Gifted Issues Discussion homepage Forums Twice Exceptional Need some more advice/suggestions..

Thanks, everyone
Polarbear, very helpful as usual. Percy, Dude, Polarbear -- we had a child psychiatrist independently evaluate my child. Clinically or medically, he does not seem to fit into categories like ADHD/ADD, Autism, SPD etc. They said that they are ruling those out, till such time testing yields more data to support some sort of diagnosis (so I can get services from the school). That said, they do see some issues, the psychiatrist said it is mostly due to asynchronousity/lower processing speed (compared to other strengths) and have recommended more testing. I think there is a waitlist for that as well

At the school, his teacher says that regardless of his ability to do well on tests/tasks, she is extremely concerned about his inappropriate behavior (like not sitting at his desk properly, needing to give multiple reminders or redirections before routine tasks etc). It has been indicated that multiple reminders were one of the main issues (for the school) -- as in, that much time is taken away from other kids. The school seems willing to evaluate. My question is should I proceed with both in parallel ? Should I let the school know where we are at the testing process with the private psychiatrist/neuropsychs ? I don't want testing by the neuro-psych to be compromised; at the same time, I don't want my child to suffer for lack of support at school.

Several things I'd consider:

--get on the waitlist for private testing

--Are you in the US? Does your district use RTI (response to intervention)? Under this model, they are supposed to try a variety of things to improve the child's behavior/challenges and see what works. This is more informal than an IEP; the advantage is that you can arrange to get things into place sooner.

A phone call to the special education or student services office in your district will tell you whether they do this.

--A hazard of having solely the school evaluate is that they are not really qualified to make medical diagnoses; further, many school psychologists are not able to really accurately assess complex behavior issues. I have always been happiest when I bring a private eval that informs the school process. On the other hand, to get services into place at school on a more permanent basis, you will likely need their eval. And since that's where the issues are most visible, perhaps they'll be willing to identify him for services.

--I would also work the parent network for information. Are children generally getting appropriate services for their challenges, or is yours one of the districts that hinders rather than helps? If you know about the environment you're operating in, you can make better guesses about what path is most useful now.

HTH,
DeeDee

Check the school psych's qualifications. Many are BCBAs (certified behavior analysts), especially the more recent grads. And if not, there may be a BCBA on staff somewhere in the system. Also, all SPs have training in FBA, unless they are really old, or didn't graduate from a NASP- or APA-approved program. So you may find that your school does have behavior resources.

And whether or not school personnel are qualified to make medical Dxs, most school systems will not allow them to do so. (Many LicSWs are, as are psychs in some states, at least for mental health Dx, which is mostly what we are talking about here.)

Deedee, very helpful. Thanks



We are already on the waitlist for this.


Yes, in the US. The teacher did indicate this is possible to do. And yes, I think they do follow RTI. They really want to seem to help. However, they keep thinking ADD (or ADHD - Inattentive), from all the conversations I have had. The psychiatrist says he does not see all the markers (perhaps, some of them)

I am wondering if this will be an issue for the school to help.



Yes, I fully agree with this, which is why we are taking this careful approach. I am also hesitant -- ADHD seems over-diagnosed, and he does not fit into the ADHD profile, though he has issues with organization and following directions quickly, especially in a group environment


The school seems generally responsive, and the kids do get appropriate services. However, apparently, the parent needs to know what to ask for; one of my friends in the school said this was especially frustrating (even though her child's situation was pretty straight-forward)


AEH, thanks. I will be sure to ask/find out. Would you be willing to explain how FBA will work, esp in a case where multiple reminders/re-directions are required ?

Also, I want to be able to understand my child (not just for school, but for regular life). I am often puzzled, at home, or at various places, we get regular comments on what an interesting child he is, how friendly he is and so on; at school, it is totally different.

Momtoone, I'd second the suggestion to ask about RTI - in our district this is required before an IEP eligibility evaluation process can be initiated.

It also will help to remember that this is going to be a journey, not a quick trip to Target where you purchase what you need to cure everything off the shelf and then it's all put in place and done You can start now by brainstorming a few things to suggest that the school try as RTI, see how they work, and in the meantime you're waiting for your private eval. When you get that eval completed, you'll have more data so you then tweak what is being done as appropriate, start the IEP process if appropriate, etc. It is frustrating not to have all the answers up front, but truthfully you'll never have really *all* the answers - because life and classroom expectations and everything changes as our kids grow, and we're also constantly learning more about them, collecting more data etc.


