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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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 – 3^rd 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 – 3^rd Ed (PEP-3) and Autism Diagnostic Observation Schedule – 2^nd 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-2^nd 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

Websites

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

www.autism-society.org

www.autismspeaks.org

www.teacch.com

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

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March Madness: It's Not Just For Basketball Anymore

As the middle of March hits, if you're like me, you're kind of drowning. March and April are crazy busy months in education, especially special education. Many districts, like mine, conduct Annual Reviews of every special education student's Individualized Education Plan (IEP) in March, so there's constant questioning, checking, fire-putting-out, and meeting related to that. Also, early spring is when the final push to get children evaluated before the end of the year begins. This "In Like a Lion, Out Like a Lamb" and "April Showers Bring May Flowers" junk needs to go out the window. "In Like a Lion, Out Like a Strung Out Wildebeast" and "April Evals Bring Crazy, Exhausted School Psychs" perhaps!

I think the most important thing to remember when facing the uphill battle of spring evaluation season is this: you are one person. It is possible that you may not be able to meet timelines and deadlines for every evaluation. If this were to happen, it only means that you are not a super human (although you will always be a Super Psychologist), and it tells your district that they are understaffed for the demand. Seriously communicate the difficulties you're facing with your workload to your supervisors, other psychologists, and the superintendent, and stress that you may not be meeting compliance despite working your best to do so (they wanted to be cited less than you do!).

Take it one evaluation, one report, and one meeting at a time. Manage your time, get organized, and make things as streamlined as possible. Collaborate with other psychologists and professionals in your building or district. Be honest with people who try to draw you into other duties and responsibilities during the school day (lunch duty? I think not). Try your best to "leave work at work" and don't stay up til all hours writing reports and IEPs--it's not healthy and you won't be at your best pumping things out in mass quantities. Communicate with teachers and administrators who are making the referrals to see if something else may be more appropriate than a special education referral (i.e. RTI, counseling, mentoring, wraparound services, etc). And remember, you are one person.

You will likely be feeling all kinds of crazy stress, pressure, and general insanity. That's okay, and it comes with the territory any month of the year. Take care of yourself, first and foremost. You will not be an effective school psychologist to your students if you're totally burnt out. Check out some of my posts on stress management for suggestions on how to keep the crazy down.

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Currently... v. 2.0

This was fun the last time I did it, a nice fluffy interlude while I try and wrap my head around some upcoming blog posts!

Listening: to the radiator in my office banging and hissing like a rhumba of rattlesnakes as it blows cold air. We've called to have maintenance take a peek inside, but I think they're scared of getting bitten or frozen. As an aside, I bet you didn't know that was the scientific term for such a grouping of snakes, eh? The more you know...

Loving: the scoring software for the BASC-2. Thank you, thank you, thank you for interpreting my data and giving me a handy print-off for these six BASC-2 protocols I have to score. While I still retype the results into my reports and do my own interpretative commentary, I love not having to hand score that thing. Now, if only I could get computer scoring for the Conners-3... man, that's a pain in the backside.

Thinking: of trying out the new WPPSI-IV with a kindergartener I'm evaluating this week. I haven't gotten the chance to use it yet and it's taunting me with its shiny child-friendlyness! In reality, I just want to play with the Bingo dauber... don't be hatin'.

Wanting: the kids in the weight room to hush their faces. The weight room shares a wall with my office and my desk is closest to said wall. I've already asked them to turn the radio down once this period, which they did (barely), but I think they just got louder as a result. If I hear one more weight bar slam down, I'm going to be Angry Psychologist.

Needing: a Cherry Coke Zero. Maybe not need, but highly want. It's like my crack, not gonna lie, and I ration it so I only drink 2-3 a month. I grabbed the last plain Coke Zero from the fridge when I packed my lunch last night and it was a real let-down seeing it this afternoon. Sorry, Coke Zero, but I think we need to talk about our relationship.

Stalking: our Individualized Education Plan (IEP) software to see if teachers are opening their drafts, generating proper letters, and starting to write their IEPs for Annual Reviews this month. I really need to let them do their thing and go check them out next month when they're all done, but I'm too Type A. Just want all our IEPs to be informative, meaningful for next year's teacher, and meet state mandates!

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How to Have Reliable, Productive Psychological Testing Sessions

Since Husband had eye surgery yesterday and Winter Storm Nemo is bearing down on Northeast, I thought today would be an excellent day to stay home and hunker down in a baggy ol' college sweatshirt with a Starbucks Skinny Cinnamon Dolce Latte and bust out a blog post!

Recently on my Facebook page, I mentioned a case where I had heard that two brothers were planning to throw their testing in order to get classified with special education services. Every now and then, I evaluate kids who do not give their "all" during testing--whether it's because they're unmotivated, uncooperative, excessively fidgety, or a plotful mastermind like these brothers. These kiddos can be challenging to test because we don't want to push too hard, but we also require reliable results for decision-making. It's a delicate balance.

