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When Is It OHI? A Review of Case Law Decisions for OHI -- ADHD Eligibility

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Title: When Is It OHI? A Review of Case Law Decisions for OHI -- ADHD Eligibility
Language: English
Authors: Tara Kulkarni (ORCID 0000-0002-0735-5010), Elizabeth L. Shaver, Thuy Nguyen (ORCID 0000-0001-6032-6756), Edvin Pepic, Evie M. Harter, Amanda L. Sullivan
Source: Exceptional Children. 2026 92(2):164-181.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 18
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Decision Making, Disability Identification, Attention Deficit Hyperactivity Disorder, Court Litigation, Federal Legislation, Equal Education, Students with Disabilities, Special Education, Eligibility, Criteria, Parent Student Relationship, Parent School Relationship, School Districts, Influences, Geographic Regions, Educational Legislation, Classification, Judges
Laws, Policies and Program Identifiers: Individuals with Disabilities Education Act
DOI: 10.1177/00144029251360445
ISSN: 0014-4029
2163-5560
Abstract: Educators, families, and policy actors rely on federal and state special education law to inform many decision-making processes. Vague eligibility criteria within the laws can result in conflict between school districts and parents. Resulting due process hearing decisions can have important implications for future practice. One area of particular ambiguity and inconsistency is the disability category--other health impairment--for which students with attention-deficit/hyperactivity disorder may qualify. We examined outcomes of cases regarding disputes about eligibility for other health impairment where attention-deficit/hyperactivity disorder was considered, including judges' decisions, rationales, and factors influencing their decision-making, as well as trends over time and location. The systematic search process yielded 202 relevant cases wherein the majority of judges' decisions (67%) were in favor of the school district, often citing educational need, or lack thereof, in their rationale. The second most common rationale was the evaluation itself being deemed (in)appropriate. Parents who had an expert witness were almost four times more likely to prevail in their cases. We discuss implications for parents, practitioners, and policy.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1490690
Database: ERIC
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  Value: <anid>AN0189687709;exc01jan.26;2025Dec02.05:58;v2.2.500</anid> <title id="AN0189687709-1">When Is It OHI? A Review of Case Law Decisions for OHI - ADHD Eligibility </title> <p>Educators, families, and policy actors rely on federal and state special education law to inform many decision-making processes. Vague eligibility criteria within the laws can result in conflict between school districts and parents. Resulting due process hearing decisions can have important implications for future practice. One area of particular ambiguity and inconsistency is the disability category—other health impairment—for which students with attention-deficit/hyperactivity disorder may qualify. We examined outcomes of cases regarding disputes about eligibility for other health impairment where attention-deficit/hyperactivity disorder was considered, including judges' decisions, rationales, and factors influencing their decision-making, as well as trends over time and location. The systematic search process yielded 202 relevant cases wherein the majority of judges' decisions (67%) were in favor of the school district, often citing educational need, or lack thereof, in their rationale. The second most common rationale was the evaluation itself being deemed (in)appropriate. Parents who had an expert witness were almost four times more likely to prevail in their cases. We discuss implications for parents, practitioners, and policy.</p> <p>Keywords: other health impairment; attention-deficit/hyperactivity disorder; case law; special education; eligibility; individuals with disabilities education act</p> <p>The rights of U.S. students with disabilities are codified in the Individuals with Disabilities Education Act (IDEA, [<reflink idref="bib25" id="ref1">25</reflink>]). IDEA includes 13 disability categories but their eligibility criteria are often vague and can have limited relations to best practice given that they are determined by Congress, not the professional community ([<reflink idref="bib52" id="ref2">52</reflink>]). When disagreements arise between parents and schools regarding eligibility or access to special education services, and mediation fails, conflicts may be settled in the courts. Thus, judges' interpretations of IDEA and psychoeducational constructs may also guide special education practice rather than research or best practice ([<reflink idref="bib44" id="ref3">44</reflink>]). With the increased frequency of children being medically diagnosed with attention deficit/hyperactivity disorder (ADHD) and families seeking educational supports, including special education services ([<reflink idref="bib13" id="ref4">13</reflink>]), the purpose of this study was to examine trends in case law regarding special education eligibility for other health impairment (OHI) due to ADHD and ADHD-like symptoms (herein, OHI-ADHD).</p> <hd id="AN0189687709-2">ADHD and Special Education Services in Schools</hd> <p>Under IDEA, students may qualify for OHI if they have "chronic or acute health problems" such as ADHD that "adversely affects ... educational performance" (§300.8[c]9), for which most states require formal evaluation or diagnosis, albeit with considerable variation across states in how this is operationalized ([<reflink idref="bib9" id="ref5">9</reflink>]). ADHD was added to OHI as an example condition in 1999 ([<reflink idref="bib35" id="ref6">35</reflink>]). A student with ADHD may also qualify for services under Section 504 eligibility if they have a "physical or mental impairment which substantially limits one or more major life activities," record thereof, or are otherwise "regarded as having such an impairment" (34 C.F.R. Part 104.3[j]), but our focus here is on IDEA given that research suggests comparatively few students are served under Section 504 relative to IDEA, including among students with ADHD ([<reflink idref="bib13" id="ref7">13</reflink>]).</p> <p>In the United States, almost 13% of children and youth receive an ADHD diagnosis at some point in their lives ([<reflink idref="bib63" id="ref8">63</reflink>]). Formal diagnosis is generally based on several chronic symptoms across multiple settings that interfere with functioning ([<reflink idref="bib11" id="ref9">11</reflink>]). ADHD is primarily characterized by challenges in executive functioning, including planning, persistence of effort, organization, and inhibitory control ([<reflink idref="bib7" id="ref10">7</reflink>]). These areas are generally considered critical for success in schools, and often students with ADHD or ADHD-like symptoms benefit from support in areas such as homework completion, attending to class content, and maintaining friendships ([<reflink idref="bib14" id="ref11">14</reflink>]). Additionally, ADHD symptoms can manifest in behaviors considered disruptive in classrooms, starting a negative feedback loop from teachers that results in students with ADHD reporting feelings of low school belonging and poor student–teacher relationships (e.g., [<reflink idref="bib43" id="ref12">43</reflink>]). Several studies have shown that ADHD is often comorbid with learning disabilities, autism, and mood disorders ([<reflink idref="bib34" id="ref13">34</reflink>]), which are also associated with increased adult reports of behavioral challenges and students' negative perceptions of school. Thus, students with ADHD may benefit not only services for ADHD features but support for social emotional functioning, mental health, and academics as well ([<reflink idref="bib17" id="ref14">17</reflink>]).</p> <p>Much of the literature examining how students with ADHD are served in schools is limited to parent reports rather than educational records. This is primarily because the Office of Special Education Programs (OSEP) does not collect data regarding the basis for OHI eligibility, the number and basic demographics of students eligible and receiving services under OHI as part of child count data. Although IDEA specifically refers to several medical conditions, including ADHD, in defining OHI (§300.8[c]9), criteria are vague and associated state policies vary. Some states require formal diagnosis whereas others do not and may permit eligibility determination based on behaviors similar to ADHD ([<reflink idref="bib9" id="ref15">9</reflink>]).