This happened with our public school experience - the parents had to know what to ask for. It's frustrating, but you can work past it - gather all the ideas you can from all the resources you have. We can brainstorm here; you can google specific items + accommodations, and you can network with fellow local parents. If you haven't tried to locate one, I'd try to see if there is a parent's advocates group in your area - look under the yellow pages listings at www.wrightslaw.org. You can ask an advocate for help in both what types of accommodations might work plus what accommodations are typical in your area. Another source of info is your state's SPED policy handbook (or your school districts if you can find it) - in many states/districts you can find the policy handbooks online, and they will contain lists of appropriate and/or typically-used accommodations for different types of student needs.


The thing is, school is a completely different type of place than the rest of life for most children. If your ds had a challenge with holding a crayon, for instance, you might not ever notice that at home because he might spend all of his time building legos and ignoring crayons so it's easy to think, he's a legos kid and not think anything twice about it. At school, he all of a sudden has to use a crayon and he doesn't know how or can't and that's frustrating - so he acts out or acts differently.

Another thing that can be different about school is the teacher. It is possible that part of what is an issue is due to how the teacher is handling it - especially if things seem to be fine one year and then suddenly different the next. I don't think that's the situation you're in, because you've had concerns with more than one teacher and over more than one year (I think? I might be remembering wrong)… and you've got a gut feeling that the teacher is trying to help - so in your case I'd suspect something more than simply difficult teacher-student fit.


I think that teachers and school staff many times suggest ADHD because it's something they *are* familiar with - it may be different in other areas, but in our schools my kids have always had at least 1 or more kids with ADHD diagnoses in each of their classes - and those are the kids I *know* about because I know their parents or because the kids told my kids - I suspect there are others). The other thing about ADHD and LDs and quite a few other challenges is that there can be overlapping symptoms - particularly in elementary when behavior is a form of communication for children. So a teacher who's had students with ADHD, is familiar with some of the symptoms, then sees the same symptoms in another student may extrapolate that the other student also has ADHD. We definitely had that happen to our ds - and we even had it happen with our dd and her pediatrician.

One thing to consider is - even though the diagnosis and root cause of symptoms such as organizational challenges may be different from ADHD, you might still be able to use some of the same accommodations/remediation techniques that teachers use for students with ADHD effectively. So one way to approach this with the school is to request RTI, if the school is trying to push for an eval for an IEP/OHI (adhd), request that they hold off, let them know you're seeking a private eval and request that the school put RTI in place now - then set a time in the future (preferably after you'll have the private eval info) to meet again, assess the effectiveness of RTI and re-look at whether or not you need to move forward with an IEP eligibility process.

I'm also on the fence re whether or not I'd let the school do an FBA at this point - I'd probably rather put RTI in place first, then consider the FBA as part of an IEP eligibility process *later*. The reason for this (just my perspective) is - you'll probably have some type of behavior survey included with your neuropsych eval, which will include both teachers and parents completing a behavior survey. If you have a teacher who is either really frustrated with your child or who has a mindset that your child may have ADHD it's *possible* the survey they fill out will come with a built-in bias. Please know, I'm not knocking teachers at all - most will do their best to be very fair, but it's also a chance that this will happen (it absolutely happened to us when we had our ds' initial neuropsych eval). It's jmo, but I would be more comfortable having a non-invested third party (the neuropsych) be the person who is attempting to interpret the survey than the school staff *if* that situation arose.

polarbear

My dd 2 1/2 is to young for this topic, but my memory of my childhood is what drives me to respond. There are many likely reasons for the troubles that I had in school:

1. Rough home life.
2. Chronic daydreamer.
3. Lack of direction.
4. Very slow writing speed.
5. Disorganization.

Disorganization was one thing that I had to solve. Unfortunately, I only solved it as an adult and not completely. My method as an adult is to try to as often as possible keep my environment organized, and deal with as much small stuff quickly as possible. I do add the as often as possible because I have the ability to walk through a room and leave a disaster in minutes. It is almost a supernatural gift. But, I have learned to be able to clean up almost as fast, and I must do it fairly regularly or my mind will soon become disorganized. Now the catch, I believe I am more creative in a mess. So, my real method. I allow myself to create a mess, but like "Cat in the Hat" I always pick up my play things. Learning to clean up fast was the key, but not easy. The fast is so important because I am not a very patient individual.

