Tag: special education

What is “Educational Autism?”

In Autism Spectrum Disorders, Education, Learning

Recently, I’ve been hearing the term “educational autism” floating around. It has been used by parents, school professionals, and other clinicians. Most often, there is confusion surrounding the term and no one knows what it means. The reason there is such confusion is that “educational autism” is not really a “thing;” my best understanding of the term is that it is a way to describe someone who meets the educational classification for autism (as defined by IDEA). The person may or may not have an actual diagnosis of an autism spectrum disorder, though they very likely do, given the similarities between the criteria. However, I think it is important to clarify the differences between educational classifications and diagnoses.

The Individuals with Disabilities Education Act (IDEA) is a federal law that governs special education services. It includes 13 disability categories, also referred to as educational classifications. In order to be eligible for special education and related services, a child must meet the criteria for at least one of these special education categories and show an educational need. IDEA defines autism as: “ a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences” (IDEA Section 300.8). In contrast, medical professionals (such as, psychologists, pediatricians, developmental-behavioral pediatricians, psychiatrists) make a diagnosis using the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013) or the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM; World Health Organization). The DSM-5, in particular, has several defined criteria that must be met in order to have a diagnosis of an autism spectrum disorder. Thus, while most individuals with an autism spectrum disorder will meet criteria under all three possible classifications, it is possible that a child may meet diagnostic classification but not meet the educational classification, and vice versa. Using the term “educational autism” appears to refer to the rare child who meets the educational classification of autism but does not meet the diagnostic criteria for an autism spectrum disorder (or has not been evaluated by a person qualified to make a diagnosis).

So, why make this distinction between “educational autism” and a diagnosis of an autism spectrum disorder if most children with autism spectrum disorders will meet both? Often, who makes the diagnosis or educational classification has funding and treatment implications. For example, a medical professional may make a diagnosis of an autism spectrum disorder for one of his or her patients. That diagnosis may make the patient eligible to apply for certain types of treatment programs funded by health insurance, medical assistance, and/or social security disability benefits. But it is not automatically accepted in the educational setting; rather, most schools will require that the educational classification be made by a school-certified professional, such as a certified school psychologist. So the school will do their own evaluation to determine whether the child meets the requirements for an educational classification of autism, which would make them eligible for special education and related services. However, the school evaluation would not be automatically accepted by treatments and interventions funded by health insurance, social security/disability, or medical assistance, especially if the evaluator is not a professional who is qualified to make a diagnosis, such as a licensed psychologist or physician.

Doesn’t this process just make things more complicated and confusing to parents and families? Why can’t a single evaluation cover eligibility for both medical and educational services, especially since we are talking about a single child? Part of the difference is that these different funding and treatment streams, medical and educational, have different definitions of autism (as described above) and different requirements for evaluators. Medical funders and treatments often require a diagnosis that is made by a licensed psychologist or a physician. In contrast, the minimum requirement for school certified psychologists (in Pennsylvania at least, though this may vary from state to state) is a master’s degree. Therefore, some school districts will make policies that they do not make “medical diagnoses” of autism because not all of their staff have the required credentials to be recognized in the medical setting. In the end, families often end up having to have multiple evaluations in order to determine their child’s eligibility for both medical and educational treatments and interventions unless they can find an evaluator who is both licensed and qualified to make a “medical diagnosis,” as well as certified to make an “educational classification.”

Many times, this complicated process is not explained to parents. Or parents may be so overwhelmed or exhausted by taking care of their child with special needs that they do not have the time or the energy to find this information. They may not know where to go to start looking. Ultimately, the burden is placed on parents to discover why and how to get their child with an autism spectrum disorder the proper types of evaluations in order to access the services that he or she needs. A good evaluator who is knowledgeable about both the educational and medical systems and requirements can be an important guide for parents navigating the various systems involved in the care of children with autism.

The Benefits and Pitfalls of Extended Time for Attention Problems

In ADHD, Education, Learning

Extended time is one of the most common accommodations given to individuals with attention problems. It is usually granted on the assumption that the person is easily distracted when completing tasks and, therefore, needs a longer time to complete them. While this assumption may be true for some people with attention problems, it is not true for all of them. Granting extended time can also lead to unintended negative consequences. Therefore, extended time should be granted to an individual based on data that demonstrates a need for extended time. Some of the common benefits and pitfalls in granting extended time for individuals with attention problems are described below.

