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ASSESSMENTOFSTUDENTSMEETINGMULTIPLEELIGIBILITIESUNDERIDEIAANDADA
SamGoldstein,Ph.D.AssistantClinicalProfessor
UniversityofUtahSchoolofMedicineClinicalDirector
Neurology,LearningandbehaviorCenter
MyTheory
• Whenapersondecidesthatapermanentsolutiontotheirtemporaryproblemsistheironlyoption.
• Whenapathtofamecannolongerbeenvisionedandapathtoinfamyisembraced.
Disclosure
• MyexpensesforthistalkaresupportedbyMulti-HealthSystems.
• IhavedevelopedtestsmarketedbyMulti-HealthSystems,Pro-EdandWesternPsychologicalServices.
• IhaveauthoredbooksmarketedbySpringer,Wiley,Guilford,DoubleDay,McGrawHill,Brookes,KluwerandSpecialtyPress.
• IamEditorinChiefoftheJournalofAttentionDisorders(Sage)andCo-EditoroftheEncyclopediaofChildDevelopment(Springer)
GoalsforThisSession
• Placeourroleasevaluatorsincontext.
• Provideanoverviewofdevelopment,behaviordiagnosisandeligibility.
• Discussroleofimpairmentinassessment.• Discusscriticalvariablesinfluencingassessment.
• Provideaframeworkforacomprehensiveassessment.
• Reviewtoolsandmethods.
IHadaRevelationinSt.Augustine
TheWorldOperatesAlongaNormalCurve!
Notsurprisinglyallbuttwothingswedoasschoolpsychologistsaredimensional!
Diagnosis
EligibilityDetermination
TheDisruptiveContinuumofBehavior
Attention Deficit
Oppositional Defiance
Conduct Disorder
Difficult Temp.
TheNon-disruptiveContinuumofBehavior
Temperament &
Development
Depression
Anxiety
Learning & Social
Problems
Howdistinctarethesedisordersfromeachother?
Muchlesssothanmakesmecomfortable!
Co-Morbidity
Co-Morbidity
Co-Morbidity
Section504isafederallawdesignedtoprotecttherightsofindividualswithdisabilitiesinprogramsandactivitiesthatreceiveFederalfinancialassistancefromtheU.S.DepartmentofEducation(ED).Section504provides:"NootherwisequalifiedindividualwithadisabilityintheUnitedStates...shall,solelybyreasonofherorhisdisability,beexcludedfromtheparticipationin,bedeniedthebenefitsof,orbesubjectedtodiscriminationunderanyprogramoractivityreceivingFederalfinancialassistance...."
TheSection504regulationsrequireaschooldistricttoprovidea"freeappropriatepubliceducation"(FAPE)toeachqualifiedstudentwithadisabilitywhoisintheschooldistrict'sjurisdiction,regardlessofthenatureorseverityofthedisability.UnderSection504,FAPEconsistsoftheprovisionofregularorspecialeducationandrelatedaidsandservicesdesignedtomeetthestudent'sindividualeducationalneedsasadequatelyastheneedsofnondisabledstudentsaremet.
Section504prohibitsdiscriminationonthebasisofdisabilityinprogramsoractivitiesthatreceiveFederalfinancialassistancefromtheU.S.DepartmentofEducation.TitleIIprohibitsdiscriminationonthebasisofdisabilitybystateandlocalgovernments.TheOfficeofSpecialEducationandRehabilitativeServices(OSERS),alsoacomponentoftheU.S.DepartmentofEducation,administerstheIndividualswithDisabilitiesEducationAct(IDEA),astatutewhichfundsspecialeducationprograms.EachstateeducationalagencyisresponsibleforadministeringIDEAwithinthestateanddistributingthefundsforspecialeducationprograms.IDEAisagrantstatuteandattachesmanyspecificconditionstothereceiptofFederalIDEAfunds.Section504andtheADAareantidiscriminationlawsanddonotprovideanytypeoffunding.
SixFoundationsofIDEA
• IndividualizedEducationProgram
• FreeAppropriatePublicEducation• LeastRestrictiveEnvironment
• AppropriateEvaluation• ParentandTeacherParticipation
• ProceduralSafeguards
IDEAChildrenareplacedinspecialeducationservicesthroughanevaluationprocess.Iftheevaluationisnotappropriatelyconducted,ordoesnotmonitortheinformationthatisneededtodetermineplacementitisnotappropriate.
ThegoalofIDEA’sregulationsforevaluationistohelpminimizethenumberofmisidentifications,toprovideavarietyofassessmenttoolsandstrategies,toprohibittheuseofanysingleevaluationasthesolecriterionofwhichastudentisplacedinspecialeducationservices,andtoprovideprotectionsagainstevaluationmeasuresthatareraciallyorculturallydiscriminatory.
