naviga&ng(dsm5(diagnoses(&( schoolsupportservicesforyour
TRANSCRIPT
Naviga&ng DSM-‐5 Diagnoses & School Support Services for Your
Child Debra B. Huss, Ph.D.
Licensed Clinical Psychologist &
Brandon D. Huss, M.A. Cer=fied School Psychologist
Objec&ves
• What an Evalua=on consists of in a school compared to community clinic
• Brief overview of DSM criteria for ASD, ADHD, and Anxiety Disorders
• Criteria for School Services • Pros & Cons of an evalua=on in the community versus within the school system
School vs. Community Clinic Evalua&ons
School Evalua=ons • Determine if the child meets criteria for a disability under the Individuals with Disabili=es Educa=on Act (IDEA).
Private Evalua=ons • Determine if a child meets DSM-‐5 criteria for a mental health diagnosis
Child with a Disability (IDEA)
What is required to be a “child with a disability” under IDEA? • Appropriate evalua=on • Meets eligibility criteria • Adverse effect • Need for special educa=on/specially designed instruc=on due to the disability
Appropriate Evalua&on
• Appropriate instruc=on and interven=ons must be provided before the referral or as part of the referral/evalua=on process
• Instruc=on and interven=on services must be research-‐based
• Data-‐based documenta=on of repeated measures of achievement and/or behavior
• Data is collected and evaluated at reasonable intervals reflec=ng systema=c assessment of student progress
• Parents are provided with results
Appropriate Evalua&on
School Evalua=ons include informa=on and data from a variety of sources, including but not limited to… • Social-‐Developmental History/Medical History/Parent Interview • Direct Observa=ons • Teacher Interview/Reports • Student Records (i.e. grades, enrollment history, aYendance, discipline, etc.) • Response to Interven=on (RtI) records and data • Behavioral Interven=on Plan (BIP) records and data • Assessment Data (cogni=ve, achievement, behavioral, adap=ve, K-‐PREP, neuro-‐
psychological, etc.) • Func=onal Behavior Assessment (FBA) • Records or evalua=ons from private therapists, physicians, psychologists, etc.
Evalua=ons have to use mul=ple data sources to substan=ate the existence of the disability (triangula=on of data).
Evalua&on in a Community Clinic
• Detailed interview with parents and child – Developmental and medical history – Family mental and medical health history – Academic history – Social/Peer history – Specific symptoms of DSM disorders, comorbid & differen=al diagnoses
(structured interview) – Stressors or significant life events – Strengths of the individual
• Standardized individually administered tests – Intelligence, achievement, neuropsychological tests
• Standardized parent, teacher, self-‐report ques=onnaires – Have reliable results over =me & measure what they intend to measure
• Clinical observa=ons of the child in office se^ng and possibly home & school se^ng
Special Educa&on Eligibility
Evalua=on informa=on confirms…… • …there is an adverse effect on educa=onal performance (must be present for eligibility)
• …that lack of instruc=on in reading and/or math was not a determinant factor in the eligibility decision.
• …that limited English proficiency was not a determinant factor in the eligibility decision
Special Educa&on Eligibility
Adverse Effect • means that the progress of the child is impeded by the disability to the extent that the educa=onal performance is significantly and consistently below the level of similar age peers.
• The Admissions and Release CommiYee (ARC) determines the significance of the disability’s impact on the child’s educa=onal performance
Au&sm under IDEA
The student….. • …has a developmental disability, generally evident before age 3, significantly affec=ng verbal and nonverbal communica=on (must be present for eligibility), and…
• …has a developmental disability affec=ng social interac=on (must be present for eligibility), and…
• The student’s deficits are not primarily the results of an emo=onal-‐behavior disability.
