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Educational Needs and Services for Children with Epilepsy David H. Salsberg, Psy.D., DABPS  © Rusk Institute of Rehabilita...
<ul><li>When to become concerned </li></ul><ul><li>What professionals do you consult with </li></ul><ul><li>What evaluatio...
Myriad of Labels/Diagnoses, Tests, Scores, and Interventions <ul><li>WPPSI-III, WISC-IV, WIAT-II, NEPSY-II… </li></ul><ul>...
Educational Implications for Children with Epilepsy <ul><li>Etiology of Seizures underlying causes/conditions </li></ul><u...
Issues in Educational Planning <ul><li>Seizure plan </li></ul><ul><li>Nurse </li></ul><ul><li>Health paraprofessional </li...
When to take notice <ul><li>Developmental lags noted </li></ul><ul><li>Discrepancy between skill area and “norm” or expect...
Birth to 3 <ul><li>Start with Evaluations –  specific or more comprehensive? </li></ul><ul><li>Early Intervention – funded...
<ul><li>When in doubt refer for evaluation </li></ul><ul><ul><li>Need to refer early </li></ul></ul><ul><ul><li>If  too ea...
Ages 3 - 5 <ul><li>Start with Evaluations –  Specific or more comprehensive? </li></ul><ul><li>Therapy specific treatments...
School Age <ul><li>Schools start with pre-referral interventions </li></ul><ul><li>Evaluations – specific or more comprehe...
Primary Evaluations <ul><li>Psychological </li></ul><ul><li>Psychoeducational </li></ul><ul><li>Neuropsychological </li></...
Developmental Evaluations <ul><li>Developmental snapshots to guide current treatment planning and diagnosis </li></ul><ul>...
Goal of Neuropsychological Testing <ul><li>Go Beyond IQ and academic scores to provide a complete picture of the child’s c...
Testing Professionals <ul><li>Psychologists School/Educational (Master’s, Doctorate) Clinical Ph.D., Psy.D. </li></ul><ul>...
Other Disciplines/Team <ul><li>Neurology  </li></ul><ul><li>Pediatrician/Developmental Pediatrician  </li></ul><ul><li>Nur...
Pediatric Specialization <ul><li>Experience </li></ul><ul><li>Rapport </li></ul><ul><li>Knowledge of educational system </...
Specific Issues in Epilepsy <ul><li>All of the above </li></ul><ul><li>Experience with Epilepsy and range of learning, att...
District/School vs.  Independent Evaluations <ul><li>Independent evaluation: </li></ul><ul><li>Parental control </li></ul>...
Variability in Reports <ul><li>Tester: Training Style Organization/Setting </li></ul><ul><li>Tests used </li></ul><ul><li>...
Variability in Tests Used <ul><li>Examiner’s choice/comfort level </li></ul><ul><li>Availability of Tests </li></ul><ul><l...
Preparation for Evaluation  - Parents <ul><li>Educate yourself regarding learning issues and process </li></ul><ul><li>Del...
Preparation for Evaluation  - Child <ul><li>Present evaluation in non-threatening, relevant and developmentally appropriat...
Factors Impacting Testing <ul><li>Why referred? </li></ul><ul><li>Motivation/Attitude </li></ul><ul><li>Rapport </li></ul>...
Overall Cognitive Functioning Intelligence Testing - IQ <ul><li>In neuropsychological and/or educational evaluation IQ tes...
IQ Scores <ul><li>IQ scores are often used as marker – need to make sure it is a good one! </li></ul><ul><li>Overall score...
Discrepancy Based LD Evaluation <ul><li>Discrepancy between IQ and achievement </li></ul><ul><li>Discrepancy between child...
IQ Scores <ul><li>In an effort to broaden the construct of IQ newer IQ measures incorporate numerous skills </li></ul><ul>...
Preschool <ul><li>Wechsler Preschool and Primary Scale of Intelligence-III (WPPSI-III)  </li></ul><ul><li>Ages 2:6 – 7:3 <...
School Age IQ <ul><li>Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Ages: 6 – 16:11 </li></ul><ul><li>...
Speech and Language <ul><li>Neuropsychologists screen these areas in relation to full battery – gather from Speech-Languag...
Visual-Motor/Visual-Perceptual <ul><li>Parts of evaluations overlap w/ OT, especially in neuropsychological evaluation </l...