</p> <p>Perhaps unsurprisingly, research on the intersections of ADHD and special education is mixed. Early research estimated that students with ADHD comprised over 40%–60% of those eligible for OHI, making it the most prevalent medical condition represented at the time (Forness & Kavale, [<reflink idref="bib21" id="ref16">21</reflink>]; [<reflink idref="bib46" id="ref17">46</reflink>]). More recently, a national survey concluded that 69% of children with an ADHD diagnosis received school supports, nearly half of which included an individualized education program (IEP) under IDEA (compared to only 13% supported via Section 504 plans), although the eligibility category was not reported ([<reflink idref="bib13" id="ref18">13</reflink>]). Early research also indicated that students with ADHD were more likely to have academic, behavioral, speech/language, mental health, and paraprofessional services, along with testing and assignment accommodations, than students without ADHD (Lovett & Nelson, [<reflink idref="bib32" id="ref19">32</reflink>]). Elsewhere, a study using nationally representative data for students who entered school in 2011 found that children eligible under OHI due to ADHD were the second most likely, after autism, to have behavior goals in their IEPs ([<reflink idref="bib30" id="ref20">30</reflink>]). The limited research addressing OHI-ADHD disproportionality indicates an overrepresentation of boys and complicated relations to race and class ([<reflink idref="bib46" id="ref21">46</reflink>]), including potential associations to social status ([<reflink idref="bib48" id="ref22">48</reflink>]).</p> <p>Despite studies showing that a large proportion of students with ADHD receive special education services, concerns remain that many students are not receiving the support they need and are legally entitled to ([<reflink idref="bib13" id="ref23">13</reflink>]; [<reflink idref="bib49" id="ref24">49</reflink>]). Notably, some estimates suggest that approximately one in nine federal complaints about denial of free appropriate public education have involved students with ADHD or ADHD-like symptoms not being evaluated appropriately—if at all—for special education eligibility ([<reflink idref="bib42" id="ref25">42</reflink>]), which may be partially attributable to vague federal criteria and variability in states' OHI eligibility criteria ([<reflink idref="bib9" id="ref26">9</reflink>]). Elsewhere, scholars have noted the relations of disability and family social status, highlighting the relative desirability of an OHI-ADHD classification over other so-called mild disabilities (e.g., emotional disturbance), given lesser stigmatization of ADHD, which may contribute to racialization of the category as evidenced by the overrepresentation of white children among those with OHI ([<reflink idref="bib48" id="ref27">48</reflink>]). Taken together, this scholarship underscores the social construction and fluidity of disability ([<reflink idref="bib6" id="ref28">6</reflink>]), and of OHI-ADHD in particular.</p> <hd id="AN0189687709-3">Complexity in Special Education Eligibility Criteria</hd> <p>As noted above, special education criteria are determined by legislators, not professionals within the communities of practice applying such criteria, and concern only legal eligibility for services, not medical diagnosis ([<reflink idref="bib62" id="ref29">62</reflink>]). Even where OHI is concerned, there can be limited relations to medical diagnoses, be they present or absent, in special education law or associated decision-making. This is due in part to the very different functions of <emph>eligibility</emph>, which determines legal entitlement, and <emph>diagnosis</emph>, which carries explanatory and prognostic functions. Law may invoke diagnosis as one component of eligibility, but they are not equivalent or interchangeable. Moreover, federal legislation, including eligibility criteria, often results from compromises to maintain state authority over education ([<reflink idref="bib36" id="ref30">36</reflink>]; [<reflink idref="bib40" id="ref31">40</reflink>]) and appease diverse constituents and leadership, even when such compromise places research and policy at odds. For example, [<reflink idref="bib52" id="ref32">52</reflink>] discussed the complicated history of emotional disturbance in IDEA, wherein the eligibility criteria directly contradicted the research on which it was based and for which Congress has repeatedly declined requests for clarification. In addition, IDEA requires that a student be deemed to both meet criteria for eligibility and need for specialized instruction and services (§300.306). Each aspect is subject to disagreement in professional communities and in practice with individual students. For example, in some states, a medical diagnosis of ADHD is one criterion for eligibility, but that alone is not sufficient for eligibility if there is no consensus about students' educational needs, as has been a point of dispute when parents and schools disagree about needed supports ([<reflink idref="bib44" id="ref33">44</reflink>]).</p> <p>To meet IDEA's OHI eligibility criteria, a student must demonstrate "limited strength, vitality, or alertness, [resulting in] limited alertness" in the educational environment, which is caused by a "chronic or acute health problem [that] adversely affects a child's educational performance" (IDEA, §300.8[c]9). In addition to listing ADHD among example conditions, this verbiage is supposed to capture the symptoms related to ADHD, as ADHD can manifest as decreased alertness in the classroom ([<reflink idref="bib23" id="ref34">23</reflink>]). Yet, many consider such criteria to be vague, making identification susceptible to inconsistent interpretation, unreliable identification, and bias ([<reflink idref="bib49" id="ref35">49</reflink>]; Sullivan et al., [<reflink idref="bib53" id="ref36">53</reflink>]a).</p> <p>Furthermore, states can specify their own criteria under the law. Presently, 11 states use the federal definition of OHI verbatim, 32 states provide some elaboration from the federal criteria, and only seven states have robust explanations for each of the criteria of OHI eligibility ([<reflink idref="bib9" id="ref37">9</reflink>]). Critically, most states (75%) require either ADHD diagnosis or other determination by licensed medical or mental health providers, but specifications vary by state ([<reflink idref="bib9" id="ref38">9</reflink>]). Texas, for example, requires diagnosis by a licensed medical professional (Texas Education Code §89.1040), whereas California does not require any official medical providers' diagnosis and extends eligibility to "a pupil whose educational performance is adversely affected by a <emph>suspected or diagnosed</emph> attention deficit disorder or attention deficit hyperactivity disorder" (California Education Code § 56339). Such policy can offset pervasive, intractable disparities in healthcare access, and thus medical diagnosis, for families from minoritized backgrounds (e.g., [<reflink idref="bib33" id="ref39">33</reflink>]), but also introduces reliance on lay understanding of a controversial condition. As asserted elsewhere, such ambiguity can contribute to a practice context ripe for unreliability, bias, and disagreement when various constituents in eligibility determination processes vary in their interpretations of eligibility criteria ([<reflink idref="bib44" id="ref40">44</reflink>]; Sullivan et al., [<reflink idref="bib53" id="ref41">53</reflink>]a). Research has often focused on educators' meaning making and potential biases (e.g., Fish, [<reflink idref="bib18" id="ref42">18</reflink>]; Sullivan et al., [<reflink idref="bib53" id="ref43">53</reflink>]), but the sense-making of all involved, including throughout dispute resolution, can affect eligibility.</p> <hd id="AN0189687709-4">Dispute Resolution Process</hd> <p>When parents and school districts disagree on eligibility, IDEA provides multiple avenues for resolution: informal resolution; mediation; due process complaint; state complaint; and due process hearings (20 U.S.C. § 1415[b–f]). When informal resolution and mediation fail, parents can opt for due process that may involve administrative law judges or federal courts; processes and associated law vary by state and can be escalated to higher courts through appeals (for descriptions of the court system and associated legal processes, see [<reflink idref="bib8" id="ref44">8</reflink>]; [<reflink idref="bib37" id="ref45">37</reflink>]; [<reflink idref="bib52" id="ref46">52</reflink>]). Thus, legal opinions regarding IDEA can be made at all levels of the judicial system. Due process hearings are particularly salient because they are "[t]he primary mechanism for dispute resolution under IDEA" ([<reflink idref="bib66" id="ref47">66</reflink>], p. 3). As noted by [<reflink idref="bib50" id="ref48">50</reflink>], p. 398):</p> <p>Hearing officers interpret the law in their decisions, and although they are not legally binding outside of the hearings per se, in any given state or region, judges may use many such decisions to aid their interpretation of IDEA and related guidance when cases advance through the courts ... which may inform actions by states, [districts], and individual practitioners.