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Educational Assessment and School Accommodations for Children and
Adolescents with ADHD
Ronna Fried, Ed.D.Director of Neuropsychology in the Clinical and Research Programs in Pediatric
Psychopharmacology and Adult ADHD, Massachusetts General HospitalAssistant Professor in Psychology, Harvard Medical School
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Educational Connections
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School
Home
Therapist
Psychiatry
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• Approximately 1,000 hrs/year in school
– Max 50 hrs/year with clinicians
• Mixed objective & subjective feedback
– Generally positive subjective feedback from clinicians
• Social environment
Why Is School Important?
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Numbers
• In 2014–15, the number of children and youth ages 3–21 receiving special education services was 6.6 million, or 13 percent of all public school students.
• Many not diagnosed before second grade
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Proportion of the National Student Population with Disabilities: 1976-77 to 2009-10
Janie Scull and Amber M. Winkler, “Shifting Trends in Special Education” (Washington, D.C.: Thomas B. Fordham Institute, 2011)
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Identification Rate of Students with Disabilities, by State: 2009-10
Janie Scull and Amber M. Winkler, “Shifting Trends in Special Education” (Washington, D.C.: Thomas B. Fordham Institute, 2011)
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Identification Rates of Students with Disabilities, By State2009-10
Janie Scull and Amber M. Winkler, “Shifting Trends in Special Education” (Washington, D.C.: Thomas B. Fordham Institute, 2011)
18% of RI students receive
special-edservices
9.1% of TX students receive
special-edservices
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Special-Education Student-Personnel Ratio, by State2008-09
Janie Scull and Amber M. Winkler, “Shifting Trends in Special Education” (Washington, D.C.: Thomas B. Fordham Institute, 2011)
New Hampshire – 320 Teachers/Paraprofessionals per 1,000 students
Mississippi – 38 Teachers/Paraprofessionals per 1,000 students
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Special-Education Population by Disability 2000-01 and 2009-10
Janie Scull and Amber M. Winkler, “Shifting Trends in Special Education” (Washington, D.C.: Thomas B. Fordham Institute, 2011)
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Increase in “Other Health Impaired”
Skull and Winkler, 2011
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Common Disorders in School-Aged Children
• ADHD• Autism Spectrum Disorder• Language –Based Learning Disabilities• Nonverbal Learning Disability • Executive Functioning Deficit (present with most above)
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ADHD
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Observations:• Difficulty sitting still• Easily overwhelmed by settings • Easily Bored• Talks Out in Class
Interventions:• Preferential Seating• Silent Signal for Disruptive• Physical Breaks (send to Office with note)
ADHD: Elementary School Years
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Observations:
• Teachers Complain about Inattention
• Grades Fall
• Described as Overly Social
Interventions:
• Coach at School (daily check-in)
• Teachers Adapt Output Expectations
• Accommodations for Time Management
ADHD: Middle School Years
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ADHD: High School Years
Observations:• May Cut Classes or School
• Peer Group May Change due to Behavior
• Missing Assignments/Procrastination
• Poor Test Grades
• Substance Use
Interventions:• Adapt Classes to Meet Abilities
• Provide Coaching on Daily Basis
• Have Notes Provided
• Technology Use for Assignments/Test Reminders
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Autism Spectrum Disorder
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ASD: Elementary School Years
Observations:• Difficulty making connections• Overwhelmed by settings (e.g. recess, field trips,
assemblies)• Mounting anxiety, esp. at transitions• Hard to explain behaviors (may be considered atypical)
Interventions:• Mainstreaming usually works OK• Kids are tolerant in early grades• May require special classroom aide in specials and field
trips• Breaks or sensory input in class-limit fine motor
**Personality of teacher crucial**Always better with adults than peers
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ASD: Middle School Years
Perhaps the hardest transition of all:
• More distant teachers
• Multiple classrooms
• Busy hallways, huge peer group, noisy, overwhelming cafeteria
• Oppositionality
• Often refuse or hate homework
• Power struggles
• Parents and teachers punitive
• Misinterpret social cues (paranoid flavor)
• Remarkable rudeness, obscenities, antisocial behavior
Observations:• Starts to Dislike Going to School
• Grades Fall
• Pattern of Wanting to Stay Home (specific classes like PE)
Interventions:• Coach at School (daily check-in)
• Teachers Adapt Output Expectations
• Find Peer Group with Perseverative Interest
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ASD: High School Years
Observations:
• Often easier: Individual differences are more accepted
• Growing possibilities for special interests: computers, chess club, video games, Star Trek
• More self conscious and aware of deficiencies
• School refusal