Other Areas of Neuropsychological Evaluation <ul><li>Attention and Concentration (In 1:1 structured testing setting) </li>...
<ul><li>Executive Functioning/Attention and Concentration Impulse control Distractibility Attention: Focused; selective; s...
<ul><li>Memory Most common complaint – but influenced by attention/executive functioning skills Visual Verbal Procedural R...
Academic Achievement Tests: <ul><li>Limitation of brief screening of single-word reading, spelling and arithmetic in diagn...
Problems in Diagnosing LD <ul><li>Discrepancy analysis </li></ul><ul><li>Qualitative/subtleties of difficulties </li></ul>...
Personality/Emotional Testing <ul><li>Projectives Rorschach (Exner Comprehensive System Scoring) Thematic Apperception Tes...
<ul><li>Depression </li></ul><ul><li>Anger </li></ul><ul><li>Anxiety </li></ul><ul><li>Reality Testing </li></ul><ul><li>D...
Family/Developmental issues <ul><li>Independence/Dependence </li></ul><ul><li>Depending on age of onset may not have a goa...
Adaptive Functioning <ul><li>Activities of Daily Living </li></ul><ul><li>Measures: Vineland-2 ABAS-II </li></ul><ul><li>O...
Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004) <ul><li>Purpose: </li></ul><ul><li>  </li></ul...
Individuals with Disabilities Education Act <ul><li>All children with disabilities receive a free appropriate public educa...
Parental Referral to Local Education Authority <ul><li>Write a letter to the Chairperson of your Committee on Special Educ...
Evaluation <ul><li>Parents must consent to an initial evaluation. </li></ul><ul><li>  </li></ul><ul><li>A variety of asses...
Identification/Development of an IEP <ul><li>Determination of eligibility </li></ul><ul><li>Classification </li></ul><ul><...
Classification <ul><li>Section 504 -  Section 504 of the American with Disabilities Act requires recipients to provide to ...
Classification <ul><li>Autism </li></ul><ul><li>Deafness </li></ul><ul><li>Deaf/Blindness </li></ul><ul><li>Emotional Dist...
Placement <ul><li>This is performed at the CSE meeting, except in New York City, where this is done by the placement offic...
School Placement <ul><li>Section 504 – Not CSE </li></ul><ul><li>Public School General Education with related services The...
Dispute Resolution <ul><li>Independent Educational Evaluation (IEE) Parent has the right to an IEE if they disagree with a...
ADHD/ADD <ul><li>Hyperactivity </li></ul><ul><li>Impulsivity </li></ul><ul><li>Distractibility </li></ul><ul><li>Issues to...
PDD <ul><li>Autism </li></ul><ul><ul><li>Rett’s </li></ul></ul><ul><ul><li>Childhood Disintegrative Disorder </li></ul></u...
Learning Disabilities <ul><li>Specific Dyslexia, Dysgraphia, Dyscalculia </li></ul><ul><li>Non-Verbal Learning Disabilitie...
Sensory Integration <ul><li>Organizing, integrating and interpreting sensory input in a variety of modalities including: t...
Auditory Processing <ul><li>Difficulties in processing orally presented information even though hearing is within normal l...
Recommendations <ul><li>School placement  </li></ul><ul><li>Therapies/Interventions </li></ul><ul><li>Compensatory techniq...
Summary <ul><li>Need to incorporate all objective data, scores from testing, observations, outside therapists, history, em...
Parents Know Best <ul><li>Trust your instincts </li></ul><ul><li>Be involved / carry-over </li></ul><ul><li>Educate yourse...
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Educational needs for Children with Epilepsy

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In order to make well thought out decisions for children with epilepsy, it is necessary to acknowledge all objective data including scores from testing, observations, outside therapists, history, emotional and personality variables, family and school data. One must pay close attention to their child and look for early signs of epilepsy in order to address specific educational needs and prevent hindered development.

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  • Congress finds that    &amp;quot;Implementation of this title [IDEA 90 and 95] has been impeded by low expectations, and an insufficient focus on applying replicable research on proven methods of teaching and learning for chidlren with disabilities.  [20 usc 1400(c)(4)] &amp;quot;having high expectations for such children and ensuring their access to the general education curriculum in regular classrooms, to the maximum extent possible... to meet the challengin expectations that have been established for all childre; and be prepared to lead productive and independent lives to the maximum extent possible...&amp;quot;  [20 usc 1400(c)(5)]
  • email - great way to communicate - it doesn&apos;t provide proof of delivery but people forget that they&apos;re documenting anything.. Whos&apos;s your chairperson- see the attached or call 311. If your District refuses to perform an evaluation of your child, it must notify you as to why it is refusing to do so, and you can become eligible to receive an independent educational evaluation, at District expense. 