</p> <p>The ambiguity of federal and state statutes confers importance to such meaning-making by these policy actors, whose decisions, in turn, can constitute another dimension of special education policy influential on practice. Legal scholars have lamented the considerable short- and long-term implications of inconsistent interpretations by educators and the courts, because, as [<reflink idref="bib49" id="ref49">49</reflink>] noted:</p> <p>The language of these standards is, at best, open to a wide range of speculation and confusion. ... The standards do not provide language that explains how a court should determine if this standard is met, and further, they do not provide guidance on how exactly the court should determine the connection between ADHD symptoms and student behaviors or how to weigh possible external factors against the ADHD diagnosis. (p. 208)</p> <p>At all levels, decision-making is likely shaped by both interpretation of the law and constituents' conceptualization of educational, medical, and psychological constructs, including judges' "lay understanding of learning problems and psychopathology" ([<reflink idref="bib44" id="ref50">44</reflink>], p. 1140; for other examples, see [<reflink idref="bib1" id="ref51">1</reflink>]). These, in turn, are shaped by public discourse, cultural narratives, and media representations about ADHD, which are often counter to consensus within the medical community ([<reflink idref="bib49" id="ref52">49</reflink>]). Further, such meaning-making can reflect a variety of assumptions and biases given the relations of the social construction of disability and associated constructs (e.g., normal/acy, intelligence, culpability) to racism, class, gender, and other social structures (e.g., [<reflink idref="bib4" id="ref53">4</reflink>]; [<reflink idref="bib48" id="ref54">48</reflink>]) and political contexts ([<reflink idref="bib55" id="ref55">55</reflink>]).</p> <p>In addition, despite the importance of due process, it is not necessarily accessible to all families. In the last few decades, there has been a decline in due process hearings (Government Accountability Office [GAO], 2019). This may be due at least in part to the 2006 Supreme Court decision in <emph>Schaffer v. Weast</emph> that put the burden of proof on the filing party, who have, historically most often been the parents ([<reflink idref="bib10" id="ref56">10</reflink>]). Families filing due process hearings may be disadvantaged by lack of legal knowledge, access to documentation, or funding for representation and experts (Itkonen et al., [<reflink idref="bib29" id="ref57">29</reflink>]). It can be a high-risk process for families, as petitioners may be held responsible for all court costs if a case is deemed unwarranted litigation ([<reflink idref="bib38" id="ref58">38</reflink>]). School districts also tend to avoid escalation to due process due to the costs related to resolution and damage to the relationship with families ([<reflink idref="bib38" id="ref59">38</reflink>]). Often, special education practice is at least partially informed by legal counsel to avoid expensive legal fees or reimbursement due to inappropriate eligibility decisions.</p> <p>Nonetheless, these hearings remain important to interpretation of the law and subsequent practice. Relatively little scholarship has been directed at systematically understanding judges' decisions and rationales regarding eligibility processes and access to services for students who have ADHD-like behaviors. For example, [<reflink idref="bib44" id="ref60">44</reflink>] used cases to illustrate the incompatibility of judicial decision-making and school psychologists' ethical obligations for research-based decisions in similar situations, but did not do so systematically in a study. Other non-empirical literature is dated, as informal analyses followed shortly after the inclusion of ADHD in IDEA (e.g., [<reflink idref="bib23" id="ref61">23</reflink>]). The one previous case law review focused on students who have been formally diagnosed with ADHD across all eligibility categories, not only OHI ([<reflink idref="bib35" id="ref62">35</reflink>]), but generalizability is limited given that medical diagnosis is not required for OHI eligibility in several states ([<reflink idref="bib9" id="ref63">9</reflink>]) and their study was limited to cases published before February 2011.</p> <hd id="AN0189687709-5">Current Study and Conceptual Framework</hd> <p>As the prevalence of ADHD increases, more students are likely to benefit from specialized support in schools, including special education, to support their learning and wellbeing. Although decisions pertaining to youths' ADHD-related support needs in other sectors of care are often related to diagnostic criteria specified by professional experts, special education eligibility is bounded by IDEA and subsequent policy guidance, including judicial interpretations ([<reflink idref="bib50" id="ref64">50</reflink>]), and all of the very human issues related to judges' funds of knowledge and biases ([<reflink idref="bib49" id="ref65">49</reflink>]). This systematic case law review builds on and expands significantly earlier works (e.g., [<reflink idref="bib1" id="ref66">1</reflink>]; [<reflink idref="bib35" id="ref67">35</reflink>]; [<reflink idref="bib44" id="ref68">44</reflink>]; [<reflink idref="bib49" id="ref69">49</reflink>]) by examining all cases in which eligibility has been disputed in the OHI category for children with ADHD-like symptoms in the years since IDEA's most recent reauthorization. Additionally, given the importance of judges' meaning making of ambiguous IDEA criteria, we examined judges' rationale, including how judges made sense of educational need, as well as the characteristics of students and families involved. Lastly, to support a contextualized examination of case law, we explored trends in eligibility by state and time, as well as any external factors related to parents being the prevailing party. Thus, the research questions that guided this systematic case law review were:</p> <p></p> <ulist> <item> What were the judges' rationales for making decisions about eligibility for OHI-ADHD?</item> <p></p> <item> What trends emerged in decisions across time and geographical areas?</item> <p></p> <item> What external factors, if any, were related to parents being the prevailing party?</item> </ulist> <p>We approached this study consistent with previous case law and policy analyses pertaining to the implementation and interpretation of various features of IDEA ([<reflink idref="bib50" id="ref70">50</reflink>]). It is grounded in theories of judicial reasoning that integrate interdisciplinary perspectives from law, psychology, and sociology. Thus recognizing that judges' reasoning—like all peoples'—is a result of the interplay of premises, facts, and biases that help to explain inconsistency across individuals and contexts ([<reflink idref="bib24" id="ref71">24</reflink>]; [<reflink idref="bib52" id="ref72">52</reflink>]). This aligns with legal endogeneity theory that proposes that "the content and meaning of law is determined within the social field that it is designed to regulate" ([<reflink idref="bib15" id="ref73">15</reflink>], p. 407). When law is ambiguous—like IDEA—meaning-making is dynamic as procedures are driven by legal mandates that are interpreted and re-interpreted through dispute resolution processes. Thus, it is integral to analyze the decision-making within these processes, not only to shed light on the general representation of the law within our field, but also to examine the variations.</p> <p>In doing so, we appreciate Zirkel's ([<reflink idref="bib64" id="ref74">64</reflink>]) critiques and cautions regarding explorations of law in special education literature in emphasizing the need for authors to differentiate between legal obligations and recommendations, and between the facts in and rulings of cases, ideally in a systematic review of cases with authors differentiating between neutral descriptions and advocacy. In particular, we sought to systematically identify and describe applicable cases—that is, describing the context as it is—as the basis for conclusions and recommendations for how professional activities in this domain can be improved in keeping with <emph>Exceptional Children's</emph> equity-oriented commitments, particularly those related to facilitating agency for students with disabilities, and their families ([<reflink idref="bib56" id="ref75">56</reflink>]).