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The Neuropsychologist’s Guide to Accommodations

By April 13, 2015July 10th, 2024ACT, LD, SAT

Neuropsych-TestingWe are proud to feature the voices of prominent Southern California neuropsychologists, Dr. Dana Chidekel and Dr. Deborah Budding. In this post, Dana and Deb explain the history of testing accommodations for college admission tests and clarify the means for submitting documentation and securing accommodations. Deb and Dana also parse out meaningful differences between the evaluations delivered by private evaluators (e.g. neuropsychologists, clinical psychologists, educational psychologists, etc.) and those offered by public school districts.

Prior to 2004, the ACT and College Board used asterisks to identify the scores of students who had taken the test with accommodations. After 2004, under pressure from disability rights activists and attorneys, they stopped doing so; scores of students who had taken the test with accommodations were reported in the same manner as were scores of those who had not. Applications for accommodations the following year increased, followed by accompanying concern that parents may have seen an opportunity to provide their children with the advantage of accommodations without the risk of the stigma associated with having a “flagged score.”

Up to that point, the ACT and College Board had been granting accommodations on the basis of simple, pro forma requests. In response to the increased applications, they identified the need to formalize the criteria a student must meet to warrant accommodations, and to establish a more formal means of evaluating requests. This change was implemented quickly, and for several years, there appeared to be no systematic means by which requests were being analyzed. Since then, the College Board and ACT have developed, and continue to refine, these requirements. Each student’s request is evaluated individually.

General Requirements

Broadly, both agencies look for evidence that a student requesting accommodations has received comparable accommodations for testing in high school. Both tests require letters and questionnaires from teachers/school administrators that document the student’s disability and its effects on the student’s performance in school. The College Board looks at the four months prior to the application, while the ACT looks at the previous 12 months. Students who have received similar accommodations in their schools, even if informally, are often at an advantage. Those whose need for accommodations becomes apparent just before they take college entry examinations can arouse suspicion.

Both tests also require applicants to demonstrate the presence of a disability, and to document the specific ways it interferes with test-taking in standard conditions. The requested accommodation(s) must clearly relate to the disability, and testing must demonstrate that providing the requested accommodations is likely to result in improvements in test scores. For students diagnosed with Specific Learning Disorders, Attentional Disorders, Autism Spectrum Disorders, and psychiatric disorders, a thorough psycho-educational or neuropsychological evaluation is required. The ACT will consider a comprehensive professional report that is that is no older than three years, whereas the College Board will accept a report up to five years old.

Falling Through the Cracks

This set of demands creates particular problems for students whose conditions stay “below the radar” until they encounter the increased executive functioning (i.e. organization and planning) demands of high school and find that they can’t meet them. Bright students and intensely achievement-focused students with learning challenges or anxiety are particularly at risk. These students are often able to compensate for a longer period of time for underlying deficits than their less driven or less intelligent classmates are. The extra hours these students spend completing homework assignments may mask problems, as may the considerable behind-the-scenes support many have received in order to be successful. The success is apparent, while the extra effort is hidden. This can also make make demonstrating these students’ limitations more challenging. Having never sought accommodations before, such students are understandably at risk for their requests to be rejected.

Start Early

For all students who will require accommodations, parents are encouraged to start the application process early. While applications to the Services for Students with Disabilities Coordinator at the College Board require a minimum of seven weeks for a response, students’ initial requests for accommodation are frequently answered with a letter requesting additional documentation. Because decision-making can seems to be somewhat capricious to parents involved in the process, parents should begin this process much sooner than they might think would be necessary, and they are counseled to anticipate up to four denials and appeals before necessary accommodations are granted. Additionally, many learning disorder specialists recommend that students with disabilities that are well documented to update their testing at or after the age of 16. It is at this age that adult-scaled tests can be given to demonstrate the areas of disability, and the associated necessary accommodations can be formulated and updated. Universities and colleges will rely on these findings to continue accommodations for incoming students. Testing students at the age of 16 will allow most students ample time to get results and create a formal request for accommodations on the SAT and ACT; at the same time, adult-scaled testing will provide college and university learning centers the information they need to consider their ability to meet the incoming student’s needs and to plan accordingly.

Beyond Extra Time

While most students seek extra time as an accommodation, there are other types of accommodations from which students with various types of disorders and challenges can benefit. These include a quiet testing room, a keyboard for writing, additional or extended breaks, and in the case of the ACT, multiple-day testing. A student may also be granted a reader or scribe, enlarged print booklets and/or answer keys, or consumable test booklets that allow him or her to mark answers directly rather than transfer responses to a Scantron form. Consumable test booklets are particularly helpful for students with limited “processing speed,” who tend to lose their place while shifting attention back and forth between the test booklet and answer form. Doing so accurately is particularly time-consuming for these students. Problems with “processing speed” are not specific to any one disorder and often occur in students with attentional problems, anxiety, and specific learning disorders.