  • Consent doesn&apos;t mean you blindly sign a permission slip for your child to be tested. &amp;quot;300.9 Consent means :   that the parent has been fully informed of all information relevant to the activity for which consent is being sought, in his or her own language, or through another mode of communication. The parents understands and agrees in writing to the carrying our of the activity for which his or her consent is sought, and the consent describes that activity and lists the records (if any) that will be released and to whom...&amp;quot;   The assessment must be administered in the child&apos;s native language or other mode of communication and in a form most likely to yield accurate information on what  the child knows and can do academically, developmentally, and functionally, unless it is clearly not feasible to so provide or administer.  300.304(c)(ii) The assessment must be used for the purposes for which is it valid and reliable and must be administered by trained and knowledgeable personnel and must be administered in accordance with any instructions provided by the producer of the assessment. The evaluation must include assessment in all areas of suspected disability, including if appropriate, health, vision, hearing, social and emotional status, general intelligence, academic performance, communicative status, and motor abilities.
  • Determination of eligibility must occur at the CSE meeting, which must include the attendance of the parent(s) of the student;  A student must be classified with one of 13 disabilities- mental retardation, hearing impairment, speech or language impairment, visual impairment, emotional disturbance, orthopedic impairment, autism, traumatic brain injury, an other health impairment, a Specific Learning Disability, deaf-blindness, or multiple disabilities Program Recommendation: states must have a continuum of services available to students with disabilities.  In NYS thru runs from General Education - Home Instruction, in between you have Special Education Teacher Support Services, CTT, Special Classes in Community Schools; in Specialized Schools; Non-Public Schools The IEP must include present levels of academic and functional performance sufficient to provide all educators who pick up your child&apos;s IEP with the ability to understand where they are currently functioning and require assistance.  How often do we see IEP&apos;s based on evaluations conducted years ago, and based on data that is no longer current.. The IEP must include a statement of annual goals, and for many student, short term objectives, that are specifically tailored for that student based upon his needs and abilities.  These goals must be designed to meet the child&apos;s needs from the disability to enable the child to be involved in and make progress in the general education curriculum.    Related Services includes OT, PT, Sp/Lang, Couns., Vision, AT, audiology, interpreting, some medical services, school health and nurse services, and parent training and counseling. 
  • Section 300.502 describes the process for receiving an IEE; a Parent has the right to an IEE if they disagree with an evaluation obtained by the LEA; upon request by a parent for an IEE, a District must either file a due process complain to show that its evaluation is appropriate or ensure than an IEE is provided at public expense.   Mediation - voluntary; must be conducted by a qualified and impartial mediator; must be paid for by the District, who maintains a list of qualified mediators that are assigned on a rotational or random basis; is binding. Impartial hearing - a legal hearing in front of an administrative law judge; Appeals - NYS is a two level state - we have the IHO and then the SRO, before you go into federal or state courts.
