Academic Accommodations for Students with Psychiatric Disabilities

By
Alfred Souma, Nancy Rickerson, and Sheryl Burgstahler
Achieving equal access through accommodations and universal design

Tens of thousands of students enrolled in American postsecondary institutions report having a mental illness. Recent increases in the size of this group are due in part to improved medications that result in symptoms mild enough for them to enjoy the benefits and meet the challenges of postsecondary education. Students with psychiatric disabilities are entitled to reasonable academic accommodations as provided by the American Disabilities Act (ADA) of 1990 and 2008 amendments. Providing effective accommodations allows students equal access to academic courses and activities. The presence of students with disabilities also contributes to the diversity of the student population.

What is a Mental Illness?

"Mental illness" refers to the collection of all diagnosable mental disorders causing severe disturbances in thinking, feeling, relating, and functional behaviors. It can result in a substantially diminished capacity to cope with the demands of daily life.

A mental illness is a hidden disability; it is rarely apparent to others. However, students with mental illness may experience symptoms that interfere with their educational goals and that create a "psychiatric disability." These symptoms may include, yet are not limited to:

  • heightened anxieties, fears, suspicions, or blaming others
  • marked personality change over time
  • confused or disorganized thinking; strange or grandiose ideas
  • difficulty concentrating, making decisions, or remembering things
  • extreme highs or lows in mood
  • denial of obvious problems and a strong resistance to offers of help
  • thinking or talking about suicide

Psychiatric Diagnoses

A student with a mental illness may have one or more of the following psychiatric diagnoses (American Psychiatric Association, 1994).

Depression. This is a mood disorder that can begin at any age. Major depression may be characterized by a depressed mood most of each day, a lack of pleasure in previously enjoyed activities, thoughts of suicide, insomnia, and consistent feelings of worthlessness or guilt.

Bipolar affective disorder (BAD, previously called manic depressive disorder). BAD is a mood disorder with revolving periods of mania and depression. In the manic phase, a person might experience inflated self-esteem, high work and creative productivity, and decreased need to sleep. In the depressed phase, the person would experience the symptoms of depression (see above).

Borderline personality disorder (BPD). BPD is a personality disorder which includes both mood disorder and thought disorder symptoms. This diagnosis has both biological and environmental determinants. Individuals diagnosed with BPD may have experienced childhood abuse and family dysfunction. They may experience mood fluctuations, insecurities and mistrust, distortion of perceptions, dissociations, difficulty with interpersonal relationships, and limited coping skills.

Schizophrenia. This is a mental disorder that can cause a person to experience difficulty with activities of daily living and possibly delusions, hallucinations, and paranoia. Schizophrenic individuals typically demonstrate concrete thought processing and appreciate structure and routines.

Anxiety disorders. These are mood disorders in which the individual responds to thoughts, situations, environments, or people with fear and anxiety. Anxiety symptoms can disrupt a person's ability to concentrate and focus on tasks at hand. Symptoms may be in response to real or imagined fears. Specific anxiety disorders include generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, social and specific phobias, and post-traumatic stress disorder (PTSD).

The following conditions are behavior or personality disorders excluded from coverage under the ADA: transvestitism, transsexualism, pedophilia, voyeurism, gender identity disorders, compulsive gambling, kleptomania, and pyromania (Blacklock, 2001).

Functional Limitations

The following functional limitations related to psychiatric disabilities may affect academic performance and may require accommodations (Center for Psychiatric Rehabilitation, 1997).

  • Difficulty with medication side effects: side-effects of psychiatric medications that affect academic performance include drowsiness, fatigue, dry mouth and thirst, blurred vision, hand tremors, slowed response time, and difficulty initiating interpersonal contact.
  • Screening out environmental stimuli: an inability to block out sounds, sights, or odors that interfere with focusing on tasks. Limited ability to tolerate noise and crowds.
  • Sustaining concentration: restlessness, shortened attention span, distraction, and difficulty understanding or remembering verbal directions.
  • Maintaining stamina: difficulty sustaining enough energy to spend a whole day on campus attending classes; combating drowsiness due to medications.
  • Handling time pressures and multiple tasks: difficulty managing assignments, prioritizing tasks, and meeting deadlines. Inability to participate in multi-task work.
  • Interacting with others: difficulty getting along, fitting in, contributing to group work, and reading social cues.
  • Fear of authority figures: difficulty approaching instructors or TAs.
  • Responding to negative feedback: difficulty understanding and correctly interpreting criticism or poor grades. May not be able to separate person from task (personalization or defensiveness due to low self-esteem).
  • Responding to change: difficulty coping with unexpected changes in coursework, such as changes in the assignments, due dates or instructors. Limited ability to tolerate interruptions.
  • Severe test anxiety: the individual is rendered emotionally and physically unable to take an exam.