Overall,thegoalofappropriateevaluationistogetstudentswhoneedhelp,extrahelpthatisappropriateforthestudentandhelpsthatspecificstudenttoreachhisorhergoalssetbytheIEPteam
EligibilitiesUnderTheSchoolPsychologist’sDirectConsideration
• EmotionalDisturbance(depression/anxietyrelatedconditions,socialimpairments,schizophrenia)
• Autism• Language• Intellectual
• SpecificLearningDisorder• OtherHealthImpairment(ADHD)
EligibilitiesUnderTheSchoolPsychologist’sIndirectConsideration
• OtherHealthImpairment(e.g.diabetes)
• Orthopedics• Hearing
• Vision
Determiningeligibilityisanoutcomebestunderstoodandobtainedbyathroughassessment.
HowShallWeUnderstand,DefineandCategorizeMentalIllness?
• Byetiologyorcause?• Byemotions,behaviorsandthoughts?
• Byimpairedfunctioninactivitiesoflife?
WhatistheGoalofaComprehensiveEvaluation?
• Identifyanddefinesymptoms?• Identifyanddefinestrengthsandweaknesses?
• Appreciatetherelationshipofasetofsymptomstoaunitarycondition?
• Meeteligibilitycriteria?• Definelimitsoffunctionalimpairmenttosetabaselineforintervention?
ComponentsofaThoroughAssessment
• History• BroadSpectrumQuestionnaires(ParentandTeacher)
• NarrowSpectrumQuestionnaires(ParentandTeacher
• SelfreportQuestionnaires• AbilityAssessment• AchievementAssessment• ClinicalAssessment(e.gASD,personality,etc.)• Interviewwithstudent
AbilityKnowledge
Skill
GeneralGuidelinesforaComprehensiveSchoolPsychologyEvaluation
• Adistinctionshouldbemadebetweenacutevs.chronicproblems.
• Assessmentshouldbestrengthfocused.
• Testresultsshouldbepresentedinwaysthatareusefultoconsumers(e.g.family,school,etc.).
• Theleastamountofassessmentneededtoanswerreferralquestionsshouldbecompleted.
PersonAttributesAssociatedWithSuccessfulCoping*
■ Affectionate,engagingtemperament.■ Sociable.■ Autonomous.■ AboveaverageIQ.■ Goodreadingskills.■ Highachievementmotivation.■ Positiveself-concept.■ Impulsecontrol.■ Internallocusofcontrol.■ Planningskills.■ Faith.■ Humorous.■ Helpfulness. * Replicated in 2 or more studies
EnvironmentalFactorsAssociatedWithSuccessfulCoping*
■ Smallerfamilysize.■ Maternalcompetenceandmentalhealth.■ Closebondwithprimarycaregiver.■ Supportivesiblings.■ Extendedfamilyinvolvement.■ Livingabovethepovertylevel.■ Friendships.■ Supportiveteachers.■ Successfulschoolexperiences.■ Involvementinpro-socialorganizations.
*Replicated in 2 or more studies.
Thepathwaysthatleadtopositiveadaptationdespitehighriskandadversityarecomplexandgreatlyinfluencedbycontextthereforeitisnotlikelythatwewilldiscovera
magic(generic)bullet.
CriticalIssues
• Demographics• Symptomsvs.consequences• Categoriesvs.dimensions• Eligibilityvs.diagnosis• Developmentalpathways:acceptamomentintime
• Therearenoshortcuts• Assesstheenvironment
CriticalIssues
• Assessforintervention• Understandpositiveandnegativepredictivepower• Understandsensitivityvs.specificity• Beginwiththedisruptive/non-disruptivecontinuum• Keeplowincidenceproblemsinmind• Considerresilience(protective)factors• Measureimpairment
Whyistheassessmentofimpairmentcriticaltoacomprehensive
evaluation?
Anexhaustivereviewoftheliteraturedemonstratesthattherelationshipbetweensymptomsandfunctioningremainsunexpectedlyweakandoftenbidirectional(McKnightandKashdan,2009).
Impairmentisthereducedabilitytomeetthedemandsoflifebecauseofapsychological,physical,orcognitivecondition.
SYMPTOMSVS.IMPAIRMENTImpairmentisnotthesameassymptoms
❑Symptomsarephysical,cognitiveorbehavioralmanifestationsofadisorder.
❑ Impairmentsarethefunctionalconsequencesofthesesymptoms.
Inattention
Difficultycompletinghomework
SYMPTOMSVS.IMPAIRMENT
Impairmentcanexistabsentofformaldiagnosis. (Balazsetal.,2013;Willeetal.,2008)
Inonestudy14.2%ofasampleofchildrenweresignificantlyimpairedwithoutaformaldiagnosis.