</p> <p>We describe this systematic process in the method below, followed by presentation of the descriptive results, to summarize how policy pertinent to OHI-ADHD eligibility has been interpreted following the approach of other policy and case law analyses in education, particularly those cited above. Although we endeavored to describe cases as neutrally as possible in the results, we recognize that no scholarship is truly neutral (Arora et al., [<reflink idref="bib5" id="ref76">5</reflink>]). Further, consistent with editorial perspectives of the journal ([<reflink idref="bib57" id="ref77">57</reflink>]), we recognize policy as a crucial structural factor shaping students' educational opportunity. Thus, we sought to use the descriptive analysis of cases as the basis for interpreting how OHI-ADHD eligibility determinations inform what is considered a disability, and for offering recommendations to improve professional practice and school-family relationships. In doing so, we aim to balance Zirkel's (2014) notions of impartiality and advocacy, with the former guiding the method and results, and the latter reflected in resultant recommendations to improve educational experiences of students and their families, recognizing, as Zirkel notes, that the law often sets a lower bar than best practice and advocacy.</p> <hd id="AN0189687709-6">Method</hd> <p></p> <hd id="AN0189687709-7">Search Strategy</hd> <p>This study was IRB exempt due to not involving human subjects. In order to identify relevant case law, we searched the LRP Special Ed Connection online database (<ulink href="http://www.specialedconnection.com">http://www.specialedconnection.com</ulink>), a comprehensive database of special education case law, statutes, and regulations, as well as federal policy. We used the search terms (Other Health Impairment, OHI, eligib%, 5) to identify all cases in which OHI or other health impairment occurred within five words of anything with the root "eligib." This returned any case that included a combination of the words "other health impairment" OR "OHI" AND "eligib*" within five words of each other, and ensured we would get all cases that discussed eligibility for Other Health Impairment. Although the initial search included all case law from 1996, only cases from 2004 and onwards were kept for screening, given that IDEA was reauthorized that year. The search was completed in two phases, one in 2017 and the other in 2021. The first phase yielded 877 cases (2004 to 2017), whereas the second search (2017 to 2021) yielded 108 cases which resulted in a total of 985 case law for initial review. Analysis of the cases began after the second search was completed.</p> <hd id="AN0189687709-8">Eligibility Criteria and Screening</hd> <p>For a case law to be included in the initial screen, the legal conflict had to be about special education eligibility under IDEA, specifically for OHI related to ADHD. A case was excluded from the initial screen if it was (a) not about eligibility (e.g., manifestation determinations, case was about provision of free appropriate public education [FAPE]), (b) about OHI eligibility but not ADHD-related, (c) a duplicate, and (d) not a case related to IDEA (e.g., Section 504 disputes or discrimination under civil rights law). In some cases, though OHI-ADHD was not the eligibility in contention, judges concluded that this could be a suspected area of disability that should be assessed. These cases were also excluded, given that eligibility was not discussed. A total of five coders screened the initial 985 articles. This screen resulted in a total of 288 cases being included. Each of these cases was then coded by four coders, including the first author. During this round of coding, a further 87 cases were excluded using inclusion and exclusion criteria, resulting in a total of 202 cases being included in this review. For a complete list of cases included see supplementary materials.</p> <hd id="AN0189687709-9">Data Extraction</hd> <p>Coding captured the year of the decision, state, type of proceeding, who the plaintiff was, the rationale of the judges when making their decision, and the final decision regarding eligibility. During analysis, states were grouped into five geographic regions ([<reflink idref="bib41" id="ref78">41</reflink>]), and years were grouped into four time periods for comparison across time. The other characteristics coded were descriptives of the case, including age, grade and sex/gender of the student; other special education categories involved; whether the student had medical diagnoses; the student's discipline history (suspensions/expulsions), academic history, social-emotional history, and behavioral history; whether a school psychologist was involved in the evaluation or testimony; who the parents or district's experts were; medical doctor involvement; what the contested aspects of the evaluation were (if any); and other notable aspects pertaining to the decision.</p> <p>Given that judges' rationales regarding eligibility are primarily based on IDEA's three prongs (meeting of federal/state eligibility criteria, adverse educational impact, need for specialized services to receive FAPE), but that several factors contribute to these conclusions, the rationale code was categorical to represent these nuances. In addition to the three prongs, other coding options were whether the evaluation was deemed (in) appropriate, whether a persuasive outside or district expert swayed the judge's opinion, whether the judge explicitly stated clinical criteria for ADHD as the primary reason for eligibility, whether needs were attributed to another eligibility category, and if there was no ruling. The code that provided the most insight and specificity into the legal rationale was selected for each case. To support the coding of the rationale, the corroborating description was extracted from the case to provide more details about the judge's rationale. For example, in several cases, the categorial code was "persuasive outside/district expert." Some examples of the corroborating descriptive quote extracted were "relying on the testimony of Dr. Stewart, the ALJ held that, due to the failure to identify C. as a student in need of special education ... resulted in an incorrect decision" (Williamson County Board of Education v. C.K, 2009, <emph>p</emph>. 14), "I further find that because such disabilities substantially limit his learning, as Dr. [ ] demonstrated ... does not disqualify him under IDEA." (Virginia State Educational Agency v. Student with a Disability, 2004, <emph>p</emph>. 3), and "the Hearing Officer finds persuasive the testimony of Ms. X, Ms. Y, and Dr. Z regarding Student's ability to pay attention in class ... attention and auditory processing deficits did not rise to the level requiring special education." (Encinitas Union School District, 2004, <emph>p</emph>. 12). For an example of each type of code, as well as a codebook, please see Supplementary Tables 1 and 2 in the online supplemental material.</p> <hd id="AN0189687709-10">Interrater Reliability</hd> <p>Interrater reliability was calculated at two stages of the screening process: initial screening and coding. The first author provided training to the second (third-year doctoral student), third (fourth-year doctoral student), and fifth (first-year graduate student) authors on the screening and coding procedures in consultation with a law colleague. To ensure standardization in the coding process, two cases were coded as a group, and then two individually during training. The authors randomly double-screened 20% of the initial articles and double-coded 15% of included articles. Cases chosen for inter-rater reliability were chosen at random and underwent masked review by raters. Raters only double-coded cases that they did not code in the first round. Agreement was 90% for the initial screen and 95% for coding. Any disagreements in coding were resolved by team discussion until agreement reached 100%.</p> <hd id="AN0189687709-11">Results</hd> <p></p> <hd id="AN0189687709-12">Descriptive Characteristics of Analytic Sample</hd> <p>A total of 202 cases met the eligibility criteria for examining judges' eligibility decisions for OHI due to ADHD (OHI-ADHD). All United States geographic regions were represented among the cases, with most cases coming from the Southeast (32%, <emph>n</emph> = 64) and West (29%, <emph>n</emph> = 58). The majority of these cases were decided at the administrative hearing level, except for cases that were appeals of previous decisions. Families were the primary plaintiffs in almost all cases (98.5%, <emph>n</emph> = 199). All parent-initiated cases were disagreements with the district finding their child ineligible for services or eligible for a category other than OHI-ADHD.