Download RTI/MTSS Universal Screening - Psych-PLC

School Psych PLC
December 5, 2013
Brian Lloyd
Ed.S., NCSP
Issues and Resources Specific to School
Psychologist Practice
• Changes Within DSM-V for Disorders That
Correspond to Eligibility
• How might these issues affect school
psychologists?
• SLD FAQ Document and Future SLD
Guideline Changes
• FBA/BIPs – What Involvement Do You Have
and What Involvement Do You Want To Have?
• Useful Information Received From David Tilly
Changes Within DSM-5 for Disorders That
Correspond to Eligibility
This is not a comprehensive look – Brian got
a copy and just pointing out what he sees.
•
SLD
•
Intellectual Disability – Replaces MR – Yeah!
•
Global Developmental Delay
•
Autism Spectrum Disorder
•
ADHD
•
Bi-Polar Disorders (Won’t Get Into)
•
Depressive Disorders (Won’t Get Into)
•
TBI (Won’t Get Into)
DSM-5 Overview
• Non-Axial
• NOS replaced with other specified
disorder and unspecified disorder
• GAF is dropped
Specific Learning Disorder (SLD)
DSM-IV TR
DSM-5
What it was called
Reading Disorder (dyslexia)
Writing Disorder (written
expression disorder)
Math Disorder (dyscalculia)
What it is now called
Specific Learning Disorder
DSM-5 SLD Criteria
A. Difficulties learning and using academic skills, as indicated by the presence
of at least one of the following symptoms that have persisted for at least 6
months, despite the provision of interventions that target those difficulties:
1. Inaccurate or slow effortful word reading (e.g. reads single words aloud incorrectly
or slowly and hesitantly, frequently guesses words, has difficulty sounding out words.
2. Difficulty understanding the meaning of what is read (e.g. may read text accurately
but not understanding the sequence, relationships, inferences, or deeper meanings of
what is read).
3. Difficulties with spelling (e.g. may add, omit, or substitute vowels or consonants).
4. Difficulties with written expression (e.g. makes multiple grammatical or punctuation
errors within sentences; employs poor paragraph organization; written expression of
ideas lacks clarity).
5. Difficulties mastering number sense, number facts, or calculation (e.g. has poor
understanding of numbers, their magnitude, and relationships; counts on fingers to add
single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst
of arithmetic computation and may switch procedures).
6. Difficulties with mathematical reasoning (e.g. has severe difficulty applying
mathematical concepts, facts, or procedures to solve quantitative problems.)
DSM-5 SLD Criteria … continued…
B. The affected academic skills are substantially and quantifiably below those
expected for the individual’s age, and cause significant interference with
academic or occupational performance, or with activities of daily living, as
confirmed by individually administered standardized achievement measures
and comprehensive clinical assessment. For individuals age 17 years and
older, a documented history of impairing learning difficulties may be
substituted for the standardized assessment.
C. The learning difficulties begin during school-age years but my not become
fully manifest until the demands for those affected academic skills exceed the
individual’s limited capacities (e.g. as in timed tests, reading or writing lengthy
complex reports for a tight deadline, excessively heavy academic loads).
D. The learning difficulties are not better accounted for by intellectual
disabilities, uncorrected visual or auditory acuity, or other mental or
neurological disorders, psychosocial adversity, lack of proficiency in the
language of academic instruction, or inadequate educational instruction.
DSM-5 SLD Criteria … continued…
Note: The four diagnostic criteria are to be met based on a clinical synthesis of
the individual’s history (developmental, medical, family, educational), school
reports, and psycho-educational assessment.
You would code the impairment with the following:
315.00 (F81.0) With impairment in reading:
Word Reading accuracy
Reading rate or fluency
Reading comprehension
Note: Dyslexia is an alternative term used to refer to a pattern of learning
difficulties characterized by problems with accurate or fluent word
recognition, poor decoding, and poor spelling abilities. If dyslexia is used to
specify this particular pattern of difficulties, it is important to specify any
additional difficulties that are present, such as difficulties with reading
comprehension or math reasoning.
