Making an Educational Diagnosis within the scope of an MFE

1. Making an Educational Diagnosis within the scope of an MFE • Current practices • Overview of DSM practices • Presentation of field interviews • Results from staff survey • Discussion

2. Current Practices • US Department of Education states that to identify ADHD there are three types of evaluations: • Behavioral • Questionnaires and rating scales • Educational • Demonstration that this affects education • Medical • Often in the form of a doctor’s note based on other information

3. Current Practices • US Department of Education notes that IDEA tells us that we must identify students with a disability that is affecting their education • DOE goes on to state: • “The results of a medical doctor’s, psychologists, or other qualified professional’s assessment of ADHD MAY be important…” • Not mandatory in language, just suggestive

4. Diagnosing: Behavioral Evaluations • The American Academy of Pediatrics (AAP) suggest using the following rating scales for accurate diagnosis of ADHD in children: • Connors Parent/Teacher Rating Scales (CPRS/CTRS) • Barkley’s School Situations Questionnaire –Original Version, Number of Problem Settings Scale (SSQ-0-1) • Barkley’s School Situations Questionnaire –Mean Severity Scale (SSQ-0-2)

5. Diagnosing: Educational Evaluation • Should be a team decision. • Should include classroom observations (2-3 different observations across different days, 20-30 minutes in length) noting the frequency of various ADHD symptoms exhibited compared to the behaviors of the other children in the classroom. • Should also include an assessment of the child’s productivity in completing classwork and other academic assignments. Its important to collect information about both the percentage of work completed as well as the accuracy of the work. The productivity of the child can be compared to the productivity of other children in the class.

6. Diagnosing: Medical Evaluation • Part B of IDEA does not necessarily require a school district to conduct a medical evaluation for the purpose of determining whether a child has ADHD. It is the schools discretion as to whether or not to require a medical evaluation by an MD as part of the MFE.

7. Distinction between a Medical Diagnosis and an Educational Assessment • Medical Diagnosis are made in order to (a) determine the best treatment strategy, (b) advise what to expect in the future (prognosis), (c) allow data collection and statistical analysis, and (d) support billing of third-party payers. • Educational Assessments are designed to determine eligibility for special educational assistance.

8. Is ADHD Medical? It is not a disorder of attention as previously thought, it is a function of developmental failure in the brain circuitry that monitors inhibition and self-control Children with ADHD display a range of symptoms and varying levels of severity Most children with ADHD are of at least average intelligence

9. ADHD (cont.) • Almost one-third of children with ADHD will have some type of learning disability • 3-5 % of the student population has ADHD with boys 4-9 times more likely to be diagnosed than girls.

10. Three subtypes of ADHD according to DSM-IV • Predominately Inattentive • Fidgety, has difficulty staying seated or playing quietly and acts as if driven by a motor • Predominately Hyperactive-Impulsive • Difficulty participating in tasks that require taking turns, blurting out answers to questions instead of waiting to be called on. Flitting from one task to another without finishing the previous task. • Combined Types

11. DSM-IV Criteria • Child must display several characteristics to be clinically diagnosed with ADHD • Severity. The behavior in question must occur more frequently in the child than in other children at the same developmental age. • Early Onset. At least some of the symptoms must have been present prior to age 7. • Duration. The symptoms must also have been present for at least 6 months prior to the evaluation. • Impact. The symptoms must have a negative impact on the child’s academic or social life. • Settings. The symptoms must be present in multiple settings.

12. Interviews • Practitioners and educators selected to answer the following questions: • What is the best way to diagnose ADHD? • What are the barriers to in-school diagnosis? • Why don’t more school psychologists do this?

13. Interview Results: Joe Kovaleski, D.Ed. • Best way to diagnose inattention/spectrum? • Liaison between school, medical community, and family • School psychologists are essential as they do the “footwork” of diagnosis such as the Conners’ and observations. Doctors just eyeball these data and make the diagnosis

14. Interview Results: Joe Kovaleski, D.Ed. • Why don’t more school psychologists diagnose? • School psychologists do not have strong enough sense of self-esteem. • We seem more comfortable referring this out even though we have the training • Many school psychologists don’t want to diagnose a disorder treated with medication. Yet we diagnose ED and CD.

15. Interview Results: Joe Kovaleski, D.Ed. • Who is resisting school psychologists becoming diagnosticians? • We are. We don’t come across as assured. When a parent comes to us and asks us for a diagnosis we say we can’t do this and it erodes our profession. The student then goes to a clinical psychologist who may have less training in educational diagnoses • We haven’t pushed this issue and we don’t come across as confident and assured

16. Interview Results: Antoinette Miranda, Ph.D. • What’s the best way to diagnose inattentive/spectrum disorders? • Note from the doctor • Behavior rating scale • Observation • Documentation that the disorder is affecting the student’s academics

17. Interview Results: Antoinette Miranda, Ph.D. • Who is restricting school psychologists from diagnosing in schools? • School districts • Why should a pediatrician or physician with no specialized training/field data be able to diagnose a student when we work with them everyday?