</p> <p>Most personal and demographic characteristics of students and families were redacted in official documents to protect confidentiality. In cases where the age of the student was disclosed, students were primarily between the ages of 14–18 (25%, <emph>n</emph> = 51), followed by 5–10 (21%, <emph>n</emph> = 42), 11–13 (15%, <emph>n</emph> = 31), and 19–20 (2%, <emph>n</emph> = 4). Nearly half of the cases involved boys (<emph>n</emph> = 109). The most prevalent concurrent eligibility category discussed was specific learning disability (<emph>n</emph> = 103; 51% of cases), followed by emotional disturbance (<emph>n</emph> = 63), autism (<emph>n</emph> = 10), intellectual disability (<emph>n</emph> = 5), developmental delay (<emph>n</emph> = 2), and other health impairments not ADHD (<emph>n</emph> = 12). Similarly, most (<emph>n</emph> = 175) cases involved students with formal diagnoses of ADHD. The most prevalent mental health disorders were those considered part of mood disorders (e.g., depressive disorders, bipolar and related disorders, <emph>n</emph> = 30) and disruptive, impulse-control, and conduct disorders (<emph>n</emph> = 26). See Table 1 and Table 2 for additional information about the descriptive characteristics of cases and the students described within.</p> <p>Table 1. Descriptive Information of Included Cases (N = 202).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left"><bold>Descriptive Characteristics</bold></th><th align="left"><bold><italic>n</italic></bold></th><th align="left"><bold>%</bold></th></tr></thead><tbody><tr><td>Geographic Region</td><td /><td /></tr><tr><td> West (Alaska, California, Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, Utah, Washington, Wyoming)</td><td>58</td><td>29</td></tr><tr><td> Southwest (Arizona, New Mexico, Oklahoma, Texas)</td><td>29</td><td>14</td></tr><tr><td> Midwest (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin)</td><td>23</td><td>11</td></tr><tr><td> Southeast (Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, West Virginia)</td><td>64</td><td>32</td></tr><tr><td> Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont)</td><td>28</td><td>14</td></tr><tr><td>Year</td><td /><td /></tr><tr><td> 2004–2007</td><td>82</td><td>41</td></tr><tr><td> 2008–2011</td><td>47</td><td>23</td></tr><tr><td> 2012–2015</td><td>48</td><td>24</td></tr><tr><td> 2016–2020</td><td>25</td><td>12</td></tr><tr><td>Type of Proceeding</td><td /><td /></tr><tr><td> Administrative hearing</td><td>183</td><td>91</td></tr><tr><td> District court</td><td>5</td><td>2</td></tr><tr><td> Appellate court</td><td>3</td><td>2</td></tr><tr><td> Administrative appeal</td><td>11</td><td>5</td></tr><tr><td>Plaintiff</td><td /><td /></tr><tr><td> Single family</td><td>199</td><td>98</td></tr><tr><td> District</td><td>3</td><td>2</td></tr><tr><td>Age of Student</td><td /><td /></tr><tr><td> 5–10</td><td>42</td><td>21</td></tr><tr><td> 11–13</td><td>31</td><td>15</td></tr><tr><td> 14–18</td><td>51</td><td>25</td></tr><tr><td> 19–20</td><td>4</td><td>2</td></tr><tr><td> Not reported</td><td>74</td><td>37</td></tr><tr><td>Sex of Student</td><td /><td /></tr><tr><td> Male</td><td>109</td><td>54</td></tr><tr><td> Female</td><td>38</td><td>19</td></tr><tr><td> Not reported</td><td>55</td><td>27</td></tr><tr><td> Suspension or Expulsion Reported</td><td>81</td><td>40</td></tr></tbody></table> </ephtml> </p> <p>Table 2. Special Education Eligibility Categories and Diagnoses Referenced in Cases (N = 202).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left"><bold>Categories and Diagnoses Referenced</bold></th><th align="left"><bold><italic>n</italic></bold></th></tr></thead><tbody><tr><td>Special Education Eligibility Category</td><td /></tr><tr><td> Specific learning disabilities</td><td>103</td></tr><tr><td> Emotional disturbance</td><td>63</td></tr><tr><td> Speech or language impairments</td><td>17</td></tr><tr><td> Other health impairments – not ADHD</td><td>12</td></tr><tr><td> Autism</td><td>10</td></tr><tr><td> Intellectual disability</td><td>5</td></tr><tr><td> Developmental delay</td><td>2</td></tr><tr><td>Clinical Diagnosis or Conditionsa</td><td /></tr><tr><td> Attention-deficit/hyperactivity disorder</td><td>175</td></tr><tr><td> Chronic physical illnessesc</td><td>37</td></tr><tr><td> Mood disordersb</td><td>30</td></tr><tr><td> Disruptive, impulse-control, and conduct disorders</td><td>26</td></tr><tr><td>Specific learning disorder</td><td>15</td></tr><tr><td> Anxiety disorders</td><td>14</td></tr><tr><td> Trauma-and stressor-related disorders</td><td>14</td></tr><tr><td> Autism spectrum disorder</td><td>5</td></tr><tr><td> Substance-related and addictive disorders</td><td>4</td></tr><tr><td> Obsessive-compulsive and related disorders</td><td>2</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. The number of cases does not equal the final number of included cases due to some cases including multiple special education categories or diagnoses.</p> <p>2 Categories of psychiatric or mental health conditions were derived from the Diagnosis and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR; [<reflink idref="bib3" id="ref79">3</reflink>]) categories in addition to groupings frequently mentioned in the included cases. <sups>b</sups> Depressive Disorders and Bipolar and Related Disorders were combined due to the separation of mood disorders from the DSM-4 to DSM-5. <sups>c</sups> This category includes disorders considered to be broad terms for a grouping of symptomology for physical health conditions.</p> <hd id="AN0189687709-13">Judges' Rationales for Eligibility Decisions</hd> <p>The district was the prevailing party in 67% of total cases (<emph>n</emph> = 136), parents the prevailing party in 27% (<emph>n</emph> = 54), and in a total of 6% (<emph>n</emph> = 12) of cases, decisions regarding eligibility were inconclusive. In most cases where the district prevailed, the judge agreed with the district's decision to find a child ineligible for special education services entirely (<emph>n</emph> = 125) or eligible for services in another category (<emph>n</emph> = 8). There were also a few cases in which the district prevailed in their decision to keep OHI-ADHD as the service of need when parents advocated for the complete removal of services (<emph>n</emph> = 1) or parents disagreed with the change in service category (<emph>n</emph> = 2). In contrast, in all cases in which parents prevailed, the judge determined that the child was eligible for services for OHI-ADHD.</p> <p>In all cases, the judges provided their rationale for making their eligibility decision. Judges' most prevailing rationale for their decisions was educational need (46.5%, <emph>n</emph> = 94), followed by whether the evaluation was appropriate (24.8%, <emph>n</emph> = 50). The third most cited rationale was the federal definition of eligibility (15.8%, <emph>n</emph> = 32)<emph>.</emph> Parents and districts often called upon expert witness testimonials; in 6.5% (<emph>n</emph> = 13) of cases, judges stated that persuasive outside experts influenced their decision. Judges relied on state eligibility definitions in 3% of cases and clinical diagnoses in 2% of their eligibility determinations. See Table 3 for a more detailed description of the judge's rationales.</p> <p>Table 3. Eligibility Decisions by Judges' Rationale for the Decisions (N = 202).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left" rowspan="2"><bold>Decision</bold></th><th align="left" rowspan="2"><bold><italic>n</italic></bold></th><th align="left" rowspan="2"><bold>% District Prevailing</bold></th><th align="left" colspan="7"><bold>Rationale Code (<italic>n</italic>)</bold></th></tr><tr><th align="left"><bold>Federal Definition</bold></th><th align="left"><bold>Educational Need</bold></th><th align="left"><bold>Evaluation Appropriate</bold></th><th align="left"><bold>Evaluation Inappropriate</bold></th><th align="left"><bold>Persuasive Expert</bold></th><th align="left"><bold>State Definition</bold></th><th align="left"><bold>DSM Criteria</bold></th></tr></thead><tbody><tr><td>Not Eligible</td><td>125</td><td>100%</td><td> 21</td><td>69</td><td>20</td><td>0</td><td>7</td><td>6</td><td>2</td></tr><tr><td>Eligible OHI-ADHD</td><td>57</td><td> 5.2%</td><td>8</td><td>25</td><td>1</td><td>17</td><td>5</td><td>0</td><td>1</td></tr><tr><td>Eligible ED</td><td>2</td><td> 100%</td><td>0</td><td>0</td><td>0</td><td>1</td><td>0</td><td>0</td><td>0</td></tr><tr><td>Eligible SLD</td><td>3</td><td> 100%</td><td>2</td><td>0</td><td>0</td><td>0</td><td>1</td><td>0</td><td>0</td></tr><tr><td>Eligible - Other Category</td><td>3</td><td>100%</td><td>1</td><td>0</td><td>0</td><td>0</td><td>0</td><td>0</td><td>1</td></tr><tr><td>Not Decided</td><td>12</td><td>NA</td><td>1</td><td>0</td><td>0</td><td>11</td><td>0</td><td>0</td><td>0</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note</emph>. There was a total of two cases that were coded "IDEA stresses on appropriate education, not labels" but were not included in the table to aid conciseness. OHI-ADHD = Other Health Impairment – Attention-Deficit/Hyperactivity Disorder; ED = Emotional Disorder; SLD = Specific Learning Disability, DSM = Diagnosis and Statistical Manual of Mental Disorders.