DSM-5 SLD Criteria … continued…
315.2 (F81.81) With impairment in written expression:
Spelling accuracy
Grammar and punctuation accuracy
Clarity or organization of written expression
315.1 (F81.2) With impairment in mathematics:
Number sense
Memorization of arithmetic facts
Accurate or fluent calculation
Accurate math reasoning
Note: Dyscalculia – also described as an alternative term like dyslexia
DSM-5 SLD Criteria … continued…
Specify current severity:
Mild: Some difficulties learning skills in 1 or 2 academic domains. Mild
enough that individual may compensate with appropriate
accommodations or support services, especially during the school years.
Moderate: Marked difficulties learning skills in one or more academic
domains, so that the individual is unlikely to become proficient without
some intervals of intensive and specialized teaching during the school
years. Some accommodations or supportive services at least part of the
day at school, in the workplace, or at home may be needed to complete
activities accurately and efficiently.
Severe: Severe difficulties learning skills, affecting several academic
domains, so that the individual is unlikely to learn those skills without
ongoing intensive individualized and specialized teaching for most of the
school years. Even with an array of appropriate accommodations or
services at home, school, or in the workplace, the individual may not be
able to complete all activities efficiently.
DSM-5 SLD Diagnostic Features
DIAGNOSTIC FEATURES – Brian notes from interesting things he sees
in the narrative
(Criterion A)
Onset during the years of formal schooling. Later it is mentioned
in (Criterion C) that difficulties are readily apparent in the early school
years, but the learning difficulties may not manifest until later school
years. (So much for the help in reduction of secondary eval.)
(Criterion B)
Criterion is for low academic achievement for age (not grade).
DSM-5 SLD Diagnostic Features cont…
* Academic skills are distributed along a continuum, so there
is no natural cutpoint that can be used to differentiate
individuals with and without specific learning disorders.
Thus, any threshold used to specify what constitutes
significantly low academic achievement (e.g., academic
skills well below age expectation) is to a large extent
arbitrary. Low achievement scores on one or more
standardized tests or subtests within an academic domain
(i.e. at least 1.5 standard deviations below the population
mean for age, which translates to a standard score of 78 or
less, which is below the 7th percentile) are needed for the
greatest diagnostic certainty. A more lenient threshold may
be used with converging evidence.
DSM-5 SLD Diagnostic Features cont…
(Criterion D)
SLD may occur in intellectually “gifted” individuals. These individuals
may be able to sustain apparently adequate academic functioning until
timed tests pose barriers to their demonstrating their learning or
accomplishing required tasks.
BRIAN NOTE: This seems to conflict with the previous criteria where the
7th percentile is used as the suggested criteria for existence of SLD.
Maybe this refers to students who begin have high IQs, and begin to
have academic scores in the average range and then their scores
decrease as academic demands decrease. *Again, this is Brian reading
between lines here.
DSM-5 SLD Diagnostic Features cont…
• Comprehensive assessment is required. SLD can only be
diagnosed after formal education starts. No single data
source is sufficient for a diagnosis of specific learning
disorder. Comprehensive assessment will involve
professional with expertise in specific learning disorder
and psychological/cognitive assessment.
• Brian Editorial: Note that this does not say that the
professional must give a cognitive assessment, just that a
professional with expertise with psychological/cognitive
assessment.
DSM-5 SLD Prevalence
• Prevalence:
• SLD in reading, writing, or math is 5%-15% among school
age children.
• Reminder that this was written by a committee. 5%-15%.
Brian Editorial: (How’s that for a range? 15%???
Sheesh!)
