The Education Exchange: Disability Diagnoses: The Latest Luxury Good at Elite Universities

PAUL PETERSON, HOST:

This is the Education Exchange with Paul Peterson. I am the director of the Harvard Program on Education Policy and Governance. Thank you for joining us. Over the past decade, those identified as in need of special education has climbed from 13 percent to 15 percent among all public school students. 13 percent to 15 percent. That’s a significant increment. But the percentage of college students presumably a set of especially high-performing students, has leaped upwards to a much higher level even at the country’s most elite universities, says Jeremy Ney, an adjunct professor at Columbia Business School and author of a forthcoming book entitled The Opportunity Map. I’m pleased to have Jeremy Ney with me on the Education Exchange today. Jeremy, thanks for joining our listeners on the Education Exchange.

JEREMY NEY: Thanks so much for having me today, Paul.

PETERSON: Well, Jeremy, you say that an astonishing 38 percent of the students at Stanford University, that’s the one in California, isn’t it? The Stanford University? Yeah, I’ve been out there. At Stanford University, has 38 percent of its students eligible for special accommodations due to their disabilities? Now, Jeremy, how can that be?

NEY: It’s absolutely right, Paul. We’ve now seen this astonishing rise in disability accommodations at elite universities and in the Ivy League. And what I found in the data is that these disability diagnoses have become a new luxury good. Over the last two decades, America has effectively established a two-tiered system of disability accommodations, one where the wealthiest students are claiming the most disabilities and those who need the most support are being left behind. So at Stanford today, 38 percent of those students are registered as having a disability. At Brown and Harvard, more than 20 percent of students are registered as disabled. And these numbers have more than doubled over the last decade.

PETERSON: What’s the cause of this explosion? Doubled, you say, doubled in the last decade. Are people falling over a cliff and coming crippled to class or what’s going on here?

NEY: No, the change really began in 2003 when the College Board stopped putting an asterisk next to student exams saying that they had taken extra time. And with these changes, more and more students started requesting these accommodations. Then in 2008. Congress amended the ADA to broaden the definition of disabilities. And at the same time, you had these nonprofits that started encouraging universities to take more of the students’ own descriptions of their disabilities into account. Those universities then started giving more and more weight to those student accounts. And by the time 2013 rolls around, this groundbreaking report shows that Around 200 post-secondary institutions practically required nothing from their students besides a doctor’s note in order to grant accommodations for many things like ADHD. And so with these changes . . .

PETERSON: You’ve listed a lot there. I just have to unpack that a little bit just to get it into my head. So one thing you say is that the . . . now I’ve just written a piece on the college board saying they’ve dumbed down their advanced placement tests so that they’re giving many more passing grades to students who are taking what is supposed to be a very high level test that can substitute for a college test. Now 80 percent or 70 percent are now passing that in the popular exams. So is this another example of the college board just opening the gate here to letting people letting people have special privileges when taking the tests, without acknowledging the fact, by putting a little asterisk on the score?

NEY: That seems to be the case, in part because many of both these… you know, test-taking organizations as well as the universities are very afraid of civil rights lawsuits that could be filed against them. We’ve seen this tremendous rise in those lawsuits. Since 2005, these civil rights disability cases have increased 395 percent. And so these organizations are just throwing up their hands and saying, I’d rather not deal with the lawsuit and instead just give students these extra time. But what we know is that when students do get extra time on those standardized tests, they tend to perform far better.

PETERSON: Well, how do we know that? Has somebody done a clinical trial or a randomized control trial that looks at, OK, now you take it under this time limit. Now you take it under that time limit. Does it change the score?

NEY: There have been studies, yes, randomized controlled trials showing that not only for the same students basically taking the test with a set amount of time and additional time, but also across geographies, we tend to see that students who have more time on the SAT, GMAT, LSAT, that that leads to better scores for them.

