Accommodation & Implementation: The School Response Tourette Syndrome Conference April 28, 2000 Margaret J. Kay, Ed.D., NC...
Learning Difficulties in Children with Tourette Syndrome <ul><li>The effect of tics on school performance </li></ul><ul><l...
The effect of tics on school performance <ul><li>MOTOR PERFORMANCES </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><...
The effect of tics on school performance <ul><li>Vocalizations </li></ul><ul><ul><li>Speech hesitations </li></ul></ul><ul...
The effect of tics on school performance <ul><li>Social Isolation </li></ul><ul><ul><li>Rejection </li></ul></ul><ul><ul><...
Obsessive-Compulsive Behaviors <ul><li>Incidence:  Affects 30 to 60% of children with Tourette Syndrome </li></ul><ul><ul>...
Attention Deficit <ul><li>Incidence:  Affects 50 to 60% of children with Tourette Syndrome </li></ul><ul><ul><li>Precedes ...
Executive Function <ul><li>Planning </li></ul><ul><li>Organization </li></ul><ul><li>Attention </li></ul><ul><li>Intention...
Timed Performances <ul><li>Almost all children with Tourette have difficulty completing timed work </li></ul><ul><ul><li>T...
Written Language <ul><li>Motor strip involvement </li></ul><ul><li>Dysgraphia </li></ul><ul><li>Obsessions & compulsions <...
Diagnosis & Intervention <ul><li>School-Based or Independent Educational Evaluation (IEE) </li></ul><ul><ul><li>Intelligen...
Tourette & Language-Based Learning Disorder <ul><li>Dyslexia </li></ul><ul><ul><li>Average to above average IQ </li></ul><...
Dyslexia & Tourette <ul><li>Associated characteristics: </li></ul><ul><ul><li>Poor STM </li></ul></ul><ul><ul><li>Word fin...
Tourette & Non-Verbal Learning Disorder (NLD) <ul><li>Good reading decoding & spelling </li></ul><ul><li>Poor listening & ...
Tourette & Non-Verbal Learning Disorder (NLD) <ul><li>Some common problems </li></ul><ul><ul><li>Poor social cognition </l...
Tourette & Frontal Region Problems <ul><li>Attention </li></ul><ul><li>Impulse control </li></ul><ul><li>Intention & follo...
Tourette & Motor Strip Involvement <ul><li>Writing </li></ul><ul><li>Time management </li></ul><ul><li>Listening & note ta...
Psychoeducational Evaluation <ul><li>Request in writing </li></ul><ul><li>District has 45 days to complete </li></ul><ul><...
Exceptional Children get IEP’s <ul><li>Present levels section </li></ul><ul><ul><li>Must be described in objective and mea...
Goals & Objectives in the IEP <ul><li>Goals </li></ul><ul><ul><li>Mechanism for determining if outcomes are being achieved...
Specially Designed Instruction in the IEP <ul><li>What happens that is special? </li></ul><ul><ul><li>Methods </li></ul></...
Objective Measures of Progress <ul><li>Measurable </li></ul><ul><li>Objective </li></ul><ul><ul><li>Test scores </li></ul>...
Program & Placement <ul><li>Program </li></ul><ul><ul><li>IEP is based in comprehensive educational evaluation (CER) </li>...
Problems & Remedies <ul><li>Failure to base the IEP on a comprehensive evaluation </li></ul><ul><li>Failure to describe SD...
Due Process Safeguards <ul><li>FAPE (The right to a Free & Appropriate Public Education) </li></ul><ul><li>The IEP must be...
Section 504 of the Rehabilitation Act of 1973 <ul><li>What accommodations and/or services will the student require in scho...
Section 504 Plan <ul><li>Access </li></ul><ul><ul><li>Schools must provide access to equivalent facilities, services & act...
Section 504 Plan <ul><li>Discipline </li></ul><ul><ul><li>Removal of a Section 540-eligible student for 10 or more days co...