• Missing Assignments/Procrastination
• Poor Test Grades
• Social Isolation
Interventions:
• Increase participation in special interests (clubs)
• Provide Coaching on Daily Basis
• Have Notes Provided
• Technology Use for Assignments/Test Reminders
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Dyslexia
Dysgraphia
Dyscalculia
Specific Learning Disabilities
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LD: Preschoolers
• Late talking
• Difficulty learning and recognizing rhyme
• Pronunciation problems
• Difficulty finding the right word in speech
• Difficulty learning color names
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LD: Elementary Years
• Difficulty pronouncing words, reverses or substitute parts of words
• Doesn’t hear fine differences in words; e.g. “pin” for “pen”: confuses order of letters
• Spells words several different ways; doesn’t recognize the correct version
• Doesn’t recognize words
previously learned
• Problems stating thoughts
in an organized way
• Difficulty carrying out a
sequence of directions
• Poor reading comprehension
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LD: Later School Years
•Spells poorly; misspelling is not phonetic
•Problems taking notes accurately
•Difficulty organizing and completing written projects
• Difficulty remembering what was just read
• Difficulty concentrating when reading or writing
• Unable to tell important information from unimportant details
• Spells poorly; misspelling is not phonetic
• Problems taking notes accurately
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LD Interventions
Provide practice exam questions that demonstrate exam format e.g. essay responses or short answer or multiple choice questions (MCQ).
Allow extra time. The amount of extra time students require will vary according to the severity of the LD, but an extra 15 to 30 minutes per hour of exam time is common.
Allow for alternative format presentation of exams: large print or electronic (on computer)
If a student has a working memory problem, change the exam paper from MCQ to essay question format.
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Nonverbal Learning Disorder
Observations:• Complex psychomotor coordination difficulties (not so good in
sports, can’t button clothes well, takes longer to ride a bike, clumsiness, etc.)
• In early primary school years, skills in reading and spelling well developed
• Some children with NLD can be thought of as “gifted” prior to testing
• Hyperverbal presentation, good form (e.g., sentence structure, vocabulary) with poverty of content, function, contextual appropriateness
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Nonverbal Learning Disorder
Interventions:• Minimize the number of adults working with the student• This student learns through discussion– Don’t isolate. Monitor
organizational skills daily. • Define processes in a linear, sequential format that can be
memorized. (Don’t expect “discovery” learning.) • This student should excel in reading programs which apply a
guided, sequential, phonetic/linguistic approach to reading. • Auditory cues will help this child learn new words. • In the upper grades, provide outlines and notes of any material to
be read—Allow student to highlight these notes.
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Executive Functioning DisorderDeficits
Inhibition
Shifting
Emotional Control
Initiation
Working Memory
Planning/Organization
Self-Monitoring
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Interventions for EFD
• Scaffolding for organization
• Time management w/ teacher for planning
• Tasks broken down for working memory
• After school checking time for inhibition
• Sheet with lecture bullets for attention
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Teaching Executive Skills
Remind to begin steps
Prompting child to perform tasks
Observing child as each step is performed
Providing feedback to improve performance
Praising the child as each step if done correctly and entire task is completed
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Teaching Executive Skills
Remind to begin steps
Prompting child to perform tasks
Observing child as each step is performed
Providing feedback to improve performance
Praising the child as each step if done correctly and entire task is completed
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BUBBLE MAPThinking Skill: Describing
Describing
word or
phrase
(adjective)
Describing
word or
phrase
(adjective)
Describing
word or
phrase
(adjective)
Describing
word or
phrase
(adjective)
Describing
word or
phrase
(adjective)
Describing
word or
phrase
(adjective)
Main
Idea or
Concept
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DOUBLE-
BUBBLE MAP
Thinking Skill: Compare/Contrast
Idea #1 Idea #2
Similarity
Similarity
Similarity
Similarity
Similarity
Unique
Attribute
of Idea #1
Unique
Attribute
of Idea #1
Unique
Attribute
of Idea #1
Unique
Attribute
of Idea #1
Unique
Attribute
of Idea #1
Unique
Attribute
of Idea #2
Unique
Attribute
of Idea #2
Unique
Attribute
of Idea #2
Unique
Attribute
of Idea #2Unique
Attribute
of Idea #2
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BRACE MAPThinking Skill: Whole to Part Reasoning
Whole Object
Major Part
Major Part
Major Part
Sub- Parts
Sub- Parts
Sub-Parts
Sub- Parts
Sub- Parts
Sub-Parts
Sub- Parts
Sub- Parts
Sub-Parts
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Recommendations
• Mapthemind.com
• inspiration.com
• Draftbuilders
• Dragon Naturally Speaking v. 11.
