How should I proceed with writing a school note for a patient with a self-reported childhood history of Attention Deficit Hyperactivity Disorder (ADHD), dyscalculia, and dyslexia, without access to their medical records?

Approach to Writing School Accommodation Letters Without Prior Documentation

You should not write a school accommodation letter based solely on patient self-report of childhood diagnoses without any objective documentation, as ADHD diagnosis requires current verification of symptoms across multiple settings with information from multiple informants, not just historical patient recall. 1, 2

Why This Matters: Core Diagnostic Requirements

The American Academy of Pediatrics is explicit that ADHD diagnosis cannot be established through patient report alone—it mandates:

• Current symptoms and impairment documented in at least two settings (home, school/work, social contexts) 1, 2
• Information obtained from multiple independent informants, not just the patient 1
• Verification that DSM criteria are currently met, including functional impairment 1

For learning disabilities like dyslexia and dyscalculia, diagnosis similarly requires psychoeducational testing demonstrating below-average performance in the context of relevant clinical assessment—not historical self-report. 3

The Clinical Problem You're Facing

Writing a school letter without documentation creates several risks:

• You're certifying diagnoses you haven't verified, potentially exposing yourself to liability if accommodations are challenged 1
• Schools may reject letters lacking objective support, as eligibility decisions require documented impairment 1, 4
• The patient may have different conditions that present similarly but require different interventions 1
• Childhood diagnoses may no longer be accurate—symptoms change over time and alternative explanations emerge in adolescence/adulthood 1, 2

What You Should Do Instead: A Stepwise Approach

Step 1: Obtain Current Diagnostic Information

Request records from the previous provider who made the original diagnoses, including:

• Original psychoeducational testing reports for dyslexia and dyscalculia 3
• ADHD diagnostic evaluation with rating scales from multiple informants 1
• Any prior IEP or 504 plan documentation 1, 4

If records are unavailable, you must conduct a new evaluation rather than accepting self-report. 1

Step 2: Conduct Your Own Current Assessment

For ADHD specifically, you need:

• Current DSM-5 based rating scales (Vanderbilt, Conners, or equivalent) completed by at least two independent observers in different settings—this could include employers, supervisors, or other adults who observe the patient regularly 1, 2
• Retrospective parent-completed rating scales to establish symptom onset before age 12 (required by DSM-5) 2
• Clinical interview documenting current functional impairment in academic/occupational and social domains 1
• Screening for alternative explanations: depression, anxiety, substance use, which are more common in previously undiagnosed young adults than unrecognized ADHD 2

For learning disabilities:

• Referral for current psychoeducational testing by a qualified psychologist, as these diagnoses require standardized achievement testing showing discrepancies 3
• Review of academic transcripts showing patterns of difficulty in specific domains 3, 5

Step 3: Address the Immediate School Need

Explain to the patient that you cannot ethically write a letter certifying diagnoses you haven't verified, as this violates diagnostic standards and could harm them if the letter is rejected. 1

Offer a bridging solution:

• Write a letter stating you are initiating a diagnostic evaluation for these conditions based on patient history 1
• Request interim accommodations while evaluation is pending, noting the patient reports prior diagnoses but you are working to obtain documentation 4
• Provide a timeline for when you expect to complete the evaluation and provide definitive documentation 1

Step 4: Consider Comorbidity Patterns

If evaluation confirms ADHD, be aware that:

• 68.8% of children with dyscalculia have comorbid ADHD 6
• 56.3% have dyslexia 6
• These often occur together and share common cognitive deficits in working memory and attention 6, 7, 8

This means if one diagnosis is confirmed, actively screen for the others with appropriate testing. 6, 7

Common Pitfall to Avoid

Do not write a letter simply stating "patient reports" these diagnoses—schools require physician certification of current conditions, and such a letter provides no meaningful support for accommodations while potentially creating documentation of diagnoses you haven't verified. 1, 4

What Accommodations Require (If Diagnoses Are Confirmed)

Once you have objective documentation, appropriate school accommodations include:

• Extended time for tests and assignments 4, 9
• Reduced homework load (typically 50% of standard) 4
• Provision of instructor's notes 4, 9
• Organizational supports including structured planners and visual schedules 4
• Preferential seating and environmental modifications 4

These require documented functional impairment, not just diagnostic labels. 1, 4