11

Update (October 24/25):

You were approved for 50% extended time, breaks, water in the testing room, separate room, pens for scratch work, and extra scratch paper

Update (October 12/13):

Please be advised, you have been registered for the exam, while we work on reviewing your accommodation request. If approved you will be testing with accommodations for the exam. Please wait for the email decision letter from our review department.


TL;DR - I'm planning to take the GRE Subject Test in Math on Saturday October 29, 2016 in Country A to boost my profile for PhD applications.

  • I have ADHD, which I discovered in August 2015.

  • I am planning to request reasonable accommodations for the GRE Subject Test in Math.

  • I have recently moved to Country A from Country B.

  • **ETS has advised me to submit documentation from both psychiatrists.

  • My Country B psychiatrist is amenable to writing me the disability documentation, but my Country A psychiatrist is not.**

  • I am unluckily the recipient of one of those doctors who (practically) doesn't believe ADHD exists

  • I am not likely going to get another psychiatrist in time to submit the required documentation (disability documentation takes 6 weeks to review; I am planning to submit on Saturday September 3, 2016).

  • How can I appeal to ETS for reasonable accommodations without disability documentation from my current psychiatrist?

Any advice on my dilemma would be highly appreciated.


Through this question which is of academic origin but somewhat medico-legal in nature, I hope that I may get advice.

I wanted to keep myself anonymous, but it looks like I will have to reveal aspects about myself in order to get advice.

My Background

I am a citizen of Country B and a permanent resident of Country A: I was born in Country A and lived in Country A for sometime until I moved to Country B (my parents are originally from Country B) for some time because we could not afford the cost of living in Country A. Eventually in 2013, we were able to afford the cost of living in Country A again and so we moved back to Country A. However I stayed in Country B to complete my master's degree which I finished this year (June 2016). I moved back to Country A last month (July 2016).

I was not treated for ADHD until last year: I was diagnosed by a psychologist in Country A in January 2000 but started treatment only in August 2015. I was not taking any classes at that time; I was in Country A having online consultations with a psychiatrist in Country B. At the same time I was under the care of a psychologist in Country A.

First time in school as an ADHD student: In January 2016, I went back to Country B to resume my masters studies and was under the care of a different Country B psychiatrist from January 2016 until July 2016 (6 months). At the same time, I was having online consultations with my Country A psychologist. This was my final semester as a masters student of mathematical finance and the first semester where I appealed for accommodations.

I was granted accommodations in my university: I submitted documentation from my Country B psychiatrist and my Country A psychologist to support my appeals for reasonable accommodations. My university doesn't have a disability office (I don't think any university in Country B has a disability office because it's third world). so while I was granted accommodations of using a timer while taking exams and taking an exam in a separate room, I was denied extra time. So I spoke to a lawyer and the head of the counselling office and appealed to the dean of student services and the dean of sciences which led me to be assessed by a third party psychiatrist (to substitute for not having a disability office) to qualify for extra time on examinations and projects. Specifically, I requested and was granted 1/3 extra time on exams.

My current dilemma:

I moved back to Country A in July 2016 and am living with my family. I have been under the care of a new psychiatrist in a public hospital and my original Country A psychologist.

The hospital in Country A where I am currently going for consultations does not treat ADHD (or "hyperkinetic disorder"*). I was told that they treated only "mild" mental disorders. So when I moved to Country A in July 2016, I was immediately referred to a different hospital. Unfortunately, I can't start having consultations until October, 2016.

Not having time to ask about the GRE in my last visit, I asked my current (Country A) psychiatrist just today if he would have problems writing me disability documentation. I explained to him my exam difficulties that led me to be assessed as qualifying for 1/3 extra time by the third party (Country B) psychiatrist, and showed the documentation from my own Country B psychiatrist, my Country A psychologist and the third party (Country B) psychiatrist. The Country A psychiatrist indicated he would have a problem writing me disability documentation. From what I remember, the opinion is that granting reasonable accommodations applies mainly to primary school/grade school students, not so much to secondary school/high school students and almost never to adults with ADHD. His view is that my difficulties are shared by normal people and that everyone gets distracted, anxious or has time management problems.

To be absolutely clear, it is not the case that my current (Country A) psychiatrist acknowledges the need for reasonable accommodations for people with ADHD and deems me as not qualifying for such.

Rather, my current (Country A) psychiatrist does not acknowledge the need for reasonable accommodations for people with ADHD.

I asked to be referred to a different psychiatrist and was told that I already had been. The most he could write for me was a note certifying my diagnosis.

I believe I do not have the time, money or probability:

  • to have an appointment with a private psychiatrist,
  • to be referred to a different psychiatrist in my current hospital,
  • to move up my appointment in my soon-to-be-new hospital,
  • to make successful complaints to my hospital or to the Hospital Authority of Country A
  • to file a legal case or
  • to be allowed to submit disability documentation from my (Country A) psychologist

If I was living in Country B, I would just submit the documentation from my Country B psychiatrist who saw me for 6 months and that would be it. Unfortunately, my discovery of the GRE Subject Test in Math was in June 2016, I moved from one country to another and I again unluckily was the recipient of one of those doctors. Technically, the Country A psychiatrist is not one of those doctors that doesn't believe in ADHD, but might as well be. I have to put up with this for about two more consultations.

