Tuesday, April 23, 2013

Declassification: When a Student No Longer Qualifies for Special Ed. Services

A reader on my Facebook page asked: "How [do you] ease the anxiety teachers may feel when students are doing well and you are recommending that the student be dismissed from special education?"

Dismissal, or declassification, from special education can be a tenuous celebration. The student has made adequate progress where support services are no longer needed, yay! But, what if the student starts to really struggle without those services, boo?

Typically, declassification reevaluations in my building are initiated by the teacher or speech/language pathologist (for kiddos who receive speech only). The direct service provider knows best how the student is functioning day-to-day in the classroom and can make the determination better than myself or the team alone. If a case comes up where as a Committee on Special Education (CSE) team we feel that services are no longer warranted, we start gathering oodles of information: standardized assessment data, classroom scores and curriculum based measurement data, attendance and report card grades, state-wide test scores, parent input and concerns, teacher interview and report, etc. We need to cover all bases to see how the student is functioning within the classroom. The key thing for school psychologists to consider when conducting any reevaluation is: does the student continue to meet the criteria that once qualified them under a certain special education classification?

If we make the decision that declassification is appropriate, we can choose a few different final outcomes. (it's important to remember that a kiddo's testing accommodations will follow them throughout their schooling and they can always access them if they choose) Some students we may choose to declassify "with support services" for a given period of time. For instance, if we are reevaluating for declassification mid-year, we can choose to continue to give the kiddo support services for the remainder of that school year, having them terminate for September. This would allow a sort of adjustment period. Another option would be to declassify from special education but refer for a 504 Accommodation Plan, which provides educational supports (program modifications, testing accommodations, formalized Functional Behavioral Assessments/Behavioral Intervention Plans) under general education. These options are both good for teachers and parents who may be unsure or uncomfortable with declassification because they allow the student a transition period.

The team may also recommend that a student no longer needs any services, and thus doesn't receive any further special education supports aside from testing accommodations, as mentioned above. If there is any uneasiness with this, we refer back to the data gathered--we don't make declass decisions lightly and without lots of supporting information. We also may recommend that a student receive tutoring with an adult or staff member in the building to reinforce skills, or suggest other ideas that can be done within the classroom (i.e. peer tutoring, flashcards, small group work, etc). Sometimes it helps assuage any fears when the teacher or parent remembers that the student will still have supports and help available to them, even if it isn't under special education.

How does your building or district handle special education declassifications? Do you have suggestions on how best to support teachers and ease their anxiety about it?

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Monday, April 15, 2013

Guest Post! - Conducting Comprehensive Autism Evaluations

Another marvelous guest post, and very timely since April is Autism Awareness Month! Today, we discuss best practices for Autism evaluations from an expert. “Dr. Tonya” Gscheidle, NCSP received her PhD in School Psychology from UNC-Chapel Hill, which is the home of TEACCH. She has been actively participating, leading, and/or training others in the art of Autism evaluations for the past 7 years. Tonya currently has the pleasure of “torturing” public school kiddos through evaluation in the Oklahoma City area. 

Conducting Comprehensive Autism Evaluations

According to the CDC, 1 in 88 children have been diagnosed with an Autism Spectrum Disorder (ASD), with boys four times more likely than girls to receive that diagnosis. While no one cause for Autism has been identified, many debates are ongoing with various hypotheses about a cause(s), as well as if Autism is being overly diagnosed. The rapid increase in prevalence also prompted significant changes to the diagnostic criteria for Autism in the soon-to-be-published DSM-5, due to be released May 2013.  One way we, as school psychologists, can help ensure that only students who meet diagnostic criteria are labeled as having Autism is by conducting comprehensive evaluations. How can we be sure our evaluations cover all bases?  

