Extended time on Tests and ADHD

00:00 Introduction
01:10 Discusses the rationale for requesting extended time on exams for people with ADHD
03:50 Discusses a study on extended time for college students with ADHD
05:40 Discusses a review of the scientific literature examing extended time for students with LDs or ADHD
07:00 Conclusion

Research Discussed in the Video

Here I want to discuss the rationale and research concerning the most requested accommodation on standardized testing by students with ADHD – getting extra time to take the exam. I first review the apparent rationale for granting extended time on exams to students with ADHD or learning disabilities. I then look at the results of one study examining this issue in college students with and without ADHD. I conclude with a discussion from a review of the entire literature on this requested accommodation for those with learning disabilities and those with ADHD.

Research cited in the article

Effects of extended time for college students with and without ADHD
LA Miller, LJ Lewandowski… - Journal of Attention Disorders, 2015, 19(8),

Provision of extended assessment time in post-secondary settings: A review of the literature and proposed guidelines for practice
AG Harrison, B Pollock, A Holmes - Psychological Injury and Law, 2022

[ArtbyPebbles]

I think it is different for each ADHDer. I had extra time on exams in university, and I didn't really need it for multiple choice, but I did need it for written exams. Any time I need to write, it takes me so long to focus and sort my thoughts, then decide on what to write, all with distractions in between. Then, once I've written a few words, I forget what the rest of the sentence was going to be, so I have to pause and remember... So for myself, I would argue that I genuinely cannot write as quickly as non-ADHDers, and having extra time was truly 'leveling the field' for me in the case of written exams.

[readeral]

Diagnosed as an adult with ADHD, I’ve already completed two university degrees prior to diagnosis, and have a few anecdotal subjective thoughts about this. I certainly don’t feel extra time would have been appropriate accommodation for the struggles I personally recall I had, but sustaining focus for exams that were sometimes 3 hours in length in some cases, breaking the papers into subunits and assessing them in discrete blocks of time would have been a far more appropriate accommodation. Even if it meant sitting alone for 30 minutes between sections, and accepting that each segment only received the discrete allotted time (meaning maybe your best-know section couldn’t claim that little bit more polish time), that would have been a godsend. Time blindness and/or hyper focus meant whole sections of a paper were missed (or given a 15 minute scrawl so it didn’t void the whole paper), and once my attention tapped out, every disturbance, every leaving student, and every opportunity to second guess my chosen essay questions created panic. I wanted to be assessed on what I knew, not how well I survived the unnatural exam environment.

[lilly_koii]

extra time was definitely necessary for me and many others with ADHD in classes like physics and calculus because of issues with word processing speed. i think it would be rash to take away even the option of accommodations based on this alone.

[juniper]

My teen (in high school) has a lot of difficulty getting their thoughts down in writing for essay-type assessments, so it takes them much, much longer to write an essay than their peers (even with 1 to 1 support, which they don't get during exams). This was one of the reasons a teacher last year suggested we seek an ADHD assessment. So, for exams with an essay component, extra time is definitely something that would "level the playing field" rather than giving them an advantage. The support plan we now have at the school specifically says extra time is not needed for maths or short-answer exams.
(I had the same difficulties at school and often failed to finish essays during exams; I also got my diagnosis in the last year.)

[Saintly]

For my work, there are constant assessments and standardized tests for us to advance. I used to struggle to finish because I’d get stuck on understanding a question or how or what I was supposed to do. One time it took me 30 minutes to figure out how to respond (high level government tests at the levels I’m applying for). I was just about to give up & then remembered they’d granted me 30 extra minutes! I managed not to cry over my frustration and finished that test with a good score.

This accommodation HELPS me so much and am grateful for an employer that has a duty to accommodate.

For me, it’s not just extra time it’s time that allows me to comprehend fully what’s required so that I can then best show my abilities. Without it… I’ve not been able to finish tests, had to guess what’s needed, guessed at answers, and repeatedly done badly. I’m excellent at my job… and now I can communicate this when I’m tested.

[TashkaGrace]

I think everyone is different in their struggles and also where they are in life. I have just been diagnosed at 54. I have 2 degrees. I didn’t finish school as I wasn’t learning anything I was interested in. Went to university at age 41. I took three times longer than everyone else but got through my exams. However, having completed masters where most things were assignments, I then tried to do my final national registration exam after a couple years internship. I couldn’t even complete the exam. I thought I had early onset dementia. Turns out I have adhd but had been going through menopause. All the struggles I had before were suddenly so much worse.