DSM-5 Intellectual Disability
Intellectual disability (aka intellectual developmental disorder) is a
disorder with onset during the developmental period that includes both
intellectual and adaptive functioning deficits in conceptual, social, and
practical domains. The following three criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving,
planning, abstract thinking, judgment, academic learning, and
learning from experience, confirmed by both clinical assessment and
individualized standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet
developmental and socio-cultural standards for personal
independence and social responsibility. Without ongoing support,
the adaptive deficits limit functioning in one or more activities of daily
life, such as communication, social participation, and independent
living, across multiple environments, such as home, school, work,
and community.
C. Onset of intellectual and adaptive deficits during the developmental
period.
DSM-5 Intellectual Disability - Severity
•
•
•
•
Mild
Moderate
Severe
Profound
•
Less of a focus on IQ scores and more
focus on what they can and cannot do
(adaptive behavior).
Criteria for severity more difficult to
determine, luckily for us severity shouldn’t
matter.
•
DSM-5 Global Developmental Delay
•
This diagnosis is reserved for individuals
UNDER the age of 5 when the clinical severity
cannot be reliably assessed during early
childhood. This category is diagnosed when an
individual fails to meet expected developmental
milestones in several areas of intellectual
functioning, and applies to individuals who are
unable to undergo systematic assessments of
intellectual functioning, including children who
are too young to participate in standardized
testing. This category requires reassessment
after a period of time. (doesn’t give the time)
DSM-5 Autism Spectrum Disorder Criteria
A.
Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by the following, currently or
by history (examples are illustrative, not exhaustive)
1. Deficits in social-emotional reciprocity, ranging, for example from
abnormal social approach and failure of normal back-and-forth
conversation; to reduced sharing of interest, emotions, or affect; to
failure to initiate or respond to social interactions.
2. Deficits in nonverbal communication behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in making eye contact
and body language or deficits in understanding and use of
gestures; to a total lack of facial expressions and nonverbal
communication.
3. Deficits in developing, maintaining, and understanding
relationships, ranging for example, from difficulties adjusting
behavior to suit various social contexts; to difficulties in sharing
imaginative play or making friends; to absence of interest in peers.
DSM-5 Autism Spectrum Disorder Criteria
B. Restricted, repetitive patterns of behavior, interests, or activities, as
manifested by at least two of the following, currently or by history
(examples are illustrative, not exhaustive)
1.
2.
3.
4.
Stereotyped or repetitive motor movements, use of objects, or speech(e.g.
simple motor stereotypies, lining up toys or flipping objects, echolalia,
ideosyncratic phrases)
Insistence on sameness, inflexible adherence to routines, or ritualized
patterns of verbal or nonverbal behavior (e.g. extreme distress at small
changes, difficulties with transitions, rigid thinking patterns, greeting
rituals, need to take same route or eat same food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus
(e.g. strong attachment to or preoccupation with unusual objects,
excessively circumscribed or perseverative interests).
Hyper- or hypoactivity to sensory input or unusual interest in sensory
aspects of the environment (e.g. apparent indifference to
pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or
movements).
DSM-5 Autism Spectrum Disorder Criteria
DSM-V recommends specifying severity. They
provide a table. The levels in the table are:
Level 1: Requiring support
Level 2: Requiring substantial support
Level 3 Requiring very substantial support
DSM-5 Autism Spectrum Disorder Criteria
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. These disturbances are not better explained by intellectual disability or
global developmental delay. Intellectual disability and autism spectrum
disorder frequently co-occur; to make comorbid diagnosis of autism
spectrum disorder and intellectual disability, social communication
should be below that expected for general developmental level.
DSM-5 Autism Spectrum Disorder Changes
Source: https://www.regonline.com/custImages/250000/250066/DSM5_PTI_2013.pdf
1.
Diagnostic Labels Were Merged – No more Asperger's
2.
Three domains reduced to two
• Was social, communication, and repetitive/stereotyped
• Now social/communication and repetitive/stereotyped
3. Merge communication & social interaction
• Persistent deficits in social communication and social interaction, manifest
by ALL THREE
4. Remove language delay criterion
5.
