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Providing an accessible education to everyone is a crucial civil-rights issue, one that went unaddressed in this country for far too long. Discrimination against people with disabilities was standard practice until the introduction of legal protections like Section 504 of the Rehabilitation Act in 1973 and the Americans With Disabilities Act (ADA) in 1990. Without these protections, blind students would have no recourse if their community college failed to provide accessible versions of textbooks and library materials, and deaf students participating in online classes would not be entitled to closed-captioning. Even with robust laws in place, disabilities are frequently missed or dismissed, a problem compounded by racial and socioeconomic disparities.
Concern about the validity of surging accommodation requests may therefore seem misplaced. To a certain extent, the trend is a positive development: the product of increased awareness, better screening practices, and less institutional discrimination. We should worry about students’ rising rates of mental-health disorders, many disability advocates say, not the willingness of colleges to accommodate them.
However, a suite of acute, well-documented problems with disability accommodations demand attention. The data is clear, for instance, that a significant minority of diagnoses are fraudulent or mistaken. In many cases, there is no empirical basis for granting common accommodation requests like extended time or distraction-free testing. And there is further evidence that the current state of disability accommodation compounds inequities in student achievement, rather than alleviating them.
Students and instructors are rightfully concerned about fairness and compromised rigor. Resources are being misallocated to unproven interventions and students who don’t need them. Worst of all, the interventions may be harming some of the students they are intended to help, exacerbating their mental-health problems and setting them up for a lifetime of struggle.
Colleges have remained complacent about the status quo for a variety of reasons. Since they want to support students and avoid lawsuits, administrators are incentivized to pursue a maximally inclusive approach to accommodation. Disability advocates fear, understandably, that calling attention to these issues will result in public backlash, creating more stigma around disability and threatening hard-won rights. Outside of academe, alarmism about accommodations has been associated with ableism and culture wars. While researching this piece, multiple people refused to speak with me about their misgivings on the record. There is a chilling effect at work, resulting in a lopsided discussion that leaves educators, students, and the public poorly informed.
However understandable the reluctance to criticize disability accommodations, refusing to do so is antithetical to the mission of higher education. Inaction harms students both with and without disabilities, allows for continued misallocation of limited resources, and calls the integrity of our institutional practices into question. We have a duty to engage in even-handed, critical reflection and pursue necessary reforms — even when it makes us uncomfortable.
Forty-nine of 50 institutions replied to the request. 23 replies came from “decision makers,” that is, people with the authority to grant accommodations. (The remaining responses from nondecision makers said someone would have to review the request but tended to include reassurance about the student’s prospect of securing accommodation.) Not only did 100 percent of decision makers approve the request, but many suggested additional accommodations, including distraction-reduced testing, extensions on assignments, and access to funds for students with disabilities.
Resources are being misallocated to unproven interventions and students who don’t need them. Worst of all, the interventions may be harming some of the students they are intended to help.
I asked Harrison if she thought the results would be similar in the United States. She told me that she had in fact gotten the idea for the study from an American researcher who ran the same experiment, and “found almost perfect compliance. However, he was too afraid to publish for fear of institutional backlash against him. So yes, the exact same findings in the States, just not published.” (The researcher Harrison mentioned refused to speak with me for this article.)
Why were these decision makers so willing to provide accommodations, even when the evidence showed no sign of disability? One potential explanation is a widespread sense in disability-services offices that their primary role is provider, not gatekeeper. Consider the University of Arizona’s Disability Resource Center, where standards for documentation of disability are expressly lenient. An official diagnosis is never required to affiliate with the office or to receive accommodations. “Getting documentation can be a really expensive, drawn out process,” Carsen Kipley, the center’s associate director, explained to me. “[Students] might not have the financial means, the time to do that, but that doesn’t mean a disability isn’t there, or they aren’t experiencing barriers. We’re trying to create a more equitable experience for those students. Let’s not make our process another barrier in getting the support you need.”
Kipley’s perspective echoed what I heard from many people in similar positions, including L. Scott Lissner, former president of the Association on Higher Education and Disability, and current ADA coordinator and Section 504 compliance officer for Ohio State University. Lissner frequently gives presentations on ADA compliance, and he told me one of his concluding talking points addressed the relationship between institutional values and accommodation practices.
“The ADA sets a floor, not a ceiling,” Lissner said. “Are you an institution that wants to say no when you can and yes when you have to? Or do you want to say yes when you can and no when you have to?”
Disability services is a classic “helping profession,” which means those who choose to go into it usually want to say yes when they can. They seek to remove barriers, not erect them. They do not approach students with forensic skepticism, which is a counterproductive attitude when vulnerable people are reaching out for help. As Julie Loppacher, director of the Kortschak Center for Learning and Creativity at the University of Southern California, put it to me: “The reason we do this work is we are looking at students from a growth mindset. If you had the support you needed, what are you capable of?”