PETERSON: So I’ve been told, I mean, this is just what I’m told as a professor in the classroom. I said, don’t worry about this because the time limit is not a significant factor. I mean, students will either do well or not well, no matter how much time that they’re given. I never was quite sure I believed that, but I was certainly told that. So you’re telling me that we actually have some pretty good studies that raise questions about just willy-nilly giving people extra time.

NEY: Yeah, that’s right. And I think we are seeing this inequality rise here where for so long, many of these students, particularly your wealthier ones, spent a lot of their extra resources buying tutors buying support for this. And now not only are they buying tutors, but they’re also buying time to get more advantage on some of these tests. And I think for many of these standardized tests, particularly the LSAT, that is very much so designed as a timed test, those extra minutes can really make quite a large difference in better outcomes for students.

PETERSON: You know, one of the things that we’re always told is that the disabled tend to be the poor. They are more likely to have challenges in their life which have resulted in either some kind of a physical disability or maybe some kind of emotional problem or mental disability or whatever it is. We always think of that as being highly associated with poverty. You’re sort of saying, not in this case.

NEY: The distinction that I like to make here is the difference between disability and accommodation, where America tends to give out these accommodations to the rich. So we actually see that 5.8 percent of students in the top 1 percent of households by income get these accommodations that give them more time on tests compared to just 1.5 percent of students in the bottom 1 percent of households by income. So you’re looking at this almost four times gap. What we would expect, right, exactly as you said, many of these students to be doing worse off in schools, we’re not actually observing that. We’re observing that at America’s most elite universities in the Ivy League and Ivy League Plus, we tend to see these students. However, in the rest of the U.S. … I spent a lot of time in West Virginia in particular for my upcoming book, we see that Americans with disabilities have three times higher rates of unemployment. They’re two times more likely to live in poverty, and they’re three times less likely to have internet access. So I think this is really where you see that divide between accommodation and disability, right? Those West Virginia families, many of whom were working in coal mines for years, right, had physical disabilities, were ravaged by the opioid epidemic, and so had deep psychological scars. Those people are not the ones in these Stanford classrooms who are getting extra time moving up the economic ladder. We really see this stark divide between disability and accommodation.

PETERSON: Well, you know, this all is reminding me of the book by William Julius Wilson, who wrote a book entitled The Truly Disadvantaged. And I think you’re talking about the truly disadvantaged. In that case, they do have a disproportionate incidence of disability. Then there is the apparent disadvantage, which may not be disadvantaged at all. They may be truly advantaged. They may be coming from a very smart, sophisticated home that can exploit all the little legal breaks that are out there to their advantage. Are we seeing that here?

NEY: I think this is the real tension that we’re observing in that in some ways, right, we like to maybe believe that as more and more students are getting into these elite schools, it perhaps connotes a sense of progress in society, right? That we are maybe overcoming some of the stigma that we have observed for generations around disability and that we’re actually accepting more of these students. But I think this stark divide, this almost four times gap between the highest income earners and the lowest incomes earners on some of these disability accommodations lends itself towards this possible manipulation of the system to get ahead. And I think we see that people respond to incentives, right? So that when people are incentivized to try to get extra time to give their children every leg up where they can, we tend to see people do that. And for those families living in poverty who aren’t able to leverage some of these accommodations to their advantages, they fall further and further behind.

PETERSON: Yeah, I don’t see much evidence that there’s been a massive increase in low incomes, students from low income families appearing at elite universities.

NEY: Yeah, I agree.

PETERSON: Maybe It’s edged up a little bit, but it’s not leaped up to 38 percent. There’s nothing like . . . This cannot be the driver of it. Maybe there’s something in there, but it can’t be the main thing. You’re not saying that that’s a big factor, are you?

NEY: No, I’m not. And I very much so agree in that that’s not really what you are seeing. You’re not really seeing many of these low-income households with disabilities moving up into these elite universities. Instead, 40 percent of people in state and federal prisons have at least one disability. I think that’s really where you end up seeing. much larger portion of people in America having these disabilities. They end up being unemployed. They end up being incarcerated. And so I think that’s where you’re starting to see some of the stratification between that disability and accommodation.