  • Transcript of "Educational needs for Children with Epilepsy"

    1. 1. Educational Needs and Services for Children with Epilepsy David H. Salsberg, Psy.D., DABPS © Rusk Institute of Rehabilitation The Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders NYU Langone Medical Center
    2. 2. <ul><li>When to become concerned </li></ul><ul><li>What professionals do you consult with </li></ul><ul><li>What evaluations are available </li></ul><ul><li>How to prepare </li></ul><ul><li>What to do with the information </li></ul><ul><li>Special Education or not </li></ul><ul><li>Interventions </li></ul>Parents and Professionals
    3. 3. Myriad of Labels/Diagnoses, Tests, Scores, and Interventions <ul><li>WPPSI-III, WISC-IV, WIAT-II, NEPSY-II… </li></ul><ul><li>LD, PDD, ADD, ADHD, SI, ED, APD, TBI… </li></ul><ul><li>PT, OT, ST, IEP’s, EI, CPSE, CSE, 504 … </li></ul>
    4. 4. Educational Implications for Children with Epilepsy <ul><li>Etiology of Seizures underlying causes/conditions </li></ul><ul><li>Seizures frequency/control </li></ul><ul><li>Medications and effects </li></ul><ul><li>Age at Onset </li></ul><ul><li>Secondary effects missing school availability for learning emotional/family/psychological </li></ul><ul><li>All can contribute to a variety of learning and attentional difficulties in children. </li></ul>
    5. 5. Issues in Educational Planning <ul><li>Seizure plan </li></ul><ul><li>Nurse </li></ul><ul><li>Health paraprofessional </li></ul><ul><li>Medications and effects </li></ul><ul><li>Effects on learning Attention Fatigue </li></ul><ul><li>Stigma and Social Considerations </li></ul><ul><li>Dietary or activity restrictions </li></ul><ul><li>Emotional and family issues affect educational planning </li></ul>
    6. 6. When to take notice <ul><li>Developmental lags noted </li></ul><ul><li>Discrepancy between skill area and “norm” or expected </li></ul><ul><li>Discrepancy between child’s own individual strengths and weaknesses </li></ul><ul><li>Signs/expressions of frustration; low self-esteem </li></ul><ul><li>Social skills difficulties </li></ul><ul><li>Mood/behavior changes </li></ul><ul><li>Academic and achievement difficulties </li></ul>
    7. 7. Birth to 3 <ul><li>Start with Evaluations – specific or more comprehensive? </li></ul><ul><li>Early Intervention – funded </li></ul><ul><li>Private therapists </li></ul><ul><li>Need team – integrated approach </li></ul><ul><li>Center-Based Program / Home program </li></ul>
    8. 8. <ul><li>When in doubt refer for evaluation </li></ul><ul><ul><li>Need to refer early </li></ul></ul><ul><ul><li>If too early to qualify – need to monitor </li></ul></ul><ul><li>Need to intervene earlier or can miss developmental window of opportunity </li></ul><ul><li>Imperative in language skills development </li></ul>
    9. 9. Ages 3 - 5 <ul><li>Start with Evaluations – Specific or more comprehensive? </li></ul><ul><li>Therapy specific treatments </li></ul><ul><li>CPSE – Board of Education/District </li></ul><ul><li>Preschool options </li></ul><ul><li>SEIT </li></ul><ul><li>Crucial to evaluate early enough to make decisions prior to Kindergarten. </li></ul>
    10. 10. School Age <ul><li>Schools start with pre-referral interventions </li></ul><ul><li>Evaluations – specific or more comprehensive? </li></ul><ul><li>Committee on Special Education (CSE) Pros and cons of evaluations, classifications, Section 504, legal issues </li></ul><ul><li>Therapies </li></ul><ul><li>School Placement considerations </li></ul>
    11. 11. Primary Evaluations <ul><li>Psychological </li></ul><ul><li>Psychoeducational </li></ul><ul><li>Neuropsychological </li></ul><ul><li>History Intelligence Testing Behavioral Assessment Emotional/Personality </li></ul><ul><li>Psychological and Full Academic Achievement </li></ul><ul><li>All of the above and further exploration of areas of strengths and weaknesses </li></ul>
    12. 12. Developmental Evaluations <ul><li>Developmental snapshots to guide current treatment planning and diagnosis </li></ul><ul><li>Needs ongoing monitoring and reassessment of treatment plan </li></ul><ul><li>Not correlated with later IQ </li></ul><ul><li>Limitations of diagnoses/labels at an early age </li></ul>
    13. 13. Goal of Neuropsychological Testing <ul><li>Go Beyond IQ and academic scores to provide a complete picture of the child’s cognitive, learning and social/emotional functioning across many domains related to brain function. </li></ul><ul><li>Should be functional perspective with clear and practical recommendations. </li></ul>
