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An Education In Special Education (Part 1)

For any parent of a child who is struggling in school it is a daunting task to understand what is happening, why it's happening, and who can help. Often times our best place to ask for help is the child's school; the vast majority of teachers and administrators are dedicated to their student's success and welcome parent's involvement in their child's education. In the case of children who may require special education, it can be confusing and disheartening trying to navigate the various requirements and procedures necessary to see their child succeed. When I assess children I can see the angst and frustration in their parent's faces. It's so simple to them; "I just want my child to succeed and be happy." That simple wish can be frustrated by the conflicting goals of the parents and the school administration.

The most challenging aspect of my job is explaining to parents that my goals, as their child's neuropsychologist, and their goals, as their child's parents, may not the same as the school's goals.

A World Unto Itself

The public school system is a world unto itself. The school's goals, as an educator, and my goals, as a health care provider, don't always match. While we both want what's best for the child; our goals and restrictions can be very different.

When I assess a child, I'm concerned with their entire behavioral well-being. I'm concerned about their educational ability, their social interactions, their behavior, and their emotional well-being. I look at verbal communication, non-verbal communication, social settings, home environment, school environment, friends and relationships, developmental history, and numerous other points where my patient interacts with the world around them. My view is holistic because I know that all these things overlap and interact in complex ways and so when I assess a child I look at all these different components in order to provide the family a myriad of recommendations that can address all the areas where I see concerns. Is the child not able to make friends? Then I'll provide the family with strategies to address this. Is the child dealing with anxiety? Then I'll suggest therapies and other methods for the child to overcome their fears. Is the child not doing well in school? Then I'll suggest educational interventions to help them improve. Is the child displaying characteristics that might indicate a medical concern? Then I'll suggest the child be seen by a medical specialist. Again, I look at all aspects of the child's current condition in order to chart the best path for them and their family.

In contrast, the school‘s job is strictly to educate – to provide the opportunities and materials that a child needs to function in everyday life. Schools were never intended to provide all of the services that a child might need. The school’s concern revolves around whether the child is making adequate academic progress and whether there are any barriers to the child’s ability to learn. These criteria are usually judged by three types of information: grades, performance on standardized tests (e.g. STAAR), and conduct. If child is making passing grades (even if he/she is significantly struggling), earns passing scores on standardized tests, and is not being disruptive, then the school is unlikely to provide additional services outside of what is available in the regular classroom. As an example, I am concerned about a child's social skills and ability to make friends because it later translates into the ability to get along with others in a workplace. However, in the absence of poor grades, low test scores, or frequent behavior problems, the school is not likely to provide services to address friendship skills because there is no “educational need.” In this particular instance, having friends does not directly relate to the child's ability to learn math or reading.

(Important Note: This article applies to public school systems only. Private Schools are not required by federal law to provide any special education services or accommodations to their students)

The Pressures on School Districts

At this point I'm sure you're asking, "Why don't school districts address the whole problem instead of just the educational piece?"

Very simply: cost & resources.

Special education services are very expensive for school districts. According to a 2008 study from the Education Commission of the States, the average cost to educate a student in a general education setting is around $6,556; for a student in special education, the average cost is $39,909. Over 6-times more expensive per-student.

Now let's take those numbers and input them into a fictional middle school that has 400 children. Let's pretend you're the administrator for this fictional middle school. If all those children are 'regular stream' children, the total cost to you to educate those children at that school is right around $2.6 million per year. If just 40 of those children are deemed as requiring special education, the total cost to educate those 400 children now becomes $3.9 Million for that school. That's a $1.3 million difference, with only 40 children requiring special education. You're the school administrator, and you have a very finite budget due to public education funding cuts, and you have to make up that shortfall. What do you do?

Let's look at another example: Fort Bend Independent School District (FBISD) is responsible for schools in Fort Bend County (the school district where our office is located) and has a current 2016 enrollment of 71,222 students. If the number of special education students at FBISD goes up by just 1% that represents a massive financial burden in the neighborhood of around $28.4 Million per year. And worse, it's a financial burden that is difficult to plan for since the school district has no idea how many children in their district will require special education services from year to year.

The Gold Standard

Another issue is that the way the schools determine if a child qualifies for special education. For example, the methods of determining if a child has Autism varies greatly from one district to another and are not always in alignment with standard research/medical criteria. For example, the current "gold standard" for assessing Autism, and the test we use here at Sugar Land Neuropsychology, is the Autism Diagnostic Observation Scale, 2nd Edition (ADOS-2). If you go to any research center (e.g. University of Texas Health Science Center), children's hospital, or specialized developmental clinic, they will use the ADOS-2 to diagnose Autism. It is a standardized test, meaning that the test is administered following very specific guidelines, ensuring that the test is given the same way every time regardless of whether it’s done in a hospital, a clinic, or at the child’s home. The ADOS-2 also has specific scoring criteria that allows for the detection of very subtle indicators of Autism Spectrum Disorder (ASD). 