Benefits of Extended Time for Attention Problems

Some individuals with attention problems work at a slower pace on tasks. They may struggle to balance speed versus accuracy. In other words, when working at an appropriate or expected pace for their age, these students are more vulnerable to making inattentive errors. They need to work at a slower than expected pace in order to work accurately.

Other individuals are slow to process information. They may appear to be daydreaming or in a fog and may move and respond more slowly than others. They may lose their train of thought or appear confused. They complete tasks more slowly and often do not finish tasks in the time allotted.

In these cases, extended time may give these individuals the opportunity to fully demonstrate their skills and abilities in a way that would not be captured in a situation where they were under more rigorous time constraints.

Pitfalls of Extended Time for Attention Problems

Many individuals with attention problems have difficulty sustaining their level of attention, concentration, and effort over an extended period of time. Some may be more active or impulsive than others and need to get up and move around frequently. Others may be easily distracted and have a difficult time re-focusing on the task. Their performance may dramatically decrease the longer a task goes on. For these individuals, extended time is likely to be ineffective and might actually lead to decreased levels of performance. Extended time does not correct for difficulties re-focusing on the task-it simply allows the person to be off-task for a longer period of time. A better intervention might be “stop-the-clock” breaks as needed to get up and move around, as well as direct instruction in strategies and techniques to monitor one’s level of attention and focus and self-direct back to the task, as needed.

In addition to being inappropriate for some individuals with attention problems, extended time can also set up a student for frustration and a never-ending game of “catch up.” Students who are granted 1.5 or double time to complete all tasks and assignments have to find the extra time within the day to complete them. Often, this may mean missing break periods, recess, or cutting back on extracurricular activities in order to have enough time to complete school work. However, breaks and recess are critical periods for students with attention problems; as described above, many of them need the time to move around and take a break so that they can come back to learning more refreshed and attentive. Extracurricular activities can also be an important way to build feelings of confidence and competence in individuals who may not feel very confident or capable when it comes to academic work (especially academic tasks that require high levels of attention and concentration, thereby emphasizing their areas of weakness).

Some students who are granted extended time, but who don’t actually need it, may develop anxiety and a sense of incompetence around timed tasks. They may become overly worried about time and time pressures, which reduces their attention and focus on the task at hand. They may see themselves as incapable of completing a task within the allotted time and never give themselves the opportunity to challenge this belief. For other students, having extended time simply reinforces poor study and time management habits. Simply granting a student additional time to complete a task does not mean that he or she will automatically know how to use that time effectively.

Finally, extended time does not make up for poor study skills or a lack of preparation for a test or exam. While extra time can result in higher levels of performance for students who actually work more slowly than others and need the time to better demonstrate what they know, it is not going to result in higher levels of performance for an individual who has not appropriately learned or studied the material. Therefore, direct instruction in effective and efficient study strategies may be a more useful approach than simply granting extended time.

In conclusion, the decision to use extended time as an accommodation should not be based on diagnosis alone. Rather, the accommodation should be granted thoughtfully, with consideration of the individual’s unique strengths and weaknesses, as well as his or her circumstances, lifestyle, and values. Even in those for whom extended time is appropriate, it must be used judiciously so that the individual is not set up to fall further and further behind and so that it does not have an unintended detrimental effect on both academic performance and emotional functioning. Other strategies and techniques may be more effective at addressing underlying attention and behavioral regulation difficulties and should be paired with extended time.

When Working Hard Doesn’t Work for Learning

In ADHD, Education, Learning, Learning Disabilities

Hard work is a value that is often celebrated and rewarded in American culture. The notion that anyone can do anything that they want as long as they work hard is an ingrained belief for American society. But what happens when working hard simply isn’t working? Many children and adults with learning or developmental differences work hard but do not always see the types of outcomes that they expect. They may spend exorbitant amounts of time studying, reading, reviewing, getting tutoring, and still perform more poorly than they expect on tests and exams. They may feel that their grades don’t reflect the amount of effort they have put in to trying to learn the material. They may feel overwhelmed by the process of learning. Over time, some individuals develop anxiety around studying and feel guilty spending time in any activity that is not studying. Other individuals may become frustrated and burnt out by repeated failures, leading to diminished effort. However, learning often does not need to be such a labor intensive, frustrating, and seemingly unsolvable problem. For many individuals with learning and developmental differences, learning strategies to work smarter and more efficiently is going to be much more effective than simply putting in more time using an inefficient or ineffective approach. And the earlier these strategies are implemented, the more they can prevent subsequent poor outcomes.