    14. 14. Testing Professionals <ul><li>Psychologists School/Educational (Master’s, Doctorate) Clinical Ph.D., Psy.D. </li></ul><ul><li>Neuropsychologists </li></ul>
    15. 15. Other Disciplines/Team <ul><li>Neurology </li></ul><ul><li>Pediatrician/Developmental Pediatrician </li></ul><ul><li>Nursing </li></ul><ul><li>Psychiatry </li></ul><ul><li>Physiatry </li></ul><ul><li>Physical Therapy </li></ul><ul><li>Speech and Language Therapy </li></ul><ul><li>Occupational Therapy </li></ul><ul><li>Special Educators/learning specialists </li></ul><ul><li>All have specific scopes of practice </li></ul>
    16. 16. Pediatric Specialization <ul><li>Experience </li></ul><ul><li>Rapport </li></ul><ul><li>Knowledge of educational system </li></ul><ul><li>Limits of overly specialized, diagnosis focused evaluations, clinics </li></ul>
    17. 17. Specific Issues in Epilepsy <ul><li>All of the above </li></ul><ul><li>Experience with Epilepsy and range of learning, attentional and psychological issues </li></ul><ul><li>Timing and locations of evaluations </li></ul><ul><li>Reason for referral may dictate or limit evaluation (i.e.: pre-surgical evaluation) </li></ul>
    18. 18. District/School vs. Independent Evaluations <ul><li>Independent evaluation: </li></ul><ul><li>Parental control </li></ul><ul><li>Timing/flexibility of evaluation </li></ul><ul><li>Goal should be to evaluate the child holistically not just to get an evaluation done </li></ul><ul><li>Specific recommendations </li></ul><ul><li>No conflict of interest Needs to provide appropriate documentation and recommendations to be accepted and useful Be sure to understand timing/procedural issues </li></ul>
    19. 19. Variability in Reports <ul><li>Tester: Training Style Organization/Setting </li></ul><ul><li>Tests used </li></ul><ul><li>Who person is writing for </li></ul><ul><li>Referral Question </li></ul>
    20. 20. Variability in Tests Used <ul><li>Examiner’s choice/comfort level </li></ul><ul><li>Availability of Tests </li></ul><ul><li>Age of child </li></ul><ul><li>Clinical Judgment </li></ul>
    21. 21. Preparation for Evaluation - Parents <ul><li>Educate yourself regarding learning issues and process </li></ul><ul><li>Delineate areas of concern/goals of evaluation </li></ul><ul><li>Understand clinician’s scope of experience and practice and ability to assess with a team </li></ul><ul><li>Should not focus primarily on single label </li></ul><ul><li>Expect written report with practical recommendations that is also geared toward specific goal (ie: funding, admission…) </li></ul><ul><li>Assure ongoing communication/follow-up </li></ul><ul><li>Parents should receive feedback and then written report before school, district </li></ul>
    22. 22. Preparation for Evaluation - Child <ul><li>Present evaluation in non-threatening, relevant and developmentally appropriate manner </li></ul><ul><li>Coordinate terminology and evaluation process with clinician </li></ul><ul><li>Consider classroom/therapy observations </li></ul><ul><li>Discuss specific behavioral/stylistic issues with clinician </li></ul><ul><li>Provide work samples, book bag, outside of school examples of concerns </li></ul><ul><li>Child should receive some form of feedback at the end </li></ul>
    23. 23. Factors Impacting Testing <ul><li>Why referred? </li></ul><ul><li>Motivation/Attitude </li></ul><ul><li>Rapport </li></ul><ul><li>Time Frame of testing </li></ul><ul><li>Disabilities </li></ul><ul><li>Need to know what each test measures/doesn’t measure </li></ul><ul><li>Age </li></ul><ul><li>Culture/Language </li></ul><ul><li>Qualitative information necessary with scores </li></ul><ul><li>Medication </li></ul><ul><li>Seizure status </li></ul><ul><li>In hospital </li></ul>
    24. 24. Overall Cognitive Functioning Intelligence Testing - IQ <ul><li>In neuropsychological and/or educational evaluation IQ test is used as starting point </li></ul><ul><li>Normative Comparison </li></ul><ul><li>Limitations of overall scores </li></ul><ul><li>Limitations of IQ as a construct </li></ul>
    25. 25. IQ Scores <ul><li>IQ scores are often used as marker – need to make sure it is a good one! </li></ul><ul><li>Overall scores do not take into account variability in scores, especially Full-Scale IQ </li></ul>