Here are some general recommendations to make sure you're getting the most accurate scores possible:

• Make sure to spend the time building rapport with the kids you're testing. Whether it's a game of Uno, asking about their interests, reading a story together, or an extra long walk & chat to the testing location, making kids feel at ease and comfortable with you is the first step towards having a productive assessment session. 
• Pick a place to test that is relatively quiet, private, and distraction free. This is one of the first things you'll learn about assessment in grad school, and 30 years later it'll still be the solid base you need. Not all of us have our own offices or even a desk (or pencils, protocols, etc...), but doing your best to find a good place for testing can make a world of difference. You may have to get creative... nurse's exam room, librarian's office, or janitor's closet ring a bell?
• Be familiar with your own assessment materials. As you're fumbling to see if an answer is 1pt or 2pt, trying to find your place in the manual, or checking to see if you're putting a model together the right way, it give kiddos chances to get off-track. This will come with time and practice, but making sure you know the assessment like the back of your hand will let you focus on the kid, not the text (which you will be able to recite in your sleep). 
• Be open and flexible, but firm and structured. The more you test, the more you'll find the balance between being Robot Psychologist and Out of Control Psychologist. We need to maintain standardization and boundaries, but also be a person who the kid can relate to. Kids will run wild when given too much freedom, but can crack under someone who is too rigid. 
• For kids that are reluctant, uncomfortable being wrong, give up easily when challenged, or who seem to not being exhibiting all their effort--be encouraging. Obviously, we can't tell kids if they are right or wrong on an answer when they ask, but saying things like, "You worked really hard on that one," "This seems easy for you," "You're positive about that answer," "Excellent effort," etc can give kids the extra push to keep going. Make sure that you give positive feedback even if a child is incorrect--it's supportive and they'll pick up if you're only responding when they're right, which can throw them.
• For kids who are excessively fidgety, hyperactive, hard to focus--be consistent and repetitious. They are going to need multiple repetitions of directions and expectations, constant reminders to "sit on your bottom/look at me/put your listening ears on/take your time/look at these *tap finger*" and possibly breaks to let their energy out. There's nothing wrong with stopping after a few subtests (or every one) for some jumping jacks or to take a walk if it means that they'll be refocused afterwards. I always give kids the option for stretch and bathroom break halfway through regardless of their attention level--I don't like sitting for 1+hrs and I'm a typically-functioning adult (unless I have too much coffee, then I'm a tweak)! Providing reinforcers, such as M&Ms or small stickers, in short, variable intervals is also a good way to help maintain attention and give reinforcement.
• That being said, don't be afraid to break testing into multiple sessions, especially if you're administering more than one measures. You will have to for especially little kiddos, because developmentally they just can't focus for taxing tasks for extended periods. If kiddos start getting frustrated, pushing them to keep going is only going to irritate them more, leading to less reliable results. If you have an inkling that things aren't going as they should, it's best to postpone until a later date. You may even want to ask the kid when they'd like to finish--maybe getting out of a certain subject they don't like will be extra incentive or motivation for them!

We can bend over backwards as Super Psychologists and do all the little things to make an assessment session as close to perfect as possible, but kids are unpredictable precious monsters that can still go rogue. In these instances, you'll have to decide how to report your assessment findings. It will be very important to write a strong "behavioral observations" section describing explicitly with observable terms what the child did during testing that might have impacted your results, and how they reacted to the things you did to maintain them. You will also need to write a statement describing why your results may not be reliable. Mine usually comes at the end of my "behavioral observations" section, right before my "assessment results" and sounds something like: Due to XX, the following results are believed to be an inaccurate and unreliable representation of CHILD'S current levels of cognitive functioning." Where "XX" is, note whatever it was that may have skewed the testing, such as "inattentive and hyperactive behaviors," "a lack of consistent and appropriate effort," etc. It would be painful to completely throw out your results and hard work, so when I appropriate I also note that "scores should be interpreted with caution" in whichever areas were particularly impacted.

What other suggestions, tips, and tricks do you have for productive testing sessions? 

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The Implications of Concussions

Yesterday, we had a Committee on Special Education meeting on an interesting, and tough, case. Although, if I'm blogging about it, it'd have to be interesting, right? When do I ever blog about the cut-and-dry cases?

R was referred for the first time this year despite many years of below grade level performance. He's currently in one of our top Integrated Co-Teaching classrooms, so he's being watched and taken care of by two fantastic, intervention driven teachers. Ms. J came to me with concerns about him a few months ago and wanted to make a referral to help him have academic support services next year for seventh grade.

Some background on R... he looks like a 20 year old man, even though he's 13. He's the perfect sports specimen, built for football but with the height for basketball, and he excels at both (like, 10 trophies at home and the kid's in 6th grade). Just this weekend, he was in Florida for a basketball tournament. He could easily get scholarships to college with his skills. He's Rico Sauve, all the girls swoon over him and he loves the attention; but, he's got a sensitive side too as he's a fantastic artist and very protective over those he cares about. Great sense of humor, great story-teller, lots of "swag." I would want to be friends with this kid.

Last year, he had a very poor teacher and it was a wasted year for him, and as you may imagine, his behavior was a problem. He was often cutting up in class and butted heads with the teacher constantly. As an adult, you would guess he often instigated some of the issues, but if my teacher called me "big lipped," I would feel the need to defend myself, too. (Yes, she really called him that. I could barely be mad at him when I had to deal with the issue.) More typical behaviors are a lack of motivation, distractibility, taking a long time to complete assignments, and becoming easily frustrated over academic tasks and shutting down.