Public school students who have existing Individual Education Plans (IEPs) or Section 504 Accommodations that are guided by psycho-educational assessments provided by their School District may benefit from the framework for accommodations that is already defined in their plans. At the same time, the scope of problems that School District assessments are allowed to address is limited. Such assessments generally do not include a comprehensive evaluation of the core attention and executive function challenges with which so many students struggle. Such information is not only important to inform a need for accommodations on college entrance exams, but it will be critical to informing the student’s academic plan when he or she is in college, where the range of available accommodations is likely to be broader.

Looking Beyond Assessment of Academic Content/Knowledge

Basic student learning assessments may include information from parent and teacher rating scales of executive function skills. While these scales may draw attention to behaviors associated with executive dysfunction, they cannot explain the cognitive processes that drive them. Additionally, School District evaluations do not use The Diagnostic and Statistical Manual of Mental Disorders (DSM) as a framework for diagnosis. Most school psychologists and similar assessors do not have the training or licensure required for providing such diagnoses. Eligibility for special education services in different categories is determined by a student meeting criteria as defined in each state’s Education Code. The ACT and College Board, however, require a DSM diagnosis for children who seek accommodations for ADHD, anxiety disorders, and mood disorders (although school districts often rely upon such diagnoses rendered by neurologists, psychologists, or other mental health professionals in order to provide Section 504 Accommodations). Accordingly, many parents seek private psycho-educational or neuropsychological evaluations to supplant or supplement School District evaluations.

To document disability, a neuropsychologist – this is a clinical psychologist who receives specific additional training and supervision in brain-behavior relationships and who may become Board Certified in relation to this additional training – clinical psychologist, or educational psychologist should follow the specific guidelines established by the SAT and ACT. For each student, this includes demonstrating how the disability interferes with academic performance without accommodations; determining  the types of accommodations needed that are specific to the academic challenges; and demonstrating that with these accommodations, a student’s scores can be expected to improve. A neuropsychologist or educational psychologist may also highlight qualitative aspects of information gathered, including the nature of errors a student makes. These aspects of information gathered during testing can be tied to the underlying diagnosis, and can be used to further clarify relevant issues and their practical significance for the student’s academic function.

Don’t Believe the Hype

Hearsay is rampant with respect to whether it is “easier” to qualify for accommodations for the SAT or ACT. There does not appear to be consensus. A 2014 brochure published by the Independent Educational Consultants Association states that in 2013, ACT. approved nearly 90% of its applications for accommodation, granting special accommodations to almost 5% of students who took the test, while The College Board granted accommodations to only 2.3% of those taking the SAT in the same year.

The process continues to evolve. The College Board and ACT have long used the Individuals with Disabilities Education Act (IDEA) as the primary framework guiding decision-making in accommodation. IDEA defines ‘disability’ as performance in an academic area of function that falls substantially below the child’s measured intellect or theoretical ability or potential. The College Board and ACT are now moving toward primarily using the model outlined by the Americans with Disabilities Act (ADA), which compares a student’s performance to that of the average person, and not to his or her measured potential. This threatens to create substantial problems for children who are gifted as well as learning disabled (“Twice Exceptional” or “2e”). These children may score in the average range in a subject with standard test conditions, while they require accommodation to demonstrate their true, much broader scope of mastery in the subject area. ADA standards threaten to create more substantial burdens for bright, underachieving students to access the accommodations they need. This is because functional impairment is emphasized, while it is more challenging to demonstrate that relative weaknesses indicate disabilities. However, these new standards allow a more finely grained approach to academic achievement, and allow both neurologically-based and culturally-based limitations to student success to receive attention. Under this new ADA model, there is a greater demand for high quality neuropsychological and psycho-educational evaluations to more clearly delineate the underlying patterns of deficits that illustrate and support the existence of diagnosable disorders and drive the recommendations to accommodate them.

Matty Steiner

Prior to joining Compass, Matty obtained their MA from the University of Chicago and a BA from UC Santa Cruz. They have over a decade of experience in the field of test preparation, having worked as an instructor, consultant, and keynote speaker on the topic of admission testing.


  • Monica says:

    Very informative article. I am studying to retake the FL bar exam. i did pass DC and PA exams after several attempts. Am now working with an ADD Coach and have discussed what issues to present to a Neuropsych Testing provider. I was diagnosed in my 30’s with ADD and was finally given accommodations for the exam after submitting a psych eval but FL gives pro forma time and a half for all that request accommodations. I don’t think they allow much else. I intend to request additional accommodations for the exam from the FL bar. I’m learning new approaches to studying and doing the practice questions with my ADD coach, and I’m learning, but it is so time consuming and laborious and am worried even more so that I will never pass this exam. Thank you for your insight and suggestions for test accommodations.

  • Tomas Killington says:

    My son has been having some issues with his academics. We believe that he may be able to benefit from a medical professional’s evaluation, but we’re not sure where to start. I didn’t realize neuropsychological testing can look past basic learning assessments to explain cognitive processes better. I’ll be sure to remember this info moving forward.

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