Criteria for Documentation of ADD/ADHD Disorders
- Student Name
- Social Security Number
- Date of Birth
- Date of Evaluation
- DSM Diagnosis
- Level of severity (mild, moderate, severe)
- Diagnosis criteria (attach test results/report)
- Describe the functional nature of this impairment.
- Is the impairment stabilized or does it fluctuate?
- Does the student have other accompanying impairments such as depression or learning disabilities, etc.?
- Describe current medication and possible side effects.
- Describe the student’s functional limitations in an educational setting.
- Does the student continue to need accommodations when utilizing recommended medications?
- What are your recommendations regarding academic accommodations for this student?
- Name, signature, and title of evaluator
- Date