    26. 26. Discrepancy Based LD Evaluation <ul><li>Discrepancy between IQ and achievement </li></ul><ul><li>Discrepancy between child and same age/grade peers </li></ul><ul><li>*Discrepancy between child’s own abilities and what should be expected </li></ul><ul><li>What is clinically meaningful should translate to what is educationally and legally relevant </li></ul>
    27. 27. IQ Scores <ul><li>In an effort to broaden the construct of IQ newer IQ measures incorporate numerous skills </li></ul><ul><li>Most notable – WISC-IV – can have high “traditional” IQ areas (Verbal, Performance) and have Full-Scale IQ lowered by Processing Speed and Working Memory </li></ul><ul><li>General Abilities Index – not always used but should be in many cases </li></ul>
    28. 28. Preschool <ul><li>Wechsler Preschool and Primary Scale of Intelligence-III (WPPSI-III) </li></ul><ul><li>Ages 2:6 – 7:3 </li></ul><ul><li>Limitations of ERB </li></ul>
    29. 29. School Age IQ <ul><li>Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Ages: 6 – 16:11 </li></ul><ul><li>Stanford Binet Intelligence Scales – 5 th Edition Ages 2:0 – 89:11 </li></ul><ul><li>Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Ages: 16 and up </li></ul><ul><li>Wechsler Abbreviated Scale of Intelligence (WASI) Ages: 6 and up </li></ul>
    30. 30. Speech and Language <ul><li>Neuropsychologists screen these areas in relation to full battery – gather from Speech-Language Evaluators </li></ul><ul><li>Speech/Oral-Motor not the same as Language </li></ul><ul><li>Need to gather audiological testing information </li></ul><ul><li>Look at expressive and receptive skills in a variety of contexts </li></ul><ul><li>Auditory Processing - APD </li></ul><ul><li>Adds valuable information to IQ scores </li></ul><ul><li>Augmentative Communication </li></ul>
    31. 31. Visual-Motor/Visual-Perceptual <ul><li>Parts of evaluations overlap w/ OT, especially in neuropsychological evaluation </li></ul><ul><li>Visual-Perceptual </li></ul><ul><li>Neglect / Inattention </li></ul><ul><li>Visual-Motor </li></ul><ul><li>Apraxia </li></ul><ul><li>Sensory Integration </li></ul><ul><li>Assistive Technology </li></ul><ul><li>Gross-Motor - PT </li></ul>
    32. 32. Other Areas of Neuropsychological Evaluation <ul><li>Attention and Concentration (In 1:1 structured testing setting) </li></ul><ul><li>Memory visual; verbal; procedural; recall vs. recognition </li></ul><ul><li>Executive Functioning: Planning, organization, sequencing, working efficiently, flexibility, impulsivity </li></ul>
    33. 33. <ul><li>Executive Functioning/Attention and Concentration Impulse control Distractibility Attention: Focused; selective; sustained/vigilance Auditory/Visual Not only attention – but organization, consolidation, etc… Planning, organization, time management Mental flexibility </li></ul><ul><li>May not manifest until older </li></ul>
    34. 34. <ul><li>Memory Most common complaint – but influenced by attention/executive functioning skills Visual Verbal Procedural Recall vs. recognition Short-term vs. long-term Long-term – usually intact – but retrieval strategies may be impacted </li></ul>
    35. 35. Academic Achievement Tests: <ul><li>Limitation of brief screening of single-word reading, spelling and arithmetic in diagnosing learning problems. </li></ul><ul><li>Reading: decoding, sight words, comprehension, speed, fluency… </li></ul><ul><li>Need different tests for reading comprehension </li></ul><ul><li>Teacher estimates are too subjective. </li></ul><ul><li>Importance of, but also limitations of Grade-Equivalents. </li></ul><ul><li>Standard Scores may be based on age or grade – very important. </li></ul>
    36. 36. Problems in Diagnosing LD <ul><li>Discrepancy analysis </li></ul><ul><li>Qualitative/subtleties of difficulties </li></ul><ul><li>Structured 1:1 setting </li></ul><ul><li>Difficulties do not always manifest themselves yet or on certain tests. </li></ul>
    37. 37. Personality/Emotional Testing <ul><li>Projectives Rorschach (Exner Comprehensive System Scoring) Thematic Apperception Test Roberts Apperception Test – 2 </li></ul><ul><li>Sentence Completion </li></ul><ul><li>Clinical Interview </li></ul><ul><li>Objective measures MMPI-A or MMPI-2 BASC-2 </li></ul><ul><li>PIC/PIY </li></ul><ul><li>All dependent on cognitive skills </li></ul><ul><li>Rating Scales – limitations but widely used – be careful – needs to correspond with clinical observation, other data…. </li></ul>