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Grounding
AANTECEDENT
BBEHAVIOR
CCONSEQUENCE
Resistance to Homework
Low Grades
Suspension
DetentionActing Up
School Refusal
Health
Environment
Cognitive
Emotional State
Limit Electronics
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Evaluate! Evaluate! Evaluate!
• Need to document disability to get services
• Need to look at cause in order to choose appropriate interventions
• Psychotherapy, behavioral interventions and medication won’t help learning disabilities
• Resource room won’t help OCD
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Testing through School
•1st Step: Parent submits written request
•Letter addressed to building administrator or Committee on Special Education chairperson:
“I am writing to refer my child ____ for an individual evaluation to determine whether he / she has a disability and would be eligible for special education services. I am concerned because ___.”
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Interventions
• Response to Intervention (RTI)
• Section 504 (ADA)
• Special Education (IEP)
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Legal Background
Congress passed the revised Individuals with Disabilities Education Improvement Act (IDEIA) in 2004
• This Federal legislation provides guidelines that schools must follow when identifying children for SPED
• Based on the changes in IDEIA 2004, the US Department of Education updated its regulations to state education departments which include:– Explicitly ALLOW states to use RTI to identify LD
– FORBID states from forcing schools to use a ‘discrepancy model’ to identify LD
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RTI: Response to Intervention
the practice of providing high-quality
instruction/intervention matched to student needs
and
using learning rate over time
and level of performance
to
inform educational decisions
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• RTI has two goals: prevent academic problems and determine students with LD.
• 2 or more tiers of increasingly intense interventions.
• Use a problem solving model or standardized treatment protocol for intervention tiers.
• Implementation of a differentiated curriculum with different instructional methods.
• Varied duration, frequency, and time of interventions
• Explicit decision rules for judging learners’ progress.
What do we mean by RTI?
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The Three-Tier Model for Reading Intervention
Tier III
Tier II
Tier I
Tier 2, occurs outside of
the time dedicated to
core instruction, in
groups of 5–8 students,
and focuses primarily on
providing increased
opportunities to practice
and learn skills taught in
the core
Tier 3 is more explicit,
focuses on remediation of
skills, is provided for a
longer duration of time (both
in overall length of
intervention and regularly
scheduled minutes of
instructional time), and
occurs in smaller groups
(i.e., groups of 1–3
students;
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Tier I: Core Classroom Reading Instruction
• Classroom teacher delivers to all students at least 90-120 uninterrupted minutes of grade-appropriate core instruction
• Teachers conduct benchmark testing to monitor student progress and then, in response to testing results, adjust and differentiate instruction for students not meeting grade-level expectations
• Teachers use flexible grouping arrangements in small groups for students to receive targeted skill instruction
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Tier II Interventions
• Targets struggling learners
• Includes additional, targeted instruction
• Involves frequent progress monitoring
• Uses assessment data to guide instruction
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Tier III Interventions
• Tier 3 consists of general education instruction plus an individualized intervention (special education instruction)• Individualized instruction (1 – 3 students)
• Two 30 minute sessions each day in addition to 90 minute block
• Progress monitored at least every two weeks
• Most qualified personnel needed to provide intensive instruction
• Conducted in and out of the general education classroom.