While some school districts use the ADOS-2, I have encountered many who do not. At the extreme, I came across an evaluation recently in which the school purchased the materials for the ADOS-2, but did not follow standardized administration or use the scoring system that has been devised. Essentially, they came up with their own test. Does it make a difference? Yes! Examiners could vary in how they give the test, leading to different results. Furthermore, the failure to use the scoring criteria makes it almost impossible to compare an individual child’s performance to what is “average” or normal for his/her age.

Unfortunately, the ADOS-2 is a very expensive test to purchase and requires specialized training to administer. Some school districts may lack the funds or time for staff to be properly trained to administer this test. So, as a result of those cost limitations, a school may rely solely on rating scales to assess Autism Spectrum Disorder; however, rating scales alone often lack the sensitivity to detect mild (or “high functioning”) Autism Spectrum Disorder.

So when the parent presents our report, which is holistic and encompasses all aspects of the child's life, the school (with all these pressures listed above) is going to be focusing on only one thing: Educational Need. What is the level of intervention required to provide for the student's educational need.

Educational Need

Whenever a child is evaluated by an "outside" provider (i.e. a person not employed by school district, like myself) the school is only legally obligated to review the report. They then have 3 choices available to them regarding the report:

1) Accept the report

2) Reject report and do their own testing

3) Reject report and do nothing

What usually happens when report is brought to school is that child is referred to a team known as the Response to Intervention (RTI) or Intervention Assistance Team (IAT), who then decides on strategies to help the child. These strategies may include tutorials, a behavior plan, classroom accommodations (often called "504 Accommodations," in reference to Section 504 of the Civil Rights statute: The Rehabilitation Act - 1974), extra assistance with a specific subject area, or placement in special education. This is where I come in, as the neuropsychologist, by suggesting in my report some strategies that the school, parents, and others, can implement to help child.

In my assessments I include recommendations for both school and other services. But schools can be limited in the services they provide. For example, I might suggest that the child receive a type of therapy known as social skills therapy. This type of therapy may not be provided in all schools. Also, sometimes I might suggest a consultation with a medical professional, which a school will very rarely adopt as part of the education plan for the child because of financial obligations (if the school recommends a medical consultation, then they are required to provide it or pay someone else to do it). The RTI team will be focused entirely on which of my recommendations speak to the educational needs of the child.

So, upon reviewing my report, the RTI team can accept all of my recommendations, some of my recommendations, or none of my recommendations. Just like a pediatrician and specialist who don’t always agree on the same course of treatment or medication for an individual, I can't guarantee that a school will agree with all of my recommendations.

With that said, I can tell you that getting additional assistance for your child is much quicker if you provide the school with an already completed evaluation by an outside neuropsychologist rather than wait for the school to do it's own testing. The average age at which schools do individual testing to determine whether a disability (e.g. ADHD or Autism) exists is around 10 or 11. Conceivably that means the child can go 5-6 years struggling in school and nothing is done. For Autism, early intervention is crucial, and that is why we recommend that parents not wait for the school to do the testing if they suspect there are some deficits. Additionally, providing a completed evaluation completes much of the leg-work that school districts are stretched very thin to provide.

A Guide Through the Maze

In Part II I'll go into more detail about the next steps in the school process of providing additional services. I'll explain what the parents can request, what they can demand, and avenues a parent has if they disagree with the decisions of their school.

For a parent, this article may sound disheartening. I don't intend for it to be so, but I believe it's important to educate parents on the reality of our current public education system so that they can navigate it with their eyes fully open. As we've interacted with the various school districts in and around south-east Texas we can tell you the vast majority of them are fully invested in providing their students with the best resources they can.

I always discuss these realities with parents of children whom I've diagnosed with a learning disability, ADHD or Autism so they will understand what their next steps should be and I'm always happy to guide them through the maze of requirements if they run into roadblocks.

Advice for All Parents

To any parent of a child whom they suspect may have a deficit I always suggest the following:

1) Talk to your child's teacher; They are, by-far, the best first step to finding solutions to assist your child in their daily life. They are dedicated to your child's success!

2) Get an assessment done early; As soon as you suspect your child may have a deficit, get them assessed. Don't wait on the school because time is critical in education. Earlier is better.

3) Documentation; Keep copies of emails to/from teachers, letters to/from RTI teams, report cards, etc. You'll need these if you need to go 'up the ladder' at your school district. Declaring 6-months later to the district administrator, "Well the school psychologist told me over the phone my son should be in Special Ed." is meaningless if it isn't written down, especially if you have to fight with your district for services. Live by these words: If it's not written down, it never happened.

4) Documentation; Yes, I know it's on the list twice. That's how important it is! Did you talk to someone on the phone about your child's needs? Before you hang up say, "I'd like to follow up this conversation with an email to summarize what we discussed." Then send the email saying, "Please confirm the following summary of our conversation..."

5) Documentation; Seriously, this is how important this is! Even if your current school district is fantastic and very accommodating, keep records of everything in case you need to switch school districts. You'll need that paper trail to get the same services at your new district.

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