Making an Educational Diagnosis within the scope of an MFE Current practices Overview of DSM practices Presentation of field interviews Results.

Making an Educational Making an Educational Diagnosis within the scope of an Diagnosis within the scope of an

MFEMFE

Current practicesCurrent practices Overview of DSM practicesOverview of DSM practices Presentation of field interviewsPresentation of field interviews Results from staff surveyResults from staff survey DiscussionDiscussion

Current PracticesCurrent Practices

US Department of Education states that to US Department of Education states that to identify ADHD there are three types of identify ADHD there are three types of evaluations:evaluations: BehavioralBehavioral

• Questionnaires and rating scalesQuestionnaires and rating scales EducationalEducational

• Demonstration that this affects educationDemonstration that this affects education MedicalMedical

• Often in the form of a doctor’s note based on other Often in the form of a doctor’s note based on other informationinformation

Current PracticesCurrent Practices

US Department of Education notes that IDEA tells us US Department of Education notes that IDEA tells us that we must identify students with a disability that is that we must identify students with a disability that is affecting their educationaffecting their education

DOE goes on to state:DOE goes on to state: ““The results of a medical doctor’s, psychologists, or The results of a medical doctor’s, psychologists, or

other qualified professional’s assessment of ADHD other qualified professional’s assessment of ADHD MAYMAY be important…” be important…”

Not mandatory in language, just suggestive Not mandatory in language, just suggestive

Diagnosing: Behavioral Diagnosing: Behavioral EvaluationsEvaluations

The American Academy of Pediatrics (AAP) The American Academy of Pediatrics (AAP) suggest using the following rating scales for suggest using the following rating scales for accurate diagnosis of ADHD in children:accurate diagnosis of ADHD in children:

• Connors Parent/Teacher Rating Scales (CPRS/CTRS)Connors Parent/Teacher Rating Scales (CPRS/CTRS)• Barkley’s School Situations Questionnaire –Original Barkley’s School Situations Questionnaire –Original

Version, Number of Problem Settings Scale (SSQ-0-1)Version, Number of Problem Settings Scale (SSQ-0-1)• Barkley’s School Situations Questionnaire –Mean Barkley’s School Situations Questionnaire –Mean

Severity Scale (SSQ-0-2)Severity Scale (SSQ-0-2)

Diagnosing: Educational Diagnosing: Educational EvaluationEvaluation

Should be a team decision.Should be a team decision.• Should include classroom observations (2-3 different Should include classroom observations (2-3 different

observations across different days, 20-30 minutes in observations across different days, 20-30 minutes in length) noting the frequency of various ADHD length) noting the frequency of various ADHD symptoms exhibited compared to the behaviors of the symptoms exhibited compared to the behaviors of the other children in the classroom.other children in the classroom.

• Should also include an assessment of the child’s Should also include an assessment of the child’s productivity in completing classwork and other productivity in completing classwork and other academic assignments. Its important to collect academic assignments. Its important to collect information about both the percentage of work information about both the percentage of work completed as well as the accuracy of the work. The completed as well as the accuracy of the work. The productivity of the child can be compared to the productivity of the child can be compared to the productivity of other children in the class. productivity of other children in the class.

Diagnosing: Medical EvaluationDiagnosing: Medical Evaluation

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

Distinction between a Medical Distinction between a Medical Diagnosis and an Educational Diagnosis and an Educational

AssessmentAssessment

Medical Diagnosis are made in order to (a) Medical Diagnosis are made in order to (a) determine the best treatment strategy, (b) advise determine the best treatment strategy, (b) advise what to expect in the future (prognosis), (c) allow what to expect in the future (prognosis), (c) allow data collection and statistical analysis, and (d) data collection and statistical analysis, and (d) support billing of third-party payers.support billing of third-party payers.

Educational Assessments are designed to Educational Assessments are designed to determine eligibility for special educational determine eligibility for special educational assistance.assistance.

