In order to make well thought out decisions for children with epilepsy, it is necessary to acknowledge all objective data including scores from testing, observations, outside therapists, history, emotional and personality variables, family and school data. One must pay close attention to their child and look for early signs of epilepsy in order to address specific educational needs and prevent hindered development.
- 1. Educational Needs and Services for Children with Epilepsy
David H. Salsberg, Psy.D., DABPS Rusk Institute of
RehabilitationThe Stephen D. Hassenfeld Childrens Centerfor Cancer
and Blood Disorders NYU Langone Medical Center
2.
- What professionals do you consult with
- What evaluations are available
- What to do with the information
Parents and Professionals 3. Myriad of Labels/Diagnoses, Tests,
Scores, and Interventions
- WPPSI-III, WISC-IV, WIAT-II, NEPSY-II
- LD, PDD, ADD, ADHD, SI, ED, APD, TBI
- PT, OT, ST, IEPs, EI, CPSE, CSE, 504
4. Educational Implications for Children with Epilepsy
- Etiology of Seizures underlying causes/conditions
- Seizures frequency/control
- Secondary effects missing school availability for learning
emotional/family/psychological
- All can contribute to a variety of learning and attentional
difficulties in children.
5. Issues in Educational Planning
- Effects on learning Attention Fatigue
- Stigma and Social Considerations
- Dietary or activity restrictions
- Emotional and family issues affect educational planning
6. When to take notice
- Discrepancy between skill area and norm or expected
- Discrepancy between childs own individual strengths and
weaknesses
- Signs/expressions of frustration; low self-esteem
- Social skills difficulties
- Academic and achievement difficulties
7. Birth to 3
- Start with Evaluations specific or more comprehensive?
- Early Intervention funded
- Need team integrated approach
- Center-Based Program / Home program
8.
- When in doubt refer for evaluation
-
- Iftoo early to qualify need to monitor
- Need to intervene earlier or can miss developmental window of
opportunity
- Imperative in language skills development
9. Ages 3 - 5
- Start with Evaluations Specific or more comprehensive?
- Therapy specific treatments
- CPSE Board of Education/District
- Crucial to evaluate early enough to make decisions prior to
Kindergarten.
10. School Age
- Schools start with pre-referral interventions
- Evaluations specific or more comprehensive?
- Committee on Special Education (CSE) Pros and cons of
evaluations, classifications, Section 504, legal issues
- School Placement considerations
11. Primary Evaluations
- History Intelligence Testing Behavioral Assessment
Emotional/Personality
- Psychological and Full Academic Achievement
- All of the above and further exploration of areas of strengths
and weaknesses
12. Developmental Evaluations
- Developmental snapshots to guide current treatment planning and
diagnosis
- Needs ongoing monitoring and reassessment of treatment
plan
- Not correlated with later IQ
- Limitations of diagnoses/labels at an early age
13. Goal of Neuropsychological Testing
- Go Beyond IQ and academic scores to provide a complete picture
of the childs cognitive, learning and social/emotional functioning
across many domains related to brain function.
- Should befunctional perspective with clear and practical
recommendations.
14. Testing Professionals
- Psychologists School/Educational (Masters, Doctorate) Clinical
Ph.D., Psy.D.
15. Other Disciplines/Team
- Pediatrician/Developmental Pediatrician
- Speech and Language Therapy
- Special Educators/learning specialists
- All have specific scopes of practice
16. Pediatric Specialization
- Knowledge of educational system
- Limits of overly specialized, diagnosis focused evaluations,
clinics
17. Specific Issues in Epilepsy
- Experience with Epilepsy and range of learning, attentional and
psychological issues
- Timing and locations of evaluations
- Reason for referral may dictate or limit evaluation (i.e.:
pre-surgical evaluation)
18. District/School vs.Independent Evaluations
- Timing/flexibility of evaluation
- Goal should be to evaluate the child holistically not just to
get an evaluation done
- No conflict of interest Needs to provide appropriate
documentation and recommendations to be accepted and useful Be sure
to understand timing/procedural issues
19. Variability in Reports
- Tester: Training Style Organization/Setting
- Who person is writing for
20. Variability in Tests Used
- Examiners choice/comfort level
21. Preparation for Evaluation- Parents
- Educate yourself regarding learning issues and process
- Delineate areas of concern/goals of evaluation
- Understand clinicians scope of experience and practice and
ability to assess with a team
- Should not focus primarily on single label
- Expect written report with practical recommendations that is
also geared toward specific goal (ie: funding, admission)
- Assure ongoing communication/follow-up
- Parents should receive feedback and then written report before
school, district
22. Preparation for Evaluation- Child
- Present evaluation in non-threatening, relevant and
developmentally appropriate manner
- Coordinate terminology and evaluation process with
clinician
- Consider classroom/therapy observations
- Discuss specific behavioral/stylistic issues with
clinician
- Provide work samples, book bag, outside of school examples of
concerns
- Child should receive some form of feedback at the end
23. Factors Impacting Testing
- Need to know what each test measures/doesnt measure
- Qualitative information necessary with scores
24. Overall Cognitive Functioning Intelligence Testing - IQ
- In neuropsychological and/or educational evaluation IQ test is
used as starting point
- Limitations of overall scores
- Limitations of IQ as a construct
25. IQ Scores
- IQ scores are often used as marker need to make sure it is a
good one!