I happily took R for testing, but was blown away by the results. R had a Full Scale IQ standard score of 57 and academic achievement standard scores around 65-70, which place him in the Intellectually Disabled range. WHAT? I'll take "Results I Would Never Bet on in Vegas" for 1,000, Alex. How did this social, artistic, could-go-pro-football-some-day kiddo obtain a lower IQ score than the student we just placed in a life skills program? The scores didn't make sense--sure, R has a lot of difficulty academically, but an ID classification?

At the end of last week, our social worker went out to R's house to meet his mom for a social history, and things began to fall into place. R met all his developmental milestones on time or even early, and was sinking baskets at age 2. Then, at age 7, he was hit by a car riding his bike, lost consciousness, and was taken to the ER, where he was diagnosed with a concussion. He repeated second grade that year. By 9, he had at least three more concussions playing football. Around age 10, his mother started noticing changes in his behavior (problems concentrating, more listless, memory difficulties, impulsivity) and his academics dropped. Suddenly unexpected results make sense--R probably has a traumatic brain injury from multiple concussions over a two year span.

The worst parts about this whole scenario are two fold: 1) R has been struggling for years, and no one ever evaluated him before, and 2) R's future could be totally changed as a result of these concussions and special education classification. A child that could've gone to college on a sports scholarship may now require intensive supports to obtain higher education, if he makes it there at all.

Concussions are serious business, and a new "buzz" in the education world. What looks like a bump on the head when it happens can have serious, lasting, devastating impact on a child's future, especially if injuries are cumulative. Check out the CDC's "Head's Up" program, which has great information for parents, coaches, etc about concussions and traumatic brain injuries and their long-term impacts. Also, here are some resources from NASP's Communique:

Sports-Related Concussions, by Don Brady and Flo Brady
Getting School Psychologists Into the Game, by Susan C. Davies

One further exciting development in concussion research is a cool new app from PAR, Inc. called Concussion Recognition & Response: Coach and Parent Version. The app helps individuals screen the likelihood of a concussion at the moment an injury occurs. This app was recently featured in the Communique. At the October 2012 NY Association of School Psychologists Conference in Niagara Falls, NY, there will be a strain on concussions and head injuries, where PAR will come to present on the app and its use, as well as experts from University at Buffalo. I highly encourage all nearby to attend (and not just because I'm on the conference planning committee!).


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Excuse Me, I Believe You Have My Chair

The last week before February break was an uber test-a-thon for me. I was on a mad dash to finish testing four kiddos before the time off, with the aspiration to work on reports over break, and be ahead of schedule for my March 1st CSE meetings (ha).

The last IQ test I had to give before sweet freedom was with a fifth grade kiddo with comorbid Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder. He was being evaluated as an initial eligibility case, due to continued behavioral and academic difficulty within an Integrated Co-Teaching classroom as a general education student. During cognitive testing, he was very cooperative (achievement testing was utterly the opposite, woah), but highly active. We tested in an unused classroom/meeting room, and upon entry, he immediately launched himself at the spinning office chair. Normally I take it, but I gave him the caveat that he could sit in it as long as he was appropriate and able to get the work done. He agreed.

No lie, the kid spun himself in a circle for the duration of the IQ test, except when he had to look at pictures or write. He would lean back with his eyes close and use one foot to keep the chair spinning. Normally, I'd put the kabosh on that immediately, because I need kids to focus to get accurate test results. You'd think he'd be totally off-task and infatuated with the chair, but he continued to answer questions very eloquently and quickly. Believe it or not, when he wasn't moving, he actually had a harder time concentrating!

At the end of the assessment, I was gathering up my things and making small talk with him, and he stood up, remarking, "Oh. I think I'm going to puke."

...really? Really? You think? Kid, you just spun for an hour and a half, I'm surprised you didn't wear a hole in the floor, let alone lose your bland and ambiguous school lunch.

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E= mc... huh?

The most common type of learning disabilities I see in my work are verbal learning disabilities, meaning that they affect the way a student reads or writes, listens, and/or speaks. These are the most widespread, largely due to the fact that they're easy to see. When a student has difficulty following directions, remembering information, reading fluently and comprehending classroom material, it's obvious to teachers that something's up.

Less common, or perhaps less often identified, are nonverbal learning disabilities. Kids with these difficulties often go unnoticed because they are highly verbal and on grade level in reading. However, they lack organizational skills, forget class materials and homework, have trouble with graphic material (graphic organizers, maps, graphs, charts, etc), and struggle with math. Some students also present with poor social skills and symptoms similar to Asperger's Syndrome. Academic difficulties become more pronounced as the students get older and have to deal with algebra, fractions, and all that other math nonsense (math was never my thing).

This summer, I worked with J, a student who was referred because he has been retained several times and is much older than he should be for the grade he's in. He's had some learning and behavioral difficulties, so I was asked to evaluate him to determine if he would qualify for special education. J is going into seventh grade and racked up oodles of suspensions last year. When I spoke to his teacher, she said that it seemed like J had "given up" and would try to get suspended so he could stay home. J was on grade level in reading and can read over 130 words per minute, but was failing math and lacked a lot of the basic skills needed to do more advanced math. Sounds like a job for Super Psychologist!