18. Interview Results: Antoinette Miranda, Ph.D. • Are school psychologists presently prepared to diagnose when they leave graduate training? • No, not yet. • Not enough specialized training in these areas. Still focused more on academic interventions than mental health

19. Interview Results: Jane Welch, Ph.D. • What’s the best way to diagnose inattentive/spectrum disorders? • In school • Do a clinical interview with family and student, an observation, rating scale, and diagnose (with consent)

20. Interview Results: Jane Welch, Ph.D. • Why aren’t school psychologists doing this? • We still don’t receive enough training in these areas • Clinical psychologists will diagnose these disorders even without specialized training or observations in the classroom. Or they will have an MA level assistant do it and they will sign off

21. Interview Results: Jane Welch, Ph.D. • Who is resisting in school diagnosing? • We are • Far too concerned with special education issues and not with clinical side • There may be a bit of ignorance on our part about what we can do in the schools

22. Interview Results: Jane Welch, Ph.D. • Are we not diagnosing because we are not Ph.Ds? • No, look at MA level Professional Counselors. They will diagnose inattentive and spectrum disorders • Eds. Level psychologists could be doing this as well

23. Interview with Dr. Jim Broyles (GCPS) • Diagnosis of ADHD: different ways to diagnose for different issues (educational problems compared to home issues) • Clinical interviews regarding child/family history along with observations and interviews • Classroom observations difficult for MD’s to diagnose • Best way to diagnose ADHD is a collaboration between School Psychologists, MD’s, well trained social workers/Psychologists

24. Dr. Broyles (cont.) • Autism is a little more challenging: best done from collecting data from variety of domains • As far as a medical diagnosis: so many domains are involved and autism is such a powerful label its best to be very thorough in gathering information, best practice is to have an expert in social function to pool information. He also believes that it is more important to determine where in each domain a child is as far as severity of symptoms not just the diagnosis • Having a school make a determination of an educational diagnosis of ADHD/Autism makes sense to him as long as the student meets criteria for each disorder

25. Dr. Broyles From a physicians point of view they just want to make sure a true evaluation is being done. They are not sure of the qualifications of the person doing the evaluation or the quality of the work done in the school. Dr’s do not understand psychology as a science, they are not current on who is truly qualified and what is competent work. They just want to make sure that a child is not being mislabeled or misidentified. Doctors also want the schools to provide more services (as far as identifying) but are not sure how to get it done. Dr. Broyles states that it is a doctors perception that it is difficult for parents to have access to school psychologists. Parents come in to doctors offices saying that the schools will not do the evaluations and reinforce this perception. Dr. Broyles thinks that overall most MD’s would be glad to have the schools to provide information/reports educationally identifying students with possible disorders.

26. Dr. Broyles (cont.) Dr. Broyles says that it is his experience thus far that some school psychologists are qualified and some are not. He has received reports from school districts in which educational identifications have been made in the report. He feels that a school psychologist with a Masters level education is qualified in gathering information and assess from all of the domains but that PhD's have the additional training and can give a better insight/understanding into what is going on with the child. They can better understand the more subtle issues that are going on with a student better than a M.A..

27. Dr. Broyles (cont) Dr. Broyles believes that the real solution for PDD/ADHD kids is not just getting the right diagnosis but to link the family to services available to them, not just school services but family services. The one benefit to having a MD make the identification is that they are more in touch with ALL services available to a family not just school services. Dr. Broyles also believes that it would be nice to have one dedicated person in a district to test/assess/measure PDD disorders. This would ensure a uniformity in identifications as well as competency.

28. What about SWCS? • District policy: • The school psychologist collects the data (observations, parent report, teacher consultation, and rating scale) • The parent is asked to have a doctor diagnose the disorder • The diagnosis is then used for determination of a presence of a disability

29. What Do You Think? • We purposely didn’t interview specialist level psychologists because we wanted to hear what you have to say now • Results from survey

30. Are you comfortable diagnosing inattentive/spectrum disorders in school? Blue: Yes Percentages same for both questions: inattention and spectrum disorders

31. Do you think school psychologists are properly trained to make in school diagnoses? Blue: Yes

32. Do you think school psychologists should be able to make these diagnoses? Blue: Yes

33. Do you think by not making these diagnoses in school we have weakened or compromised our profession? Blue: Yes

34. Questions and Discussion What do you think?