</p> <p>Notable themes emerged among the cases for the rationales in decision-making. In a total 40 out of the 202 cases, judges explicitly mentioned the need for specialized services in determining eligibility. For example, when denying eligibility, it was observed that students could be served in the general education setting with accommodations. When educational need was stated as the rationale for deciding eligibility, both academic performance (e.g., grades, standardized tests) and behavioral evidence (disruptive behavior, aggression, etc.) was used. Similarly, although 40% of cases included students who had a history of formal disciplinary actions, this was not related to judges' decisions about eligibility. When judges deemed the evaluation was inappropriate, the primary themes that emerged included not taking into account external medical reports or outside evaluations (<emph>n</emph> = 9), only considering grades and not assessing for social-emotional functioning and behavior in school settings (<emph>n</emph> = 9), and lastly, excluding important sources of data from the evaluation (e.g., information from private schools, general education teachers; <emph>n</emph> = 3).</p> <hd id="AN0189687709-14">Trends Over Time and Geographical Area</hd> <p>For the purpose of analyzing trends in the number of cases and decision rationale over time, the cases ranging from 2004 to 2020 were split into four time periods: 2004 to 2007, 2008 to 2011, 2012 to 2015, and 2016 to 2020. The overall trend in the frequency of cases regarding OHI eligibility for ADHD is a decrease over time from 2004 to 2020. Most cases were decided right after the reauthorization of IDEA, with 41% (<emph>n</emph> = 83) of cases decided in 2004 to 2007. In terms of geographical area, the majority of cases came from four states/districts, three of which are the most populous states in the country: California (<emph>n</emph> = 43), the District of Columbia (<emph>n</emph> = 41), Pennsylvania (<emph>n</emph> = 18), and Texas (<emph>n</emph> = 25). The district was the prevailing party in the majority of cases within three of these states: Pennsylvania (78% of cases within the state), California (72%), and Texas (68%). In the District of Columbia, however, the district was the prevailing party in fewer than half (46%) of the cases. Across all four states, judges most often cited educational need in their decision rationale. Some states (ND, NE, UT, VA, WI, CA, OK, DC, CO, NY; [<reflink idref="bib9" id="ref80">9</reflink>]) do not require that children have a medical diagnosis of ADHD as part of eligibility criteria for OHI. However, 87% (<emph>n</emph> = 97) of the cases in these states had children with formal medical diagnosis of ADHD, and thus there was no discernible trend that having a formal diagnosis increased chances of being found eligible.</p> <hd id="AN0189687709-15">Expert Witnesses</hd> <p>An outside factor that emerged in parents being a prevailing party was the presence of an expert witness, regardless of whether the judge specifically cited the expert witness in their decision rationale. In 68% of cases, parents had a type of expert witness (<emph>n</emph> = 137). When compared to parents who did not have an expert witness, parents who did were three times more likely to win their case (<emph>OR</emph> = 3.67, 95% CI [1.75, 7.75]). The most common expert witnesses, almost half, who testified on behalf of parents were licensed psychologists (<emph>n</emph> = 67). Other experts included medical doctors (<emph>n</emph> = 25, 18%) and educational advocates (<emph>n</emph> = 23, 17%). For school districts, members of the multidisciplinary evaluation teams were the most common expert witnesses, including special education teachers, school psychologists, speech-language pathologists, school counselors, social workers, and interventionists (<emph>n</emph> = 125, 62% of cases). School psychologists were individually reported as expert witnesses or testified in 47% of the cases (<emph>n</emph> = 94), and this number is likely an underestimation as they are usually considered part of the school's multidisciplinary team. Districts relied on special education directors, coordinators, or directors of student services as expert witnesses in 13% of cases. Principals and assistant principals were called upon as expert witnesses in 6% of cases (<emph>n</emph> = 12). School districts rarely relied on medical doctors (1% of cases) as expert witnesses.</p> <hd id="AN0189687709-16">Discussion</hd> <p>This study reviewed 202 case law decisions in which parents and districts disagreed on whether a child was eligible for services in the category of OHI for ADHD. Consistent with previous findings on due process decisions (e.g., [<reflink idref="bib39" id="ref81">39</reflink>]), most decisions were in favor of the school district. Judges primarily relied on educational need to make decisions regarding eligibility, and academic performance was the most common evidence that judges used when determining eligibility, suggesting that judges primarily conceptualize disability in terms of its academic manifestations. These results aligned with Martin and Zirkel's (2011) review, which highlighted that academic performance was commonly used as evidence of adverse effects and need for specialized services. However, a substantial number of decisions also relied on behavioral evidence, especially in cases where parents prevailed, suggesting that broader conceptualizations of disability may have been influential. Such conceptualizations are consistent with research showing that ADHD and ADHD-like symptoms affect both academic and behavioral performance in school.</p> <p>In the years since the passage of IDEA, and the subsequent incorporation of ADHD as a condition explicitly referenced in OHI criteria, ample case law has grappled with the vague mandates around eligibility criteria for OHI-ADHD; however, there was a general decline in the number of cases from 2004 to 2021. This reflects a downward nationwide trend of due process cases in special education overall ([<reflink idref="bib65" id="ref82">65</reflink>]). This may indicate the success of federal mandates encouraging school districts to mediate conflicts with parents to prevent escalation to due process (IDEA, 2004; [<reflink idref="bib38" id="ref83">38</reflink>]), as well as the effect of <emph>Schaffer v. Weast</emph> (2006) in discouraging families to pursue disputes through the courts. It may also reflect growing public awareness of ADHD, both generally, and in the context of IDEA specifically.</p> <hd id="AN0189687709-17">Limitations and Future Directions</hd> <p>This study provided a comprehensive analysis of case law on eligibility for OHI-ADHD, but is not without limitations. Results represent published judicial decisions about eligibility disputes for ADHD-OHI, but are not representative of disputes at large (e.g., unpublished cases, those resolved in mediation meetings), as most disputes are settled before reaching a court hearing (GAO, 2019). Thus, results may not be generalizable to the full spectrum of eligibility disputes regarding eligibility, but rather only when cases move to due process. Future research could explore the features and outcomes of disputes that do not proceed to this stage, consistent with recommendations elsewhere ([<reflink idref="bib35" id="ref84">35</reflink>]). Additionally, pursuing judicial action for dispute resolution requires considerable resources ([<reflink idref="bib60" id="ref85">60</reflink>]), so the school districts, families, and students represented within these cases may reflect an especially privileged subset of the population. Because demographics were omitted from most case documents, we were not able to explore issues related to different social statuses despite their importance to meaning making and access. In addition, although students with ADHD may be eligible for services under IDEA or Section 504, the scope of this study centered on judges' decisions about eligibility under IDEA. Future research could expand on disputes related to Section 504 entitlement. Lastly, further examination of whether specific state variation in eligibility is related to judges' decision-making is warranted.