• Includes a strong supplemental curriculum
• Referral for Special Education may or may not be warranted
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The Individuals with Disabilities Education Act
Students between the ages 3 - 21 with disabilities that
adversely affect their education
IEP developed
•autism •deaf-blindness•deafness •developmental delay•emotional disturbance•hearing impairment •intellectual disability•multiple disabilities•orthopedic impairment•other health impairment (ADHD)•specific learning disability•speech or language impairment•traumatic brain injury•visual impairment (including blindness)
Categories of Eligibility
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Section 504 of the Rehabilitation Act
A federal Anti-Discrimination Law.
Protects ALL people with a disability that impairs one or more major life activity (including learning).
Prohibits discrimination in ANY program that receives federal dollars.
Provides accommodations to remove discriminatory barriers.
In education, a “504 Plan” removes barriers to learning and opportunities
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IDEA SECTION 504
PURPOSETo insure that all children
with disabilities have available to them a free
education
To prohibit discrimination on the basis of disability in any program receiving federal
funds
WHO IS PROTECTED
13 categories of specific disabilities
Much broader, all school-age students with a physical or
mental impairment that substantially limits a major
life activity
DUTY TO PROVIDE A FREE
APPROPRIATE EDUCATION
Requires the district to provide IEPs. “Appropriate
education” means a program designed to provide
“educational benefits.”
“Appropriate” means education comparable to the education provided to non-
handicapped students
IDEA/504 Charts
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IDEA/504 CHART
no
Not eligible
IDEA eligibility
yes
Disability adversely
affects educational
performance
CONSIDERATION
OF IDEA
not eligible
no
504 Protected
yes
Handicap substantially
limits one or more
major life activities
CONSIDERATION
OF 504
STUDENT NEED
no
not eligible
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Accommodations vs.
Modifications
• An Accommodation levels the playing field
– Example: larger print, extended time
• A Modification changes the playing field
– Example decrease number of possible answers, out-of-level testing
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Accommodations:
• A device, practice, intervention, or procedure that affords equal access to instruction or assessment.
• Purpose: to reduce or eliminate the impact of the student’s disability so that he or she can achieve the standard.
• Key point: an accommodation does not change content being taught nor reduce learning/achievement expectations.
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Examples of Academic Accommodations
• Extended time for test taking
• Reduced distraction testing environment
• permission to record lectures (smart pen use)
• Use of computers during lectures
• Use of computers for exams
• Use of text readers for exams
• Note takers
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Modifications
• Definition:
– curriculum and/or instruction is changed quite a bit.
– changes made to the content and performance expectations for students.
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Modification Examples
• Lessen depth or breadth in the information/material covered (e.g. fewer objectives, shortened units or lessons, fewer pages or problems, etc.)
• Materials written at a lower readability level (high-interest, low-ability books).
• Out-of-grade level materials (third-grade math standards for a seventh grader)
• Provide hints or clues
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Getting Services after High School
Typically no IEP in college… but
•Can still get a 504
• Must establish presence of diagnosis and impact student’s ability to learn
• Many schools have a Student Disabilities Service office to facilitate the process
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Assessment of Disability
• Past academic/work history
• Objective medical data, test scores, clinical observations and assessment
• Individuals actions and statements regarding condition
• Legitimacy of the findings and conclusions of the individual’s experts
• Any evidence of achievement without accommodation
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ADA Amendments Act: of 2008 (adaaa)
• Inclusions of episodic conditions if impairing when active
• An impairment need not be severely restricting to be substantially limiting
• Mitigating measures should not be considered (except glasses)– Meds for ADHD cannot eliminate determination
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Disability Documentation
• Establish childhood onset of symptoms (report cards, support services, medication…)
• Use DSM criteria to describe current and childhood symptoms
• Demonstrate the substantial impairment in daily life activities
• Connect Accommodation recommendations to functional limitations
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“Unreasonable” Requests in Higher Ed. (per colleges)
• Reducing the amount of work required in a course
• Extended time for all assignments
• Reduced caseload every term
• Modifying assessments to student preference
• Priority in registration when not connected to a specific disability ,related issue
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