Working smarter and more efficiently starts with a comprehensive understanding of a person’s strengths and weaknesses and how those strengths and weaknesses impact the learning process. Many factors can affect how well someone learns, including his or her underlying cognitive and reasoning capacities, as well as the demands and expectations of the learning environment. In addition, factors such as attention, behavioral and emotional regulation, and social skills can all impact how well a person learns. Health and environmental factors, such as a neurological condition or living in poverty, can impact learning. A comprehensive evaluation conducted by a psychologist or neuropsychologist can help to clarify where a person is struggling and the factors that are impacting their difficulties.

Take reading problems, for example. For one student, problems with attention make it difficult for her to pay attention to what she is reading. She tends to speed through without taking time to focus on getting the main idea. Another student has dyslexia; his brain has a hard time understanding and making connections between sounds and symbols. As a result, he often misreads information and reading is much slower and more effortful for him. Another student is highly anxious and re-reads sections of text over and over to make sure she hasn’t missed anything. A fourth student is so overwhelmed by sensory stimuli in the environment that he cannot effectively focus his attention on the reading material given to him. A fifth student missed breakfast this morning and is wondering when it will be lunch time. Another student has a sick parent at home and is worried about them. In the classroom, it may appear that all of these students are struggling with reading. But the underlying source of their difficulties is very different and requires very different types of intervention. Working harder may help some of these students, though it will not address the underlying difficulties for many of them.

Once an individual’s learning strengths and weaknesses have been identified, specific areas of weakness can be more directly targeted. Without a comprehensive evaluation and understanding of a person’s learning, interventions and strategies may be implemented that do not effectively address the underlying areas of weakness or build on areas of strength. As a result, time may be spent trying lots of different types of interventions with minimal levels of success, rather than focusing on those strategies that are most likely to be helpful for that particular person. In the meantime, the person may continue to struggle with learning and fall further behind. Emotionally, they may become frustrated, angry, depressed, anxious, or unmotivated. Family members and teachers may see the student as lazy, a behavior problem, or disinterested in learning. The student may get the message that if they would only work harder, they would do better; yet, their hard work may go unrecognized and be overlooked. They may be spending lots of time using a strategy that doesn’t work for them or they may give up entirely because they don’t know what strategy will work or help. Early recognition and accurate identification of difficulties through a comprehensive evaluation can help to prevent, or at least reduce, these secondary difficulties. An individual can then employ his or her hard work, motivation, and dedication in a much more intentional, effective, and rewarding way.

The Differences Between Public and Private Educational Evaluations

In ADHD, Autism Spectrum Disorders, Education, Learning, Learning Disabilities, Neuropsychological Evaluations

When a child is struggling with learning, parents may wonder what to do. Usually, the first step is to get a comprehensive evaluation in order to identify the nature and severity of the child’s problem and determine what interventions are likely to be useful and helpful. Under the Child Find provision of IDEA, states are required to find and evaluate any student suspected of having a disability, even if the child attends private school or is homeschooled. Specifically, IDEA states that any child who needs special education and related services is to be “identified, located, and evaluated” (IDEA, Section 300.111). In many states, this requirement falls to the local school district to evaluate any child who may need special education and related services at public expense. In other words, the school district is ultimately responsible for ensuring that a child with special needs is identified and evaluated. However, some parents may choose to pursue a private evaluation, for some of the reasons below. In this article, I am hoping to clarify the main differences between evaluations conducted in the public education sphere and those in the private realm. (Disclaimer: I am not an attorney and nothing I have written should be construed as legal advice. The information presented is my opinion based on my experience and understanding of the regulations. Please refer to an educational attorney in your area for more specific guidance and information).

Choice of Evaluator

Typically, parents do not have a choice in who will evaluate their child in the public school environment. Most often, the evaluation is assigned to a specific school psychologist who is assigned to that child’s school or grade level (in larger districts, there are sometimes school psychologists who specialize in certain types of evaluations, such as autism spectrum disorders). In the private realm, parents are free to go to an evaluator of their choice, provided that evaluator has the appropriate credentials and experience to conduct an evaluation. Parents may seek out an evaluator with experience and expertise with the issue their child is facing, specialized knowledge and training (such as a neuropsychologist), or who is referred by family members or friends. Parents often have more access (or can request access, such as asking for a CV) to an evaluator’s experience and credentials in the private realm.