</p> <hd id="AN0189687709-18">Implications for Practice, Partnership, and Policy</hd> <p>In one-quarter of the cases, judges based their decision about eligibility on their determination of the evaluations' (in) appropriateness. Contested aspects included domains of evaluation (i.e., not accounting for social, emotional, and behavioral functioning), and, to a smaller extent, external sources of data, including private evaluations and medical reports. Potential for conflict may be reduced when multidisciplinary evaluation teams ensure that eligibility evaluations are comprehensive and include consideration of a range of data sources that span multiple domains of functioning, contexts, and sources, consistent with best practice recommendations for multi-method, multi-source evaluations—a commonly used tool to help guide school teams is the RIOT/ICEL matrix ([<reflink idref="bib12" id="ref86">12</reflink>]). For example, including standardized behavioral data in psychoeducational reports to justify eligibility recommendations will likely make districts' arguments stronger, and better inform planning for services, supports, and accommodations regardless of eligibility decisions. Although judges highlighted the importance of considering external evaluation data, the results of this study indicate that, in general, judges do not rely on the medical diagnosis of ADHD to make decisions on eligibility. Instead, most relied on direct observable evidence of adverse educational impact, underscoring the centrality of perceived educational needs in their decision-making. Additionally, independent of state regulations, most children already had an ADHD diagnosis implying that, in due process, diagnosis is rarely a point of contention. Thus, team members have a necessary role as liaisons with community-based professionals and medical providers who provide diagnoses of ADHD, and families navigating complex and often confusing processes across sectors of care. This role includes educating others about the difference between educational disability eligibility and medical diagnosis, as well as clarifying this distinction throughout the evaluation process, both to families and outside providers, given research suggesting that misunderstanding of special education may be common among physicians (Shah et al., [<reflink idref="bib47" id="ref87">47</reflink>]).</p> <p>Finally, educators and related service providers should stay up to date with relevant policy, case law, and public discourse related to ADHD and disability that may contribute to conflicts with families in the special education evaluation process. Misconceptions about neurodevelopmental disorders, including ADHD, appear equally common with the general public and educational community, so psychoeducation holds value for both (e.g., [<reflink idref="bib22" id="ref88">22</reflink>]). To support appropriate practice, state educational agencies can provide explicit guidance on eligibility criteria as it pertains to ADHD. This guidance could lean on current clinical understandings of how ADHD can manifest in school contexts to support educators and families to make meaning of the terms within OHI criteria, such as "limited vitality and alertness" (34 CFR§300.306).</p> <p>Additionally, in order to further contribute to dispute prevention efforts, educational staff must be cognizant of the factors that exacerbate special education conflict with families and associated strategies to respond to these factors. Some of these factors include differences in the school and parents' views of the student (i.e., parents perceive school as using a deficit-based lens), lack of procedural knowledge sharing with parents, and breakdown in school–parent relationships (e.g., communication, trust, honesty, dynamics of power; see [<reflink idref="bib31" id="ref89">31</reflink>]). Through relationship building, collaboration, and transparent, accessible information sharing, teams can support shared decision making, family engagement, and co-leadership in decision-making processes, and thus avoid preventable disputes.</p> <p>Shared decision-making should be predicated on shared knowledge, access, and equal participation. Power and knowledge imbalances impede this. Districts were, overall, much more likely to be the prevailing party, a finding replicated across other studies of due process (e.g., [<reflink idref="bib39" id="ref90">39</reflink>]; [<reflink idref="bib65" id="ref91">65</reflink>]). School districts in more economically advantaged geographical areas are disproportionately represented in disputes, including due process, mediation, and state complaints, implying that families with more financial resources are more likely to file due process complaints, more likely to reject mediation efforts, and more likely to be represented in due process hearings (GAO, 2019).</p> <p>Unsurprisingly, families often consider due process hearings to be time consuming, costly, emotionally draining, and overall "unfair" ([<reflink idref="bib38" id="ref92">38</reflink>], p. 137). When juxtaposed with research on special education, attorneys suggests that the lack of resources (e.g., access to representation, knowledge of the complexities of the process when self-representing, cost of attorneys and expert witnesses, and time) may contribute to mediation agreements being more favorable toward districts. This underscores the imbalance of power in these processes ([<reflink idref="bib60" id="ref93">60</reflink>]). Additionally, families' limited understanding of special education law, rights, and procedures likely contributes to district advantages. Taken together, this suggests that the underlying assumption within IDEA that parents are equal participants in special education decision-making and can fully participate in processes—including conflict resolution—is often erroneous. Improving transparency, accessibility, and participation with explicit ongoing attention to status and power imbalances is crucial.</p> <p>One key area for improvement is in how family rights and special education processes are communicated. Research on the readability of parental rights documents found that not only was just 4% to 8% of the documentation across states written at the recommended reading level of seventh to eigth grade or below, but about 20% to 50% of the documents were written at college-level or higher ([<reflink idref="bib19" id="ref94">19</reflink>]), rendering them inaccessible to many users. Where documents are not written accessibly, advocates, technical assistance centers, parent information centers, and even school personnel such as school psychologists can be helpful in supporting understanding of parent rights and contributing to more equitable decision-making processes.</p> <p>Not only is understanding crucial, but resources to follow through in the dispute process are important. Results highlighted that the use of an expert witness increased a family's odds of being the prevailing party, and thus could be a reasonable recommendation to parents when entering the dispute resolution process. However, many of these experts were licensed psychologists and educational advocates whose services can be expensive and time-consuming. Thus, families with greater resources may not only be more likely to reach the due process stage (GAO, 2019), but our results highlight that they also could be much more likely to prevail and, as a consequence, their children are more frequently given access to the specialized services sought by the families. This represents a unique aspect of educational inequity. On average, children from under-resourced and marginalized families are disproportionately identified for special education services, especially in categories that have vague eligibility criteria or are "soft" disabilities for which bias in identification is a concern ([<reflink idref="bib2" id="ref95">2</reflink>]; [<reflink idref="bib54" id="ref96">54</reflink>]). However, when viewed within the context of school districts serving families that are from a high socioeconomic status, these families are much better positioned to engage in dispute resolution with school districts when they perceive that their disabled child's rights are not being met. This relates back to Skrtic and colleagues' (2021) analysis of disability as status competition, although their concern was race. Fulfilling the spirit of IDEA necessitates preventing such dynamics ([<reflink idref="bib51" id="ref97">51</reflink>]).