Psychiatric Disability Accommodations in Higher Education

Q&A with Alan Levinovitz on the controversial reception of his article

Alan Levinovitz is a professor of philosophy and religion who specializes in the intersection of religion, philosophy, science and medicine, as well as classical Chinese thought. His most recent book is “Natural: How Faith In Nature’s Goodness Leads to Harmful Fads, Unjust Laws, and Flawed Science” (Beacon Press, 2020).

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Awais Aftab: You wrote an article for The Chronicle of Higher Education, “Are Colleges Getting Disability Accommodations All Wrong?” (September 25, 2024) that has generated a lot of heated debate. It has made a lot of people angry, especially in the disability justice community. For my part, I thought the article asked some tough questions that many would rather avoid asking, and it highlighted important incongruities in current practices, even though I don’t necessarily agree with what you suggest as the solution at the end. (Full disclosure to the readers: I was interviewed by Levinovitz as he was researching the story and I am quoted in the article.)

Here are some excerpts from the article for the benefit of the readers (since reading the article requires creating an account):

“If you assume that diagnoses [of ADHD, mood disorders, anxiety disorders] 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’s another question that those committed to the current disability-services approach may be reluctant to ask: Do disability accommodations even work? Here, too, the data is discouraging. Researchers have studied a range of common accommodations, and their findings are bleak: In almost all cases, evidence for the effectiveness of these accommodations is nonexistent, or mixed at best. Distraction-free environments, for example, do not appear to benefit students with ADHD. Extra time benefits students on standardized tests that are time-pressured, but in the context of college classes it frequently goes unused, which means its primary function is to relieve anxiety, not to remediate a disability like dyslexia.”

“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.”

“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?”

Let’s start with a summary of what the article is about and what questions you are examining in it.

Alan Levinovitz: The article addresses how disability accommodations in higher ed have gone wrong. There are four central issues:

• The problem of ineffective, generic accommodations, granted by overwhelmed disability service providers who are receiving unprecedented numbers of accommodation requests. The quintupling of requests over the last decade is accounted for almost entirely by an increase in accommodations for ADHD and mood disorders, and, to a lesser extent, specific learning disabilities. The research is quite clear on both the disorders responsible for the increase and the ineffectiveness of (most) common accommodations for these disorders. I cite some of the studies to that effect in the piece.

• A part of the problem is that a significant minority of the diagnoses responsible for the increase (~20-30%) are fraudulent or mistaken. We know this from uncontroversial extrapolation of effort test failure rates. Despite what official statements may say, it seems clear many colleges do little or nothing to address this particular issue, choosing instead to err on the side of not pushing back on anything vaguely official.

• Because these diagnoses are disproportionately secured by higher socioeconomic status students, the trend in accommodations exacerbates inequity. This, too, is uncontroversial.

• Lastly, higher ed’s attitude towards diagnoses and accommodations contributes to what Ian Hacking described as “looping effects,” leading to more expansive understandings of disorder. This can harm students by reinforcing a biogenetic understanding of their struggles, which results in avoidant coping and prognostic pessimism. 

Aftab: A lot of people seem to misunderstand what your article is saying. What are some common misconceptions that you’ve come across, and what factors do you think have contributed to the misunderstanding? (It also doesn't help that the article shows up on social media previews with the title “Do Colleges Provide Too Many Disability Accommodations”!)

Levinovitz: What a terrible headline! Some people may not know this, but writers do not choose their headlines. As soon as I saw it, I had it changed to “Are Colleges Getting Disability Accommodations All Wrong?” So yes, that contributed to a misunderstanding of the article.

Another misunderstanding was that the article suggested “all” or “most” requests for accommodations are fraudulent or the result of deliberate faking. This is not the case, and the article does not say this, but I could have been extremely scrupulous and pointed out at all times that I was referring specifically to the diagnoses and accommodations that are most common, namely ADHD, mood disorders, and specific learning disabilities.

Likewise, some people thought I was suggesting all accommodations are ineffective for all people. Again, I do not say this in the article, but I could have been more scrupulous about making that clear at all times.

There were also many, many people who thought I did not care about people with disabilities (hated them!), for two reasons. First, I do not interview anyone for the piece who identifies publicly as having a disability, and I do not center the experiences of people with disabilities who have been outright denied accommodations or struggled to receive them. In retrospect, I wish I had done so. However, I don’t think that would have made much difference to the reception of the article.

Aftab: What was the reaction to your article? And what does this reaction reveal about the current state of public discourse?

Levinovitz: Well, I was the subject of a massive online “dragging,” as the folks call it these days. Extremely high-profile advocates called attention to me as someone who was deliberately harming people with disabilities. Thousands upon thousands of people accused me of everything from supporting eugenics to causing the deaths of people with disabilities. My department head received emails demanding I lose my job. The torrent of abuse continues as I write this.

In the article I touch briefly on why the issues I raise have gone almost entirely undiscussed, namely a chilling effect on any public discussion. The chilling effect is created by an extremely intense community of activists and advocates, who identify themselves as part of a “discipline” or academic specialty called disability studies. So, in a way, this was not a surprise, although the scope, scale and intensity of it has left me shocked.

And I’d like to take a moment to talk more about this “discipline,” given the enormous power it exerts over discussions of disability. Disability studies is not, as one might think, comprised by legal experts and neuropsychologists and the like, who, you know, study disability. Rather, this interdisciplinary field is defined by its founders and practitioners explicitly as an advocacy field. You can be a legal scholar or a research psychologist and also be in disability studies — but what qualifies you is not the object of your study, it’s the ideological flavor of your methodology and conclusions.