Evaluator Training, Experience, and Credentials

All school psychologists working in a public school district are required to meet certain minimum education and training standards, though these may vary slightly from state to state. For example, to become a certified school psychologist in Pennsylvania, the individual must have a master’s degree that covers specific educational content, a supervised internship of at least 1000 hours, and must pass both the basic skills Praxis exam, as well as obtain a minimum passing score on the School Psychology Praxis exam. Since these are minimum requirements, there are many school psychologists with higher levels of education and training or specialized training in specific areas. However, as noted above, parents often cannot choose which school psychologist in a district will be responsible for their child’s evaluation. At the same time, because the evaluation is conducted by a school district employee, families do not need to be concerned about whether the report will be accepted by the district.

In the private realm, states vary in terms of their requirements for who can conduct an educational evaluation. Continuing with our example of Pennsylvania, to practice privately a psychologist needs to have a doctoral degree (though some who were licensed in the 1980s and early 1990s were able to do so with master’s degrees), at least two years of supervised training and experience, and pass both a national and state exam. Parents and families looking for a neuropsychologist should look for someone who has specific training and expertise, beyond the doctoral level, in the study of brain-behavior relationships (in Pennsylvania, there is no separate license or credential for neuropsychologists; instead, they are licensed as psychologists). However, public school entities are not required to accept a private evaluation and can choose to have their school psychologist conduct an evaluation. If the outside evaluator is also certified as a school psychologist in Pennsylvania, then the district is required to acknowledge the evaluator’s report and conclusions (though they may still conduct their own evaluation). Thus, knowing the credentials of an outside evaluator is important and may affect whether the evaluation is accepted in the educational setting.

Comprehensiveness of Evaluation

Both public and private evaluations vary significantly in how comprehensive and thorough they are. Thus, careful choice of an evaluator and examination of his or her credentials and experience is key. In general, though, evaluators in private practice (especially those who are private pay) have lower caseloads than those who work in school districts. As a result, the private evaluator likely has more time to work with your child. Additionally, if the evaluator has advanced training and experience, such as a neuropsychologist, he or she may be able to evaluate areas of function that are not typically included in standard psychoeducational evaluations in the public school setting (including memory, executive functioning, attention). Private evaluators are not beholden to school district regulations, policies, or procedures regarding what is included in the evaluation. Thus, they may be able to evaluate the child in a deeper, more comprehensive manner.

At the same time, school district evaluations are typically multidisciplinary. If your child also needs a speech, occupational therapy, or physical therapy evaluation, these can be included in the school district psychoeducational report. In the private setting, these types of multidisciplinary practices are much more rare; a child may need to see several different providers who all do independent evaluations.

Diagnosis and Conclusions

Public school evaluations typically determine whether a child meets one of 13 educational classifications, which are defined by IDEA. In order to be eligible for special education, a child must meet the criteria for at least one of these categories and show an educational need. Thus, some children may have a diagnosed condition that does not affect education; this child would not meet the criteria to receive special education and related services. Often, school districts will not make diagnoses for conditions that are not defined by IDEA, such as attention-deficit/hyperactivity disorder (ADHD) or dyslexia; instead, they will refer to an outside provider to make these diagnoses. In the public school setting, classification decisions are also typically made by a multidisciplinary team, following the policies and procedures of the district. It is important to keep in mind that school districts often have limited resources and competing interests and goals; these factors can explicitly or implicitly impact the conclusions that are drawn and the recommendations that are made.

In the private realm, evaluations typically determine whether a child has a diagnosis, as defined by specific diagnostic criteria. Whether the diagnosis affects education and learning is irrelevant in this type of evaluation. For example, a child with a severe fear of dogs may be diagnosed with a specific phobia and require treatment to reduce his anxiety and fears. However, this diagnosis is unlikely to affect school functioning, especially if there are no dogs present in the school environment. At the same time, school and learning comprises a large portion of a child’s daily life; therefore, many diagnosed conditions have an educational impact. Private evaluators are not beholden to school district policies and procedures; therefore, their conclusions and recommendations are often viewed as more objective and more aligned with the child’s best interests. At the same time, private evaluations are sometimes criticized as being unrealistic for an educational environment. Nevertheless, an evaluator who is experienced in working with educational settings and has a good understanding of the school environment can usually make recommendations that are relevant, applicable, and flexible enough to be implemented in the school setting.