Is ADHD Medical?Is ADHD Medical?It is not a disorder of attention as It is not a disorder of attention as previously thought, it is a function of previously thought, it is a function of developmental failure in the brain circuitry developmental failure in the brain circuitry that monitors inhibition and self-controlthat monitors inhibition and self-control

Children with ADHD display a range of Children with ADHD display a range of symptoms and varying levels of severitysymptoms and varying levels of severity

Most children with ADHD are of at least Most children with ADHD are of at least average intelligenceaverage intelligence

ADHD (cont.)ADHD (cont.)

Almost one-third of children with ADHD Almost one-third of children with ADHD will have some type of learning disabilitywill have some type of learning disability

3-5 % of the student population has ADHD 3-5 % of the student population has ADHD with boys 4-9 times more likely to be with boys 4-9 times more likely to be diagnosed than girls. diagnosed than girls.

Three subtypes of ADHD according Three subtypes of ADHD according to DSM-IVto DSM-IV

Predominately InattentivePredominately Inattentive Fidgety, has difficulty staying seated or playing quietly Fidgety, has difficulty staying seated or playing quietly

and acts as if driven by a motorand acts as if driven by a motor

Predominately Hyperactive-ImpulsivePredominately Hyperactive-Impulsive Difficulty participating in tasks that require taking Difficulty participating in tasks that require taking

turns, blurting out answers to questions instead of turns, blurting out answers to questions instead of waiting to be called on. Flitting from one task to waiting to be called on. Flitting from one task to another without finishing the previous task. another without finishing the previous task.

Combined TypesCombined Types

DSM-IV Criteria DSM-IV Criteria Child must display several characteristics to be Child must display several characteristics to be

clinically diagnosed with ADHDclinically diagnosed with ADHD Severity. The behavior in question must occur more Severity. The behavior in question must occur more

frequently in the child than in other children at the frequently in the child than in other children at the same developmental age. same developmental age.

Early Onset. At least some of the symptoms must Early Onset. At least some of the symptoms must have been present prior to age 7.have been present prior to age 7.

Duration. The symptoms must also have been Duration. The symptoms must also have been present for at least 6 months prior to the evaluation. present for at least 6 months prior to the evaluation.

Impact. The symptoms must have a negative impact Impact. The symptoms must have a negative impact on the child’s academic or social life. on the child’s academic or social life.

Settings. The symptoms must be present in multiple Settings. The symptoms must be present in multiple settings. settings.

InterviewsInterviews

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

Interview Results: Joe Interview Results: Joe Kovaleski, D.Ed.Kovaleski, D.Ed.

Best way to diagnose Best way to diagnose inattention/spectrum?inattention/spectrum? Liaison between school, medical community, Liaison between school, medical community,

and familyand family School psychologists are essential as they do School psychologists are essential as they do

the “footwork” of diagnosis such as the the “footwork” of diagnosis such as the Conners’ and observations. Doctors just Conners’ and observations. Doctors just eyeball these data and make the diagnosiseyeball these data and make the diagnosis


Why don’t more school psychologists Why don’t more school psychologists diagnose?diagnose? School psychologists do not have strong School psychologists do not have strong

enough sense of self-esteem.enough sense of self-esteem. We seem more comfortable referring this out We seem more comfortable referring this out

even though we have the trainingeven though we have the training Many school psychologists don’t want to Many school psychologists don’t want to

diagnose a disorder treated with medication. diagnose a disorder treated with medication. Yet we diagnose ED and CD.Yet we diagnose ED and CD.


Who is resisting school psychologists becoming Who is resisting school psychologists becoming diagnosticians?diagnosticians? We are. We don’t come across as assured. When a We are. We don’t come across as assured. When a

parent comes to us and asks us for a diagnosis we parent comes to us and asks us for a diagnosis we say we can’t do this and it erodes our profession. The say we can’t do this and it erodes our profession. The student then goes to a clinical psychologist who may student then goes to a clinical psychologist who may have less training in educational diagnoseshave less training in educational diagnoses

We haven’t pushed this issue and we don’t come We haven’t pushed this issue and we don’t come across as confident and assuredacross as confident and assured

Interview Results: Antoinette Interview Results: Antoinette Miranda, Ph.D.Miranda, Ph.D.

