Download DSM-5 Specific Learning Disability

Navigating DSM-5 Diagnoses &
School Support Services for Your
Child
Debra B. Huss, Ph.D.
Licensed Clinical Psychologist
&
Brandon D. Huss, M.A.
Certified School Psychologist
Objectives
• What an Evaluation consists of in a school
compared to community clinic
• Brief overview of DSM criteria for ASD, ADHD,
and Anxiety Disorders
• Criteria for School Services
• Pros & Cons of an evaluation in the
community versus within the school system
School vs. Community Clinic
Evaluations
School Evaluations
• Determine if the child meets criteria for a
disability under the Individuals with
Disabilities Education Act (IDEA).
Private Evaluations
• Determine if a child meets DSM-5 criteria for a
mental health diagnosis
Child with a Disability (IDEA)
What is required to be a “child with a disability”
under IDEA?
• Appropriate evaluation
• Meets eligibility criteria
• Adverse effect
• Need for special education/specially designed
instruction due to the disability
Appropriate Evaluation
• Appropriate instruction and interventions must
be provided before the referral or as part of the
referral/evaluation process
• Instruction and intervention services must be
research-based
• Data-based documentation of repeated measures
of achievement and/or behavior
• Data is collected and evaluated at reasonable
intervals reflecting systematic assessment of
student progress
• Parents are provided with results
Appropriate Evaluation
School Evaluations include information and data from a
variety of sources, including but not limited to…
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Social-Developmental History/Medical History/Parent Interview
Direct Observations
Teacher Interview/Reports
Student Records (i.e. grades, enrollment history, attendance, discipline, etc.)
Response to Intervention (RtI) records and data
Behavioral Intervention Plan (BIP) records and data
Assessment Data (cognitive, achievement, behavioral, adaptive, K-PREP, neuropsychological, etc.)
Functional Behavior Assessment (FBA)
Records or evaluations from private therapists, physicians, psychologists, etc.
Evaluations have to use multiple data sources to
substantiate the existence of the disability (triangulation of
data).
Evaluation in a Community Clinic
• Detailed interview with parents and child
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Developmental and medical history
Family mental and medical health history
Academic history
Social/Peer history
Specific symptoms of DSM disorders, comorbid & differential diagnoses
(structured interview)
– Stressors or significant life events
– Strengths of the individual
• Standardized individually administered tests
– Intelligence, achievement, neuropsychological tests
• Standardized parent, teacher, self-report questionnaires
– Have reliable results over time & measure what they intend to measure
• Clinical observations of the child in office setting and possibly home &
school setting
Special Education Eligibility
Evaluation information confirms……
• …there is an adverse effect on educational
performance (must be present for eligibility)
• …that lack of instruction in reading and/or math
was not a determinant factor in the eligibility
decision.
• …that limited English proficiency was not a
determinant factor in the eligibility decision
Special Education Eligibility
Adverse Effect
• means that the progress of the child is
impeded by the disability to the extent that
the educational performance is significantly
and consistently below the level of similar age
peers.
• The Admissions and Release Committee (ARC)
determines the significance of the disability’s
impact on the child’s educational performance
Autism under IDEA
The student…..
• …has a developmental disability, generally evident
before age 3, significantly affecting verbal and
nonverbal communication (must be present for
eligibility), and…
• …has a developmental disability affecting social
interaction (must be present for eligibility), and…
• The student’s deficits are not primarily the results of
an emotional-behavior disability.
Autism Eligibility Form
DSM-5
Autism Spectrum Disorder (ASD)
A. Persistent deficits in social communication &
social interaction across multiple contexts as
manifested by the following, currently or by
history:
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communication behaviors
used for social interaction
3. Deficits in developing, maintaining, and
understanding relationship
ASD Criteria continued
B. Restricted, repetitive patterns of behavior, interests, or
activities as manifested by at least 2 of the following
(by history or currently):
1. Stereotyped or repetitive motor movements,
use of objects, or speech
2. Insistence on sameness, inflexible adherence to
routines, or ritualized patterns of verbal or nonverbal
behavior
3. Highly restricted, fixed interests that are
abnormal in intensity or focus
4. Hyper-or hyporeactivity to sensory input or
unusual interest in sensory aspects of the environment
ASD Criteria continued
C. Symptoms must be present in the early
developmental period (but may not become fully
manifest until social demands exceed limited
capacities, or may be masked by learned
strategies in later life).
D. Symptoms cause clinically significant impairment
in social, occupational, or other important areas
of current functioning.
E. Symptoms not better accounted for by
intellectual disability or global developmental
delay
Other Health Impairment
• means having limited strength, vitality, or alertness,
including a heightened alertness to environmental
stimuli, that results in limited alertness with respect to
the educational environment, that…
• …is due to a chronic or acute health problem, such as
acquired immune deficiency syndrome, asthma,
attention deficit disorder, attention deficit hyperactivity
disorder, diabetes, epilepsy, a heart condition,
hemophilia, lead poisoning, leukemia, nephritis,
rheumatic fever, sickle cell anemia, tuberculosis or
Tourette Syndrome;
DSM-5 Attention-Deficit/
Hyperactivity Disorder
A.
