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

Objective: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often receive instruction and take tests using educational accommodations. This review aims to summarize and integrate the research literature on accommodations for this specific population. Method: Electronic databases in medicine (MEDLINE), psychology (PsycINFO), and education (ERIC) were systematically searched (last update January 13, 2020), with inclusion criteria selecting any document with a focus on accommodations in educational settings or on academic tasks for children or adolescents with ADHD. The search yielded 497 unique documents. Additional searches yielded 13 more documents. Of the 510 total potentially useful documents, 68 met criteria for topical relevance and age range, to be discussed in the narrative review. The wide range of document types led to a qualitative synthesis. Results: Accommodations are by far the most common response to ADHD in educational settings, with testing accommodations such as extended time being particularly prevalent. However, most accommodations fail to show evidence of benefits that are specific to students with ADHD, and many of the more common accommodations have few or no experimental studies supporting them. An exception is read-aloud accommodations, which have two randomized experiments finding specific benefits for younger students with ADHD. Students and those who work with them often express ambivalence and dissatisfaction over the accommodations process. Conclusion: 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 only be provided along with evidence-based interventions, or after interventions have failed, as suggested by the "life course" model of managing ADHD.