More ADHD - Extra Time

[DynamicDidactic]

So...




From the review mentioned:

Quantitative data analysis has shown no significant difference in performance in the conditions of regular time versus extended time in either paper–pencil or computerized testing conditions (Cahalan-Laitusis et al., 2006; Jansen et al., 2019; Lee et al., 2010; Miller et al., 2015; Pritchard et al., 2016).

those with AD/HD felt that they needed extra time, but in fact were able to access as many test questions as non-disabled students even when no extra time was offered.
Further supporting this finding, Miller et al. (2015) found that college students with an AD/HD diagnosis did not benefit from additional time to take a highly speeded test any more than did their nondisabled peers. Lewandowski et al. (2015) examined the test-taking skills of high school students with and without AD/HD. Students with AD/HD made some (but not significantly more) errors on some reading tasks, yet performed similarly to typical students on indices of speed and number of test items accessed.

Lovett and Leja (2015) found that students who reported more symptoms of AD/HD actually benefitted less from extra time than did students without AD/HD, and their self-reported perceptions of their need for extra time did not predict benefit from this accommodation.

I have to say that this is pretty shocking information. I always just assumed this was somehow supported by the literature (I guess this goes to reinforce my skepticism about typical clinical practice). Is there any evidence for additional time for ADHD without an LD? Are resources going to waste for this extended time? Should we stop recommending extended time?

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[DynamicDidactic]

There may be some evidence for extended time in children but I don't have the time to figure it out right now. Will get back to it on Friday.

 

[R. Matey]

Systematic Review: Educational Accommodations for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder - PubMed

More empirical research is needed to examine the effects of these extremely common supports. In the absence of supportive evidence, health professionals should be hesitant to recommend accommodations immediately after a diagnosis. Even when such evidence exists, educational accommodations should...

pubmed.ncbi.nlm.nih.gov

 

[WisNeuro]

Yeah, for some of us who have been in the area of practice, it isn't new info. One of the many reasons I generally stay away from anything involving accommodations,

 

[cara susanna]

Theoretically, doesn't it make sense? It's not like ADHD is associated with impaired processing speed. If attention and/or executive functioning are the issue, having more time wouldn't necessarily help that.

 

[R. Matey]

Theoretically, doesn't it make sense? It's not like ADHD is associated with impaired processing speed. If attention and/or executive functioning are the issue, having more time wouldn't necessarily help that.

I mean, there are deficits in processing speed associated with ADHD. The effects are just too small and unreliable to be clinically meaningful. But, yeah, if someone is a disorganized test taker, giving them more time to be disorganized without any accompanying intervention doesn't seem like a solid testing recommendation.

 

[MCParent]

Where I was, the accessibility office didn’t like clinicians giving specific recommendations for test taking etc. Too much variability, with some people saying 1.5x, some 2x, some even saying unlimited, time on tests etc or making other unreasonable recs, too much variability in things like whether adhd gets extra time, etc. Then students complain when they don’t get what their friend got. They had a (good, as I recall) set of things that activated for each disorder.

 

[AcronymAllergy]

Where I was, the accessibility office didn’t like clinicians giving specific recommendations for test taking etc. Too much variability, with some people saying 1.5x, some 2x, some even saying unlimited, time on tests etc or making other unreasonable recs, too much variability in things like whether adhd gets extra time, etc. Then students complain when they don’t get what their friend got. They had a (good, as I recall) set of things that activated for each disorder.

That was generally my experience as well, although it's been a while. The university had a relatively prescribed package of accommodations based on diagnosis.

 

[futureapppsy2]

That was generally my experience as well, although it's been a while. The university had a relatively prescribed package of accommodations based on diagnosis.

Having worked in disability services for practicum, this is pretty standard.

I’m not sure if the logic behind extended time for ADHD is accessing questions so much as it is being able to go back and check for errors, though. Some research does indicate that people with ADHD tend to make more errors, but I’m not sure if there’s evidence that extended time actually helps with that.

 

[AcronymAllergy]

Having worked in disability services for practicum, this is pretty standard.