  • Screen, screen, screen! How many times have you been pulled aside by a teacher or parent stating that a student may have Autism because they do not make eye contact? Or does not speak in class? Prefers to play alone? Each one of those observations is a symptom of ASD, but in isolation, does not necessarily mean a child warrants a formal diagnosis of an Autism spectrum disorder. Just as we do not automatically rush to evaluate for Emotional Disturbance based on a single tantrum or ADHD if they are easily distracted, it is best practice to do classroom observations and gather information to develop a profile of behaviors for a particular student before rushing to obtain consent for an evaluation for special education. Screening is a relatively quick and easy way to do that – and there are screeners published for both the home and school settings. (We use the Autism Screening Instrument for Educational Programming – 3rd Ed (ASIEP-3) for school and Social Communication Questionnaire (SCQ) for parents.) Screeners help you know how to proceed with your evaluation, as well as to help further educate parents and teachers. If they are insistent on an Autism evaluation based on one isolated symptom (e.g., does not make eye contact) but the screeners do not show that a full evaluation is warranted, you have documentation that you addressed their concern and can provide that information to the team without completing a full Autism evaluation (though an evaluation in another area may be indicated). 
  • Social-Developmental/Medical History is crucial! Diagnostic criteria clearly state that symptoms must be present before age 3 for a student to be diagnosed with Autism. How else can you gather that information other than interviewing a parent?  Although some questionnaires can be sent home with a student for the parent to complete and return, I have found that it is better to do these interviews face to face or via phone conference so that you can ask follow up questions. Remember to include questions about sensory differences, responses to transitions/schedule changes, and family/peer relationships in any interview you use. Part of the history gathering should also include a medical history to rule out any possible diagnosis that could be causing the behaviors of concern.
  • There is no “I” in play based evaluations! ASD is characterized by significant disruptions in language and communication, reciprocal social interactions, and repeated/restricted stereotyped behaviors. The best way to assess those areas is thru a structured play-based assessment. The Psychoeducational Profile – 3rd Ed (PEP-3) and Autism Diagnostic Observation Schedule – 2nd Ed (ADOS-2) are the two most commonly used standardized play-based assessments used in Autism evaluations and allow direct assessment of those specific areas through activities or presses. As communication and sensory differences are two main diagnostic areas, Autism evaluations should be completed using a multi-disciplinary team approach to the greatest extent possible. If that is not the practice in your school district, consider seeking out your Speech/Language Pathologist or Occupational Therapist to see if the findings they found in the course of their evaluations support or contradict your own. The ADOS-2 has a scoring algorithm built in to quantify observations through ratings to determine if a student’s behaviors rise to the diagnosis of an ASD. When doing the PEP-3, teams in my district complete the CARS-2 rating scales to quantify our observations. The focus of your report should be on the behaviors observed in response to the presses/activities and NOT on the scores obtained.  In fact, the authors of the ADOS-2 advise NOT to report scores from the ADOS-2 in the report.  
  • What – more behavior rating scales? In most instances, Autism is considered to be a life-long disability. A student may (and should!) learn compensatory strategies to be productive in school and the community, but in most cases Autism will always be present.  This “life-long disability” label should not be taken lightly. Additional rating scales can be collected to further validate your observations. Preferred rating scales for teams I have been involved with include the Social Responsiveness Scale (SRS) and Gilliam Autism Rating Scale-2nd Ed (GARS-2). 

A word about cognitive testing: I would strongly recommend using low-verbal batteries that utilize manipulatives such as the KABC-II NVI or Stanford-Binet 5.  Remember that while we engage our worlds socially and through language, those with ASD tend to engage through the sensory realm.  It may help to start a student with a brief sensory activity (e.g., using a Rain Stick, Bumble Ball, texture bocks, or digging through a bucket of dried beans) to help them regulate emotionally before putting academic stressors on them. To keep sessions structured, I almost always use a sticker chart and allow students to put a sticker in a box for every activity (subtest) completed. The chart gives students a visual of the progress made, how much is left, and something to take with them as tangible evidence of how much was able to be completed during a given session.

Recommendations should address particular concerns that drove the initial referral as well as behaviors observed throughout the evaluation. Commonly, recommendations include strategies to increase structure in the classroom (including structuring play scenarios for younger students), warn students of impending transitions, provide frequent sensory breaks, and explicit teaching of expected behaviors followed by immediate consequences or rewards.  Often, it takes students with ASD a significantly longer time to directly associate specific behaviors with rewards or consequences. Many more discreet trials are often needed. Visual supports and hands-on learning may also be considered depending on the needs of the student.