- Overall scores do not take into account variability in scores,
especially Full-Scale IQ
26. Discrepancy Based LD Evaluation
- Discrepancy between IQ and achievement
- Discrepancy between child and same age/grade peers
- *Discrepancy between childs own abilities and what should be
expected
- What is clinically meaningful should translate to what is
educationally and legally relevant
27. IQ Scores
- In an effort to broaden the construct of IQ newer IQ measures
incorporate numerous skills
- Most notable WISC-IV can have high traditional IQ areas
(Verbal, Performance) and have Full-Scale IQ lowered by Processing
Speed and Working Memory
- General Abilities Index not always used but should be in many
cases
28. Preschool
- Wechsler Preschool and Primary Scale of Intelligence-III
(WPPSI-III)
29. School Age IQ
- Wechsler Intelligence Scale for Children-Fourth Edition
(WISC-IV) Ages: 6 16:11
- Stanford Binet Intelligence Scales 5 thEdition Ages 2:0
89:11
- Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)
Ages: 16 and up
- Wechsler Abbreviated Scale of Intelligence (WASI) Ages: 6 and
up
30. Speech and Language
- Neuropsychologists screen these areas in relation to full
battery gather from Speech-Language Evaluators
- Speech/Oral-Motor not the same as Language
- Need to gather audiological testing information
- Look at expressive and receptive skills in a variety of
contexts
- Auditory Processing - APD
- Adds valuable information to IQ scores
- Augmentative Communication
31. Visual-Motor/Visual-Perceptual
- Parts of evaluations overlap w/ OT, especially in
neuropsychological evaluation
32. Other Areas of Neuropsychological Evaluation
- Attention and Concentration (In 1:1 structured testing
setting)
- Memory visual; verbal; procedural; recall vs. recognition
- Executive Functioning:Planning, organization, sequencing,
working efficiently, flexibility, impulsivity
33.
- Executive Functioning/Attention and Concentration Impulse
control Distractibility Attention: Focused; selective;
sustained/vigilance Auditory/Visual Not only attention but
organization, consolidation, etc Planning, organization, time
management Mental flexibility
- May not manifest until older
34.
- Memory Most common complaint but influenced by
attention/executive functioning skills Visual Verbal Procedural
Recall vs. recognition Short-term vs. long-term Long-term usually
intact but retrieval strategies may be impacted
35. Academic Achievement Tests:
- Limitation of brief screening of single-word reading, spelling
and arithmetic in diagnosing learning problems.
- Reading: decoding, sight words, comprehension, speed,
fluency
- Need different tests for reading comprehension
- Teacher estimates are too subjective.
- Importance of, but also limitations of Grade-Equivalents.
- Standard Scores may be based on age or grade very
important.
36. Problems in Diagnosing LD
- Qualitative/subtleties of difficulties
- Difficulties do not always manifest themselves yet or on
certain tests.
37. Personality/Emotional Testing
- Projectives Rorschach (Exner Comprehensive System Scoring)
Thematic Apperception Test Roberts Apperception Test 2
- Objective measures MMPI-A or MMPI-2 BASC-2
- All dependent on cognitive skills
- Rating Scales limitations but widely used be careful needs to
correspond with clinical observation, other data.
38.
- Emotional functioning needs to be given more concern before
behavioral manifestation
39. Family/Developmental issues
- Depending on age of onset may not have a goal of returning to
previous level of independence and autonomy/achievement.