I’m not sure if the logic behind extended time for ADHD is accessing questions so much as it is being able to go back and check for errors, though. Some research does indicate that people with ADHD tend to make more errors, but I’m not sure if there’s evidence that extended time actually helps with that.

Yep, I've always conceptualized it (entirely subjectively/without data) as allowing more time to get organized/to compensate for disorganization, and to allow for checking of "careless" errors.

 

[smalltownpsych]

When I was teaching a class, after a few semesters I decided to allow all of the students unlimited time to take their test. It actually shortened the time to take possibly because the students that work more slowly weren’t wasting time looking up at the clock and worrying.

 

[futureapppsy2]

When I was teaching a class, after a few semesters I decided to allow all of the students unlimited time to take their test. It actually shortened the time to take possibly because the students that work more slowly weren’t wasting time looking up at the clock and worrying.

How would that have worked had a student wanted/needed to go beyond the class period?

 

[AcronymAllergy]

Then why not prompts to check for mistakes rather than additional time? This would insulate against overall test fatigue, IMHO.

I imagine that might be more effective, although I'm not sure. I'm not in the camp of extra time necessarily being helpful, just discussing what I think the rationale is behind it.

 

[R. Matey]

I imagine that might be more effective, although I'm not sure. I'm not in the camp of extra time necessarily being helpful, just discussing what I think the rationale is behind it.

I deleted that question because it occurred to me that those aren't necessarily mutually exclusive and prompts, which would probably be more effective, would also probably be harder to implement.

 

[quickpsych]

Yep, I've always conceptualized it (entirely subjectively/without data) as allowing more time to get organized/to compensate for disorganization, and to allow for checking of "careless" errors.

It's also useful for reducing test anxiety and allowing careful reading and consideration of each test item (especially since if processing speed is impaired, it may take the student longer for each item).

The OP video and research says there's little to no benefit to extended time for ADHD, but note there's generally also no harm in providing extended time. I think it should be recommended as an accommodation with careful consideration of all the variables, history, and evaluation results but to say it has no benefit and then have some who say "well see that's why I never recommend extended time" is just ignoring real world usage and application of extended time. Some may argue in the real world we can't always get extra time in things we do, but I'd argue extra time as an accommodation is often for a very narrow, specific, and limited usage application (i.e. EPPP, MCAT, LSAT, GRE, etc).

Look at our own EPPP where the recommendation is to spend "under one minute per item then flag ones we aren't sure of to review with time left over." Which requires not only good focus and attention, but also avoiding test anxiety, while also managing time in one minute increments. So if someone fails to finish enough questions, was it because they didn't know the answers or because they ran out of time? Most standardized testing have time limits that make little sense for measuring the actual knowledge they're assessing, don't actually measure anything using a time limit, and often if anything are a detriment rather than a benefit to measuring what the test taker actually knows.

 

[R. Matey]

The OP video and research says there's little to no benefit to extended time for ADHD, but note there's generally also no harm in providing extended time. I think it should be recommended as an accommodation with careful consideration of all the variables, history, and evaluation results but to say it has no benefit and then have some who say "well see that's why I never recommend extended time" is just ignoring real world usage and application of extended time.

I think the research consensus is more extra time with some additional supportive interventions pending further well-designed studies rather than supporting the allocation of extra time alone. Also, as I said, you can't assume that people with ADHD will use the extra time to somehow be less careless.

 

[smalltownpsych]

How would that have worked had a student wanted/needed to go beyond the class period?

It was a three hour class and the longest test taker in the few years I was teaching it was under an hour. I suspect if I told them they had to finish in an hour, then I would have had seen a number struggle with that. Someone should do a study on this.

 

[DynamicDidactic]

note there's generally also no harm in providing extended time

harm to the test taker, probably not (despite some reservations in the review).

However, this can be a drag on resources. Accommodations need to be made, often with additional staff and space.

Personally, I have no problem with extended time and allow all students to take extra time if they need it. However, I also want to do something helpful and not just because it’s tradition to do it. I can easily see this as a token accommodation rather than investing in research that can identify actual helpful accommodations.