I end with a few recommendations of my own. The number of resources out there for Autism is exponential but there is a handful that I use regularly when consulting with parents and teachers and keep close when asked for resources that I will share with you lucky readers out there. This list is not at all meant to be comprehensive, rather just “tried and true” suggestions you may want to consider adding to your toolbox.

Parent/Teacher Resources
-Practical Ideas That Really Work for Students with Autism Spectrum Disorders – Kathleen Mc Connell and Gail R. Ryser
-Educating the Young Child with Autism Spectrum Disorders – Michael Abraham
-*Anything* by Temple Grandin [side note from Musings--I'm reading The Way I See It, 2nd Edition and it's stellar)

Student Resources (fictional stories about living with an Autism spectrum disorder)
-Understanding Sam and Asperger’s Syndrome – Clarabelle van Niekerk and Liezl Venter
-Mockingbird – Kathryn Erskine

www.do2learn.com (picture cards and picture schedules)

Please consider “Lighting it Up Blue” this April to show support for those with Autism Spectrum Disorders! 

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Saturday, April 6, 2013

It's 1:20pm and I'm Losing My Mind: Mid-Day De-Stressing

Here's a question from a reader of my Facebook page... "What do you do to de-stress during your day when you feel like you are going crazy?"

Great question! A lot of times, we feel like we're stuck at the desk or in our office, dealing with crises/ issues or chained to a computer typing reports. Once we leave for the day, we can redirect ourselves, hit the gym, go home to our families... but what do you do when you can't escape during the day? I think we all need an Individual Education Plan (IEP) with "refocusing and redirection" on it!

Personally, I rarely leave the building, because my workload is such that I can't take much time away, plus there's no place to go near my school since we're not in a great neighborhood. If I do leave, I drive to a better part of the city to get Starbucks (nom nom Skinny Caramel Macchiato, Cinnamon Dolce Latte, and the new Hazelnut Macchiato). Very very occasionally, a co-worker and I will pick up lunch to bring back to the office. That being said, I have to at least get out of my office during the day if I'm starting to crack!

Sometimes, I just need a quiet place for a bit where there's no phone ringing, no kids in the office, and no co-workers, so I'll go to our meeting/group counseling room by myself to focus. Usually, I take a walk. If a stop to check my mailbox and chat with the main office clerk isn't enough, I climb the stairs and do a few laps around the building, tactically avoiding a trip past certain classrooms so I don't get dragged into something (goodness knows I can't show my face outside my door some days without something happening!). On my way, I'll check in with a few kids that I work with or chat with a teacher. If I'm still plotting to rip out my hair, I stop by the cafeteria or one of my favorite classrooms to hang out with the kids and hand out Positive Behavior Intervention Supports (PBIS) tickets to boost all our moods. It's impossible to be grumpy after spending time with the little ones. I like to observe as they learn, have them show me the literacy computer games they're doing, or sit down and work alongside them with manipulatives or a hands-on activity. My classroom of choice this year is our first grade 6:1+1 Special Class, who I did a counseling group with this fall. They are utterly precious... except for the times when they're having a massive freak-out and kicking me in the chest (that's another story).

If I can't get away from the desk or don't want to venture outside (and possibly getting dumped on :) ), I chit chat with co-workers. I share an office with three other people on a regular basis (with a few other part-timers), so there's always someone around and we typically get along well. Our favorite light-hearted, possibly inappropriate, past-times include: reading our daily "FML" calendar, making "That's What She Said" jokes (and hitting the TWSS button in my desk drawer), and dancing to "Friday" by Rebecca Black (but only on the appropriate day). Laughter is an absolute must to de-stress! I also will talk to Husband on Gmail Chat throughout the day to break up the monotony, or check Facebook, Pinterest, or play a quick game on my iPhone (anything in the "... With Friends" series does me good, or this Jetpack Joyride game that Husband downloaded).

How do you de-stress and re-boot during the day?

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