[voikalternos]

I am not sure if it's due to my ADHD (& might have a factor of CDS), but while I am doing exams, I very frequently forget my trace of thoughts. In that case I would need to go back to the question, re-read everything, and try to pick my thoughts back up from there. Noting things down helps for picking thoughts back up, but doesn't stop myself from completely forget my trace of thoughts. It happens to every question in the exam no matter it's easy for me or not, and even several times during the same question.

[martine]

As a mature age uni student I don't have too much trouble with multiple choice or short answer questions so long as I take my time to read the questions properly the first time. Long answer questions are where I fall in a hole because I need time to organise my thoughts and that definitely takes me longer, especially now I'm in perimenopause.

[bluebasset]

My thoughts on this after looking at both articles as a college student with severe adhd: The first study you showed, while it did show higher test scores for individuals with adhd even at standard time, the sample was 76 individuals from a private university, which I feel might increase the odds of people being incorrectly diagnosed with adhd being admitted as there is no shortage of college admissions scandals where children with rich parents at private schools fake symptoms in order to receive increased test time. Another limitation, with both the first study and the meta-analysis you showed after is that even the meta-analysis mostly only looked at scores on reading comprehension, with very few looking at writing, math, or more complicated exams. I feel like for me personally the problem is more with my ability to use long-term recall of things I already know and to hold multiple things in my head at once, examples: I read a lot, and have a fairly high vocabulary, if you were to show me a word and ask me what it means I would be able tell you the correct answer nine times out of ten but if you were to ask me to recall a specific word when writing a long essay it would either take me a significant amount of time or I would have to use a thesaurus. Math in particular is a nightmare for me, as it requires me to juggle multiple parts of the problem inside my head at once, and I will frequently understand how to do the problem and end up getting it wrong on the exam anyway due to one piece or another of the problem falling out of my head as I do it, resulting in me getting the wrong answer.
In addition, while the first article used the interaction hypothesis (which assumes the person with disability scores lower with regular time and will “catch up” to his non-disabled peers) the meta-analysis hardly mentioned this and seemed to go with a rationale which states that accommodations are reasonable so long as disabled peers benefit more from extra time than do non-disabled peers, i.e. they receive a “differential boost” as the article put it. This rationale seems flawed from the get-go IMO, it would seem logical to assume that if you give them both extra time the non-disabled peer would still do better, their brain works better on a default level, so of course given the same amount of time they would do better. A better question to ask would be “what level of extra time given to disabled peers normalizes their test scores relative to the level of non-disabled peers” which is what the interaction hypothesis tested.
Another thought I had was about some of the info in the meta-analysis which stated that people with adhd actually used less time for their exams than typical individuals. It might be true that they “used” less time but that’s not the same as “needing” less time. It could be that their decision to use less time was a hasty, poorly thought out decision brought on by lack of emotional control from adhd, and that had they actually used it they would have scored better, would be interesting to see statistics on those who use their full allotted time and if it allowed them to score better, as well as on different populations other than the 18-24 demographic, perhaps older individuals with adhd would have more wisdom and patience to use the extra time allotted and it would benefit them more.
It’s not like I’m completely opposed to this being true, for example if many repeated studies found that 25% extra time was the amount required to normalize test scores for the population I would be fine with that, I just would like broader studies which include things like scores for the entire SAT rather than just a reading comprehension test with bigger swathes of the population studied before this was used as evidence to remove additional testing time completely. For me personally, it’s the ability to delay taking the test a couple days rather than additional test time that really helps since my brain for whatever reason refuses to cooperate and study except in the last few days before a test. I think the ability to get extra time for late assignments would probably be the biggest boon for me as that can mean the difference between getting a 0 or getting a full grade. The suggestion in one of those studies to have a proctor sit by you as you do the test, or even extending this to include having them watch you do your homework in front of them I think would help boost people with adhd’s gpa tremendously. I wonder if focusing on accommodations for homework/assignments would have a better impact on gpa than accommodations for tests, would be an interesting thing to have people study.