Require more of restricted, repetitive patterns of behavior, interests, or
activities (used to be one, now two)
6.
Social (Pragmatic) Communication Disorder:
• Focus on communication, but not repetitive/ restrictive behaviors
• May cover those excluded by requiring 2 criteria
DSM-5 ADHD Criteria
A. 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) of symptoms for at least 6 months that is
inconsistent with developmental level and that negatively impacts
directly on social and academic/occupational activities:
a.
b.
c.
d.
e.
f.
g.
h.
i.
Often fails to give close attention to details or makes careless
mistakes
Often has difficulty sustain attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instruction s and fails to finish
schoolwork, chores or duties in the workplace
Often has difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort.
Often looses things for tasks or activities.
Is often easily districted by extraneous stimuli
Is often forgetful in daily activities.
DSM-5 ADHD Criteria Continued…
2. Hyperactivity and impulsivity: Six (or more) of the following symptoms
have persisted for at least 6 months to a degree that is inconsistent
with developmental level and that negatively impact directly on social
and academic/occupational activities:
NOTE: The symptoms are not solely a manifestation of oppositional
behavior, defiance, hostility, or a failure to understand tasks or instructions.
For older adolescents and adults (17 or older), at least five symptoms are
required.
a.
b.
c.
d.
e.
f.
g.
h.
i.
Often fidgets with or taps hands or feet or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs or climbs in situations where it is inappropriate.
Often unable to play or engage in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has difficulty waiting his or her turn.
Often interrupts or intrudes on others.
DSM-5 ADHD Criteria Continued…
B. Several inattentive or hyperactive-impulsive symptoms were present
prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present in
two or more settings.
D. There is clear evidence that the symptoms interfere with, or reduce the
quality of social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of
schizophrenia or another psychotic disorder and are not better
explained by another mental disorder.
Specify whether
314.01 Combined presentation
314.00 Predominately inattentive presentation
314.01 Predominately hyperactive-impulsive presentation
DSM-5 ADHD Severity and Other
• Mild
• Moderate
• Severe
• DSM-5 also has 314.01 – Other Specified
Attention-Deficit/Hyperactivity Disorder and
314.01 Unspecified AttentionDeficit/Hyperactivity Disorder
•
Symptoms are bad, but don’t meet ADHD criteria.
• SLD FAQ Document and Future SLD
Guideline Changes
• SLD FAQ Document
• IISD is currently working on updating SLD
Guidelines (again).
• I have a good idea of what you DON’T
want in the next revision.
• What DO you want in the next revision.
Functional Behavior Plans / Behavior
Intervention Plans
• FBA/BIPs – What Involvement Do You Have
• What Involvement Do You Want To Have?
• Forms – Does anyone have ones that they
really like?
• Share
Useful Information Received From David
Tilly
• David Tilly presented on the marriage
between RTI/MTSS and Special Education
• He presented perspective on special
education and the outcomes that have
produced for students with special education
eligibility.
Useful Information Received From David
Tilly
• David Tilly presented on the marriage
between RTI/MTSS and Special Education
• He presented perspective on special
education and the outcomes that have
produced for students with special education
eligibility.
Overcoming Dyslexia
1. The most important variable in how much a student
learns is their IQ.
• The most critical
components in how much a
student learns are:
– Instruction
– Curriculum
– The environment
2. Grouping children for instruction based on student characteristics
(e.g., disability status, learning style, processing modality) results in
enhanced results for students.
• For individuals, aptitude by
treatment interactions have
not been proven.
• Matching treatments to
learner characteristics
seems to make sense, but it
DOES NOT WORK! (e.g.,
Arter & Jenkins, 1979;
Cronbach, 1975; Good, et
al., 1993; Teeter, 1987,
1989; Ysseldyke & Mirkin,
1982).
3. If we use research validated reading practices, monitor students’ progress
and make changes to instruction based on what we find, between 95 and
100 percent of children can become proficient readers.