J did not attend summer school, so his mom brought him in for testing. When he entered our office, he removed his hat, necklace chains, and wallet chain and set them aside on top of a cabinet so they wouldn't "get in his way" during testing. He worked with our CSE chairperson doing achievement testing first, then I took him for cognitive testing. While working with me, J was well-spoken and articulate, polite, and respectful. I noticed right away that he had an excellent vocabulary and was able to verbalize his responses accurately and concisely. Most kiddos ramble without any direction, but J would nail an answer on the head in five words or less (made testing go by sooo much more quickly).

When J was working on nonverbal tasks, it was another story. On the first perceptual reasoning task, J had to put blocks together to replicate a printed pattern. He was so flustered and overwhelmed it was almost awkward to watch. He scrambled with the blocks, did trial and error combinations, and had little attention to detail. At first I attributed some of it to nerves, but as he did other nonverbal, visual-spatial reasoning tasks, I realized that he seriously lacked perceptual skills. He had trouble finding visual patterns and grouping pictures based on shared characteristics. Things that made me say, "hmmm."

When the scores were calculated, J scored within the average to high average range on all areas of cognitive testing, with the exception of perceptual reasoning. His perceptual score was so low that, when compared to other cognitive areas, a score profile like his happens in less than 2% of the population. On achievement testing, his math score was the pits, while reading and writing were age appropriate. J had trouble correctly identifying which operation (add, subtract, multiply, divide) to use on simple math problems, couldn't borrow/regroup, and struggled greatly with even simple word problems, let alone do algebra. What does all this mean? J had a classic nonverbal, math learning disability profile.

 

I have to admit, I totally geeked out. I had to tell everyone that might have even remotely cared or knew what I was talking about (who has two thumbs and is a loser? this gal). Being such a nerd, seeing a textbook case of something that was considered more "rare" in my line of work was kind of exciting. My CSE chairperson and I started putting together an Individual Education Plan (IEP) for J. We put in a lot of testing support and program accommodations for J to use in math and when taking math tests, such as extended time, use of a calculator, additional math examples, and simplified charts, graphs, organizers. These supports are designed to level the playing field educationally, so that with them, J can access the curriculum to a level comparable to his non-disabled peers.

J's referral to special education at the beginning of the summer was a bit of a fluke, but in the end, I'm glad that the referral went through, since we identified a kid who otherwise would've continued having difficulty unnoticed. Looking at J's past year of not-so-great behavior, it makes sense that he purposefully acted out to get suspended and intentionally had poor attendance, since he likely did not want to show that he was having difficulty, or wanted to be doing something difficult in the first place. I'll be very curious to see how J does this year with special education supports in the classroom. I also hope that he'll find positive ways to use his verbal gifts... if only my school had a debate club, poetry club, or other public speaking goodness!

Basking in the Dying Days of Summer

Now that I've finally finished working summer school, I can enjoy my summer vacation. Granted, I was only working half days, but there's something about having to get up at 7:00am to go into the office that puts a damper on the whole carefree summer vacation thing. So, for the next almost three weeks, I'll be pumping the lazy to the max... which will probably get old after a week, since I'm the type of person that perpetually has to be busy to be satisfied.

Here are some highlights from my summer, both professional and personal:

• Booking an all-inclusive trip to Cancun with Boyfriend for November 2011. Never been out of the country before (aside from Canada)--so excited for some tropical chillaxin'!
• Somehow finished testing, reports, meetings, and IEPs for 20 cases. Still have four more that we couldn't fully process over the summer, so they'll be completed in September. So much for a slow transition back into school!
• Moving into a townhouse with Boyfriend in a lovely little neighborhood. Upside: close to everything we could want! Downside: his sock piles on the floor. :)
• Got to see friends from undergrad that live far away. It was great catching up, playing paintball, and discovering that even though our lives have changed, some things have stayed exactly the same.
• Had a really interesting case of a student with a textbook nonverbal learning disorder. Must remember to blog about it. Done... here it is!
• Took a great field trip with some 5th & 6th graders to the local naval park and harbour downtown. What a thrill to see them explore two battleships and a submarine, and really get into the history. And the guns... pre-teen boys love guns.
• The long-awaited weddings of two of the gals from my graduate programs... ain't no party like a cohort party!
• Setting out some good plans for the school year with my colleagues in terms of PBIS, counseling groups, FBA/BIPs, and other interventions. If the year only goes 25% as we planned, it'll be a step in the right direction!

I've got a few more days vacation at my dad's house visiting him and my grandfather, then it's back home to tackle a to-do list of the things I won't get to once the school year starts. You know, exciting goodies like an oil change, haircut, time at the gym, and doctor's appointments. And of course, letting my laziness reach new lows... or would "highs" be more appropriate? Regardless, September 7th will be here before we know it!

Accomplishment: Autism

As the school year is drawing to a close, I'm going to be doing a lot of looking back and making observations on my first year as a school psychologist (assuming I have time, since the end of the year is B-A-N-A-N-A-S right now). One case I want to highlight is A, one of the boys in my social skills/anger management group.

Mrs. C, A's teacher, came to me with concerns that A exhibits characteristics of an autistic spectrum disorder. These are signs that I noticed in the times I visited the classroom prior to beginning group, and have also documented a little bit in blogging about our sessions. Mrs. C's primary concerns were A's severe lack of social skills, resistance to changes in his environment, and his unusual reactions to his environment (i.e. smells, sounds, touches). She noted that these are really interfering with his ability to make friends and function fully within the room. In a 6:1+1 classroom of severely learning disabled and emotionally disturbed kids, A doesn't quite fit.