(Angoldetal.,1999)
AdaptiveBehaviorvs.Impairment
vs.
Doyou
know
HOWto
doit?
DoyouACTUALLYdoit?
Skill Performance
AdaptiveBehaviorvs.Impairment
Usingutensils
Notusingutensilstoeat
vs.
ChildwithaDisability IDEIAdefinesthistermasfollows:
• (a)General.(1)Childwithadisabilitymeansachildevaluatedinaccordancewith§§300.304through300.311ashavinganintellectualdisability**,ahearingimpairment(includingdeafness),aspeechorlanguageimpairment,avisualimpairment(includingblindness),aseriousemotionaldisturbance(referredtointhispartas‘‘emotionaldisturbance’’),anorthopedicimpairment,autism,traumaticbraininjury,anotherhealthimpairment,aspecificlearningdisability,deaf-blindness,ormultipledisabilities,andwho,byreasonthereof,needsspecialeducationandrelatedservices.
ChildwithaDisability IDEIAdefinesthistermasfollows:
• (2)(i)Subjecttoparagraph(a)(2)(ii)ofthissection,ifitisdetermined,throughanappropriateevaluationunder§§300.304through300.311,thatachildhasoneofthedisabilitiesidentifiedinparagraph(a)(1)ofthissection,butonlyneedsarelatedserviceandnotspecialeducation,thechildisnotachildwithadisabilityunderthispart.
Symptomsvs.Impairment
Inattention Difficultycompletinghomework
vs.
RatingScaleofImpairment(RSI)Forms
RSI(5-12Years)
ParentForm TeacherForm Parent
FormTeacherform
RSI(13-18Years)
41items 29items 49items 29items
TotalScore TotalScore
RSIScalesSchoolSocialMobilityDomesticFamily
RSIScalesSchoolSocial
Mobility
RSIScalesSchool/WorkSocialMobilityDomesticFamily
Self-care
RSIScalesSchoolSocialMobility
RelationshipBetweenTheRSIAndOtherMeasures
Beginwithhistory,impairmentmeasureandabroadspectrumratingliketheConnersBehaviorRatingScale
Content:Scales&Subscales
1WithinEmotionalDistressscaleonConnersCBRS-P;2WithinEmotionalDistressscaleonConnersCBRS-T;3SubscaleofAcademicDifficultiesscale;4ScaleonConnersCBRS-P&CBRS-Tformsonly;5ScaleonConnersCBRS-Tformonly.
EmotionalDistress! UpsettingThoughts1;Worrying1;UpsettingThoughts/PhysicalSymptoms2;SocialAnxiety2
Defiant/AggressiveBehaviors
AcademicDifficulties
SocialProblems1
SeparationFears2
Hyperactivity5/Impulsivity
Perfectionist&
CompulsiveBehaviors4
PhysicalSymptoms
DSMScales
ADHDInattentive
ADHDHyperactive-Impulsive
ADHDCombined
ConductDisorder
OppositionalDefiantDisorder
MajorDepressiveDisorder
ManicEpisode
MixedEpisode
AutismSpectrumDisorder
SeparationAnxietyDisorder
SocialPhobia
Obsessive-CompulsiveDisorder
GeneralizedAnxietyDisorder
1ScaleonConnersCBRS-P&CBRS-Tformsonly.
OtherClinicalIndicators
1ScaleConnersCBRS-P&CBRS-Tformsonly;2ScalesonConnersCBRS-P&CBRS-SRformsonly;3ScalesonConnersCBRS-SRformonly.