• Torgesen, 2000,
Learning Disabilities
Research and Practice.
• Individual Differences in
Response to Early
Intervention in Reading:
The Lingering Problem
of Treatment Resisters
4. The use of research validated practices is the most important
variable in whether individual intervention plans are successful.
• There are two keys
– One is research
validated practices. This
gives us the “best shot”
at an improved outcome
– The other is good
problem analysis and
MATCH with student
need. Powerful
interventions are
doomed if they are
applied to the wrong
problems.
5. Special Education, as it has been defined nationally since 1975 has
been very effective at raising student achievement in reading and
mathematics.
• We have lots of anecdotal
evidence of individual
student success stories
• Our practices have
precluded our answering
this question
– Different curriculum
– Lack of assessment
• The evidence is mixed
• We must fix this
6.
Scientifically Research-validated strategies are widely
available in reading and mathematics across K-12 to help
us work smarter at remediating student learning problems.
• We have the most in
early literacy
• We have less at later
literacy
• We have even less in
mathematics
• We do, however have
promising practices that
we can implement in
most areas
7. Grouping students for instruction based on student skill, monitoring
their progress over small periods of time, adjusting instruction based on
the data and providing kids feedback on their performance is one of the
most powerful sets of educational practices that exists.
Treatment/Intervention
Effect Size
Special Education Placement
-.14 to .29
Modality Matched Instruction
(Auditory)
+.03
Modality Matched Instruction
(Visual)
+.04
Curriculum-Based Instruction/
Graphing and Formative Evaluation
+.70
Curriculum-Based Instruction,
Graphing, Formative Evaluation and
Systematic use of Reinforcement
+1.00
8. It will be possible to close the achievement gaps between at
risk groups and others without unifying, simplifying and
rationalizing how we allocate instructional resources.
• It hasn’t happened
anywhere that I know
of
• We spend too much
of our attention on
instructionally
irrelevant stuff
• Rome is burning!
False – OK, Tilly’s Bias
9. Knowing specifically why students are experiencing
learning problems is critical to remediating their skill
problems.
• Not all students with the
same general
performance deficits
have the same learning
needs
• Different performance
profiles will require
different approaches to
remediate
10. Placing children in classrooms based on their specific
disability is permissible by federal law. False, False, False
• “The unavoidable consequence of such a labeling
practice is to identify and plan to meet each child's
educational needs on the basis of what that child has in
common with other children similarly identified rather
than on the basis of that child's individualized needs.
Thus it is the view of this office that any labeling practice
that categorizes children according to their disability in
order to facilitate the individual determination of any
child's appropriate educational needs or services will be
presumed to violate the protections accorded under
Federal and State Law.”
Thomas Bellamy, former OSEP Director
Eligibility Decision
Educational
Progress
Tells us
what
accelerate
s learning.
Discrepancy
Tells us how
unique the
student is
compared to
peers.
Educational
Needs
Tells us
what and
how to
teach.
Eligibility
Decision
Tells us whether
or not interventions
require special
education
resources.
Impact of Focus on
Evidenced-Based Practices
John Hattie
Evidenced-Based Practices
Feedback
.75
Classroom Management
.52
Teacher-Student
Relationships .72
Teacher Clarity .75
Evidenced-Based Practices
Explicit Instruction .75
Spaced vs.
Massed Practice
.71
Questioning .46
Reciprocal Teaching
.74
What We Should Always Ask…
 Strengths
• Within academic area and learner strengths
 Clear understanding of need area
• Supported by data
 Match with intervention
 Adequate time
 Adequate frequency
 Continuity with core
 Are we confident about what to change or do we need additional
data?
Re-Authorization of NCLB Coming
Soon
• There will almost certainly be an increased emphasis
on data support outcomes.
• There will almost certainly be an increased emphasis
on MTSS/RTI.
•DISCUSSION?