</p> <p>The complexities of the special education system in general, combined with the variation in eligibility criteria for the OHI category, make it more difficult for families to navigate due process, especially when the burden is often on them to prove the inappropriateness of district actions. Inequities may be compounded by placing the burden of proof on the petitioner ([<reflink idref="bib38" id="ref98">38</reflink>]), which may, in turn, contribute to early settlement or districts prevailing more frequently, as the results show. Sociologists have pointed out that the more ambiguous the law, the more open it is to social construction, and thus vulnerable to dominant group interpretations that further marginalization ([<reflink idref="bib15" id="ref99">15</reflink>]). As such, the dispute resolution process may reinforce the status quo rather than providing legitimate avenues for justice to students with disabilities, especially those who are marginalized. In order to make the resolution process more equitable, and to avoid costly disputes, school districts must involve <emph>all</emph> parents fully in the intervention, referral, and evaluation processes.</p> <p>Accessibility could be supported via modifications toward "more comprehensive and uniform standards for procedure, discovery, and admission of evidence" ([<reflink idref="bib60" id="ref100">60</reflink>], p. 240). Taken together, there are numerous actions that can be taken at multiple levels—from interactions with families to state policy and technical assistance—to increase the transparency and accessibility of the myriad processes, including due process, where OHI-ADHD is concerned.</p> <hd id="AN0189687709-19">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-ecx-10.1177_00144029251360445 for When Is It OHI? A Review of Case Law Decisions for OHI - ADHD Eligibility by Tara Kulkarni, Elizabeth L. Shaver, Thuy Nguyen, Edvin Pepic, Evie M. Harter and Amanda L. Sullivan in Exceptional Children</p> <hd id="AN0189687709-20">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-2-ecx-10.1177_00144029251360445 for When Is It OHI? A Review of Case Law Decisions for OHI - ADHD Eligibility by Tara Kulkarni, Elizabeth L. Shaver, Thuy Nguyen, Edvin Pepic, Evie M. Harter and Amanda L. Sullivan in Exceptional Children</p> <hd id="AN0189687709-21">Acknowledgements</hd> <p>The contents of this report were developed in part under the Birkmaier Educational Leadership Professorship awarded to the last author. We would like to thank Mollie Weeks, Haley-Blue Isbell, and Dan Osher for their contributions to earlier iterations of this study.</p> <ref id="AN0189687709-22"> <title> References </title> <blist> <bibl id="bib1" idref="ref51" type="bt">1</bibl> <bibtext> Aggeler K. L. (2000). Is ADHD handy excuse? Remedying judicial bias against ADHD. 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Journal of Disability Policy Studies, 21(1), 3–8. https://doi.org/10.1177/1044207310366522</bibtext> </blist> </ref> <ref id="AN0189687709-23"> <title> Footnotes </title> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The authors received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Tara Kulkarni https://orcid.org/0000-0002-0735-5010 Thuy Nguyen https://orcid.org/0000-0001-6032-6756</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> </ref> <aug> <p>By Tara Kulkarni; Elizabeth L. Shaver; Thuy Nguyen; Edvin Pepic; Evie M. Harter and Amanda L. 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  Data: <searchLink fieldCode="DE" term="%22Decision+Making%22">Decision Making</searchLink><br /><searchLink fieldCode="DE" term="%22Disability+Identification%22">Disability Identification</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Court+Litigation%22">Court Litigation</searchLink><br /><searchLink fieldCode="DE" term="%22Federal+Legislation%22">Federal Legislation</searchLink><br /><searchLink fieldCode="DE" term="%22Equal+Education%22">Equal Education</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Education%22">Special Education</searchLink><br /><searchLink fieldCode="DE" term="%22Eligibility%22">Eligibility</searchLink><br /><searchLink fieldCode="DE" term="%22Criteria%22">Criteria</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Student+Relationship%22">Parent Student Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+School+Relationship%22">Parent School Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22School+Districts%22">School Districts</searchLink><br /><searchLink fieldCode="DE" term="%22Influences%22">Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Geographic+Regions%22">Geographic Regions</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Legislation%22">Educational Legislation</searchLink><br /><searchLink fieldCode="DE" term="%22Classification%22">Classification</searchLink><br /><searchLink fieldCode="DE" term="%22Judges%22">Judges</searchLink>
– Name: SubjectThesaurus
  Label: Laws, Policies and Program Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Individuals+with+Disabilities+Education+Act%22">Individuals with Disabilities Education Act</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/00144029251360445
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0014-4029<br />2163-5560
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Educators, families, and policy actors rely on federal and state special education law to inform many decision-making processes. Vague eligibility criteria within the laws can result in conflict between school districts and parents. Resulting due process hearing decisions can have important implications for future practice. One area of particular ambiguity and inconsistency is the disability category--other health impairment--for which students with attention-deficit/hyperactivity disorder may qualify. We examined outcomes of cases regarding disputes about eligibility for other health impairment where attention-deficit/hyperactivity disorder was considered, including judges' decisions, rationales, and factors influencing their decision-making, as well as trends over time and location. The systematic search process yielded 202 relevant cases wherein the majority of judges' decisions (67%) were in favor of the school district, often citing educational need, or lack thereof, in their rationale. The second most common rationale was the evaluation itself being deemed (in)appropriate. Parents who had an expert witness were almost four times more likely to prevail in their cases. We discuss implications for parents, practitioners, and policy.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1490690
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1490690
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/00144029251360445
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 164
    Subjects:
      – SubjectFull: Decision Making
        Type: general
      – SubjectFull: Disability Identification
        Type: general
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Court Litigation
        Type: general
      – SubjectFull: Federal Legislation
        Type: general
      – SubjectFull: Equal Education
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Special Education
        Type: general
      – SubjectFull: Eligibility
        Type: general
      – SubjectFull: Criteria
        Type: general
      – SubjectFull: Parent Student Relationship
        Type: general
      – SubjectFull: Parent School Relationship
        Type: general
      – SubjectFull: School Districts
        Type: general
      – SubjectFull: Influences
        Type: general
      – SubjectFull: Geographic Regions
        Type: general
      – SubjectFull: Educational Legislation
        Type: general
      – SubjectFull: Classification
        Type: general
      – SubjectFull: Judges
        Type: general
      – SubjectFull: Individuals with Disabilities Education Act
        Type: general
    Titles:
      – TitleFull: When Is It OHI? A Review of Case Law Decisions for OHI -- ADHD Eligibility
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Tara Kulkarni
      – PersonEntity:
          Name:
            NameFull: Elizabeth L. Shaver
      – PersonEntity:
          Name:
            NameFull: Thuy Nguyen
      – PersonEntity:
          Name:
            NameFull: Edvin Pepic
      – PersonEntity:
          Name:
            NameFull: Evie M. Harter
      – PersonEntity:
          Name:
            NameFull: Amanda L. Sullivan
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 0014-4029
            – Type: issn-electronic
              Value: 2163-5560
          Numbering:
            – Type: volume
              Value: 92
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Exceptional Children
              Type: main
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