    38. 38. <ul><li>Depression </li></ul><ul><li>Anger </li></ul><ul><li>Anxiety </li></ul><ul><li>Reality Testing </li></ul><ul><li>Defenses </li></ul><ul><li>Coping abilities/style </li></ul><ul><li>Motivation </li></ul><ul><li>Self-esteem/confidence </li></ul><ul><li>Frustration tolerance </li></ul><ul><li>Emotional functioning needs to be given more concern before behavioral manifestation </li></ul>
    39. 39. Family/Developmental issues <ul><li>Independence/Dependence </li></ul><ul><li>Depending on age of onset may not have a goal of returning to previous level of independence and autonomy/achievement. </li></ul><ul><li>Parents often more protective ‑ furthering these difficulties </li></ul><ul><li>Fantasy of all-protective parent/safe world potentially impacted </li></ul><ul><li>Social Issues </li></ul>
    40. 40. Adaptive Functioning <ul><li>Activities of Daily Living </li></ul><ul><li>Measures: Vineland-2 ABAS-II </li></ul><ul><li>Observation </li></ul><ul><li>Interviews </li></ul><ul><li>Needed for diagnosis of Mental Retardation </li></ul>
    41. 41. Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004) <ul><li>Purpose: </li></ul><ul><li>  </li></ul><ul><li>    To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living. 20 U.S.C. Sect. 1400(d) </li></ul>
    42. 42. Individuals with Disabilities Education Act <ul><li>All children with disabilities receive a free appropriate public education (FAPE) </li></ul><ul><li>A school district must provide special education and related services (PT, OT, Speech, Special Education, Counseling, Health paraprofessional) at no cost to the child or his/her parents. </li></ul><ul><li>Only required to provide what’s appropriate – not optimal or best </li></ul>
    43. 43. Parental Referral to Local Education Authority <ul><li>Write a letter to the Chairperson of your Committee on Special Education requesting an evaluation for possible special education needs. </li></ul><ul><li>Federal and New York State law requires that Districts complete the evaluation process within 60 school (business) calendar days.  </li></ul><ul><li>All communication with your district should be in writing, and you must have proof of delivery of all communication. </li></ul><ul><li>Your School District cannot refuse to evaluate your child upon your request. </li></ul>
    44. 44. Evaluation <ul><li>Parents must consent to an initial evaluation. </li></ul><ul><li>  </li></ul><ul><li>A variety of assessment tools and strategies must be utilized to gather relevant functional, developmental, and academic information about the child.  This includes information provided by the parent. </li></ul><ul><li>No single measure or assessment may be used as the sole criterion for determining whether a child is a child with a disability or to determine an appropriate educational program. </li></ul><ul><li>Must be appropriate to be used with that child.  </li></ul><ul><li>Copies of results of all assessments performed must be provided to the parents, at no cost.  </li></ul>
    45. 45. Identification/Development of an IEP <ul><li>Determination of eligibility </li></ul><ul><li>Classification </li></ul><ul><li>Program Recommendation </li></ul><ul><li>Present Levels of Academic Performance </li></ul><ul><li>Goals/Objectives </li></ul><ul><li>Related Services </li></ul>
    46. 46. Classification <ul><li>Section 504 - Section 504 of the American with Disabilities Act requires recipients to provide to students with disabilities appropriate educational services designed to meet the individual needs of such students to the same extent as the needs of students without disabilities are met. A 504 Accommodation does not require an IEP, but simply provides for classroom modifications and/or related services </li></ul><ul><li>CPSE – Preschooler with Disability </li></ul><ul><li>CSE – 13 Classifications </li></ul>
    47. 47. Classification <ul><li>Autism </li></ul><ul><li>Deafness </li></ul><ul><li>Deaf/Blindness </li></ul><ul><li>Emotional Disturbance </li></ul><ul><li>Hearing Impairment </li></ul><ul><li>Learning Disability </li></ul><ul><li>Mental Retardation </li></ul><ul><li>Multiple Disabilities </li></ul><ul><li>Orthopedic Impairment </li></ul><ul><li>Other Health Impairment </li></ul><ul><li>Speech or Language Impairment </li></ul><ul><li>Traumatic Brain Injury </li></ul><ul><li>Visual Impairment including Blindness </li></ul><ul><li>*Can have very different implications for services and placement </li></ul>
