The short answer
Students and adults with Tourette syndrome or another tic disorder can get accommodations on the SAT, ACT, AP, graduate admissions tests and licensing exams, and can challenge a denial. The testing organization decides, under the ADA. College Board usually approves school-submitted requests for accommodations the student already uses under a formal school plan; when it reviews documentation, it wants an evaluation update that is usually no more than a year old and that describes how often tics occur and how they affect the student on the exam. If a request is denied, each agency has its own reconsideration or appeal rules and deadlines.
Tics don't follow a schedule. A student may go weeks with mild symptoms and then have a hard stretch the week of the SAT. Holding tics in during a long, silent exam can be exhausting, and the effort itself takes attention away from the questions. Testing accommodations are meant to remove that barrier. This guide explains how testing organizations handle Tourette syndrome and other tic disorders, what documentation they look for, and what to do if a request is denied.
How testing organizations decide
Admissions and licensing exams fall under the ADA's testing rule: the exam has to be given so the results reflect what it measures, not the person's disability. Documentation requests must be reasonable and limited to the need for the accommodation, and testing organizations should give considerable weight to past accommodations, including those in an IEP or 504 plan (28 C.F.R. ยง 36.309; U.S. Department of Justice).
A diagnosis can help establish eligibility, but it doesn't establish which accommodations a student needs. College Board notes that symptoms and needs of students with Tourette's or other tic disorders vary greatly (College Board), and ACT says it does not approve accommodations based on a diagnosis alone (ACT). What matters is how tics affect you during the exam and how each accommodation addresses that.
How tics can affect test day, and what may help
| How tics can affect test day | What may help |
|---|---|
| The student spends so much effort suppressing tics around others that it's hard to focus on the test. | A small-group setting may help if it reduces that pressure. An individual room may help if testing around others remains a barrier. |
| The urge to tic builds during a long section, and the student needs to pause. | Extra breaks, or breaks as needed if the exam offers them. |
| Tics repeatedly interrupt reading or writing, leaving the student with less time to complete the test. | Extended time may help compensate for time lost to interruptions. |
| Motor tics make it difficult to write responses by hand or fill in a separate answer sheet. | Typing or using a scribe may help with written responses. On some paper exams, marking answers directly in the test booklet may help if the barrier is using the separate answer sheet. |
These are examples, not a menu, and available options and approval requirements vary by exam. The Tourette Association lists additional time, a separate smaller testing site, frequent breaks, a computer and a scribe among the accommodations students with Tourette syndrome are likely to request, and notes that some students don't need any (Tourette Association of America).
SAT, PSAT and AP (College Board)
Students with tic disorders must request accommodations from College Board's Services for Students with Disabilities, even if they have an IEP or 504 plan (College Board). Most requests go through the school's SSD coordinator, and College Board says most students who receive accommodations at school and request them are approved (College Board); if the request matches the student's plan, SSD Online may not ask for documentation (College Board).
When College Board does review documentation, its tic disorder guidelines ask for:
- A clearly stated diagnosis of the specific tic disorder.
- Current information. In most cases of tic disorder, evaluation updates should be no more than one year old.
- Educational, developmental and medical history supporting the diagnosis and the functional limitation.
- More than a medical note, which is usually not enough on its own.
- A description of how the tic disorder affects academic functioning and the ability to take College Board exams, such as how often symptoms occur and how they affect the student in and out of school.
- A rationale for each accommodation, following College Board's separate guidelines for extended time, breaks and other frequently requested accommodations.
- Evaluator credentials: evaluators must be licensed in the state where they practice.
Source: College Board documentation guidelines for tic disorders or Tourette's. See our SAT guide for the full process.
ACT
A school official submits the request through ACT's TAA system, and Tourette's syndrome and tic disorders are among the documentation categories ACT lists (ACT). Because many people with Tourette syndrome also have ADHD, OCD or anxiety, note that ACT wants documentation of a psychiatric disorder from within the past year (ACT); if a co-occurring condition is part of the request, its documentation has to meet that condition's guidelines too. See our ACT guide.
Questions about your own request?
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Graduate and licensing exams
For the GRE, GMAT, LSAT, MCAT, USMLE and bar exams, you apply to the testing organization yourself. Check the testing organization's documentation requirements; some accept proof of prior approvals for some requests. If a clinical evaluation is needed, it can describe how often tics occur, how severe they are, and how they affect the applicant under standard exam conditions. For example, explain whether tics interrupt reading or writing during timed sections, or whether suppressing tics around others makes it hard to concentrate. Connect each requested accommodation to the specific barrier it would address. Include records of prior accommodations, if available and relevant. DOJ guidance says documentation requests should be limited to what is needed to establish the disability and the need for the accommodation (U.S. Department of Justice). Our exam guides cover each organization's forms, recency rules and deadlines.
On test day
The Tourette Association suggests letting the proctor know you have Tourette syndrome so tics don't come as a surprise, whether you test in a standard room or an accommodated one (Tourette Association of America). Bring your approval letter, and confirm before test day that your accommodations are attached to your registration.
If your request is denied
Start by reading the decision closely. Most denials point to a specific gap: an evaluation older than the agency allows, a report that names the diagnosis without describing how tics affect testing, no rationale for a particular accommodation, or a co-occurring condition that wasn't documented. Your response should answer each reason with new evidence, such as an updated evaluation, a clinician's addendum that explains how tics affect timed testing, or teacher observations of tics during tests.
After a denial: next steps and timing
- College Board: follow the decision letter and reopen the request with new or additional documentation. The new review may take up to seven weeks.
- ACT: for the U.S. national ACT, submit an appeal by the regular registration deadline for the preferred test date.
- LSAC: notify LSAC of your intent to appeal within 2 business days and submit supporting documents within 5 calendar days. Both periods start when the decision is posted to your online account. If the appeal arrives after five calendar days, you may request a move to the next administration at no additional cost so LSAC can consider it.
- AAMC (MCAT): AAMC generally reviews complete reconsideration and appeal requests within 30 days of submission.
- USMLE: you may request one reconsideration per Step exam registration. Submit new and compelling supporting information with the request.
Our guide to appeals and appeal letter guide walk through each step.
A checklist before you submit or resubmit
- Read the agency's documentation guidelines for tic disorders, if it has them, and give them to your evaluator.
- Make sure the evaluation is current: for College Board, updates usually within one year.
- Describe tic frequency, severity and how tics affect reading, writing and focus on a timed test, not just the diagnosis.
- Tie each requested accommodation to a specific effect of the tics.
- Document co-occurring conditions such as ADHD, OCD or anxiety under their own guidelines.
- Include teacher observations and records of accommodations already used.
- Track the agency's deadlines, and submit early enough to allow a reconsideration if needed.
Common questions
Does Tourette syndrome qualify for SAT or ACT accommodations?
It can. A diagnosis can help establish eligibility, but College Board and ACT decide based on how tics affect the student during the exam and whether each accommodation addresses that.
How recent does a Tourette evaluation need to be for College Board?
College Board says that in most cases of tic disorder, evaluation updates should be no more than one year old.
Is a doctor's note enough?
Usually not. College Board says a medical note is usually not sufficient, and asks for history, a description of how symptoms affect the student, and a rationale for each accommodation.
Can I appeal a denied Tourette accommodation on the SAT?
Yes. Follow the decision letter and reopen the request with new or additional documentation; College Board's new review may take up to seven weeks. ACT, LSAC and other organizations have their own appeal or reconsideration processes and deadlines.
Should I tell the proctor about my tics?
The Tourette Association suggests letting the proctor know you have Tourette syndrome so tics don't come as a surprise.