The Committee on Special Education began the reevaluation process, so that we could take a look at A's classification and program to determine if he needed something more or different to better meet his needs. I ran into a little roadblock because A is not currently diagnosed as autistic from a medical doctor, something I was worried would impede me from possibly classifying him as a student with autism. However, after talking to my psychologist colleagues, I got a resounding "YES," I could classify A as a student with autism, despite the fact that he does not have a diagnosis. One of the psychs summed it up best, "There is a medical model diagnosis and an educational model diagnosis. We are making educational classifications, not medical diagnoses."

In order to evaluate whether A may be educationally disabled due to an autistic spectrum disorder, I gave Mrs. C oodles of ratings scales to fill out to gain more information about A's behavior, including the Asperger Syndrome Diagnostic Scale (ASDS), the Childhood Autism Rating Scale (CARS), and the Vineland II Adaptive Behavior Scale. I also observed A within the classroom, which was easy because I see him for group every week. The rating scale results, Mrs. C's notes, and my observations all showed overwhelming evidence that A may have an autistic spectrum disorder.

I did a record review of A's previous evaluations and reports. What I found was both surprising and upsetting. The more I reviewed old documents, the more I realized that A has grown exponentially over the past five years. He started out nonverbal, violent, and what appeared to be very mentally delayed. Today, he scores with generally average intelligence and academic skills. However, I also found that for just as long, folks have noticed "oddities" that have been described as those similar to an autistic spectrum disorder. What frustrated me the most was A's most recent psychological evaluation. He was described very plainly as having autistic behaviors, but his classification was changed to Learning Disabled, despite him having fairly average skills across the board. Why had no one investigated the possibility of a classification of autism for A?

It seemed totally unfair to A that no one had stepped up to the plate. True, "autism" can spook the best psychologists, so it certainly spooks me (since I can in no way claim to be in the "best" category). It's like Mental Retardation or Emotional Disturbance: it sticks and it can be harsh. But, for all my reservations, it became extremely important to me to "do right" by A and get him services that would benefit him. Our district has a program at one of it's schools solely for high-functioning students with autism. It provides them with great social skills training, job training and transition help, and just real life skills in general. A's mom, Mrs. C, and I all thought this would be a great program for him.

At A's CSE meeting this week, I changed his classification from Learning Disabled to Autism. We're in the process now of getting paperwork together so A can attend the specialized program for students with autism next year (if all goes according to plan). Rock on.

In no way do I mean for this blog post to be self-serving or "tooting my own horn." For those that know me, I put others before myself constantly, maybe more than I should, and don't really want much in return. For me, it's for the kids, not any pats on the back I may get. So, I call this blog post "Accomplishment: Autism" because if I look back and find nothing else to be proud of after this year (unlikely), I can be happy knowing that A will be in the right setting for him next year with the right classification. That's what matters!

It's a type-athon!

I was supposed to have yet ANOTHER training today, but instead the psychologists were given a reprieve and allowed to return to their building to complete evaluations and reports. I'm not completely sure how this could be considered a reprieve on what is a day off for students, but I'm not going to complain when I get a day to myself to work on all my paperwork. Nerd alert! So, I am using today to finish the MOUNTAIN of reports that I need to type. I snuck into my building this morning and told the office staff that I am "not here" today, hoping that I would be left alone to do my work (so far, so good). Get ready for the TYPE-ATHON!!

It is currently two hours into my self-imposed exile in my office, and I have finished two initial evaluation reports for our CSE meeting tomorrow. Of course, my printer has decided NOT to print them (they're just hanging out in the queue... come on out friends, I need to put my John Hancock on you!). I have five more reports I hope to finish today, which will get me to a good place for the meetings scheduled between now and June 1st.

On your mark... get set... TYPE!

Do You Like My Hat?

I've spent 3.5 of the past 6 days in trainings... sitting in a window-less conference room, breathing in 70 other colleagues carbon dioxide, wondering where the "airplane smell" is coming from (are they pumping it through the ducts?) while counting down the minutes til lunchtime. Needless to say, not the most splendid time (though the trainings were informative and useful, for the most part).

Here's a testing tidbit to brighten my (and your) evening. I was giving a kindergartener a perceptual reasoning task last week, and we were on a subtest where she had to match a picture to complete a visual matrix. In plain language, it's like a visual analogy: here's a dog and a doghouse, a fish and... what matches? Anyway, we arrived at an item that had a variety of hats and the kiddo perked up. "Oh, I know this one. It's a pimp hat!" she said, pointing to a wide-brimmed hat.

Game, set, match, young lady. I'll be over here, giggling.

Ineligible

Get ready for a Debbie Downer post. Wah waaaahh... (that was the Debbie Downer noise, by the way)

We had some rough CSE meetings today. Two students who have social-emotional and behavioral issues were found ineligible for services by the committee, much to the dismay of their teacher and for one student, parent (the other's parent didn't attend). The decision was based on assessment data and teacher reports that revealed that the students were of low average cognitive ability, but had standardized achievement within an average range. They are benchmark in reading and math and while their grades were not Ivy League, but they were not terrible. This information tells us that, while they have behavior problems that are difficult within the classroom, the issues are not significantly impacting their achievement or grades. Since special education is about providing service to students with educational disabilities, we could not qualify the students because their academics were acceptable.

