Minimal research has been conducted contrasting the effectiveness of various testing accommodations for college students diagnosed with ADHD. The current assumption is that these students are best served by extending the time they have to take a test. It is the supposition of these investigators that paced item presentation may be a more beneficial accommodation than extended time. To test the effects of paced item presentation, the investigators designed a mixed methods sequential explanatory study to explore the relationship between computer-paced and student-paced item presentation on the academic test performance in college students diagnosed with ADHD. The participants were randomly assigned to 1 of 2 testing conditions. Half of the participants were provided a computer-paced testing condition, and half were provided a student-paced testing condition within a computer-based environment. Interviews were conducted after the test administration to discern the students' perceptions of the value of the various components of the testing environment. No significant differences were found in performance scores between the students tested under the two conditions; however, the interview data illuminated the quantitative findings in that the students reported that the computer-based testing environment itself, as well as other environmental variables, provided a beneficial structure and format conducive to their overall successful performance under both accommodations. The practicability of university disability offices offering a computerized format for students diagnosed with ADHD is also discussed. (Contains 2 figures and 3 tables.)