Although it is widespread, not every institution takes a maximalist approach. At the University of Virginia, official documentation of a diagnosis is often required, and even that doesn’t guarantee accommodations. “Having a diagnosis doesn’t necessarily mean you have a disability,” said Barbara Zunder, director of UVA’s Student Disability Access Center. “What we’re looking for is documentation about duration and severity. We’re very mindful and discerning when it comes to that.”
Zunder takes seriously the equity challenges associated with securing a diagnosis, and her center works with students who claim a disability but don’t have adequate documentation. Sometimes her team will seek funding for official diagnosis and rigorous testing through the student council, or work with community providers who administer them at reduced costs. “Because we have a neuropsychologist and a clinical psychologist on our staff, we can use provisional accommodations to give them time to get this done,” Zunder said.
Even with a team of nine and a neuropsychologist on staff, processing thousands of requests is extraordinarily time-consuming. In 2023, Zunder’s office sent out an astonishing 21,527 accommodation letters to instructors, 1,300 more than the year before. (UVA has a total of about 25,000 students.) “They’re terrific at the Student Disability Access Center,” said Michael J. Kennedy, professor of special education and the former chair of UVA’s faculty senate. “But they’re largely understaffed, and as a result of it, they have a hard time keeping up, not through any fault of theirs, they don’t have the space or the people.”
Kennedy’s comment applies to virtually every disability-services office in North America. Rising numbers of requests are leaving them overwhelmed, with less time to carefully tailor accommodations to each student’s specific needs. Few are equipped to responsibly evaluate student requests. And only a minority of the people they employ have the highly specialized expertise necessary to analyze the evidence base for a pediatrician’s diagnosis of ADHD or scrutinize a neuropsychological battery for signs of unreliability.
Nor is pushing back an appealing task, even for those with the expertise required to do so. At Boston University, the neuropsychologist Lorre Wolf, whose scholarly focus is learning disabilities, was fiercely criticized for her stricter approach to accommodations, which included asking some students with diagnoses to be retested, and occasionally denying requests. The student newspaper suggested that her actions might constitute a violation of students’ civil rights, and excoriated her for being dismissive and unempathetic. (Wolf retired in 2024; a successor has not been named.)
Most people in disability services don’t see the need for Wolf’s level of scrutiny. “This perception that students are self-diagnosing, or trying to game the system for their advantage? I haven’t seen any evidence of that,” Kipley said. Juliana Calhoun, assistant director of USC’s Kortschak center, agreed. “From any research I’ve seen, it doesn’t seem to be an issue that people are coming in and lying for extra time,” she told me.
If disability diagnoses are often questionable, and accommodations are often ineffective or unfair, then a more permissive approach, whatever its virtues, starts to look a lot more problematic.
The need for efficiency also leads to generic, standardized interventions: time-and-a-half on all exams, a note taker, distraction-free testing, and extensions. Everyone I interviewed was frank about the arbitrariness of these common accommodations. There are no methods in place to determine exactly how much time a certain student needs, or which specific circumstances require a note taker. “In North America it’s 50 percent extra time,” Harrison said. “It’s not based on any research.” To show how arbitrary the numbers are, Harrison compared North American policy to other countries: “In Great Britain it’s 25 percent, in Australia it’s 15 percent.” These numbers are not supported by any rigorous research on how much extra time students with specific disabilities might need: “It’s just throwing darts.” (Researchers have long known the numbers are unscientific.)
Nevertheless, advocates for disability rights are usually unconcerned about the possible unfairness of awarding extra time. “From my perspective as a special educator, I want to err on the side of more” time, UVA’s Michael Kennedy told me. “50 percent more, that sounds about right. 100 percent, that sounds good.” Influential researchers like the dyslexia expert Sally E. Shaywitz, have argued extra time is only beneficial if you have a disability, a position that is widely accepted in disability studies. Karen Ullman, a long-term substitute teacher in Washington State, told me she attended a training session about dyslexia in which the presenter claimed extra time actually harmed students without disabilities. “They said, if you give kids who are on the normal track extra time, they don’t do as well,” Ullman told me. “They said they second guess themselves.”
In fact, there is considerable evidence to the contrary. In review after review, it is clear that with very few exceptions, extra time benefits students without learning disabilities the same amount that it does those with disabilities. Ironically, in some cases extra time may help students without disabilities more. Benjamin Lovett, a professor of psychology at Columbia University’s Teachers College, and a leading expert on disability accommodation, put it bluntly to me. “On time-pressured tests, extended time tends to help students both with and without disabilities. Students know this intuitively, and they’re right, and it should be scandalous that some disability advocates claim otherwise.”
If you assume that diagnoses are always to be trusted and that accommodations only help if you’re disabled, it makes perfect sense to adopt a more permissive approach, which reduces the risk of denying accommodations to someone who needs them and has the added virtues of reducing labor and heading off potential lawsuits.