- Parents often more protective furthering these
difficulties
- Fantasy of all-protective parent/safe world potentially
impacted
40. Adaptive Functioning
- Activities of Daily Living
- Measures: Vineland-2 ABAS-II
- Needed for diagnosis of Mental Retardation
41. Individuals with Disabilities Education Improvement Act of
2004 (IDEA 2004)
- To ensure that all children with disabilities have available to
them a free appropriate public education that emphasizes special
education and related services designed to meet their unique needs
and prepare them for further education, employment, and independent
living. 20 U.S.C. Sect. 1400(d)
42. Individuals with Disabilities Education Act
- All children with disabilities receive a free appropriate
public education (FAPE)
- A school district must provide special education and related
services (PT, OT, Speech, Special Education, Counseling, Health
paraprofessional) at no cost to the child or his/her parents.
- Only required to provide whats appropriate not optimal or
best
43. Parental Referral to Local Education Authority
- Write a letter to the Chairperson of your Committee on Special
Education requesting an evaluation for possible special education
needs.
- Federal and New York State law requires that Districts complete
the evaluation process within 60 school (business) calendar
days.
- All communication with your district should be in writing, and
you must have proof of delivery of all communication.
- Your School District cannot refuse to evaluate your child upon
your request.
44. Evaluation
- Parents must consent to an initial evaluation.
- A variety of assessment tools and strategies must be utilized
to gather relevant functional, developmental, and academic
information about the child. This includes information provided by
the parent.
- No single measure or assessment may be used as the sole
criterion for determining whether a child is a child with a
disability or to determine an appropriate educational program.
- Must be appropriate to be used with that child.
- Copies of results of all assessments performed must be provided
to the parents, at no cost.
45. Identification/Development of an IEP
- Determination of eligibility
- Present Levels of Academic Performance
46. Classification
- Section 504 -Section 504 of the American with Disabilities Act
requires recipients to provide to students with disabilities
appropriate educational services designed to meet the individual
needs of such students to the same extent as the needs of students
without disabilities are met.A 504 Accommodation does not require
an IEP, but simply provides for classroom modifications and/or
related services
- CPSE Preschooler with Disability
47. Classification
- Speech or Language Impairment
- Visual Impairment including Blindness
- *Can have very different implications for services and
placement
48. Placement
- This is performed at the CSE meeting, except in New York City,
where this is done by the placement office.
- You do have the right to view any placement proposed for your
child.
- Charge and goal is for the least restrictive environment
(LRE)
49. School Placement
- Public School General Education with related services Therapies
Special Education Teacher Support Services (SETSS)
Paraprofessional
- Inclusion /Co-teaching/CTT
- NPS approved
schoolshttp://www.vesid.nysed.gov/specialed/privateschools/
50. Dispute Resolution
- Independent Educational Evaluation (IEE) Parent has the right
to an IEE if they disagree with an evaluation obtained by the
district Upon request by a parent for an IEE, a District must
either file a due process complaint to show that its evaluation is
appropriate or ensure than an IEE is provided at public
expense
- Voluntary; must be conducted by a qualified and impartial
mediator; must be paid for by the District, who maintains a list of
qualified mediators that are assigned on a rotational or random
basis; It is binding
- Impartial Hearing Impartial Hearing Officer
- Appeals State level first
51. ADHD/ADD
- Overly diagnosed/overly simplified
- Medication issues in Epilepsy
52. PDD
-
- Childhood Disintegrative Disorder
- Wide variability in presentation
53. Learning Disabilities
- Specific Dyslexia, Dysgraphia, Dyscalculia
- Non-Verbal Learning Disabilities
- Gaps in abilities/IQ and achievement
- Track over time/different demands
54. Sensory Integration
- Organizing, integrating and interpreting sensory input in a
variety of modalities including: touch, movement, body awareness,
visual, and auditory information.
- Does it impact functioning?
- Overlaps and/or interacts with other diagnoses conditions
55. Auditory Processing
- Difficulties in processing orally presented information even
though hearing is within normal limits
- Beware of knee-jerk label
- Audiologist needs to diagnose
- Age expectations These skills develop between ages 5-7.
- Interventions/recommendations
- Overlap with other diagnoses
56. Recommendations
- Compensatory techniques and strategies
- Modifications in the Environment
- Accommodations/Expectations
- Some sound good but may not help (e.g. tape recording lectures
requires >2x to listen and transcribe; laptop in class only if
great/fast typist)
57. Summary
- Need to incorporate all objective data, scores from testing,
observations, outside therapists, history, emotional/personality
variables, family, and school data in order to make well thought
out decisions for children. Need to know rights and law as
well.
58. Parents Know Best
- Educate yourselves(pros and cons of internet)
- Work closely with medical team
- Know your rights (Advocacy/Lawyers)