Au&sm Eligibility Form
DSM-‐5 Au&sm Spectrum Disorder (ASD)
A. Persistent deficits in social communica=on & social interac=on across mul=ple contexts as manifested by the following, currently or by history: 1. Deficits in social-‐emo=onal reciprocity 2. Deficits in nonverbal communica=on behaviors used for social interac=on 3. Deficits in developing, maintaining, and understanding rela=onship
ASD Criteria con&nued
B. Restricted, repe==ve paYerns of behavior, interests, or ac=vi=es as manifested by at least 2 of the following (by history or currently): 1. Stereotyped or repe==ve motor movements, use of objects, or speech 2. Insistence on sameness, inflexible adherence to rou=nes, or ritualized paYerns of verbal or nonverbal behavior 3. Highly restricted, fixed interests that are abnormal in intensity or focus 4. Hyper-‐or hyporeac=vity to sensory input or unusual interest in sensory aspects of the environment
ASD Criteria con&nued
C. Symptoms must be present in the early developmental period (but may not become fully manifest un=l social demands exceed limited capaci=es, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupa=onal, or other important areas of current func=oning.
E. Symptoms not beYer accounted for by intellectual disability or global developmental delay
Other Health Impairment
• means having limited strength, vitality, or alertness, including a heightened alertness to environmental s=muli, that results in limited alertness with respect to the educa=onal environment, that…
• …is due to a chronic or acute health problem, such as acquired immune deficiency syndrome, asthma, aYen=on deficit disorder, aYen=on deficit hyperac=vity disorder, diabetes, epilepsy, a heart condi=on, hemophilia, lead poisoning, leukemia, nephri=s, rheuma=c fever, sickle cell anemia, tuberculosis or ToureYe Syndrome;
DSM-‐5 ALen&on-‐Deficit/ Hyperac&vity Disorder
A. Persistent paLern of inaLen&on and/or hyperac&vity-‐impulsivity that interferes with func&oning or development as characterized by (1) and/or (2) 1. inaLen&on: 6 or more symptoms present for at least 6 months;
inconsistent with developmental level & nega=vely impacts social and academic/occupa=onal ac=vi=es
a. Lack aYen=on to detail; careless mistakes b. Difficulty sustaining aYen=on c. Does not listen when spoken to directly d. Does not follow through on instruc=ons & fails to finish schoolwork, chores,
workplace du=es e. Difficulty organizing tasks and ac=vi=es f. Avoids, dislikes or reluctant to engage in tasks that require sustained mental
effort g. Loses things necessary for tasks or ac=vi=es h. Easily distracted by extraneous s=muli (includes unrelated thoughts) i. Forgeiul in daily ac=vi=es
ADHD criteria con&nued
2. Hyperac&vity and Impulsivity: 6 or more symptoms las=ng at least 6 months; not at developmental level & cause impairment
a. Fidgets with or taps hands or feet or squirms in seat b. Leaves seat when expected to remain seated c. Runs about or climbs where inappropriate (feels restless for older
adults) d. Unable to play or engage in leisure ac=vity quietly e. On the go or driven by a motor f. talks excessively g. Blurts out answers before ques=on completed (completes
people’s sentences; cannot wait turn in conversa=on) h. Has difficulty wai=ng turn i. Interrupts or intrudes on others
ADHD criteria con&nued
B. Several symptoms of inaYen=on or hyperac=ve-‐impulsive symptoms present before 12 years of age
C. Several symptoms present in 2 or more se^ngs D. Clear evidence symptoms interfere with or reduce quality of social, academic, or occupa=onal func=oning
E. Symptoms do not occur exclusively during course of schizophrenia or another psycho=c disorder and are not beYer accounted for by another mental disorder
Emo&onal Behavior Disability means that a child, when provided with interven=ons to meet instruc=onal and social-‐emo=onal needs, con=nues to exhibit one (1) or more of the following, when compared to the child’s peer and cultural reference groups, across se^ngs, over a long period of =me and to a marked degree: • (a) Severe deficits in social competence or appropriate behavior, which cause
an inability to build or maintain sa=sfactory interpersonal rela=onships with adults or peers;
• (b) Severe deficits in academic performance which are not commensurate with the student’s ability level and are not solely a result of intellectual, sensory, or other health factors but are related to the child’s social-‐emo=onal problem;
• (c) A general pervasive mood of unhappiness or depression; or • (d) A tendency to develop physical symptoms or fears associated with
personal or school problems. • This term does not apply to children who display isolated (not necessarily one
(1)) inappropriate behaviors that are the result of willful, inten=onal, or wanton ac=ons unless it is determined through the evalua=ons process that the child does have an emo=onal-‐behavioral disability.