But if disability diagnoses are often questionable, and accommodations are often ineffective or unfair, then a more permissive approach, whatever its virtues, starts to look a lot more problematic.
And that is exactly what the evidence shows.
There is some disagreement in the literature about rates of feigned or exaggerated ADHD in higher education, but there is unanimity on its existence. Estimates of feigning and exaggeration among those who are officially tested for ADHD range from 25 percent to 50 percent, which, at the low end, is slightly higher than the base rate of 20 percent estimated for the general adult population. For specific learning disabilities, the rate of validity test failure is a bit lower, at 16 percent.
Despite these relatively high rates, the vast majority of clinicians do not use validity tests when diagnosing ADHD, instead relying on self-reported symptoms. This casts doubt on their diagnoses, because self-report is notoriously unreliable when it comes to ADHD. People tend to overestimate their own difficulties in comparison to others, and students without ADHD identify as having many of the symptoms that characterize the disorder.
The ADAA defines disability as substantially limiting an individual compared “to most people in the general population.” To accurately assess someone’s relative level of impairment, clinicians would need to compare self-reports with other evidence like grades and evaluations from teachers. Gathering that information is very labor-intensive. “Oftentimes [a patient’s] retrospectives are being colored by how they’re feeling now,” said Awais Aftab, a practicing psychiatrist who writes about mental-health diagnoses. More context and evidence is required to make a reliable diagnosis of ADHD or a learning disability. “But I’m not going to go chase down their parents,” Aftab told me. “I’m not going to chase down their school teachers.”
That is understandable, of course: Like disability-service providers at universities, clinicians have limited time and expertise. “If you’re just the average run-of-the-mill family doctor, an internist, or a pediatrician, you probably don’t have any business doing much more than saying, ‘I see a disability here, but I can’t tell you really what the impacts are,’” said Lissner. That’s why an expert on learning disabilities, like BU’s Lorre Wolf, might ask students for additional documentation, even when they already have a diagnosis.
Physicians and psychologists, too, are members of helping professions, which means they are generally uninterested in nit-picking whether their patient fits the exact criteria described in the DSM. “Clinicians are making an effort to help people who want and need help,” said Aftab. “So they might disregard or not pay much attention to the official diagnostic criteria, treating them more or less as just suggestions of sorts and going by what they see as the practical need of the kind of person involved.” The evidence supports Aftab’s observation: Most diagnoses of ADHD do not adhere to the DSM guidelines, and nearly half of psychologists believe the point of performing a psychoeducational assessment is to secure accommodations, not to discover whether they are necessary.
The 2019 Varsity Blues admissions scandal highlighted egregious examples of clinical malpractice, when it came out that wealthy families had paid psychologists to provide disability diagnoses. I brought this up with multiple forensic psychologists who review suspicious accommodation requests for testing agencies like the College Board and state medical boards. They told me a similar kind of practice remains commonplace, where simply going to get tested and paying the substantial fee will almost always result in a diagnosed disability. One New York-based assessment company boasts “a 95 percent success rate in getting learning disability accommodations” for the people who come in to get tested. On YouTube, the owner says, “I can’t even think of a case” — out of over 4,000 clients — “where we have not been granted accommodations.”
Post-Covid, a new set of accommodations, almost entirely unstudied and ad hoc, are becoming more common. These involve variations on extended deadlines and exemptions for attending class. Although there isn’t good data yet — disability-services offices usually don’t have the staff to engage in rigorous documentation — professors I’ve spoken with are noticing a marked increase, and so are disability-services providers.
“Since Covid, there’s just a lot of students who are uncomfortable going back to that traditional environment and needing a little more support,” University of Arizona’s Kipley explained. “Now there’s a good amount of students who are looking specifically for flexibility with attendance and turning in assignments.” I’ve experienced this in my own classes. Like most professors, I was much more lenient with requests for extensions and attendance exemptions during Covid. Now, those requests continue to be made, formally and informally, despite the situation no longer being what it was two years ago.
Advocates of a more relaxed approach see no reason to be unduly alarmed about the rise in such accommodations, despite a lack of evidence about their effectiveness. Nor are they worried about potentially misdiagnosed students. As long as significant numbers of students with disabilities are being missed by the system, they argue, our focus should be on reaching them. “The percentage of students affiliated with our office is still lower than national numbers” of people with disabilities, Kipley said, and he’s right. Among undergraduates, nationally, 18 percent of male students, 22 percent of female students, and 54 percent of nonbinary students identify as having a disability.They are clearly suffering. Mental-health disorders are on the rise. For advocates, it only makes sense to err on the side of affirmation and accommodation, with whatever tools we have at our disposal. The system might not be perfect, and a few people will game it, but that’s a small price for reducing stigma and supporting disability rights.
