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Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved. 04/19/23

UNRAVELING THE COMPLEXITIES OF TRAUMATIC BRAIN INJURY (TBI) DOCUMENTATION IN COLLEGE

STUDENTS

July 16, 2015Loring Brinckerhoff, Director

Nora Pollard, Senior Disability Policy CoordinatorMorgan Murray, Disability Policy Consultant

ETS - Office of Disability Policy

Confidential and Proprietary. Copyright © 2012 Educational Testing Service. All rights reserved.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

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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.

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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

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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.

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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

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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

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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

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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

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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 abilitiesAdapted from: Center for Students with Disabilities, University of Connecticut, Storrs, CT, (2014). www.csd.uconn.edu/fs_tbi.html

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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.

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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.”

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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.

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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.

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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 2012- 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

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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?

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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.

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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-50th%ile, Sentence Comprehension 42%ile, Written Spelling-32%ile, Math-47%ile, Reading Composite-50%ile

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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?

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Contact Information• Loring Brinckerhoff, Director

- [email protected]• Nora Pollard, Senior Disability Policy Coordinator

- [email protected]• Morgan Murray, Disability Policy Consultant

- [email protected]

• Tips for Disability Service Providers brochure is now available!

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