Enter the firestorm. The teacher was very upset, and I don't blame her in the least. These students are tiring, frustrating, and difficult to manage when they are "off." The teacher is a good teacher who has expended a lot of energy managing her entire class. It was understandable that she was dismayed. The parent of one student was also very upset, because she obviously wants anything to help her child. She is going to appeal our committee's decision at the district level, and we encouraged her to do so.

Thankfully, both students are receiving counseling within the building and are also being seen by outside agencies. Wraparound services are going to be discussed to provide both families with more behavioral help in the house and respite. The two students do not have individual behavior plans and show inconsistent response to the classroom plan the teacher has in place. We're going to set up behavior plans for them, in addition to providing them other supports to help them in the classroom and during testing.

I think the worst part of the whole ordeal was the knowing that the students needed some kind of help, but being unable to provide them with services. True, I wouldn't say that they needed special education, because they did not appear to have educational disabilities, but they have obvious issues that need to be addressed. It was a tough place to be in with a fine line to follow. I felt very unsatisfied and drained after the meetings, like nothing had been accomplished. It's hard to deny a kid who has problems help that they may need, especially when it upsets other key players in the child's life, like the teacher and parent. I would have given these kids the world if my hands were not bound by state and district eligibility requirements and expectations. I'm hoping that through concentrated counseling efforts, behavioral intervention, and medication, if appropriate, we'll start to see the behavior and mental health concerns improve. The situation still stinks though.

Blech. Ick. Ugh.

CSE Meetings for Dummies

In checking my blog "stats," I discovered that some people have found my blog recently by Googling how school psychologists present at Committee of Special Education (CSE) meetings. First, I have to thank Google, or as I call it "The Googs," for helping people find my blog. Hi friends, welcome to the party!

Second, I'll give you a rundown of how a CSE meeting typically goes in my building. I posted a brief ditty about CSEs at the beginning of the year, but I'll get more in depth now for those who are interested and Googling their hearts out.

CSEs meet for initial referrals for special education services or if changes need to be made to a student's program, such as adding or removing services, changing a student's classification, or moving a student to a different classroom placement. In my building, the CSE chairperson, school psychologist (me!!), social worker, child's special education and general education teachers, and child's parent(s) are invited. The parents also may bring whomever they choose, such as an outside counselor or another family member. Unfortunately in my district, not many parents attend (nature of the urban, inner city beast).

We tape our CSE meetings with a handheld tape recorder. It's much easier than trying to write or type minutes during the meeting, while attempting to keep up with what's actually going on and being discussed. Plus, it holds everyone at the meeting accountable for what was agreed upon. The meetings begin with introductions of everyone in attendance, then the parent reports about the child's progress or concerns. The social worker provides information regarding developmental milestones, family life, and other life concerns and how they might relate to the child's school-life. The teacher provides information about the reason for referral, how the child is doing in the classroom, their concerns, and the child's academic and behavioral functioning.

Then we get into the meat of the meeting: the evaluations. As previously discussed in my blog land, most CSE meetings contain two assessments, the achievement and cognitive. These measure a child's potential to learn (the cognitive, my domain) and what they actually have learned (the achievement).

I always begin my report at CSE meetings with behavioral observations. Typically, I observe a child in the classroom before giving the cognitive test to see how the student works, solves problems, and interacts with peers and adults. I also document these same behaviors during the actual assessment. I discuss the child's work habits, frustration levels, effort and motivation, etc before getting into the juicy test findings.

My description of the cognitive testing results depends on what assessment I give. Typically, the assessment I administer produces one overall Full Scale Intelligence Quotient (FSIQ) score that is a combination of four areas--verbal comprehension, perceptual reasoning, working memory, and processing speed. To start, I describe the FSIQ and where it falls in relation to the child's other same age peers (i.e. is the child Average intelligence?). I describe each of the four areas, what they measure, and how the child performed on each task subsumed beneath them. I try and describe tasks in as plain of language as possible, so that the teachers and parents understand what exactly is being measured. For instance, instead of saying something like "nonverbal part-whole synthesis ability," I'll say "ability to assemble puzzles and replicate a pattern." Makes more sense, eh?

I also point out any strengths/weaknesses, oddities, discrepancies, or scatter, and if they are related to anything I observed behaviorally from the child. If a child performs averagely on one working memory task, but bombs the second, what does it mean? If the child has average verbal comprehension but extremely low perceptual reasoning, why does it matter? I try to describe in terms of what the child can do or is "good" at, and then what they may struggle with. In the working memory case, I might say something like, "Tammy has strong memory skills when asked to remember simple, rote information, but might have difficulty when she has to both remember information and also put facts in order or recall information at a later date." I always discuss positive points with negative ones. Nobody wants to listen to everything the child has trouble with or can't do. Special education is not about how or what a child can't learn, but how they learn differently.

