The Americans with Disabilities Act of 1990 has done for U.S. citizens with disabilities what the Civil Rights Act of 1965 has for other minorities. The book addressed the pressures the ADA has brought to bear on institutions of higher learning and on professional testing organizations, in as much as these entities are responsible for providing accommodations to disabled individuals.
As noted by the editors, the numbers of examinees petitioning for test accommodations in colleges and universities across the United States has skyrocketed over the past five years and the vast majority of ADA claims in higher education are based not on physical disabilities, but on learning and psychiatric disorders. Each student seeking accommodations consults a physician, psychologist, or other clinician to establish documentation of a disability. “Why should Canadian psychiatrists and psychologists concern themselves with an American law?” you may ask. Although Canada does not have equivalent legislation in place at this time, the Council for Canadians with Disabilities published, in November of 1999, a position paper entitled National Strategy for Persons with Disabilities recommending the creation of a Centre of Responsibility for the Coordination of Disability Policy within the Federal Government. It is further proposed that such a centre apply an “Access and Industry lens to all federal programs and new initiatives, not just those which are disability-specific.” In other words, a Canadians with Disabilities Act is overdue and it will not be long before Canadian clinicians face the same requests for detailed, current and professional documentation of disabilities and accommodation needs of individuals who meet the essential functions and criteria of a job or educational program.
This practical manual offers essential information and guidance for anyone who may be called upon to provide such documentation now, or in the future. It goes far beyond providing a road map to the ADA as it affects higher education, to exposing the morass of confusion, which underlies current definitions of disability in our society.
The first section of this book, entitled “Essential Concepts/Administrative Considerations” reviews key ADA concepts and objectives, underlining the fact that this is a Civil Rights Act, not an entitlement program. Unlike the American Education for All Handicapped Children Act of 1975 and the Canadian Bill 82 of 1985, which entitles children with disabilities to a free and proper education within the public school system, the ADA does not guarantee young adults with disabilities acceptance to a university or position. It simply guarantees that individuals who are otherwise qualified to jobs or educational programs will not be denied access simply because they have a disability.
According to the ADA, the term disability means, with respect to an individual, a physical or mental impairment that substantially limits one or more of the major life activities of such individual. What constitutes “substantial limitations” is crucial for clinicians and administrators to determine. Furthermore, “an individual is not substantially limited in a major life activity if the limitation does not amount to a significant restriction when compared with the abilities of the average person.” Thus “clinically significant impairment,” in DSM-IV language, and “substantial limitations relative to the general population,” in ADA-language, may or may not overlap. Another interesting distinction made in section I is the definition of “reasonable and appropriate accommodations,” which in turn depends upon the nature of the disability and the demands of the educational program. For instance, the student who suffers from irritable bowel syndrome may make two requests for accommodation: to be seated near the restroom and to have double the allotted time to take the examination. The test organization has no problem granting him the first, but not the second request. While off-the-clock breaks may be justified, it is hard to provide a rationale for expending time working on the test or not. The ADA would argue that it’s intent is not guaranteed success in a particular program or endeavour, only equal opportunity for success.
Section II of the book starts with a description of the five sections (or “Titles”) of the law that apply to different sectors of the economy. While this particular chapter is not of interest to Canadians, the following five chapters on how to document ADHD, Language based learning disabilities, Mood and Anxiety Disorders, Physical Disabilities and Visual Disorders and Dysfunctions, respectively, provide some invaluable insights into how one might measure and document “significant impairment” in each one of these areas. For example, here are some of the “parting shots” offered by Michael Gordon, one of the editors of this book and director of the ADHD Program at SUNY Health Science Center in Syracuse, New York:
the consequences of having talents insufficient to attain certain goals should not be labeled ADHD.
having to work harder than others is not necessarily a symptom of ADHD or a disability.
In conclusion, this well-organized, clearly written and very thoughtful book addresses a number of ethical questions faced by clinicians asked to document disabilities. Although it does not answer all of these questions, the step-by-step guidelines and principles involved in dissecting “significant impairment” from DSM IV diagnosis, on the one hand, and for determining what constitutes “specific and reasonable accommodations,” on the other hand, are absolutely invaluable!