Recognizing LD, ADHD and TBI in adults

Many adults have learning problems that interfere with success in educational or vocational endeavors. Learning disabilities (LD), attention deficit/hyperactivity disorder (ADHD), and traumatic brain injury (TBI) share features and may occur together in some individuals. Difficulty in differentiating these disorders may be exacerbated in adulthood, when developmental history is more remote. Basic knowledge of the characteristics of LD, ADHD and TBI can help adult educators to recognize symptoms, make appropriate referrals and individualize instruction and accommodations. Frameworks for Identification Operational definitions of LD and TBI are provided in the Individuals with Disabilities Education Act (IDEA), which applies to individuals only from birth through age 22. Children identified under IDEA as having a handicapping condition are eligible for special education services if need is established. ADHD is not specifically identified as an eligibility category under IDEA; however, children with ADHD may be eligible for special education services under the category of Other Health Impaired (OHI). While IDEA does not apply to adult learners who have graduated from high school, if services were obtained during school-age years, documentation of a disability may exist in school records. The Association on Higher Education and Disability (AHEAD) is an international organization supporting full participation in higher education for persons with disabilities. AHEAD has published guidelines for adult LD evaluation (Brinckerhoff et al., 1997). Guidelines for ADHD and TBI have not been published. The LD guidelines address qualifications of evaluators, recency of documentation, appropriate clinical documentation of LD, and evidence to establish the rationale to support recommended accommodations. While quite detailed, they do not provide diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-IV-TR, American Psychiatric Association [APA], 2000) provides a clinical framework for the diagnosis of developmental disorders, including LD and ADHD. In the DSM-IV-TR framework, TBI is not a distinct mental disorder, although psychological problems resulting from or associated with brain injury may be diagnosed and the associated brain injury reported. In the DSM-IV-TR, learning disabilities are referred to as disorders, for example, Reading Disorder or Disorder of Written Expression. Both Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA) protect the civil rights of individuals who have disabilities. A disability is described in Section 504 as a physical or mental impairment that substantially limits one or more major life activities. Persons with disabilities who have appropriate documentation are eligible for accommodations, modifications, or auxiliary aids, which will enable them to participate and benefit from all postsecondary educational programs and activities. While diagnostic criteria for LD, ADHD, and TBI are not provided in these laws, these disorders clearly fall under the umbrella of disability as described in Section 504 and ADA. While assessment and diagnosis might come from a variety of professionals using different terminology, it is clear that both ADA and Section 504 apply to adults with LD, ADHD or TBI. Descriptive Features The nature and definition of learning disabilities have long been debated (Lyon, 1994). However, most discussions refer to a lack of expected achievement in one or more academic areas in the face of apparently normal intelligence, sensory function, educational and cultural opportunity and motivation. LD is a developmental disorder, with features present from early childhood, although diagnosis may occur much later. IDEA and the DSM-IV-TR refer to determination of a significant discrepancy between general intelligence and achievement in one or more academic areas as a criterion; however, the methodology for determining significant discrepancy is not specified and in practice varies across settings (Lyon, 1994). …