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Tourette Conference April 2000

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Tourette Conference April 2000

  1. 1. Accommodation & Implementation: The School Response Tourette Syndrome Conference April 28, 2000 Margaret J. Kay, Ed.D., NCSP Licensed Psychologist*School Psychologist
  2. 2. Learning Difficulties in Children with Tourette Syndrome <ul><li>The effect of tics on school performance </li></ul><ul><li>CONCENTRATION </li></ul><ul><ul><li>Mental effort to suppress tics </li></ul></ul><ul><ul><li>Interference with concentration of others </li></ul></ul><ul><ul><li>Teachers may encourage tic suppression </li></ul></ul><ul><ul><li>Peers encourage tic suppression </li></ul></ul>
  3. 3. The effect of tics on school performance <ul><li>MOTOR PERFORMANCES </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Note-taking </li></ul></ul><ul><ul><li>Handwriting problems </li></ul></ul><ul><ul><li>Homework </li></ul></ul><ul><ul><li>Exams </li></ul></ul>
  4. 4. The effect of tics on school performance <ul><li>Vocalizations </li></ul><ul><ul><li>Speech hesitations </li></ul></ul><ul><ul><li>Embarrassment </li></ul></ul><ul><ul><li>Tics are exacerbated by anxiety, anger & fatigue </li></ul></ul><ul><ul><li>Presence of tics are often emphasized by peers, teachers and family members </li></ul></ul>
  5. 5. The effect of tics on school performance <ul><li>Social Isolation </li></ul><ul><ul><li>Rejection </li></ul></ul><ul><ul><li>Ridicule </li></ul></ul><ul><ul><li>Barrier to learning </li></ul></ul><ul><ul><li>Case of Robbie: Ate alone in classroom to avoid taunting of peers </li></ul></ul>
  6. 6. Obsessive-Compulsive Behaviors <ul><li>Incidence: Affects 30 to 60% of children with Tourette Syndrome </li></ul><ul><ul><li>Concentration: Interference of repetitive thoughts & images </li></ul></ul><ul><ul><li>Fine & Gross motor performances: Interference of repetitive actions (e.g. written work has to be perfect) </li></ul></ul>
  7. 7. Attention Deficit <ul><li>Incidence: Affects 50 to 60% of children with Tourette Syndrome </li></ul><ul><ul><li>Precedes onset of tics in children with Tourette by 2 to 3 years </li></ul></ul><ul><ul><li>Often is the first diagnosis </li></ul></ul><ul><ul><li>Impulsivity, Inattention, Hyperactivity </li></ul></ul>
  8. 8. Executive Function <ul><li>Planning </li></ul><ul><li>Organization </li></ul><ul><li>Attention </li></ul><ul><li>Intention </li></ul><ul><li>Impulse control </li></ul><ul><li>Frontal lobe function </li></ul>
  9. 9. Timed Performances <ul><li>Almost all children with Tourette have difficulty completing timed work </li></ul><ul><ul><li>The Double Bind: </li></ul></ul><ul><ul><ul><li>Fast & Incorrect </li></ul></ul></ul><ul><ul><ul><li>Slow & Correct </li></ul></ul></ul><ul><ul><li>Lose-Lose situation </li></ul></ul>
  10. 10. Written Language <ul><li>Motor strip involvement </li></ul><ul><li>Dysgraphia </li></ul><ul><li>Obsessions & compulsions </li></ul><ul><li>Dyslexia (spelling problems) </li></ul><ul><li>Fine-motor control </li></ul><ul><li>Pencil grip </li></ul>
  11. 11. Diagnosis & Intervention <ul><li>School-Based or Independent Educational Evaluation (IEE) </li></ul><ul><ul><li>Intelligence </li></ul></ul><ul><ul><li>Achievement </li></ul></ul><ul><ul><li>Perception </li></ul></ul><ul><ul><li>Language </li></ul></ul><ul><ul><li>Social & Emotional </li></ul></ul><ul><ul><li>Vocational & Career (14 years+) </li></ul></ul>
  12. 12. Tourette & Language-Based Learning Disorder <ul><li>Dyslexia </li></ul><ul><ul><li>Average to above average IQ </li></ul></ul><ul><ul><li>Low reading decoding & spelling </li></ul></ul><ul><ul><li>High listening comprehension </li></ul></ul>
  13. 13. Dyslexia & Tourette <ul><li>Associated characteristics: </li></ul><ul><ul><li>Poor STM </li></ul></ul><ul><ul><li>Word finding difficulties </li></ul></ul><ul><ul><li>Speech delays </li></ul></ul><ul><ul><li>Articulation deficits </li></ul></ul><ul><ul><li>Rapid naming problems </li></ul></ul><ul><ul><li>Poor spelling & written language </li></ul></ul>
  14. 14. Tourette & Non-Verbal Learning Disorder (NLD) <ul><li>Good reading decoding & spelling </li></ul><ul><li>Poor listening & reading comprehension </li></ul><ul><li>Poor understanding of novel material and complex mathematics </li></ul>
