Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. 10/14/2015 UNRAVELING THE COMPLEXITIES OF TRAUMATIC BRAIN INJURY (TBI) DOCUMENTATION IN COLLEGE STUDENTS July 16, 2015 Loring Brinckerhoff, Director Nora Pollard, Senior Disability Policy Coordinator Morgan Murray, Disability Policy Consultant ETS - Office of Disability Policy

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Agenda Overview of TBI ETS documentation policy statement for TBI A rationale for each accommodation must be provided Case Discussion Q&A 10/14/2015 2

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Rationale for Creating TBI Guidelines Approximately 2.5 million emergency room visits per year in the U.S. by individuals with TBI or concussions Many returning veterans have experienced a TBI and want to continue their education. From 2013 to 2014 ETS has seen a 22% increase in accommodation requests from test takers with TBI. 10/14/2015 3

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Defining the Population Athletes with repeated concussions Accident victims – Auto accidents – Sports-related accidents – Gunshot wounds to the head – Repeated blows to the head Co-occurring diagnoses – Veterans with TBI and/or PTSD 10/14/2015 4

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Common Terminology Traumatic Brain Injury – TBI involves a sudden trauma that injures the brain and results in disturbance of normal brain function. It may include swelling, oxygen loss, increased intracranial pressure, etc. It can be classified by type and severity from mild to severe. 10/14/2015 5

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Terminology (cont’d) Concussion – a clinical subset of TBI accounting for 75 to 90% of all injuries Post-Concussive Syndrome – a set of symptoms that may continue for weeks, months, or occasionally a year or more after a concussion 10/14/2015 6

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. ETS Documentation Requirements A qualified professional must conduct the evaluation. Documentation necessary to support the diagnosis and accommodations – Specific diagnosis/diagnoses in accordance with DSM or ICD – Description of current as well as residual symptoms 10/14/2015 7

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. ETS Documentation Requirements (cont’d) Detailed medical information on test taker’s current needs, including effects of current medications A narrative discussion of all relevant information, including results of standardized assessment measures, if applicable 10/14/2015 8

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Historical Information, Diagnostic Interview, and Psychological Assessment History of presenting problems including date and cause of injury, date of release from hospitalization/rehab, etc. Behavioral observations, combined with the clinician’s professional judgment, are often critical in formulating a diagnostic impression. Neuropsychological/psycho-educational testing 10/14/2015 9

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Domains to Include in Neuropsychological Assessment Memory Attention Speed of thinking Communication/language Spatial reasoning Conceptualization Executive functioning Psycho-social behaviors Motor/sensory or physical abilities Adapted from: Center for Students with Disabilities, University of Connecticut, Storrs, CT, (2014). 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Recency of the Documentation The most recent documentation should be no more than three years old. – The recovery process for TBIs can continue for many months or years. – Secondary complications such as seizures or mood disorders may arise after the initial event. 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Psychotropic Medications Many test takers with TBI are being treated with psychotropic medications. The discussion should include the name, dosage, and side effects the test taker experiences for each agent. Appendix C is “A Primer on Medications and Testing Accommodations for Test Takers with TBI.” 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. A Rationale for Each Accommodation Should be Included Accommodations will be provided only when a clear and convincing rationale is given. A link must be established between each requested accommodation and the individual’s current functional limitations. A diagnosis in and of itself does not automatically warrant approval of requested accommodations. 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. A Rationale for each Accommodation Should be Included (cont’d) A history of accommodations should be given considerable weight, but it does not, in and of itself, warrant the provision of accommodations. If there is no history of accommodations, the evaluator and/or test taker must include a detailed explanation of why accommodations were not needed in the past but are needed now. 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Case Discussion Test taker information: - 37 yr old sustained a TBI in 2011 due to a motor vehicle accident - applying to take a teacher certification exam in requesting 100% extended test time, extra breaks; an ETS hand held spell checker - no history of use of accommodations in post- secondary education or employment within the last three years 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Sample Documentation #1 The documentation consists of a letter from a medical doctor which reads: This letter is regarding my patient, XXX, with specific regards to his educational learning and testing environment. XXX has been diagnosed with having a traumatic brain injury following a motor vehicle accident, and has difficulty with concentration and synthesis of complex concepts. He does require longer periods of time to complete test written tests, and requires a quiet environment to be able to take tests. Within the letter, the doctor states that he would recommend double time and a computer program to help test taker with spelling and grammar. How would you proceed with determining eligibility for accommodations? 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Sample Documentation #2 The same test taker is presenting different documentation for the same accommodations. This time, the documentation submitted is a recent neuropsychological evaluation from a clinical neuropsychologist. Evaluation includes: - comprehensive cognitive testing, measures of attention, memory, executive functioning, motor functioning and academic achievement as well as mental status exams. - a rich discussion regarding test taker’s three month recovery. 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Score Report Highlights WAIS-IV -Verbal Comprehension Index-103, Perceptual Reasoning Index-105, Working Memory Index-89, Processing Speed Index-74 Wechsler Memory Test-IV - Logical Memory I-5%ile, Logical Memory II-4%ile, Logical Memory Recognition-25 to 50%ile Wisconsin Card Sorting Test - Preservative Responses-43%ile, Categories Completed-16%ile, Boston Naming Test - 42%ile WRAT-IV -Word Reading-50 th %ile, Sentence Comprehension 42%ile, Written Spelling-32%ile, Math-47%ile, Reading Composite-50%ile 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Documentation Demonstrates Results of neuropsychological evaluation revealed weakness in processing speed, multi-tasking, fine motor coordination, writing, and learning/memory. Issues with variable sustained attention Based on academic achievement, spelling skills are below average How would you proceed with determining eligibility of the requested accommodations now? 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Q/A 10/14/

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. Contact Information Loring Brinckerhoff, Director - Nora Pollard, Senior Disability Policy Coordinator - Morgan Murray, Disability Policy Consultant - Tips for Disability Service Providers brochure is now available! 10/14/