Timeline of the Evaluation

IDEA regulations require that school district evaluations are completed with 60 days. States vary on whether the 60 days are counted as 60 school days or 60 calendar days and whether summers count toward the 60 day timeline. In any event, school districts are legally required to complete the evaluation under specific timeline guidelines.

Private evaluators vary significantly in their availability. Some evaluators may have immediate openings, while others may be scheduling out several weeks or months or even have a waiting list. Private evaluators are not required to follow a specific timeline; therefore, it is important to inquire about a private evaluator’s availability and typical report turnaround time.

Cost

Evaluations conducted by the public school entity are done at no cost to the family. In contrast, private evaluations can be costly, sometimes up to several thousand dollars. Many evaluators do not accept or participate in insurance for these evaluations; in fact, most medical insurers will not cover testing for primarily educational purposes, stating that this is an educational service that should be provided by the educational entity, not a medical service that should be covered by health insurance. At the same time, some families are approved for an Independent Educational Evaluation (IEE), which is a private evaluation conducted at public expense (typically, the school district contracts with the private evaluator and pays him or her directly). Finally, some families are able to request reimbursement from the school district for private evaluations that they had done, especially if that evaluation was done because the school district evaluation was not done, was inadequate, or did not identify conditions or learning issues that should have been identified and addressed.

When to Consider a Psychoeducational or Neuropsychological Evaluation for your Child

In ADHD, Autism Spectrum Disorders, Education, Learning, Learning Disabilities, Neuropsychological Evaluations, Practice Information

Parents of children with special needs or those facing behavioral or emotional challenges are often told to have their children “evaluated.” Similarly, adults with learning differences or challenges, neurological injuries or illnesses, or behavioral and emotional concerns may be told to get an “evaluation.” But what will an evaluation tell you about your child (or yourself)? And when should you consider an evaluation for yourself or your child?

First and foremost, a psychoeducational or neuropsychological evaluation will help to determine whether there is a diagnosis that accounts for the difficulties the child is experiencing. A diagnosis can be helpful in identifying the nature of the problem, and suggesting possible helpful interventions, accommodations, or modifications. It can be a quick way of capturing what a child, adolescent, or adult is experiencing. Additionally, a diagnosis is often required for eligibility to certain types of programs and services, such as special education, behavioral/emotional services, or medical interventions. However, diagnostic labels are often limited. They tend to describe conditions and disorders in broad strokes, rather than the specific ways they are affecting a particular individual. They do not identify what cognitive, emotional, behavioral, and environmental factors have contributed to the development or maintenance of the condition. They also do not describe the individual’s unique pattern of strengths and weaknesses. Comprehensive psychoeducational and neuropsychological evaluations are individualized, and help to provide a thorough understanding of the individual being assessed. By understanding why an individual is having difficulties, how to help becomes clearer. Therefore, this in-depth understanding of the individual can help those providing treatment to be more targeted and specific in their interventions, and to choose interventions that are more likely to be effective.

Because they are more comprehensive, individualized, and in-depth, psychoeducational and neuropsychological evaluations can be useful in a number of circumstances. Some examples of situations where an evaluation may be helpful are listed below. This list is not all-inclusive; rather, it is designed to provide some common examples where evaluations may be useful:

The person is having difficulties in learning, memory, executive functioning, attention, behavior, and/or emotional functioning.
The person is suspected of having a specific condition (such as an autism spectrum disorder or learning disability), and testing is required to determine whether the disorder is present.
The person has shown a significant change in mood, behavior, or learning. These changes may suggest the onset of a condition in those without a history of difficulties. They may also suggest the onset of an additional condition, ineffectiveness of interventions, a change in course or severity, or an incorrect initial diagnosis in those who have been previously identified and evaluated.
The person has not responded to standard treatment or research-based educational interventions.
The child requires special education or related services.
An adolescent or adult requires accommodations or modifications in a college or job training program, standardized testing situation, or in an employment setting.
The person was previously evaluated, but the evaluation was not comprehensive, inadequate, or invalid.

In general, evaluations may be repeated every 2–3 years for children/adolescents in order to assess progress and update treatment recommendations. In some cases, re-evaluations may be unnecessary, especially if the condition has resolved and the person is no longer experiencing any difficulties. However, re-evaluations should be completed in shorter intervals if there is a major change in functioning, if the person has not responded to treatment or treatment has stalled, or if the person has a condition that is known to cause progressive deterioration in functioning.