In my building, my CSE chair reports the achievement testing and she discusses strengths & weaknesses in regards to basic, intermediate, and comprehensive reading, writing, and math skills. After she describes the achievement scores, I will relate my test results back to hers. I point out any similarities between the achievement and the cognitive. I also discuss what the implication the cognitive results will have for the student's academic achievement. For instance, if a child does have poor "nonverbal part-whole synthesis ability," meaning that they have trouble putting parts together to make a whole product, they may have difficulty in reading. Letters and letter sounds are put together to make words, words are put together to make sentences, etc... and all result in a final synthesis into something that has meaning or comprehension. Capice?

After hearing from the teacher(s), parent, social worker, and all the test results, we discuss the outcome of the meeting. If it is an initial referral, the psychologist (me again!!) will provide evidence for or against special education services and will suggest an educational disability classification for the child (one of thirteen possible classification areas). Discussion ensues, and if the parent and CSE agree to classification, then an Individual Education Plan (IEP), including goals, testing accommodations, and program modifications will be developed. These are designed to "even the playing field" between the general education children and the child in special education, so that they can access and benefit from the curriculum equally. We then all say we agree to what was discussed and developed (aye), turn the tape off, run to the restroom, and get ready for the next meeting.

Now you know... and knowing is half the battle. Knowing also takes away the mystery of what goes on behind closed doors that have "CSE Meetings in Progress, Do Not Enter" signs on them. Our magic spell is broken!

Moving Day

I had a tough conversation with one of my buddies yesterday. T is in 5th grade for the second time and is having a lot of trouble. He's in special education and receives services in his general education classroom. He refuses to do work, will not complete assignments, and disrupts others who are trying to get their work done. He is in the lowest groups for reading and math and is struggling with basic concepts. He's experiencing a lot of frustration.

We had a CSE meeting last week for T to reevaluate his individualized education program (IEP). There was a lot of discussion between the team and his teachers to try and figure out what would be best for him. We were concerned that T would fail 5th grade again and remain in the same place academically he's been for the past year. Ultimately, we decided to place T in a 6:1+1 classroom. We thought that his intensive behavioral and academic needs could best be met in a smaller classroom.

T comes down a few times a day to check-in for good behavior. When he came down yesterday, my colleague MB and I explained to him that he was going to a different classroom that would help him be more successful in school. T was extremely upset. He is a very proud young man who doesn't respond well to embarrassment, upset, or unexpected situations. T was completely against going to the 6:1+1. He didn't want to leave his friends, and, although he wouldn't say it, I imagine he took it as a blow to his pride. We told him that we would never do anything to hurt him, and were thinking of his best interest and what would help him the most.

As the afternoon continued, T calmed, though he still wasn't keen on the idea. I went to his new classroom (which is the room that my "average" friend B is in) and explained to the rest of the class that they would have a new student after our February break. I told them that T was nervous and scared to come to their classroom, and that they would have to make him feel welcome when he arrived. The boys were so excited! They knew T and were happy he was going to be in class with them. Seriously, they're some of the sweetest boys ever.

I think that the 6:1+1 placement will be good for T and will give him all the positive adult attention and academic support he needs. I'm sure that on his first day, the boys will be overly welcoming. But, how T will react on February 28th? Not sure.

Squirmy McAntsypants

After a few serious and informative blog posts, I figured it's time to get back to business. It's time to tell you about Squirmy McAntsypants.

Squirmy, a kindergarten student, came across my desk because his agency case worker referred him for a re-evaluation to see if he needs a more restrictive environment for behavioral issues (i.e. smaller classroom or agency). He's currently only receiving speech services. I observed Squirmy in the classroom yesterday and he was decidedly not squirmy. He was mostly composed, on-task, and got his work done. Hm. Curious.

I took Squirmy for IQ testing this morning, and his true colors began to shine through. He was quite excited, and took off running down the hall towards my office. After choosing a special Santa pencil to do his test, and sharpening it for approximately 2.25 minutes until it was half gone, Squirmy bolted down the hallway towards the room I was going to be testing in. He was instantly overwhelmed and intrigued by his surroundings. There were bags of donated clothes, uniform shirts, hats & gloves, computers, coffee making supplies, office supplies, tables, chairs, white board markers, wall hangings, and all kinds of goodies. Squirmy cataloged this in his mind for later.

Whoever decided to make the first subtest on a preschool IQ test have blocks as manipulatives is possibly insane. Squirmy immediately began rolling the blocks as dice around the table (and floor), stacking them, and generally doing everything with them except replicating the patterns I modeled for him. He also decided it was time to check out his surroundings, and went for the computers. He was so insistent on trying to play on them  that he checked each one by pounding the mouse and keyboard. After redirecting Squirmy and getting a few more answers out of him, he was off again to pull clothes off the shelves, investigate a carousel of funky scissors, and see if said scissors could cut through shirt fabric (the shirts went unharmed). He also asked if he could wear my glasses and tried to remove them from my face. Remembering that he had broken his own glasses in half yesterday after my observation, I kindly declined. Squirmy decided he wanted to try and pull the American flag from the wall instead, anyway.

Squirmy calmed somewhat after the promise of stickers for good behavior upon completion of our "games" and became interested in subtests where he had to complete picture patterns and match pictures that had similar characteristics. But oh! What was that on the floor? A red sticky gift bow left over from our holiday donations?! Squirmy had to have it, and couldn't concentrate on defining any vocabulary words that I was throwing around. Determined to make it stick to his head, Squirmy ignored all else... except his special Santa pencil, which he began rolling across the table. I pulled Squirmy into my lap, thinking proximity would help him to focus.