BullyingPerpetration
BullyingVictimization
Enuresis/Encopresis1
PanicAttack
PervasiveDevelopmentalDisorder3
Pica2
Post-TraumaticStressDisorder
SpecificPhobia
Tics
Trichotillomania
ObtainaThoroughHistory
• Immediateandextendedfamilyrisks.• Pregnancyanddelivery• Infancyandtoddlerhood(temperament)• Preschoolandschoolhistory• Socialization• Familyrelations• Sleep,appetiteandhygiene• Pasttreatmentsoreducationalservices• Discipline• Situationalproblems
DecideonNarrowSpectrumQuestionnaires
• Anxiety• Depression• AutismSpectrum• Resilience• ExecutiveFunctioning• Personality
AutismSpectrum
AutismRatingScales
51
DSM5
ASRSValidityforages2-5Parents
52
40
50
60
70
80
TotalScore DSM-IV-TRScale Social/EmoqonalReciprocity BehavioralRigidity
ASDbyParents&Teachers
Clinical
GenPop
ASRSValidity:Ages6-18Parents
5340
50
60
70
80
TotalScore Self-Regulaqon AdultSocializaqon Stereotypy Arenqon
ASD
ADHD
Clinical
GenPop
Anxiety
MASC-2ScalesTotalScore
SeparationAnxiety/Phobias SocialAnxiety
Humiliation/Rejection
PerformanceFears
GADIndex Obsession&Compulsions
PhysicalSymptoms
Panic
Tense/Restless
HarmAvoidance
AnxietyProbabilityScore
InconsistencyIndex
MASC2Scales
Depression
Scale Structure: Parent and Teacher
Total Score Parent: 17 items
Teacher: 12 items
Emotional Problems
Parent: 9 items Teacher: 5 items
Functional Problems
Parent: 8 items Teacher: 7 items
4-point Likert-type rating: 0=“Not at All” ; 3=“Much or Most of the Time”
Scale Structure: Self-Report (Full Length)
Total Score (all 28 items)
Emotional Problems
(15 items)
Negative Mood/ Physical
Symptoms (9 items)
Negative Self-Esteem
(6 items)
Functional Problems (13 items)
Interpersonal Problems (5 items)
Ineffectiveness (8 items)
CDI-2 Self-Report
Eachsentenceisgiveneither0,1,or2points
CDI Profile
ExecutiveFunctioning
CEFIScales
EachformyieldsaFullScalescoreand9separatecontentscaleswhichcontainitemsasfollows…
63
GroupDifferences:ADHD(Naglieri&Goldstein,2013)
64
80
87.5
95
102.5
110
Parent Teacher Self-Report
ADHDControl
GroupDifferences:ASD(Naglieri&Goldstein,2013)
65
80
85
90
95
100
Parent Teacher
GeneralPopulation
ASD
GroupDifferences:LearningDisabilities(Naglieri&Goldstein,2013)
66
80
87.5
95
102.5
110
Parent Teacher Self-Report
LDControl
GroupDifferences:MoodDisorders(Naglieri&Goldstein,2013)
67
80
87.5
95
102.5
110
Parent Teacher Self-Report
MoodControl
Resilience
EffortstoMeasureResilienceinClinicalPractice
■ DevereuxElementaryStudentStrengthAssessment(81itemratingscale).
■ DevereuxEarlyChildhoodAssessment.(45items).
■ ResiliencyScalesforChildrenandAdolescents(60+itemratingscales).
■ PsychologicalResilienceScale(25items).
AbilityandAchievement
• PASStheoryisamodernwaytodefine‘ability’basedonmeasuringneurocognitiveabilities
• Planning=THINKINGABOUTTHINKING• Attention=BEINGALERT• Simultaneous=GETTINGTHEBIGPICTURE
• Successive=FOLLOWINGASEQUENCE
PASSTheory
71
72
TheBrainasPASS
PASS:AneuropsychologicalapproachtotheBrainbasedonthreeFunctionalUnitsdescribedbyA.R.Luria(1972)
PASSTheory:Planning
!Planningisaneurocognitiveabilitythatapersonusestodetermine,select,anduseefficientsolutionstoproblems– problemsolving– developingplansandusingstrategies– retrievalofknowledge– impulsecontrolandself-control– controlofprocessing
73
KnowledgeandPlanningLearningCurves
• Learningdependsuponinstructionandintelligence(PASS)
• Atfirst,PASSplaysamajorroleinlearning• Whenanewtaskislearnedandpracticeditbecomesaskilland
executionrequireslessPASS
Novel Task Well Learned Task
Overtimeandwithexperience
Maximum Use
Minimum Use
RoleofKnowledgeandSkillsRole of Planning
!Attentionisabasicneurocognitiveabilityweusetoselectivelyattendtosomestimuliandignoresothers – focusedcognitive activity– selectiveattention– resistancetodistraction
75
PASSTheory
No Response
No Response
Response
PASSTheory
• Simultaneousprocessingisabasicneurocognitiveabilitywhichweusetointegratestimuliintogroupsandsolveproblems
• – Stimuliareseenasawhole
– Eachpiecemustberelatedtotheothers
76
!Successiveprocessingisabasicneurocognitiveabilitywhichweusetomanagestimuliinaspecificserialorder– Stimuliformachain-likeprogression– Stimuliarenotinter-related
77
PASSTheory:Successive
GirlCow Wall Car
AbilityProfiles
ADHD
ASD
SLD
OrganizingtheData
• Adayinthelife.
• Ability/Knowledge/Skill
• Protectivefactors• Determiningeligibility
• Suggestingpossiblediagnoses
• Recommendingneeds• Consideringcontinuumofservices
MultipleHandicaporPrimary/Secondary?
ADOPTALEARNINGTOSWIMMINDSET!
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