Anyway, I have to submit the documentation soon (again, Saturday September 3, 2016). How can I appeal to ETS given my situation? The only thing that comes to mind is explain what I just explained and then ask for the possibility of the following:

  1. To submit documentation only from my Country B psychiatrist who saw me for 6 months (January 2016 - July 2016)

  2. To submit documentation from my Country B psychiatrist who saw me for 6 months (January 2016 - July 2016) and my Country A psychologist

Again, any advice on my dilemma would be highly appreciated.


*Psychiatrist follows ICD not DSM. I didn't mention DSM initially but BrianDHall brilliantly deduced its relevance.

  • Comments are not for extended discussion; this conversation has been moved to chat. – ff524 Oct 17 '17 at 20:01
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+50

I think the most important part of the ETS documentation page is their conclusion:

ETS is committed to providing equal access to our assessments for all test takers. If you have been diagnosed with ADHD and believe you need accommodations for equal access during the standardized testing process, ETS will evaluate, individually, the information that you provide and will work with you to identify any additional documents we require to make a timely determination of your eligibility for accommodations. Of the many thousands of applicants who request accommodations every year, over 80 percent ultimately receive accommodations.

In short: provide them with what you have, give a short, professional description of any material request that you cannot obtain, and hope for the best. Either they will accommodate you (as ETS reports they do for "over 80 percent" of people "ultimately"), or they won't and you will not have extra time on the test - which will not necessarily prevent you from doing acceptably on the exam, but obviously isn't ideal.

First, give it your best shot with what you have. Give them as much of the paperwork requested as you can, such as including paperwork from the professional from Country B. You will want to be honest but very concise. If they requested info from the second provider and they only agree to confirm your diagnosis but nothing else, you may want to basically say "the provider has stated that they do not personally believe in adult accommodations for anyone, and can only confirm the diagnosis" - which may violate at least American norms for standard of care, but is not so strange as to be unbelievable at all.

For those not familiar with this area of psychology, note that the ETS specifically mentions the DSM 5, which is a standard for mental health diagnosis in the US - but is not universally well regarded or used outside the US (though is not at all unheard of). The ETS and GRE are US based, but they should be familiar with the issues of how non-US providers may view things like ADD/ADHD and their lack of support for the DSM 5.

You can basically hope for the best, but "prepare for the worst". They may simply deny your request, or require more paperwork that will mean that you can't take the test during your required period of time.

As for preparing for the worst, if you are only requesting a 1/3rd extra time on the test, it is very possible that you can still do acceptably on the test as is. You should prepare for the test as best as you can and may have no choice but to give it the best go you can and do as well as you can in spite of the non-ideal circumstances. Some people require far more drastic accommodations, such as having a personal reader, assistive technology, even more extra time, etc. These people would have no chance of completing the test without accommodations, so I guess it could help to think "well, it could be a lot worse".

To build your comfort you can download timed example test software from the ETS website, and simulate normal test taking conditions in the place of your choosing, for free. It will even give you an estimated, unofficial score. You may find it helpful to go ahead and give it a try to see how you can do, and to improve your test preparation. You can also have the software simulate 1/3rd extra time on the second example test, to test just how big of a difference it could potentially make for you and if it would be worth the extensive work and expense to try to delay taking the test and getting some kind of paperwork to get accommodations.

I wish you the best regardless, and I hope this can help you even a little.

  • Thank you BrianDHall :) Does violation of norms count as malpractice? I'm not in the US obviously, but what if an American doctor did that? – Jack Bauer Sep 16 '16 at 13:28
  • @BrianDHall, The DSM-5 is a bit flawed. Like in my case, I was diagnosed with Asperger's Syndrome in 2011, but under DSM-5 all specific autism related diagnosis are now just "Autism Spectrum Disorders." There are other missteps taken in the current version as well. – NZKshatriya Oct 29 '16 at 15:18
  • BrianDHall and @NZKshatriya Actually, I think ETS mentions ICD as well. That's what my previous psychiatrist was following. I think ICD uses hyperkinetic disorder while DSM uses ADHD – Jack Bauer Nov 4 '16 at 17:23
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    @JackBauer Part of my education is in psychology, which included some practical psychological assessment (I'm not a clinician, nor training to be), one aspect of my research is in psychology (also not clinical), and I often advocate in this area for others with mental health-related issues. I've also come across people who believe that ADHD is over-diagnosed/abused in the US, and thus the ICD often comes up as it differs from the DSM - and your mention of multiple countries made me think at least one country probably didn't use the DSM. – BrianH Nov 4 '16 at 18:57
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    @JackBauer And to your earlier question about malpractice, my understanding is that it's generally a pretty high bar - and notes from doctors/psychologists/psychiatrists requesting things like accommodations is often considered optional (they are generally free to refuse to issue any at all as it's not a standard of care that is strictly required of them). But IANAL either, so I can't say with any certainty - I've just never heard of such a thing being discussed as a useful measure in a situation like this. – BrianH Nov 4 '16 at 19:00

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