What’s the best way to diagnose What’s the best way to diagnose inattentive/spectrum disorders?inattentive/spectrum disorders? Note from the doctorNote from the doctor Behavior rating scaleBehavior rating scale ObservationObservation Documentation that the disorder is affecting Documentation that the disorder is affecting

the student’s academicsthe student’s academics


Who is restricting school psychologists Who is restricting school psychologists from diagnosing in schools?from diagnosing in schools? School districtsSchool districts Why should a pediatrician or physician with Why should a pediatrician or physician with

no specialized training/field data be able to no specialized training/field data be able to diagnose a student when we work with them diagnose a student when we work with them everyday?everyday?


Are school psychologists presently Are school psychologists presently prepared to diagnose when they leave prepared to diagnose when they leave graduate training?graduate training? No, not yet.No, not yet. Not enough specialized training in these Not enough specialized training in these

areas. Still focused more on academic areas. Still focused more on academic interventions than mental healthinterventions than mental health

Interview Results: Jane Welch, Interview Results: Jane Welch, Ph.D.Ph.D.

What’s the best way to diagnose What’s the best way to diagnose inattentive/spectrum disorders?inattentive/spectrum disorders? In schoolIn school Do a clinical interview with family and student, Do a clinical interview with family and student,

an observation, rating scale, and diagnose an observation, rating scale, and diagnose (with consent)(with consent)


Why aren’t school psychologists doing this?Why aren’t school psychologists doing this? We still don’t receive enough training in these areasWe still don’t receive enough training in these areas Clinical psychologists will diagnose these disorders Clinical psychologists will diagnose these disorders

even without specialized training or observations in even without specialized training or observations in the classroom. Or they will have an MA level assistant the classroom. Or they will have an MA level assistant do it and they will sign offdo it and they will sign off


Who is resisting in school diagnosing?Who is resisting in school diagnosing? We areWe are Far too concerned with special education Far too concerned with special education

issues and not with clinical sideissues and not with clinical side There may be a bit of ignorance on our part There may be a bit of ignorance on our part

about what we can do in the schoolsabout what we can do in the schools


Are we not diagnosing because we are not Are we not diagnosing because we are not Ph.Ds?Ph.Ds? No, look at MA level Professional Counselors. No, look at MA level Professional Counselors.

They will diagnose inattentive and spectrum They will diagnose inattentive and spectrum disordersdisorders

Eds. Level psychologists could be doing this Eds. Level psychologists could be doing this as wellas well

Interview with Dr. Jim Broyles Interview with Dr. Jim Broyles (GCPS)(GCPS)

Diagnosis of ADHD: different ways to Diagnosis of ADHD: different ways to diagnose for different issues (educational diagnose for different issues (educational problems compared to home issues)problems compared to home issues)

• Clinical interviews regarding child/family history Clinical interviews regarding child/family history along with observations and interviewsalong with observations and interviews

• Classroom observations difficult for MD’s to Classroom observations difficult for MD’s to diagnosediagnose

• Best way to diagnose ADHD is a collaboration Best way to diagnose ADHD is a collaboration between School Psychologists, MD’s, well trained between School Psychologists, MD’s, well trained social workers/Psychologistssocial workers/Psychologists

Dr. Broyles (cont.)Dr. Broyles (cont.)

Autism is a little more challenging: best done Autism is a little more challenging: best done from collecting data from variety of domainsfrom collecting data from variety of domains

• As far as a medical diagnosis: so many domains are involved As far as a medical diagnosis: so many domains are involved and autism is such a powerful label its best to be very and autism is such a powerful label its best to be very thorough in gathering information, best practice is to have an thorough in gathering information, best practice is to have an expert in social function to pool information. He also believes expert in social function to pool information. He also believes that it is more important to determine where in each domain that it is more important to determine where in each domain a child is as far as severity of symptoms not just the a child is as far as severity of symptoms not just the diagnosisdiagnosis

• Having a school make a determination of an educational Having a school make a determination of an educational diagnosis of ADHD/Autism makes sense to him as long as diagnosis of ADHD/Autism makes sense to him as long as the student meets criteria for each disorderthe student meets criteria for each disorder

Dr. BroylesDr. Broyles

From a physicians point of view they just want to make sure a true 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 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 person doing the evaluation or the quality of the work done in the school. Dr’s do not understand psychology as a science, they 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. 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 They just want to make sure that a child is not being mislabeled or misidentified. misidentified.