That is the dominant perspective on campuses, and it is the reason accommodations look the way they do today.
But what if the price of that approach is even higher than it seems? What if the issues go beyond misdiagnosed students, misallocated resources, and ineffective or unfair interventions? Could the accommodation system also be contributing to the problems it seeks to solve, and actively hurting the people it is intended to help?
Specific learning disabilities appeared to be an exception. In 2013, the DSM-V dropped the discredited “IQ-discrepancy model,” which argued that you must have a disability if your ability in a specific area — reading, say, or mathematics — is substantially lower than what would be predicted by your IQ. The model had two significant drawbacks. First, it failed to identify learning disabilities in people whose IQ was average or lower than average, because it was thought the absence of a discrepancy entailed the absence of a disability. Second, it turned up absurdly high rates of disability in people with high IQs — one landmark study found it identified up to 92 percent of gifted students as potentially learning disabled.
But in 2022, the DSM-V-TR (Text Revision) brought back a version of the discrepancy criterion. For certain “gifted” students, read the revision, “achievement scores will be low relative to ability level or achievement in other domains, rather than to the population mean for achievement.”
Lovett, Harrison, and other accommodations researchers I spoke with were stunned and disappointed by this development. “The criteria for diagnosing these disabilities has gradually expanded, little by little,” said Richard Sparks, emeritus professor of education at Mount St. Joseph University, who has researched language-learning disabilities for over 40 years. “At some point everybody will have a disability.”
Relaxed institutional standards for diagnoses and accommodations contribute to concept creep by playing a key part in what the philosopher Ian Hacking described as “looping effects.” People perceive academic struggles as a disorder or disability; they go to a clinician who bends the rules for a diagnosis; they receive disability accommodations without pushback; and researchers then redefine disorder and disability according to what has now been certified as such.
Haslam meant concept creep as a neutral descriptive term, but with mental-health disorders it may be causing at least two serious problems. The first involves equity and distribution of resources. “The rates of people getting diagnosed with hidden disabilities are going up exponentially,” said Harrison, “and it’s people in higher income backgrounds that are getting diagnosed more often.”
If accommodations help everyone, and we relax the diagnostic criteria necessary for securing them, wealthier students will experience even more of an advantage, which is precisely what we are seeing.
The equity problem should be clear: If accommodations help everyone, and we relax the diagnostic criteria necessary for securing them, wealthier students will experience even more of an advantage, which is precisely what we are seeing. Accommodations are disproportionately secured by the highest performing students, further increasing the achievement gap. In one study of students receiving accommodations at a selective private college, most “showed above-average cognitive abilities, average academic skills, and no evidence of impairment.” Limited resources should be going to the students who need them most, not the students who are most skilled at securing them. A more restrictive approach to diagnosing disability and granting accommodations would allow for increased focus on lower-socioeconomic status students who are dramatically underperforming compared to their peers but do not have a diagnosis (or a disability). It would also lower the disability-provider-to-student ratio, facilitating better care for students with more serious disabilities.
The second problem is that misdiagnosis can be harmful. Medical diagnosis is, itself, a medical intervention, and medical interventions have potential side effects. Sociologists of medicine have shown that people interpret diagnosis of a mental-health disorder according to a biogenetic model of the mind, and emerging evidence suggests that embracing this model as an explanation of one’s suffering is a “mixed blessing.” Although official diagnosis can provide relief and a sense of not being to blame (“it’s not me, it’s my disorder”), it can also induce prognostic pessimism, a helpless sense that one’s “real” identity is disordered or disabled and can never be changed. In the context of higher education, it will mean some students come to believe, erroneously, that they are intrinsically incapable of succeeding without accommodations — accommodations that are unavailable in a work world where deadlines are not flexible and attendance, so to speak, is mandatory.
When assistance and grace are only open to those with medical diagnoses, we will continue to expand what counts as a medical condition. How can we blame students and parents for seeking out medical diagnoses to explain difficulties in school, if diagnosis offers the easiest, clearest route to getting help? How can we blame clinicians who bend the rules for their suffering patients when there seem to be no other options? And how can we respond to skeptics who deny the existence of legitimate and serious disabilities, if we are incentivizing the medicalization of everyday suffering?
These issues affect nearly every domain of American life, but higher education is ideally positioned to take the lead on them. Colleges can hold pay-to-play clinicians accountable by refusing to accept their dubious assessments. They can insist on evidence-based accommodations and attend to the harms that come from relaxed definitions of disability. This will free up resources, which can be reallocated to study-skill programs, peer-support groups, and temporary interventions that help students make it through stressful periods without giving them a permanent biogenetic explanation for their challenges.
Until we do, disability-services offices will continue to be overworked, rates of disorders will continue to rise, and accommodations will demand ever more resources. The problems they are meant to address, meanwhile, will remain unresolved.