    48. 48. Placement <ul><li>This is performed at the CSE meeting, except in New York City, where this is done by the placement office. </li></ul><ul><li>You do have the right to view any placement proposed for your child. </li></ul><ul><li>Charge and goal is for the least restrictive environment (LRE) </li></ul>
    49. 49. School Placement <ul><li>Section 504 – Not CSE </li></ul><ul><li>Public School General Education with related services Therapies Special Education Teacher Support Services (SETSS) Paraprofessional </li></ul><ul><li>Inclusion /Co-teaching/CTT </li></ul><ul><li>12:1 </li></ul><ul><li>12:1:1, 8, 6…. </li></ul><ul><li>NPS – approved schools http://www.vesid.nysed.gov/specialed/privateschools/ </li></ul><ul><li>Carter Funding </li></ul>
    50. 50. Dispute Resolution <ul><li>Independent Educational Evaluation (IEE) Parent has the right to an IEE if they disagree with an evaluation obtained by the district Upon request by a parent for an IEE, a District must either file a due process complaint to show that its evaluation is appropriate or ensure than an IEE is provided at public expense </li></ul><ul><li>Mediation </li></ul><ul><li>Voluntary; must be conducted by a qualified and impartial mediator; must be paid for by the District, who maintains a list of qualified mediators that are assigned on a rotational or random basis; It is binding </li></ul><ul><li>Impartial Hearing – Impartial Hearing Officer </li></ul><ul><li>Appeals – State level first </li></ul>
    51. 51. ADHD/ADD <ul><li>Hyperactivity </li></ul><ul><li>Impulsivity </li></ul><ul><li>Distractibility </li></ul><ul><li>Issues to Consider </li></ul><ul><li>Developmental </li></ul><ul><li>Gender Bias </li></ul><ul><li>Overly diagnosed/overly simplified </li></ul><ul><li>Medication issues in Epilepsy </li></ul>
    52. 52. PDD <ul><li>Autism </li></ul><ul><ul><li>Rett’s </li></ul></ul><ul><ul><li>Childhood Disintegrative Disorder </li></ul></ul><ul><li>Asperger’s </li></ul><ul><li>PDD-NOS </li></ul><ul><li>Wide variability in presentation </li></ul>
    53. 53. Learning Disabilities <ul><li>Specific Dyslexia, Dysgraphia, Dyscalculia </li></ul><ul><li>Non-Verbal Learning Disabilities </li></ul><ul><li>More General </li></ul><ul><li>Gaps in abilities/IQ and achievement </li></ul><ul><li>Developmental </li></ul><ul><li>Track over time/different demands </li></ul>
    54. 54. Sensory Integration <ul><li>Organizing, integrating and interpreting sensory input in a variety of modalities including: touch, movement, body awareness, visual, and auditory information. </li></ul><ul><li>Developmental </li></ul><ul><li>Does it impact functioning? </li></ul><ul><li>Overlaps and/or interacts with other diagnoses conditions </li></ul>
    55. 55. Auditory Processing <ul><li>Difficulties in processing orally presented information even though hearing is within normal limits </li></ul><ul><li>Beware of “knee-jerk” label </li></ul><ul><li>Audiologist needs to diagnose </li></ul><ul><li>Age expectations – These skills develop between ages 5-7. </li></ul><ul><li>Interventions/recommendations </li></ul><ul><li>Overlap with other diagnoses </li></ul>
    56. 56. Recommendations <ul><li>School placement </li></ul><ul><li>Therapies/Interventions </li></ul><ul><li>Compensatory techniques and strategies </li></ul><ul><li>Modifications in the Environment </li></ul><ul><li>Accommodations/Expectations </li></ul><ul><li>Assistive Technology </li></ul><ul><li>Medication/Treatments </li></ul><ul><li>Some sound good but may not help (e.g. tape recording lectures requires >2x to listen and transcribe; laptop in class – only if great/fast typist…) </li></ul>
    57. 57. Summary <ul><li>Need to incorporate all objective data, scores from testing, observations, outside therapists, history, emotional/personality variables, family, and school data in order to make well thought out decisions for children. Need to know rights and law as well. </li></ul>
    58. 58. Parents Know Best <ul><li>Trust your instincts </li></ul><ul><li>Be involved / carry-over </li></ul><ul><li>Educate yourselves (pros and cons of internet) </li></ul><ul><li>Work closely with medical team </li></ul><ul><li>Know your rights (Advocacy/Lawyers) </li></ul>
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