epilepsy assessment


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epilepsy assessment

  1. 1. Educational Assessment in Pediatric Epilepsy Thomas B. King, M.Ed. Debbie Ramer, M. Ed. Educational Consultants Division of Child Neurology
  2. 2. Why Assess?
  3. 3. Incidence of Epilepsy 2,000,000 people in the United States have some form of epilepsy 30 %, or about 300,000 are under the age of 18 6/1000, or approximately 0.5 % to 1% of children in the US are diagnosed with epilepsy Large numbers of children may have undetected or untreated epilepsy. (Epilepsy Foundation of America)
  4. 4. Incidence Most common CNS disorder affecting children About 5% to 10% of children will have a seizure within the first 20 years of life
  5. 5. Educational Implications Most children with epilepsy test within the Average IQ range and will remain in regular education classes. (Epilepsy Foundation of America) The majority of children with epilepsy will attend their neighborhood schools. However, some children with epilepsy will experience academic and/or behavior problems.
  6. 6. Hidden Epilepsy you don’t have to have a seizure BECTS to LKS spectrum about 8% of children with Rolandic Discharges have epilepsy most will have cognitive dysfunction IQ may not be affected processing disorders cause learning disabilities and behavior disorders Epilepsia. 2006 Nov;47 Suppl 2:67-70
  7. 7. Factors that effect school performance Type of epilepsy Level of control Any related medical condition Age of onset is a factor
  8. 8. Problems that children with epilepsy may face in school Learning Disabilities are a common, but frequently overlooked co-morbid condition. (Pellock, 1999) Almost 1/3 of children with epilepsy are also identified as ADHD (Kanner, 2001) Grade retention and special education identification is more common in children with epilepsy. (Bailet & Turk, 2000) There is a higher rate of psychiatric disorders in children with epilepsy (Kanner, 2001)
  9. 9. Problems that children with epilepsy may face in school Poor seizure control is associated with decreased reading achievement. (Bailet & Turk, 2000) Nocturnal seizures are believed to have a detrimental effect on language, memory, and alertness. (Aldenkamp, 1999)
  10. 10. Reasons that children with epilepsy have these problems Underlying etiology – what is causing the seizure may also interfere with one or more of the child’s psychological processes. Medicines for seizures may affect a child’s ability to learn (side effects). Unrecognized seizure activity in the brain may interfere with attention. Absence from school may affect academic performance
  11. 11. Reasons that children with epilepsy may face these problems Behavior problems can result from the seizure activity itself, medication, the child’s own anxiety, or parental overprotection. Behavior problems are twice that of other chronic disorders not involving the CNS and four times that of healthy children
  12. 12. Questions a physician can ask to determine if there are problems at school How is the child’s attention span? Have any teachers ever mentioned attention as a concern? Is the child able to complete assignments and homework within a reasonable amount of time? Can the child follow verbal and written instructions?
  13. 13. Questions a physician can ask to determine if there are problems at school (cont.) Is the child able to retain information short-term and over time? What were the child’s grades on the last report card? How many days of school has the child missed this year? Has the school referred the child for any remedial classes or for any testing?
  14. 14. Questions a physician can ask to determine if there are problems at school (cont.) Has the child ever repeated a grade? Does the child have an IEP or 504 plan at school? Is there inconsistency in the child’s performance from day to day? How is the child’s handwriting and written performance?
  15. 15. Why do we need to assess children with epilepsy? Needs of children vary greatly. Long-term risk of learning problems requires monitoring of educational progress, neurocognitive screening, and possibly comprehensive educational evaluation. Testing conducted by a specialist knowledgeable about epilepsy can determine whether the child’s difficulty at school is due to a specific learning disability.
  16. 16. School’s Role The school must have a plan that outlines the appropriate response to a seizure The teacher can contribute to a child’s social and psychological development by reassuring other students and including the child with epilepsy as fully as possible in regular classroom activities.
  17. 17. Role of the educational consultant Provide education for the school about the child’s seizure type, seizure first aid, and educational implications of the child’s condition. Facilitate communication between the child’s school, family, and the doctor. Determine if learning problems exist and recommend appropriate educational interventions.