  15. 15. Tourette & Non-Verbal Learning Disorder (NLD) <ul><li>Some common problems </li></ul><ul><ul><li>Poor social cognition </li></ul></ul><ul><ul><li>Difficulty interpreting non-verbal, social cues </li></ul></ul><ul><ul><li>Trouble with inferential thinking </li></ul></ul><ul><ul><li>Problems not apparent until later grades </li></ul></ul><ul><ul><li>Writing difficulties related to poor comprehension </li></ul></ul>
  16. 16. Tourette & Frontal Region Problems <ul><li>Attention </li></ul><ul><li>Impulse control </li></ul><ul><li>Intention & follow through </li></ul><ul><li>Organization </li></ul><ul><li>Hyperactivity </li></ul><ul><li>Hypoactivity </li></ul>
  17. 17. Tourette & Motor Strip Involvement <ul><li>Writing </li></ul><ul><li>Time management </li></ul><ul><li>Listening & note taking </li></ul><ul><li>Homework </li></ul><ul><li>“Something gets lost on the way to the task.” </li></ul>
  18. 18. Psychoeducational Evaluation <ul><li>Request in writing </li></ul><ul><li>District has 45 days to complete </li></ul><ul><li>Ask for list of tests to be used </li></ul><ul><li>Request results in writing </li></ul><ul><li>If you disagree with district results, you have the right to obtain a publicly funded IEE </li></ul>
  19. 19. Exceptional Children get IEP’s <ul><li>Present levels section </li></ul><ul><ul><li>Must be described in objective and measurable terms </li></ul></ul><ul><ul><li>Children who are learning disabled must demonstrate a severe discrepancy between ability & achievement in one or more of the following areas: Basic Reading Skill, Reading Comprehension, Math Reasoning, Math Calculation, Written Expression, Listening Comprehension or Spoken Language </li></ul></ul>
  20. 20. Goals & Objectives in the IEP <ul><li>Goals </li></ul><ul><ul><li>Mechanism for determining if outcomes are being achieved </li></ul></ul><ul><ul><li>Allow you to keep track of educational progress (or lack of it) </li></ul></ul><ul><li>Objectives </li></ul><ul><ul><li>Measurable </li></ul></ul><ul><ul><li>Intermediate steps between presents levels & goals </li></ul></ul><ul><ul><li>Milestones for measuring progress (or lack of it) </li></ul></ul>
  21. 21. Specially Designed Instruction in the IEP <ul><li>What happens that is special? </li></ul><ul><ul><li>Methods </li></ul></ul><ul><ul><li>Schedule </li></ul></ul><ul><ul><li>Teacher-to-student ratio </li></ul></ul><ul><ul><li>Where instruction is to be delivered </li></ul></ul><ul><ul><li>How instruction will be delivered </li></ul></ul><ul><ul><li>Materials </li></ul></ul>
  22. 22. Objective Measures of Progress <ul><li>Measurable </li></ul><ul><li>Objective </li></ul><ul><ul><li>Test scores </li></ul></ul><ul><li>Not subjective </li></ul><ul><ul><li>Teacher judgment </li></ul></ul><ul><li>Standard scores </li></ul>
  23. 23. Program & Placement <ul><li>Program </li></ul><ul><ul><li>IEP is based in comprehensive educational evaluation (CER) </li></ul></ul><ul><ul><li>Program is based upon present educational levels </li></ul></ul><ul><li>Placement </li></ul><ul><ul><li>Must be determined after IEP is completed </li></ul></ul><ul><ul><li>Must be appropriate </li></ul></ul><ul><ul><li>Appropriate does not mean “The Best” </li></ul></ul>
  24. 24. Problems & Remedies <ul><li>Failure to base the IEP on a comprehensive evaluation </li></ul><ul><li>Failure to describe SDI’s </li></ul><ul><li>Failure to specify placement </li></ul><ul><li>IEP must confer educational benefit </li></ul>
  25. 25. Due Process Safeguards <ul><li>FAPE (The right to a Free & Appropriate Public Education) </li></ul><ul><li>The IEP must be reasonably calculated to confer “educational benefit” </li></ul>
  26. 26. Section 504 of the Rehabilitation Act of 1973 <ul><li>What accommodations and/or services will the student require in school to “level the playing field”? </li></ul><ul><li>Also applies to extracurricular activities & non-student situations, such as employment </li></ul>
  27. 27. Section 504 Plan <ul><li>Access </li></ul><ul><ul><li>Schools must provide access to equivalent facilities, services & activities. </li></ul></ul><ul><li>Accommodations </li></ul><ul><ul><li>Regardless of the nature or severity of the handicap </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>Districts must determine who is in need to Section 504 services </li></ul></ul>
  28. 28. Section 504 Plan <ul><li>Discipline </li></ul><ul><ul><li>Removal of a Section 540-eligible student for 10 or more days constitutes a “significant change in placement.” </li></ul></ul><ul><ul><li>Triggers a reevaluation & due process requirement. </li></ul></ul>

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