DSM-‐5 Anxiety & OCD Disorders
I. Social Anxiety Disorder: marked fear/anxiety about social situa=on(s) where individual is exposed to scru=ny by others; fear doing something that will result in nega=ve evalua=on;
II. OCD: presence of obsessions, compulsions or both that are =me consuming or cause distress/impairment
III. Separa=on Anxiety Disorder-‐ excessive distress when an=cipa=on or experiencing separa=on from major aYachment figure; developmentally inappropriate or more extreme than expected
Specific Learning Disability
means a disorder that adversely affects the ability to acquire, comprehend, or apply reading, mathema=cal, wri=ng, reasoning, listening, or speaking skills to the extent that specially designed instruc=on is required to benefit from educa=on. The specific learning disability (LD) may include dyslexia, dyscalculia, dysgraphia, developmental aphasia, and perceptual/motor disabili=es. The term does not include deficits that are the result of other primary determinant or disabling factors such as vision, hearing, motor impairment, mental disability, emo=onal-‐behavioral disability, environmental or economic disadvantaged, cultural factors, limited English proficiency, or lack of relevant research-‐based instruc=on in the deficit area.
Specific Learning Disability
SLD Areas • Basic Reading • Reading Comprehension • Reading Fluency • Math Calcula=on • Math Reasoning • WriYen Expression • Oral Expression • Listening Comprehension
Specific Learning Disability
Methods of Eligibility Determina=on • Discrepancy Model (Regression Es=mated True Score Method for KY)
• Response to Interven=on Model – Consistent lack of progress to research-‐based instruc=on and interven=ons verified by repeated measures of progress
– Consistently low rate of improvement – Verified by evalua=on data
Specific Learning Disability
RtI Data Example 3rd Grade Student • Ver=cal Axis is Words
per Minute (WPM) • Horizontal Axis is Week
of School • Top data points are
Average 3rd Grade student progress
• BoYom points show 3rd grade student in RtI not making progress
DSM-‐5 Specific Learning Disability
A. Difficul=es learning & using academic skills (at least 1 symptom las=ng >=6 months) despite interven+ons targe+ng the deficit 1. Inaccurate or slow & efforiul word reading 2. Difficulty understanding meaning of what is read 3. Difficul=es with spelling 4. Difficul=es with wriYen expression 5. Difficul=es mastering number sense, number facts, or calcula=on 6. Difficul=es with mathema=cal reasoning
Specific Learning Disability Criteria con&nued
B. The affected academic skills are substan=ally and quan=fiably below those expected for individual’s chronological age, cause interference in academic, work, or daily living as confirmed by individually administered standardized achievement measures & comprehensive clinical assessment
C. Learning difficul=es began during school age years but may not become fully manifest un=l demands for those affected academic skills exceed individual’s limited capaci=es
D. Not beYer accounted for by intellectual difficul=es, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruc=on, or inadequate educa=onal instruc=on
Factors to consider when seeking an evalua&on
• Treatment recommenda=ons • Time Frame • Cost • What assessment instruments are being used • Training and Experience of Evaluator • What informa=on will I actually receive in the psychological report
• Confiden=ality
Contact Informa&on
Debra Huss, Ph.D. Licensed Psychologist Mindpsi Psychological Services 859-‐361-‐9617 [email protected] Mindpsi.net
Brandon Huss, M.A. Cer=fied School Psychologist Jessamine County Schools East Middle (859-‐885-‐5561) Red Oak Elem (859-‐885-‐0616) [email protected]
www.jessamine.kyschools.us
References Jessamine County Special Educa=on Procedures
hYp://www.jessamine.k12.ky.us/dept/18/ KY Special Educa=on Forms and Policies
hYp://educa=on.ky.gov/specialed/excep/Pages/default.aspx Diagnos=c Sta=s=cal Manual 5th Edi=on (2013). American Psychiatric Associa=on