Within disability studies, one is allowed to discuss certain extremely important problems: Students not receiving the accommodations they need and have a right to; ongoing discrimination against disabled students; the desirability of universal design that allows all students, with and without disabilities, to access course content without an accommodation. There is disagreement and insightful discussion of all those problems.

But discussion of any issue that might undermine a maximally inclusive approach to accommodation is strictly taboo. There are even terms-of-art for dismissing such issues out of hand. Fraudulent diagnoses are called the “disability con,” and just mentioning them is seen as ableist. The same is true for any discussion of how universal design might have trade-offs, or the potential unfairness of any accommodations.

There is also an associated set of rhetorical techniques used to quash discussion of the kind I tried to have:

• If someone without a disability raises these issues, their identity will immediately be used to disqualify them from speaking. (If one aligns ideologically with those in disability studies, identity is typically ignored.)

• If someone with a disability raises these issues, or is quoted as supporting a perspective that doesn’t toe the ideological line, they can be dismissed as having “internalized ableism” or “being used as a shield by an ableist.”

• Should someone seek to defend their position on these issues, their response can also be dismissed as an “academic debate” over something that should not be up for debate, because it is existentially significant to people with disabilities.

Aftab: Were there criticisms that you thought were legitimate?

Levinovitz: Absolutely. One really important criticism was that universities are not the best place to put pressure on mistaken or fraudulent diagnoses. Their job is to help students with disabilities secure the accommodations they deserve, not scrutinize requests to see if they are deserved. That’s a very fair position, and we would have to be very careful about how that sort of scrutiny would be implemented. My own initial take would be to make sure at least some people working in these offices have experience with forensic neuropsychology.

I also believe that including the voices of people with disabilities who have been denied accommodations would have provided a necessary counterpoint to the critiques I made. (I also should have included the voices of people with disabilities who are frustrated by people receiving unwarranted and/or ineffective accommodations, of which there are many!)

Aftab: From my perspective, although you do a great job outlining the potential harms and burdens of a soft, flexible, and inclusive approach towards disability that relies on self-report, I didn’t see any clear or persuasive evidence in your article that such an approach hurts more than it helps. Sure, the approach comes with certain disadvantages; it comes with costs and burdens on teachers as well as administrative staff; and the way we currently go about the whole thing is rather inconsistent and incoherent. I agree with all that, but that is still compatible with the fact that individuals with disabilities are better off now than they were before. Even if a relaxed approach disproportionately benefits the well-off, it’s still worth it to me if it allows disabled students to accomplish what they couldn’t have accomplished otherwise. The takeaway of your article for me was that change is needed, but my inclination is to go into the opposite direction. Be more coherent in our relaxed approach: build in more flexibility for everyone and then provide personalized accommodations that disproportionately benefit the most severely impaired. Thoughts?

Levinovitz: Right, I think these are very legitimate objections. Unfortunately I was given a strict word limit, so there was only so much time to discuss the issues! I tried, in the last section, with what remaining space I had, to discuss the serious consequences of diagnostic concept creep, which is my own personal biggest concern.

However, I also believe that there are many negative consequences to a relaxed approach, as well as to what some call universal design (more flexibility for everyone).

Consider two approaches to universal design that many disability advocates see as having no downsides: Allowing all students to have laptops/tablets in class, and recording all lectures so if students cannot attend class, they can view them online. No need to require accommodations, just have that all in place for everyone. All upside, right?

But as an educator, I know there are serious downsides to these seemingly uncontroversial forms of flexibility. I have banned phones and laptops in my classes, unless students have a disability that absolutely requires them. As a result, my students are far more focused. Before class, since phones and laptops are banned in the classroom, period, the students talk with each other, building a classroom community. There is a hum of excitement that does not exist when people can come in and get on their phones or computers. If I make lectures available online, as all professors know, students with and without disabilities will be tempted to not attend. All of these are serious downsides, for the classroom community and for the individual students. They are especially problematic for students with disorders that make it hard for them to motivate, or allow them to be easily distracted.

As for the personalized accommodations that benefit the most severely impaired, I think that’s a terrific approach. But given the relatively high rates of misdiagnosis of the most common disabilities, and given how they are disproportionately secured by high performing students, there’s a better approach to doing it than using disability accommodations.

It is worth keeping in mind that disorder is not disability. Disability is a major impairment compared to the general population. When it comes to ADHD, mood disorders, and specific learning disabilities, there’s an easy way to address them as disabilities. If the student has rigorous documentation of the disability, provide an empirically-backed accommodation that will set them up for success ­— that is, don’t just hand out extra time, lenient deadlines and attendance policies, and distraction-free testing. And for students that do not have documentation, the best way to address their needs is by creating resources that are specifically for underperforming students. These resources should include peer mentors and support, study-skill teaching, and other skill-building interventions, which help both disabled and non-disabled students alike. By gearing them to underperforming students, we ensure we are serving the students who are struggling the most, and ensure we will reach low SES students who are underperforming, but do not have a diagnosis (or a disability).

Aftab: One of the concerns raised by disability justice advocates in response to your article was that whatever your intentions, your article will be weaponized to restrict disability accommodations and this will result in the disabled individuals being worse off. Do you think there is a possibility of your article being weaponized in this way? And if so, what should be done about it?

Levinovitz: Yes, and that’s another criticism that I think I should have addressed in the piece. I think the answer is legal: School should be held accountable by the law anytime they deny a valid accommodation. To a certain extent this is already the case, but I am a very strong supporter of draconian legal sanctions against any and all institutions of higher education that discriminate against people with disabilities.

Aftab: Thank you!

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See prior interviews and discussions on this Substack fostering a re-examination of conceptual and scientific debates in the psy-sciences.

See also: my book Conversations in Critical Psychiatry, out from Oxford University Press (2024).

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