Purpose: Every year increasing numbers of candidates request special accommodations for high-stakes medical licensing examinations, due to ADHD, on the basis of the Americans with Disabilities Act (ADA). This poses significant challenges for both the applicant and the medical boards and has significant financial, legal, and ethical implications. The purpose of this survey is to review all applications requesting ADA accommodations, on the basis of ADHD, submitted to the National Board of Osteopathic Medical Examiners (NBOME) COMLEX exam. Method: The authors review all 50 requests for special accommodations, on the basis of ADHD, submitted to the NBOME between 2005 and 2007. All requests are reviewed by the investigators independently and then cross-checked to determine interrater reliability. Results: Of all applicants, only 14% (7/50) provide sufficient documentation to support a diagnosis of ADHD. Interrater reliability is high. Conclusions: The majority of applicants who request special testing accommodations on the basis of ADHD do not provide adequate documentation to the medical boards to support the diagnosis. (Contains 3 notes and 3 figures.)