  18. 18. Role of the educational consultant (cont.) Guide the family and school in obtaining appropriate school services for the child. Provide workshops and programs to educate school personnel and classmates about epilepsy and educational implications.
  19. 19. Why do we need to assess these children? Once identified for special education, appropriate educational services and instructional techniques can be sought. Early identification can lead to strategies for compensation and lead to a more successful school experience.
  20. 20. What needs to be assessed? Overall Cognitive or Intellectual Ability Processing Abilities Academic Achievement
  21. 21. Overall Intellectual Ability Verbal Abilities vs. Performance Abilities or What you know and how you show what you know Weschler Intelligence Test (WISC-III) Woodcock Johnson III (W-J III)
  22. 22. WISC-IV Indices Verbal Comprehension Perceptual Reasoning Working Memory Processing Speed
  23. 23. WISC-R Subtest Profiles Children with epilepsy, as a group, tended to do less well on the following WISC-R subtests (Aldenkamp et al., 1990) Vocabulary Coding Information Digit Span
  24. 24. WISC-R Subtest Profiles (Rodin et al., 1986) Vocabulary Coding Information Picture Arrangement
  25. 25. WISC-R Subtest Profiles (Dodrill, 1986) Arithmetic Coding Information Digit Span
  26. 26. W-J III Broad Cognitive Areas Verbal Ability Thinking Ability Cognitive Efficiency
  27. 27. W-J III Cattell-Horn-Carroll Factors Comprehension-Knowledge Long-Term Retrieval Visual-Spatial Thinking Auditory Processing Fluid Reasoning Processing Speed Short-Term Memory
  28. 28. W-J III Additional Clinical Test Clusters Phonemic Awareness Working Memory Broad Attention Cognitive Fluency Delayed Recall Knowledge
  29. 29. Processing Abilities Factors of Cognitive Function Auditory Processing Visual Processing Visual-Motor Integration Processing Speed Memory Language Functions Attention and Concentration
  30. 30. Auditory Processing (Important in Temporal Lobe Epilepsy) Auditory Analysis Auditory Synthesis Auditory Memory
  31. 31. Tests used to assess auditory processing (You might see the term CAP in your chart) SCAN (given by an audiologist) Filtered Words Auditory Figure Ground Competing Words W-J III Sound Blending Incomplete Words Sound Awareness Auditory Attention
  32. 32. Phonological Processing (Auditory Processing’s “Evil Twin” Phonological Awareness Phonological Memory Rapid Naming
  33. 33. Tests to Assess Phonological Processing (Standard Audiometric Evaluations are not enough) Comprehensive Test of Phonological Processing (CTOPP) Phonemic Awareness Phonemic Memory Rapid Naming Test of Phonological Awareness (TOPA) Lindamood Auditory Conceptualization Test
  34. 34. Processing Speed (Is the child efficient with processing?) Clerical Speed Rapid Naming
  35. 35. Tests to Measure Processing Speed (There is no one test, but tests within batteries should be monitored) WISC-IV Processing Speed Index (Coding-Symbol Search) W-J III Visual Matching Decision Speed Pair Cancellation CTOPP Rapid Naming Index
  36. 36. Processing Abilities Visual-Motor Integration Visual Perception Motor Coordination Integration
  37. 37. Tests to Assess VMI (Simple handwriting assessment can also help) Developmental Test of Visual-Motor Integration Visual Perception Motor Coordination Integration Bender Gestalt
  38. 38. Memory (What you don’t process deeply, you don’t remember) Visual Memory Verbal Memory
  39. 39. Tests to Assess Memory (Memory should always be assessed in the smallest possible slice) Test of Memory and Learning (TOML) Wide Range Assessment of Memory and Learning (WRAML) WISC-III Freedom from Distractibility W-J III Long-Term Retrieval Short-Term Memory Working Memory
  40. 40. Language (Where many processes intersect) Oral Language Receptive Vocabulary Expressive Vocabulary Written Language Reading Comprehension
  41. 41. Tests to Assess Language (Language is a part of most Verbal Ability assessments) WISC-IV Verbal Comprehension W-J III Oral Language Comprehension-Knowledge Verbal Ability
  42. 42. Tests to Assess Language (cont.) Peabody Picture Vocabulary Test (PPVT-III) Expressive One-Word Picture Vocabulary Test Receptive One-Word Picture Vocabulary Test Oral and Written Language Scales (OWLS)