Persistent pattern of inattention and/or hyperactivity-impulsivity that
interferes with functioning or development as characterized by (1)
and/or (2)
1. inattention: 6 or more symptoms present for at least 6 months;
inconsistent with developmental level & negatively impacts social
and academic/occupational activities
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Lack attention to detail; careless mistakes
Difficulty sustaining attention
Does not listen when spoken to directly
Does not follow through on instructions & fails to finish schoolwork, chores,
workplace duties
Difficulty organizing tasks and activities
Avoids, dislikes or reluctant to engage in tasks that require sustained mental
effort
Loses things necessary for tasks or activities
Easily distracted by extraneous stimuli (includes unrelated thoughts)
Forgetful in daily activities
ADHD criteria continued
2. Hyperactivity and Impulsivity: 6 or more symptoms lasting at least 6
months; not at developmental level & cause impairment
a. Fidgets with or taps hands or feet or squirms in seat
b. Leaves seat when expected to remain seated
c. Runs about or climbs where inappropriate (feels restless for older
adults)
d. Unable to play or engage in leisure activity quietly
e. On the go or driven by a motor
f. talks excessively
g. Blurts out answers before question completed (completes
people’s sentences; cannot wait turn in conversation)
h. Has difficulty waiting turn
i. Interrupts or intrudes on others
ADHD criteria continued
B. Several symptoms of inattention or hyperactiveimpulsive symptoms present before 12 years of
age
C. Several symptoms present in 2 or more settings
D. Clear evidence symptoms interfere with or
reduce quality of social, academic, or
occupational functioning
E. Symptoms do not occur exclusively during course
of schizophrenia or another psychotic disorder
and are not better accounted for by another
mental disorder
Emotional Behavior Disability
means that a child, when provided with interventions to meet instructional and
social-emotional needs, continues to exhibit one (1) or more of the following,
when compared to the child’s peer and cultural reference groups, across settings,
over a long period of time and to a marked degree:
• (a) Severe deficits in social competence or appropriate behavior, which cause
an inability to build or maintain satisfactory interpersonal relationships with
adults or peers;
• (b) Severe deficits in academic performance which are not commensurate with
the student’s ability level and are not solely a result of intellectual, sensory, or
other health factors but are related to the child’s social-emotional problem;
• (c) A general pervasive mood of unhappiness or depression; or
• (d) A tendency to develop physical symptoms or fears associated with personal
or school problems.
• This term does not apply to children who display isolated (not necessarily one
(1)) inappropriate behaviors that are the result of willful, intentional, or
wanton actions unless it is determined through the evaluations process that
the child does have an emotional-behavioral disability.
DSM-5
Anxiety & OCD Disorders
I.
Social Anxiety Disorder: marked fear/anxiety about
social situation(s) where individual is exposed to
scrutiny by others; fear doing something that will
result in negative evaluation;
II. OCD: presence of obsessions, compulsions or both
that are time consuming or cause
distress/impairment
III. Separation Anxiety Disorder- excessive distress when
anticipation or experiencing separation from major
attachment figure; developmentally inappropriate or
more extreme than expected
Specific Learning Disability
means a disorder that adversely affects the ability to acquire,
comprehend, or apply reading, mathematical, writing,
reasoning, listening, or speaking skills to the extent that
specially designed instruction is required to benefit from
education. The specific learning disability (LD) may include
dyslexia, dyscalculia, dysgraphia, developmental aphasia, and
perceptual/motor disabilities. The term does not include
deficits that are the result of other primary determinant or
disabling factors such as vision, hearing, motor impairment,
mental disability, emotional-behavioral disability,
environmental or economic disadvantaged, cultural factors,
limited English proficiency, or lack of relevant research-based
instruction in the deficit area.
Specific Learning Disability
SLD Areas
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Basic Reading
Reading Comprehension
Reading Fluency
Math Calculation
Math Reasoning
Written Expression
Oral Expression
Listening Comprehension
Specific Learning Disability
Methods of Eligibility Determination
• Discrepancy Model (Regression Estimated True Score
Method for KY)
• Response to Intervention Model
– Consistent lack of progress to research-based instruction
and interventions verified by repeated measures of
progress
– Consistently low rate of improvement
– Verified by evaluation data
Specific Learning
Disability
RtI Data Example
3rd Grade Student
• Vertical Axis is Words
per Minute (WPM)
• Horizontal Axis is Week
of School
• Top data points are
Average 3rd Grade
student progress
• Bottom points show 3rd
grade student in RtI not
making progress
DSM-5
Specific Learning Disability
A. Difficulties learning & using academic skills (at least 1
symptom lasting >=6 months) despite interventions
targeting the deficit
1. Inaccurate or slow & effortful word reading
2. Difficulty understanding meaning of what is read
3. Difficulties with spelling
4. Difficulties with written expression
5. Difficulties mastering number sense, number facts,
or calculation
6. Difficulties with mathematical reasoning
Specific Learning Disability
Criteria continued
B. The affected academic skills are substantially and
quantifiably below those expected for individual’s
chronological age, cause interference in academic, work, or
daily living as confirmed by individually administered
standardized achievement measures & comprehensive
clinical assessment
C. Learning difficulties began during school age years but may
not become fully manifest until demands for those affected
academic skills exceed individual’s limited capacities
D. Not better accounted for by intellectual difficulties,
uncorrected visual or auditory acuity, other mental or
neurological disorders, psychosocial adversity, lack of
proficiency in the language of academic instruction, or
inadequate educational instruction
Factors to consider when seeking
an evaluation
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Treatment recommendations
Time Frame
Cost
What assessment instruments are being used
Training and Experience of Evaluator
What information will I actually receive in the
psychological report
• Confidentiality
Contact Information
Debra Huss, Ph.D.
Brandon Huss, M.A.
Licensed Psychologist
Certified School Psychologist
Mindpsi Psychological Services
859-361-9617
[email protected]
Mindpsi.net
Jessamine County Schools
East Middle (859-885-5561)
Red Oak Elem (859-885-0616)
[email protected]
www.jessamine.kyschools.us
References
Jessamine County Special Education Procedures
http://www.jessamine.k12.ky.us/dept/18/
KY Special Education Forms and Policies
http://education.ky.gov/specialed/excep/Pages/default.aspx
Diagnostic Statistical Manual 5th Edition (2013). American Psychiatric Association