PETERSON: Well, maybe it’s these judges that are the problem. What does the law        actually say that is being used here to say, “I deserve this. It’s my legal right to have this special accommodation?”

NEY: Yeah, so there’s really two core laws here. One is the Americans with Disabilities Act, and the other is the Rehabilitation Act. The first one signed in 1990, the other one signed in 1973. And these two laws have stipulated what really counts as a disability and gives guidelines to universities as well as employers on what these accommodations used to say. In 2008, this expansion that Congress enacted on the ADA is really where we started to see some of this rise in more and more students moving into here. And so basically what that started to note was that when student learning was disrupted by a disability, whether that was learning, reading, concentration, or thinking, that that could now be counted under the ADA. the Rehabilitation Act, which a lot of these students are getting this thing called a Section 504 accommodation, that also became much easier in universities for doctors to basically give that accommodation for, namely for ADHD. severe anxiety as well and the rules by which universities need to abide by those two laws is not highly standardized so you see this huge range of different organizations basically taking students words . . . doctor notes that have also become much easier to get at their word. So those two pieces are really what hold universities’ feet to the fire. But I think we’ve seen a loss of teeth in what actually is required by those two pieces of legislation.

PETERSON: Well, how widespread is this in higher education? Is it just the top 20 elite universities or is this happening at big state universities? Is this happening at junior colleges? Is this all over the place? I know your essay focused pretty much on Stanford and Harvard and the big names, but what’s the general size, you know?

NEY: So at UC Berkeley, for example, we’ve seen the number of disability accommodations quintuple over the last 15 years. At the University of Chicago, the number has more than tripled over the past eight years. And so, although only 14 percent of Americans below 35 have a disability, even at smaller schools like Amherst, 34 percent of students report a disability. And so we’re still collecting more and more data on which universities tend to be some of these outliers. But you are observing some of these highest rates in some of these elite universities, but also at some of these smaller schools like Amherst, as well as some of these other places like UC Berkeley.

PETERSON: Well you talk about the Varsity Blues scandal where the wealthy got side the door into the university instead of going through the main door. And is this one of the side doors they used?

NEY: It seems to be the case that this is acting as a new side door. Again, we sometimes see this challenge where students who have quote unquote legitimate disabilities, as many of their like peers tend to use that framing. You know, this is still a positive sign that many of them are getting more access to these universities. But we also see these cases, right, where you have these doctors, particularly in some of these wealthier areas, who are charging $6,000 to basically get these disability accommodations. There was a very famous case of that where there’s one doctor, basically about 70 percent of his patients would end up leaving with a diagnosis. He was also a doctor for a large crime boss. And there’s kind of these like fanciful examples of him kind of testifying that this crime boss was had this mental illness that he didn’t actually know about. And so you tend to see these wealthy families who are sometimes paying some of these doctors who are willing to maybe look the other way or children who are exaggerating their symptoms or doctors who maybe tell the parents in certain ways to act. And I think it very much so does ring quite similarly to that Varsity Blues singer trial that we saw where parents were willing to say that their child was exceptional at water polo, that they had been riding horses for years, that they were one of the best fencers in the world and trying to create a system for their child to get ahead with any means possible.

PETERSON: Has anybody ever prosecuted a student for claiming a disability? Apart from these Varsity Blues kind of stories about the sort of explicit lying that went on there. But has anybody actually been punished for falsely claiming that they have a disability that you know of?

