ADHD and Accommodations
ADHD and School Accommodations: Helpful Support or Hollow Fix?
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood-onset conditions affecting learning and behavior. Because school demands sustained attention, impulse control, organization, and productivity, students with ADHD often struggle academically and behaviorally. On average, they earn lower grades, are more likely to repeat a grade, and are at higher risk of not completing high school.
Schools respond in two primary ways: interventions and accommodations. Interventions aim to build skills. Accommodations adjust the environment.
Accommodations are far more common.
But are they working?
What Are School Accommodations?
Educational accommodations alter how instruction or testing is delivered without changing the core academic content.
Examples include:
Extended time on tests
Testing in a separate room
Having test questions read aloud
Personal reminders about due dates
Reduced homework load (e.g., only even-numbered problems)
Unlike interventions—such as organizational skills training or writing strategy instruction—accommodations do not aim to improve executive function or academic skills. They are adjustments to expectations or delivery, designed to meet students where they are.
They are widely used. In fact, accommodations are often the primary response to ADHD in schools, supported by multiple federal laws.
Given how common they are, you might assume their effectiveness is well established.
It isn’t.
What the Research Actually Shows
A large systematic review examining educational accommodations for students with ADHD found four striking conclusions.
1. Accommodations Are Extremely Common
When ADHD is recognized, most students receive some form of accommodation—especially testing accommodations like extended time.
Accommodations are often the first step after diagnosis.
But frequency does not equal efficacy.
2. Most Accommodations Do Not Show ADHD-Specific Benefits
Experimental studies often fail to show that accommodations meaningfully improve performance specifically for students with ADHD.
Some accommodations raise performance for all students, which suggests they may lower testing demands rather than address ADHD-related barriers.
One exception stands out:
Read-aloud accommodations for younger students have shown ADHD-specific benefits in randomized experiments. This suggests that when reading demands interfere with demonstrating knowledge, altering the presentation format can meaningfully help.
However, beyond that, the evidence base is surprisingly thin.
3. Many Common Accommodations Have Almost No Direct Research
Consider the most common accommodation: extended time.
Despite its prevalence, fewer than ten empirical studies directly examine its effects in students with ADHD. Even fewer explore whether it improves long-term academic outcomes or skill development.
Private room testing? Almost no direct studies specific to ADHD.
Instructional accommodations? Very limited experimental evidence.
A study examining five common testing accommodations in students with ADHD found no association between receiving accommodations and better reading or math performance compared to similar students without accommodations.
That doesn’t mean accommodations never help. It means the evidence is sparse and inconsistent.
4. Students and Stakeholders Often Feel Ambivalent
Surveys of students with ADHD, parents, and educators show mixed feelings about accommodations.
Some students appreciate the support.
Others report:
feeling stigmatized
feeling dependent
feeling misunderstood
frustration with bureaucratic processes
Very few surveys report widespread satisfaction with how accommodations are implemented.
That should give us pause.
The Accommodation vs. Intervention Distinction
Interventions aim to change skill level. Examples include:
Organizational skills training (large effects on those skills; small-to-moderate effects on academics)
Writing strategy instruction
Instructional techniques like flash cards
Behavioral parent and classroom interventions
Accommodations, in contrast, change expectations or delivery.
This distinction matters because accommodations may function best as:
Temporary scaffolds while interventions build skill
Supports when evidence-based interventions have been tried and insufficiently effective
They may not be ideal as first-line, standalone solutions.
Potential Risks of Overreliance
Accommodations are well-intentioned. They represent a genuine attempt to help.
But there are possible unintended consequences:
Dependency
Extended time, for example, may unintentionally reduce pressure to develop pacing skills.
Skill stagnation
If expectations are permanently lowered without building executive function capacity, long-term independence may suffer.
Misuse and exaggeration
In competitive educational environments, there is evidence that some students exaggerate symptoms to obtain accommodations—particularly extended time.
Placebo comfort
Accommodations may provide a sense of support without meaningfully changing learning trajectories.
None of this suggests we should eliminate accommodations. It suggests we should apply them thoughtfully.
When Accommodations Make Sense
Accommodations are most defensible when:
They directly address a clear barrier.
There is evidence (even modest) supporting the approach.
They are paired with active skill-building interventions.
They are periodically reviewed rather than automatically renewed.
The student understands why they are receiving them.
Accommodations should ideally support independence—not replace it.
A Smarter Framework Going Forward
The research suggests a “life-course model” of ADHD services:
Diagnose carefully.
Implement evidence-based interventions first.
Add accommodations as scaffolding where needed.
Reassess regularly.
Gradually fade supports when possible.
More research is urgently needed—especially large, well-designed studies examining common accommodations like extended time and private room testing.
Until then, health professionals and educators should be cautious about reflexively recommending long lists of accommodations immediately after diagnosis.
The Bottom Line
Accommodations are common.
They are legally supported.
They are often well-intentioned.
But the scientific evidence supporting many of them is surprisingly limited.
The goal should not be to eliminate accommodations. It should be to use them wisely—strategically, temporarily when possible, and always in combination with interventions that build the skills students need for long-term success.
Support should empower.
Not just cushion.