficulties or unexplained ineffectiveness with fundamental activities usually considered important for learning. These may include reading, writing, or understanding spoken information in one’s native language in a manner that belies their understanding of the material, intelligence, effort, and interest.

If a student is primarily concerned about difficulties sustaining attention and focus, or that they may have Attention Deficit/Hyperactivity Disorder, then the student should make an appointment at the Counseling and Human Development (CHD) department at Dick’s House by calling 646-9442.

1. Pre-screening procedures – brief

• A student is referred to SAS by self or others (most commonly: undergraduate deans, professors, Dick’s House, other students).
• The student is offered an initial appointment to discuss.
• If the student and SAS decide to pursue pre-screening, the student completes a pre-screening questionnaire and a form that includes a brief writing sample.
• The SAS Director or Assistant Director may request additional information from others (usually a professor or practitioner, sometime an undergraduate dean).
• The SAS Director or Assistant Director reviews materials before next step.
• The student and SAS Director or Assistant Director have a pre-screening meeting (Usually, the Director/Assistant Director can tell the student whether SAS will “refer” for testing at the end of this meeting).

If the student is not referred: This is usually a provisional decision, while the student tries other resources first (e.g. study &/or test-taking strategies at ASC, counseling, “rule-out” consultation with medical/psychological practitioners). SAS makes proper referrals and invites students to return if these do not work well.

If the student is referred:

• The SAS Director or Assistant Director prepares notes meant to be helpful to a testing practitioner. If the student wishes, the notes can be sent to the practitioner and the student as they prepare for the testing.  
• The student is provided information about arranging testing.
• The student is then responsible for arranging the appropriate testing (see “Cognitive Disability Assessment Process at Dartmouth College”).

2. “Provisional” Services
To the extent that the pre-screening process reveals particularly frustrating struggles and suggests the need for services on a provisional basis until the testing results are available, SAS facilitates such services.  The circumstances vary and are determined on an individual basis.

3. Dartmouth College Sources of Possible Funding for Assessment
These are, in the order utilized:

• Up to $1,500 is available for students who have Dartmouth Student Group Health Plan (DSGHP) coverage and who choose among several vetted psychologists in the Upper Valley area.  
• Up to $500 if the student has a Financial Aid package that includes “Dartmouth General Scholarship.”
• Substantial assistance for varsity athletes may be available from the Athletic Department (primarily or wholly using NCAA Opportunity Funds).
• Consult SAS for other possible sources.