Thursday, December 29, 2011

Multiply Disabled, Doubly Blessed

Earlier this month, we had a Committee on Special Education (CSE) meeting on a rather tough case. X, a kindergarten student, was referred by his foster mom/aunt and his doctor due to suspected developmental delays. I had to blog about X and his CSE referral, since cases like his don't come around very often. Here's a list of notable things in X's social history, shortened for brevity:

Facial features of children with Fetal Alcohol Syndrome
-heavily exposed to alcohol and marijuana in utero. Recently diagnosed with Fetal Alcohol Syndrome. (also exhibits facial features)
-traumatic brain injury at 6-months (suspected that biological mother dropped him, cracking his skull).
-no medical care after first well-visit after birth.
-significant history of malnutrition (often left to fend for himself to eat, which led to injuries as he attempted to cook for himself; currently, hoarding food and pica-like behaviors of eating inedible objects).
-not toilet trained (a requirement for attending kindergarten in my district--he was asked not to return to school until he was toilet trained, because he was having accidents throughout the day).
-much smaller than is typical for his age--looks about 3 years old when he's 5-years, 7-months.
-speech concerns (articulation, voice tone and quality, expressive and receptive language deficits).
-underdeveloped fine motor abilities (shoe tying, writing, cutting; also sensory concerns).
-removed from biological mom's care 6-months ago due to severe neglect; living with his aunt.
-no exposure to school or age-appropriate social interactions prior to entering kindergarten this year.

During testing with me, X exhibited no spontaneous conversation, and when he did speak, it was in a whisper (I must've driven him nuts asking him to repeat himself so much because I couldn't hear him!). His sentences were no more than three words and he would gesture or point rather than speak at times. Throughout our time together, he exhibited flat affect and appeared lethargic. He was slow to respond to many assessment tasks. He rarely smiled or responded appropriately when I tried to make him laugh (I probably am not funny).

Lots of assessments were done, to get a full picture of X's developmental levels. Speech/language and occupational therapy evaluations were indicative of significant delays, so he qualified to receive those related services. My cognitive testing was in the borderline intellectually disabled range, as was standardized academic testing (i.e. standard scores in the 70 range). Behavioral rating scales were also completed by X's teacher, which indicated high levels of atypical or "strange" behaviors and moderate hyperactivity and attention problems. Adaptive behavior was also delayed, with daily living skills (self-care skills) and socialization were the lowest areas.

Standard scores within the 70 range across all areas (cognitive, academic, adaptive behavior) would in most cases lead to a classification of Intellectually Disabled. However, I recommended a classification of Multiple Disabilities. What are the criteria for this disability, in New York State?
Multiple disabilities means concomitant impairments..., the combination of which cause such severe educational needs that they cannot be accommodated in a special education program solely for one of the impairments. The term does not include deaf-blindness. [Part 200.1(zz 8)]
Due to his pervasive level of delays and needs, and concurrent head trauma and Fetal Alcohol Syndrome, Multiple Disabilities was a more appropriate classification for X. After the New Year, we are going to look into an agency self-contained classroom for him to be placed in. This setting will meet not only his educational needs, but also his daily living, self-care, and toileting.

So with all these hurdles to overcome, why is X "doubly blessed?" Because of his foster mother and aunt. She is working so hard to support him and provide him with the nurturing environment that he has lacked for the last five years. He is receiving routine medical care, nutritious food, an education, and most importantly, love and social interaction. She has advocated for him in ways that most people would find difficult, starting first by taking him in when she has other children of her own, and by initiating the special education referral that will get him the support he needs. I am confident that X will quickly catch up to where he needs to be with her care and appropriate educational services.

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