  43. 43. Academic Performance Areas to be Assessed Reading Decoding Comprehension Fluency Writing Basic Skills Expression Fluency Spelling (encoding)
  44. 44. Academic Performance Additional Areas to be Assessed Math Basic Concepts of Math Math Operations Math Applications Language Listening Comprehension Vocabulary (expressive and receptive) Oral Language Performance
  45. 45. Weschler Achievement (WIAT) Basic Reading (Reading Words in Isolation) Reading Comprehension Math Reasoning (Problem Solving) Numerical Operations Spelling Listening Comprehension Written Expression
  46. 46. W-J III Areas of Achievement Assessed Reading Broad Reading (Including reading fluency) Basic Reading Skills (Including word attack) Reading Comprehension Math Broad Math (including math fluency) Math Calculation Skills Math Reasoning
  47. 47. W-J III Academic Areas Written Language Broad Written Language (including writing fluency) Basic Writing Skills Written Expression Oral Language Oral Language Skills Listening Comprehension Skills Oral Expression Spelling
  48. 48. Testing Younger Children Examples of Achievement Tests Test of Early Reading Ability (TERA-2) Test of Early Written Language (TEWL-2) Test of Early Math Ability (TEMA)
  49. 49. Other Achievement Tests of Note There are a great many achievement tests on the market Kauffman Test of Educational Achievement (K-TEA) Peabody Individual Achievement Tests (PIAT) KeyMath - Revised (KeyMath-R/NU) Woodcock Reading Mastery Tests - Revised/NU (WRMT-R/NU) Test of Written Language (TOWL-3)
  50. 50. Post- Assessment Now What?
  51. 51. Staffings Staffings are offered to all families after an educational evaluation is conducted Staffings allow the parents, educational consultant, and doctors to discuss all the test results, address questions and concerns, and develop a comprehensive treatment plan. An educational treatment plan is suggested.
  52. 52. Common Learning Problems Learning Disabilities Mental Retardation Developmental Delays Slow Learner Generic Learning Problem (sometimes the result of motivation, interest, etc.)
  53. 53. Some children with epilepsy and learning difficulties will qualify for special education services in public schools. (But not all kids)
  54. 54. Special Education Special Education Services Federal Regulations IDEA 1997 State Regulations (Must comply with IDEA 1997) Local School Division Guidelines (Must comply with IDEA 1997 & State Regulations)
  55. 55. Disability Categories in Virginia Autism Multiple Disabilities Deaf-Blindness Orthopedic Impairment Developmental Delay Other Health (ages 5 - 8) Impairment Emotional Severe Disabilities Disturbance Speech/Language Hearing Impairment Impairment/Deaf Traumatic Brain Injury Learning Disabilities Visual Impairment Mental Retardation
  56. 56. Most children with epilepsy and learning problems qualify for special education services under one of the following categories: Learning Disability (LD) Mental Retardation (MR) Other Health Impairment (OHI) Developmental Delay Speech-Language Impairment
  57. 57. Specific Learning Disability “Specific learning disability” means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations. The term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include learning problems that are primarily the result of visual, hearing, or motor disabilities; of mental retardation; of emotional disturbance; or of environmental, cultural, or economic disadvantage.
  58. 58. Specific Learning Disability Criteria for Identification In Virginia, a child may be determined to have a learning disability if: (1) The child does not achieve commensurate with the child’s age and ability levels in one or more of the areas listed in subdivision 2 … if provided with learning experiences appropriate for the child’s age and ability levels; and (2) the team finds that the child has a severe discrepancy between achievement and intellectual ability in one or more of the following areas:
  59. 59. Specific Learning Disability (cont.) Oral Expression; Listening Comprehension; Written Expression; Basic Reading Skill; Reading Comprehension; Mathematical Calculations; or Mathematical Reasoning.