After he stopped trying to pull my sweater up, he discovered that maybe the red bow had stick left to it after all (or maybe I just have better balance, since it kept falling off his head. I wonder why). Onto my head the red bow went, and we began some word riddles.

Yes, gentle readers, there I was: sitting with a red holiday bow atop my head and Squirmy McAntsypants wriggling in my lap waving his special Santa pencil like a baton. I love my job.

"Average" Part Deux

In my entry about B, I referred to him as having average IQ. But, what is considered "average"? Brace yourselves, I'm about to get bust out some Super School Psychologist Lingo.

The above graph is a bell curve showing a normal distribution of IQ scores. When I describe a student's IQ, I use terms such as Very Superior, Superior, High Average, Average, Low Average, Borderline, and Extremely Low ("Mentally Deficient" has gone out of style). An IQ score of 100 is considered Average. There's a 15 point leeway on either side of 100, getting us to Low Average or High Average. From there, we either work up or down by 15 points to reach the other descriptors. 

Kids that are considered Gifted and Talented typically fall at 130 or above (to Very Superior, and beyond!). Students who could be described as mentally retarded are a bit more tricky to pin down. A classification of "Mental Retardation" typically requires an IQ of below 65-70 (varies on what you consult), achievement in reading, writing, and math below 65-70, and delayed adaptive behavior. Adaptive behavior refers to skills needed for independent living, such as feeding and dressing one's self, communicating effectively, and appropriate social skills. There are varying degrees of mental retardation: mild, moderate, severe, and profound. Individuals with moderate, severe, or profound mental retardation are likely to have adaptive behavior too low to live independently.

Fun (yet horrifying) Fact: In the early 1900s, the terms mild, moderate, severe, and profound were not used to describe mental retardation. Instead, moron, imbecile, and idiot were used. Classy.

"Average"

I'm currently working on a reevaluation of a young man's special education program to see if it is still the right fit for him. B's in a 6:1+1 classroom, which has 6 students, 1 teacher, and 1 aide, but he actually goes to a general education classroom that has a special education teacher helping in it for most of the day and does very well academically. B has average IQ and reading, writing, and math scores.

B came down to my office this morning for testing and was such a peach to work with! He was polite and well-mannered, cooperative, attentive, and put forth great effort. As much as I love the "problem children" that have difficulty in school and working with them to help them learn more effectively, it's such a treat to work with an "average" student. It puts things back in perspective, and B really started the day off on a lovely note. After we finished our "yay, you finished 1.5hr of IQ testing!" celebratory game of Uno and B went back to his classroom with his new Spiderman pencil as a reward, I happily went on with my day. Of course, I was almost immediately called to go deal with a student who was running the building, so it was downhill from there. Blargh. But hey, I'll take what I can get.

Testing, Testing

I've been exchanging phone calls with M, a psychologist from our Central Committee of Special Education (CSE) building, this week to arrange to pick up my test kits. See, probably the biggest part of being a school psychologist is conducting psycho-educational tests to determine if a child is eligible for special education services. These most often contain a cognitive test (read: IQ test; the "psycho" part) and an achievement, or educational, test. These measure a child's potential to learn (the cognitive) and what they actually have learned (the achievement). In traditional school psychology, if a student's cognitive ability, or their ability to learn, is not comparable to their actual achievement, their may be reason to suspect that they have an educational disability. So, if Sadie's IQ is 100 (the average standard score), while in math, reading, and writing she has standard scores below 70, it suggests that she is capable of learning at a typical rate, but that she has not achieved to the "average" level. This is called the discrepancy model, which is quickly being replaced with Response to Intervention (RTI), as per federal and state mandates. In the RTI model, students who are identified as struggling are engaged in targeted academic interventions in order to increase their skills before they fall low enough to qualify for special education. The whole discrepancy vs. RTI battle is something I could write about forever, so to spare you, there's information about the two models here at the LD Info website. You're welcome.

Anyhoo, I digress. Being a new psychologist in the district, I had no test kits available to me at my building. The psychologist who was previously in my spot took them all when she went to her new building. M called me this morning to say I could come over to another building in the district to get my test kits. Hooray! You must understand, getting test kits is like Christmas for school psychologists. New manuals to read, new manipulatives (read: toys) to test out, etc. They're like a security blanket, the one constant in the job that rarely changes and that we come back to day in and day out. Remember how I said I was a dork? Indeed.

When we spoke this morning, M suggested that I come early so that he could get some test kits that he had been saving specifically for me. After driving around the building block literally 5 times trying to figure out where to park (I still hate big city transportation drama), I finally get inside and find M. What blew my mind was the sheer lack of resources that were available. In the tiny stock room, there were many test kits that were extremely out of date, masses of test booklets but no way to score them, and very few kits of the tests used most frequently by psychologists. I couldn't decide if I was surprised by this. But, all of that aside, I should be very thankful that I got what I did, especially being a brand new psychologist and at the bottom of the feeding chain. I struggled back to my car with a few cognitive tests, behavior rating scales, and a visual-motor processing evaluation. Time to hunker down with my security blankets.