assessment of multiple disabilities nasp.k 1 hourey · meet the student's individual...

ASSESSMENTOFSTUDENTSMEETINGMULTIPLEELIGIBILITIESUNDERIDEIAANDADA

SamGoldstein,Ph.D.AssistantClinicalProfessor

UniversityofUtahSchoolofMedicineClinicalDirector

Neurology,LearningandbehaviorCenter

www.samgoldstein.cominfo@samgoldstein.com

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!

www.samgoldstein.cominfo@samgoldstein.com

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