  60. 60. Specific Learning Disability (cont.) (3) The group may not identify a child as having a specific learning disability if the severe discrepancy between ability and achievement is primarily the result of: (A) a visual, hearing, or motor impairment; (B) mental retardation (C) emotional disturbance; or (D) environmental, cultural, or economic disadvantage.
  61. 61. Developmental Disability “Developmental Disability” is defined in IDEA 1997 as a disability affecting a child aged 3 through 9 who is (I) experiencing developmental delays, as defined by the State and as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas: physical development, cognitive development, communication development, social or emotional development, or adaptive development; and (II) who, by reason thereof, needs special education and related services. Virginia regulations do not specify any further criteria, so the local school divisions are left to define the term “developmental delays” for eligibility purposes.
  62. 62. Mental Retardation The term “Mental Retardation” is not defined in IDEA 1997. The Virginia state regulations define “Mental Retardation” as significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a child’s educational performance. Virginia regulations do not set forth any specific criteria for defining or determining what is considered “subaverage.”
  63. 63. Mental Retardation (cont.) The American Association on Mental Retardation (AAMR) defines “subaverage general intellectual functioning” as scores more than two standard deviations below the mean on a standardized test of intelligence. Most schools use the following scores to further define the level of mental retardation: (A) IQ = 50-55 to approx. 70 = Mild MR/ EMR (B) IQ = 25 to 50 -55 = Moderate MR/ TMR (C) IQ = Below 25 = Severe & Profound MR
  64. 64. Mental Retardation (cont.) Many children with IQ’s that fall within the 70 - 80 range are considered “Slow Learners”. Such students, in general, are not found eligible for special education services under the category of mental retardation or learning disabilities, even if they are struggling in school.
  65. 65. Other Health Impairment (OHI) In Virginia, “Other Health Impairment” is defined as having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that (a) is due to chronic or acute health problems such as heart condition, tuberculosis, rheumatic fever, nephritis, arthritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, attention deficit disorder or attention deficit hyperactivity disorder, and diabetes, and (b) adversely affects a child’s educational performance.
  66. 66. Other Health Impairment (OHI) (cont.) Virginia regulations do not set forth any further criteria for eligibility under OHI. IDEA 1997 does not define the term “Other Health Impairment”
  67. 67. Educational Treatment Options: The continuum of special education services Regular Education Curriculum -- with or without accommodations and modifications Regular Education Curriculum - in co-taught classes (Both a regular and special education teacher) Resource class - part of the day (<50%) is spent in a separate classroom with a special education teacher receiving instruction that is supposed to be individualized to the student’s needs.
  68. 68. Educational Treatment Options: The continuum of Special Education Services Self-Contained class -- more than 50% of the day is spent in a separate class with a special education teacher receiving instruction that is supposed to be individualized to meet the child’s needs. Special Schools Home-based Instruction Instruction in hospitals and institutions
  69. 69. Educational Treatment Options: The Continuum of Special Education Services Placement decisions are made by the IEP team, which parents are members of, after goals and objectives have been written to address the child’s needs. Children must be served in the “least restrictive environment” possible.
  70. 70. Clinical versus School Realities Unfortunately, some of the children we see in the clinic who are having school/ learning problems and appear to need special help in school, will not qualify for special education services for a variety of reasons.
  71. 71. Clinical versus School realities These reasons include: (A) the child does not meet the specific criteria for eligibility under one of the 14 disability categories, which is further complicated by (B) differences between school system definitions of eligibility criteria for certain disability categories;
  72. 72. Clinical versus School Realities (C) multiple interpretations of test results; and (D) the ambiguity of the language in many of the definitions of the disability categories.
  73. 73. Clinical versus School Realities Schools are only required to provide an “appropriate” education, not an “optimal” education. It is important to note that schools are also limited, in many cases, by financial and personnel resources.
  74. 74. Clinical versus School Realities As such, even if a child is found eligible for special education services, he/she may not receive the “best” educational treatment of program.
  75. 75. Clinical versus School Realities The good news is, not all children with epilepsy will need special education services in the schools in order to be successful.