Doctors also want the schools to provide more services (as far as 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 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 that it is a doctors perception that it is difficult for parents to have access to school psychologists. Parents come in to doctors offices access to school psychologists. Parents come in to doctors offices saying that the schools will not do the evaluations and reinforce this saying that the schools will not do the evaluations and reinforce this perception. perception.

Dr. Broyles thinks that overall most MD’s would be glad to have the Dr. Broyles thinks that overall most MD’s would be glad to have the schools to provide information/reports educationally identifying schools to provide information/reports educationally identifying students with possible disorders. students with possible disorders.

Dr. Broyles (cont.)Dr. Broyles (cont.)

Dr. Broyles says that it is his experience thus far that some Dr. Broyles says that it is his experience thus far that some school psychologists are qualified and some are not. He school psychologists are qualified and some are not. He has received reports from school districts in which has received reports from school districts in which educational identifications have been made in the report. educational identifications have been made in the report.

He feels that a school psychologist with a Masters level He feels that a school psychologist with a Masters level education is qualified in gathering information and education is qualified in gathering information and assess from all of the domains but that PhD's have the assess from all of the domains but that PhD's have the additional training and can give a better additional training and can give a better insight/understanding into what is going on with the child. insight/understanding into what is going on with the child. They can better understand the more subtle issues that They can better understand the more subtle issues that are going on with a student better than a M.A.. are going on with a student better than a M.A..

Dr. Broyles (cont)Dr. Broyles (cont)

Dr. Broyles believes that the real solution for PDD/ADHD Dr. Broyles believes that the real solution for PDD/ADHD kids is not just getting the right diagnosis but to link the kids is not just getting the right diagnosis but to link the family to services available to them, not just school family to services available to them, not just school services but family services. The one benefit to having a services but family services. The one benefit to having a MD make the identification is that they are more in touch MD make the identification is that they are more in touch with ALL services available to a family not just school with ALL services available to a family not just school services. services.

Dr. Broyles also believes that it would be nice to have one Dr. Broyles also believes that it would be nice to have one dedicated person in a district to test/assess/measure dedicated person in a district to test/assess/measure PDD disorders. This would ensure a uniformity in PDD disorders. This would ensure a uniformity in identifications as well as competency. identifications as well as competency.

What about SWCS?What about SWCS?

District policy:District policy: The school psychologist collects the data The school psychologist collects the data

(observations, parent report, teacher (observations, parent report, teacher consultation, and rating scale)consultation, and rating scale)

The parent is asked to have a doctor The parent is asked to have a doctor diagnose the disorderdiagnose the disorder

The diagnosis is then used for determination The diagnosis is then used for determination of a presence of a disabilityof a presence of a disability

What Do You Think?What Do You Think?

We purposely didn’t interview specialist We purposely didn’t interview specialist level psychologists because we wanted to level psychologists because we wanted to hear what you have to say nowhear what you have to say now

Results from surveyResults from survey

Are you comfortable diagnosing inattentive/spectrum disorders in school?

Blue: Yes

Percentages same for both questions: inattention and spectrum disorders

27%

73%

0%0%

Do you think school psychologists are properly trained to make in school diagnoses?

Blue: Yes

50%50%

0%0%

Do you think school psychologists should be able to make these diagnoses?

Blue: Yes

50%50%

0%0%

Do you think by not making these diagnoses in school we have weakened or compromised our profession?

Blue: Yes

33%

67%

0%0%

Questions and Questions and DiscussionDiscussion

What do you think?What do you think?

Making an Educational Diagnosis within the scope of an MFE Current practices Overview of DSM practices Presentation of field interviews Results.

Documents

education medical medical

medical doctors

information slide

medical evaluation

suggestive slide

different observations

classroom observations

childs productivity