[vanslyf]

I completely agree with this. I got diagnosed with ADHD as an adult after completing multiple degrees and never requested extra time during exams because I was a beast at exams, as the adrenaline was high so I could hyperfocus easily on the test. What KILLED me in school and still as an adult was project work. That's where my ADHD comes to shine and destroy me. Having to self regulate and break down projects and do it consistently feels so impossible for me. It destroys my career as I'm in a research oriented field which requires solo project work. That's what led me to diagnosis. The accommodation for this in school was a week extension without penalization, which doesn't help at all as the problem isn't the deadline it's the self-regulation skills to do the work consistently prior to the deadline. A true accommodation would be several smaller deadlines, to help us break up the project and achieve the milestones.

[Robert.Marshall]

Recently diagnosed last month at 54. I started college(for the 4th time in 35 years) a little over a year ago part time while also working. I was always running out of time on math tests. I did get an accomidation for adhd extended time on tests for this and future semesters. But that is also based on my undiadnosed/treated study retention of the past. Im anxious for this semester to progress to see if treatment is going to help with attention and focus, and the extended teats times are there if i need it.

[amphibien]

My experience with extended time is that it’s important for higher level math courses (Calculus) when medication isn’t improving working memory. I needed extended time to neatly show my work, do math that others could do mentally, and avoid mistakes when it comes to working memory. However, once I got on the right medication that addressed those issues, I definitely found extended time to be advantageous and detrimental to my overall learning because it allowed me get away with less studying. I will no longer be using accommodations.

It did take me over half a year to get on a medication that addressed my working memory issues. Stimulants did not work for my working memory (co-morbid anxiety), and I had to switch to Straterra to finally move past the need for accommodations for higher level math. Other courses, I did not use extended time nor did I see the need to use them.

[CloroxBleach-rqme]

I'm a student with ADHD and I never liked the idea of extra time accommodations, nor did I seek it out. I'm glad that the scientific literature supports this.

[relaxedanchored]

dang, this vid hit hard! Been messin with ADHD stuff for a minute, and it’s wild how we all got different struggles. Big ups for breaking it down like this, makes me feel like I ain't alone in this mess. Keep doin’ what you do, fam

[unnotabelle]

When I applied for accommodations from my university, I wanted two things - to be allowed 'time off the clock'/rest time and to hand-write my exams. I got extra time and the ""special"" permission to type my exam (when the default mode of completion was already typing). I actually fought with my disability coordinator to NOT give me extra time and allow me breaks instead but my school refused to allow it. Frustrated me to no end that I wasn't trusted to reliably convey what was actually an accommodation I needed.

[Handle]

I think you mentioned in one of your books -- I cannot remember which -- that a "movement break" in the middle of a test is a more appropriate accomodation for ADHD students than is extra time. I am glad that you bring attention to these studies that show extra time as an ADVANTAGe rather than simply as a levelling of playing field.

I hear a lot people who are skeptical of ADHD suggest that we only have our children assessed/ diagnosed because we want all sorts of financial benefits and extra advantages to help give them a "leg up" over other students. I, and most of the parents of ADHD children I know, receive ZERO financial benefits (unless you count ADHD medication, since any and all medication for children is "free" in my country) and only want accommodations that are fair, not those that give unfair advantage. By being honest about which accommodations do no more and no less than level the field, we can show that we are trying to do right by our children, not "game the system.

Another great video, Dr. B. Thank you.
💙

[HowndsOfDoom]

Wow! I've been tuning in to the best source for reliabilie info on adhd for over a year!! Pirate day already? Wow!

[wilaustu]

I didn't need more time on multiple-choice tests, but I did for exams that involved writing in response to a single essay prompt. In French high schools, there are several written exams of this nature. Some allow up to 4 hours to write your essay. Most of my classmates would be done after 1-2 hours, but I would always use the full time just to write 3-4 pages.

[MaryMcKeown-itkn]

I was finally diagnosed with ADHD at age 40 when I was in nursing school BECAUSE I had difficulty getting all of the reading done. I had to read everything two or three times, so for me, more time would have helped.

[Chriztina]

I wrote a 2.5 hour exam last week. A different chair would have been ideal. I tend to change positions a lot and the chair had a curved up seat on the sides which basically forced me to keep my legs together and forward which was not comfortable and I got restless. I've worn foam ear plugs for my last 3 exams and I'm convinced they would have made a big difference for me in high school and earlier college and university tests.