NEY: I don’t know of that, but that isn’t to mean that it doesn’t exist. I mean, in many ways, it has been really challenging I think for schools to kind of press back on this where much of these cases, like a student comes to the school to say I have a disability, right … it’s different in high school where you know administrators or principals or teachers tend to observe it and create the accommodation for the student. And so when you take the student’s word for it or a doctor’s word for it, schools … the incentive isn’t necessarily there for them to punish or try to create a lawsuit against this singular student. But it’s interesting talking with one of the officials at the Stanford Disability Office who recently gave this interview. He was like, “What do we do when our student body reaches 50 or 60 percent of students with disabilities? How do we push back then? Is that an acceptable threshold for us? Do we have some kind of line that we think of?” And I think at that point you might start to see schools push back, whether they do so in a legal way or they create more administrative barriers to do it. But I think also just as the students are responding to the incentive of, “If I get extra time, I can maybe do better in class, do better on my standardized exams,” I think the universities are also responding to their incentives of, “What do I really benefit from creating a lawsuit against the student when it could be very expensive and challenging for me to win?”

PETERSON: Yes, indeed. And it could be bad publicity for the university as well as for the student to get engaged into this kind of washing your dirty linen in public kind of thing. Now, you did say that getting this disability identification is beneficial. But I don’t think we really zeroed in on what are some of the benefits you get if you are identified as disabled.

NEY: So the biggest benefit here is extra time, often extra time on homework assignments, on exams. You can also, with these 504 accommodations, you can get full credit in class for participation without participating at all. You can be able to take your exams in a room by yourself. So absent of distractions or noise with your own proctor. But we’re also seeing many students starting to get additional benefits outside of the

traditional academic setting. So at Stanford, there is this rampant scene that we’re seeing students basically take advantage of where they get single rooms in the freshman year as a result of their accommodations.

PETERSON: Oh, my goodness. If you can get a single room just by calling yourself disabled, I’m in. That’s not a minor benefit. That’s to die for.

NEY: Yeah, so many … yeah, we are seeing students, yeah, get single rooms, basically saying that they are an accommodation. It’s very … physical disabilities, in particular, that they can be really struggling in pain and don’t want to be around a roommate for that. Students as well can leverage accommodations at some of these Ivy League schools to change their meal plans into basically like cash, effectively so they don’t have to dine in the same dining hall.

PETERSON: Oh, you can get special food? You get it from one of the fine restaurants you have in Silicon Valley?

NEY: Yes, exactly.

PETERSON: There’s a lot of good restaurants there. Do they order in?

NEY: Yes, they’re able … yeah, I don’t know if it translates exactly to a DoorDash or Grubhub account, but they are able to change their meal plans as a result. And so I think students are also seeing these other ways that that can benefit them. And I think some of that is also these universities understanding that these accommodations don’t only show up in the classroom, right? The university life is very expansive. But I think when students are also trying to say, “Okay, do I want to be eating in this dining hall every day? Or can I just have this quick appointment?” They often have this one-on-one meeting. These disability offices are almost all women who are very accommodating and understanding and very much they’ll want to help you have that kind of quick 30- or 45-minute meeting, and you get to come out on the other side with a single room, with a meal plan that’s beneficial to you with extra time on tests, able to take tests on your own time, not having to take participation in a class that you didn’t want to participate in anyways. Some of these students are seeing that calculation and saying like, “Well, why don’t I do it if everyone else around me is doing it?”

PETERSON: Well, this is a really disturbing set of findings here. But, you know, because you’re really trying to protect the other kids. I always think about the other kids. How about those who weren’t so shrewd or were more just decent, honest kids, and they just are not going to do that kind of thing. And those are the people that really an administration, a university, has to constantly think about. These are the people to protect. And are university is really taking into … recognizing their responsibility as a protector of the innocent?