Instructional Strategies

Students with a history of psychiatric disabilities can be intelligent, sensitive, creative, and interesting. You can employ strategies that will promote their success in your class. For example:

  • Address a variety of learning styles (e.g. auditory, visual, kinesthetic, experiential, or a combination of styles).
  • Incorporate experiential learning activities.
  • Be prepared to set behavioral expectations for all students in your class.
  • Embrace diversity to include people with psychiatric disabilities.

Accommodations

Some students with mental illness may require accommodations to allow them equal access to classes, programs, and coursework. An accommodation is the removal of a barrier to full participation and learning. The emphasis is on access, not outcome. This is done by providing the student with a disability equal access to the content and activities of a course, but not necessarily assuring their success.

Each student with a disability is encouraged to register with the office that supports students with disabilities in order to receive accommodations. Personnel from this office typically send instructors a letter documenting specific accommodations required for the student with the disability. It is the responsibility of the instructor to provide the accommodations. It is the student's responsibility to fulfill the academic requirements of the course. The best solutions result when the instructor, student, and disability support service professional work cooperatively. Meeting as a group may facilitate problem-solving alternatives. Respecting the privacy of the student by not discussing his or her disability or accommodations with others outside of this meeting is essential. Review accommodations periodically with the student to assess effectiveness and adjust to changing needs.

The following are typical classroom, exam, and assignment accommodations that may be recommended by the disability student service professional for a student with a psychiatric disability.

Classroom Accommodations

  • Preferential seating, especially near the door to allow leaving class for breaks.
  • Assigned classmate as volunteer assistant.
  • Beverages permitted in class.
  • Prearranged or frequent breaks.
  • Tape recorder use.
  • Notetaker or photocopy of another student's notes.
  • Early availability of syllabus and textbooks.
  • Availability of course materials (lectures, handouts) on disk.
  • Private feedback on academic performance.

Examination Accommodations

  • Exams in alternate format (e.g., from multiple choice to essay; oral, presentation, role-play, or portfolio).
  • Use of assistive computer software (e.g., Optical Character Recognition, allowing scanned text to be read aloud by the computer's sound card; or speech recognition for converting the spoken word to printed word on the computer screen).
  • Extended time for test taking.
  • Exams individually proctored, including in the hospital.
  • Exam in a separate, quiet, and non-distracting room.
  • Increased frequency of exams.

Assignment Accommodations

  • Substitute assignments in specific circumstances.
  • Advance notice of assignments.
  • Permission to submit assignments handwritten rather than typed.
  • Written assignments in lieu of oral presentations or vice versa.
  • Assignments completed in dramatic formats (e.g., demonstration, role-play, and sculpture).
  • Assignment assistance during hospitalization.
  • Extended time to complete assignments.

Not all requested accommodations are "reasonable." An accommodation is not reasonable if:

  • Making the accommodation or having the individual involved in the activity poses a direct threat to the health or safety of others.
  • Making the accommodation means making a substantial change in an essential element of the curriculum.
  • Making the accommodation would require a substantial alteration in the manner in which educational opportunities are provided, such as the course objectives being altered.
  • Making the accommodation would impose an undue financial or administrative burden to the institution.

References

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed). Washington, DC: Author.

Center for Psychiatric Rehabilitation. (1997). How does mental illness affect the way I function at school? Boston University. www.bu.edu/cpr/jobschool/functed.htm.

Additional Resources

DO-IT has created a collection of videos that can be freely viewed at www.uw.edu/doit/Video. Of particular relevance are the following titles: Building the Team: Faculty, Staff and Students Working TogetherEqual Access: Universal Design of Instruction, and Invisible Disabilities and Postsecondary Education. You may also find the following resources useful as you explore this topic further.

American Academy of Psychiatry and the Law 
www.aapl.org

American Psychiatric Association 
www.psych.org

American Psychological Association 
www.apa.org

Anxiety Disorder Association of America (ADAA) 
www.adaa.org

The Center for Universal Design in Education 
www.uw.edu/doit/CUDE

National Mental Health Association 
www.nmha.org

National Alliance on Mental Illness (NAMI) 
www.nami.org

National Institute of Mental Health (NIMH) 
www.nimh.nih.gov

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Acknowledgment

This publication was developed under a grant from the U.S. Department of Education, #P33A990042. However, these contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the federal government.

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