Now, that said, I might have and might still benefit by understanding what if any learning disability I might have had, but I was intelligent enough to stay out of special help and so did not learn some tactics that would have helped me in school. I do, however identify with many statements I have read under this forums 2e section. Being that I likely had some of these issue, I intend to become better educated in case my daughter shares them, as well as to gain more insight for myself.

By college I was fairly organized, but it was as it still is an artificial process. I am not naturally organized.

Aeh, I have a question about your comment on who is qualified to do FBAs. A few years ago, I asked my son's school if someone could observe him to see why he was having trouble at school. We later found out he was being bullied. At the time, though, they had their behavioral specialist observe him for two days and tell me he was fine. When I called to talk with the behavior specialist, I discovered that she was a special education teacher and apparently responsible for FBAs without additional training (she said she just had special education certification).

I know they have an SP, but assumed they asked whoever was most qualified to do the assessments. The person who did the observation told me she did them, regularly, so I don't think they were simply choosing the easiest option.

Is an FBA supposed to be conducted by someone with specific training in it? Would someone requesting an FBA need to know what to ask for in order to get someone qualified to do it? Do special education teachers get trained to do FBAs even though the one I talked with seemed to say fairly clearly she didn't have specialized training in it?

I'm just curious in case we need to ask again and it seems relevant to the overall discussion.

There is no certification in FBAs, though you could assure training by asking for a BCBA. It should be done by a person with specific training in behavior assessment, though, with or without the BCBA. In most buildings, that would be the SP. In some places, there may be a BCBA who is not also the SP.

One of the complications is that anyone can do a classroom observation, but that doesn't necessarily mean they are observing with intelligence. A good FBA should minimally have interviews or surveys of behavior from multiple sources, including parents, a well-defined/operationalized set of target behaviors, and direct or indirect assessment to identify the antecedents, consequences, and functions of behavior. I usually conduct multiple classroom observations, at various times of day, during different instructional settings, with various staff, and across many days. I also prefer time-sampling behavior, with a non-referred comparison peer, as I love data. There is no FBA that should conclude that the child is "fine." The outcome should identify the four elements listed above (antecedent-behavior-consequence and function of behavior). Someone saw a pattern of behavior of some kind, or there would be no referral. One could conclude that it was setting specific, and thus not observed at that time, or that it was a singularity, arising from a low-frequency set of setting events.

If your FBA does not clearly indicate ABC and function, then it is not an adequate assessment. In the event that the observer can document a plethora of observations, without any sighting of the target behavior, then that, at least should be supported with data. (E.g., time samplings, with the target behavior occurring in 0 out of 150 rated intervals, observed in five sessions, across three days and four settings.)

It sounds like your observer did not see the behavior at all, probably because it resulted from bullying, and the aggressors were smart enough not to do it right in front of the teacher. That's why I interview the student, too, and try to observe as unobtrusively as possible when I'm in the classroom, cafeteria, or on the playground.

Saw this in reverse order. I answered some of your questions in reply to apm.

For a child who needs frequent reminders/re-direction, I would be looking for settings where performance is better (off-task behaviors are fewer) and worse, and analyzing for patterns, for example, in terms of task-type, group structure, seating, outside distractions, time of day, staff-child and peer-child interactions. Also, the frequency with which cueing is needed in various settings, and what kinds of cues are most effective.

Mom2one - Polar bear has excellent advice and info! My son also has Dyspraxia/DCD (it is called so many different things) and pretty severe dysgraphia. I would seek someone who is very familiar with dyspraxia/DCD and dysgraphia to make sure he is being properly looked at for it. I know in my area, for some odd reason, it has been difficult finding psychs, neurospychs, etc who are familiar with the condition (and I live in a suburb of which I think is the largest city in the country). There are two nationally well-renowned childrens hospitals in the country are in my area and both do not identify dyspraxia/DCD or dysgraphia. I hope that helps.