NEY: That is 100 percent the goal of these laws, these regulations in these schools to make sure that they can be providing more equality and equity in a system that is highly unequal and doing what they can to make sure that students with physical disabilities or learning accommodations, that they can basically start getting ahead in a system where they are often not given the  opportunity to do so. And so I think that many of these universities are trying quite hard to do that. I think this broader system, though, that we’re seeing has these negative externalities, has created these incentives that students are responding to. But I definitely don’t think we want to throw the baby out with the bathwater here, right? The ADA is an incredibly powerful piece of legislation for supporting the 40 million Americans who live with disabilities. It has become a cornerstone of American equity. Hundreds of other countries … over 100 other countries have also basically created their own ADAs, very much so following off of the legislation in the U.S. And so I think that has really created this strong foundation for us. And there will always be people who try to manipulate some of these systems to their ends. But I do want to very much so emphasize that schools are trying quite hard in order to give a lot of these students the accommodations that they need because they do, in fact, need them.

PETERSON: Well, that’s a perfectly valid point. But you do point out in your essay that those who get the disability are more likely to come from communities where there’s plenty of money in the neighborhood. And could you just give us some of those statistics?

NEY: Absolutely. So one of the counties that I … communities that I looked at for this piece was Weston, Connecticut, where the median household income is $220,000. And in Weston, one in five of the students there claim a disability. But just 30 minutes north in Danbury, Connecticut, where the median household income is $83,000, so about a third lower, the number of students claiming a disability is eight times lower. And this isn’t just unique to Connecticut, right? We tend to see this across the U.S. So even for the top 20 percent of households, we see that they are, by income, we see that they’re twice as likely to get a disability accommodation compared to the bottom 20 percent of households. And some of this, I think, has a lot to do with access, right? Many of these communities, you don’t have doctors in the area who can be supporting many of these students. Some of these appointments can be expensive. Families often don’t have the time to do that. They don’t understand necessarily the questions that they need to be asking of the doctors. So we tend to see these big geographic divides as well on which communities are getting a lot of these accommodations.

PETERSON: Yes, but it could be that rich people are more clever, sophisticated, know what the deal is. They’ve got friends who are already at these places. They know what’s going on there. And they say, “Why can’t I have that for my child as well?”

NEY: I think that’s exactly what’s happening.

PETERSON: So now in high school … is this a problem at the high school level, or is this just a college issue?

NEY: This is not as large of a problem at the high school level. We’re tending to see it much more on standardized tests and at elite universities. And part of that is because high schools have a different set of regulations that govern these disability accommodations. In high school, it’s governed by the Individuals with Disabilities Act—IDEA is basically the acronym for there—as opposed to in higher ed, where it’s much more so around the Americans with Disabilities Act, the ADA. And in high school and K-12 more broadly, the schools there identify the need for support for services and accommodations, whereas in higher ed, students themselves disclose. You also end up seeing much more parent involvement in K-12, where parents will engage the schools. Whereas in college, you can have students directly engage there. And so any possible embarrassment or stigma of like having to ask your mom or your dad to get this accommodation for you, students can just like go ahead and do that yourselves. You were maybe raised in a home of like high virtue that says like, “Hey, you don’t need that accommodation. So stop trying to get that leg up.” But once a student enrolls in Brown or Harvard or Stanford, and they see everyone else around them, they might say like, “Mom and dad are far away now. Perhaps I’m going to do this different approach instead.”

PETERSON: So what are your policy recommendations? You just said that you didn’t want to throw the baby out with the bathwater, but it does seem to me like you need to do something. So what … how do you avoid destroying the system by over-regulating it and at the same time not letting the system get totally out of hand by abuse.

NEY: Yeah, I think step one is creating a clearer guidance for universities about what goes into granting these disability accommodations, because there is really not that much standardization across universities. You have schools with these huge ranges, right—at Stanford at 38 percent—granting many of these types of abilities for students. I think the second thing is also trying to say where can we draw some of the boundaries for how many benefits some of these students can get. I think when they look around them and they see great meal plans and better housing, as a result of that, they’re maybe even more inclined, they see even more incentive to start getting that accommodation. And so areas where it might be possible to create a tiered structure to say, in order to get a single housing accommodation, you need XYZ additional burden of proof. Where right now the ADA and the Rehabilitation Act has also limited and reduced that burden of proof. And I think third would be really a focus on geography and trying to understand which communities are we trying to give more equity and support to these areas. So when I think about Danbury, Connecticut, those students there with these lower median household incomes probably need more support than the students in Weston, Connecticut, just 30 minutes away, where the household income is so much higher. West Virginia is the state with the highest disability rate, and again we’re not seeing—as you mentioned too—we’re not seeing those students being the ones admitted to these elite universities. Breathitt County, Kentucky, is the county where one in three individuals there has a disability, the highest rate anywhere in the U.S. Again, we are not seeing students from there attending these places. And so if universities could do more to say where are these areas in the U.S. that we could be recruiting more from where we actually are trying to help more of these students instead of just focusing on these high income areas that also have these higher disability rates we might be able to level the playing field a bit more there, too.

