Manifestation determination reviews (MDRs) are a federally mandated practice that prevents schools from suspending students with disabilities for more than 10 days before determining if the student's disability is significantly and directly related to the problem behavior. The process is a controversial one, and prior research has shown that the process is often interpreted loosely and implemented haphazardly. Although the practice lacks defined theoretical parameters and empirical testing, the results of the team's assessment will have significant consequences for the student. Similarly, in the intervening years since the 1997 federal regulations, schools have witnessed a rise in MDR associated litigation from aggrieved families. Consequently, MDRs can be described as a high-stakes assessment for both students and schools that relies on unsound empirical and theoretical support. Current MDR approaches may be improved by systematically reviewing and updating to contemporary practices. This paper examines the current research on MDR practices and provides recommendations that may be employed by school psychologists and district officials. Implementation recommendations and suggestions for future research are discussed.