PETERSON: You don’t think that there’s a possibility that the colleges themselves could set up an office that would have more rigor to it, that would say, “Okay, you are applying for disability status. We’re going to have you see a doctor on the staff here, or we’re going to have you see a specialist.” And they have to make a recommendation one way or another after examining the case in detail.

NEY: I see that as part of step one of those three solutions that I had mentioned, where step one is not only this standardization across universities, but also improving the way that schools do it as well, thinking about what are those thresholds that we expect from students. And yes, leveraging the medical staff, right, at universities to do that instead of perhaps one of these doctors across the US that you could just pay. $6,000 to you when you have a 70 percent chance of likely walking away with a doctor’s note saying that, yes, this person has ADHD.

PETERSON: So do we have a movement to do this? I mean, I sort of feel like nothing happens unless you really make it into a political issue. Do you see any signs that there’s an awareness that this is an issue, or are you just blowing in the wind here?

NEY: Two signs where I see that there is a movement to push back on this. One kind of comes from a corollary of the grade inflation debate where we are seeing many schools start wrestling with, does it make sense for us to be giving plus 50 percent of our class A’s or A+’s or A–’s, and what that does to the learning environment, what it possibly does to stress. And I think many of those same questions kind of exist in this debate here, too, around accommodations, right? Does this show a sign of the times? Is it helpful for students? Does it reduce the academic stress that many of them are experiencing this? Or are we actually just dropping the floor out from underneath people and not putting as high a burden or doing a disservice to our students there? I think the second area and where I actually saw quite a lot of commentary after I published this article on my Substack was many people who were employers responding, saying that they are now experiencing many of these students from these schools graduating, having experienced accommodations and benefiting from accommodations for four years and now starting to work at Bain and BCG and McKinsey, expecting extra time on cases, expecting different working environments, expecting spaces in their buildings at JPMorgan to accommodate their disabilities that they were leveraging while … or experiencing while they were at universities. And many of these employers are really struggling with how to navigate that. I think given the tight relationship that we see from a lot of these big employers and universities, that might be another area where we start to see some momentum of saying employers ended up being downstream of this, they find themselves holding the bag at the end. And so how can they work with schools to make sure that they aren’t then getting Stanford graduates who are also kind of expecting certain accommodations when in fact those employers themselves aren’t really well set up to do that either.

PETERSON: Well, thank you, Jeremy, for this fascinating account of a development in American higher education that is almost unknown and yet can be terribly significant in many significant ways. So thank you for joining me on the Education Exchange.

NEY: Thank you again, Paul, and it was really great to chat.

PETERSON: I’ve been speaking with Jeremy Ney. He’s an adjunct professor at Columbia Business School, and he’s the author of a forthcoming book. The title of the forthcoming book is Inequality and Opportunity. No, The Opportunity Map. Correct me. I didn’t get you. What’s the title’s name?

NEY: The Opportunity Map.

PETERSON: The Opportunity Map. And he’s focused our attention on the tendency at our elite universities to have excessive self-identification of disabilities. So thank you, Jeremy, for joining me on the Education Exchange. I am Paul Peterson. Please join me for a new Education Exchange podcast that’s released on the Education Next website every Monday at noon Eastern time.