How to Navigate the Muddy Road to the Diagnosis of Specific Learning Disabilities Pt1

How to Navigate the Muddy Road to the Diagnosis of Specific Learning Disabilities Pt1


[Walt Bower]: Good afternoon! I’m Walt Bower and
I’d like to welcome you to the Human Development Institute’s
third Fall Seminar. We welcome the participants who are joining us online
as well as the participants who are here with us at the University of Kentucky.
Our presenter will provide an opportunity for questions this afternoon,
and we welcome questions from all of our participants. Please type your questions
in the chatbox. If you are online, should you have any questions about CEUs, you
can contact me. Please take a moment at the conclusion of the seminar to
complete our brief evaluation. The evaluation will be sent to your email
address after the seminar. It is really helpful as we plan for upcoming seminars.
Now to introduce today’s presenter. Dr. Alissa Briggs is an assistant professor
of pediatrics at the Kentucky Children’s Hospital within UK Healthcare. The title
of the seminar is ‘How to Navigate the Muddy Road to the Diagnosis of Specific
Learning Disabilities.’ I’m now going to turn it over to our presenter, Dr. Briggs. [Dr. Briggs]: Hi! Thank you. This is a new thing for me, so this is exciting. Also, thank
you to those of you who are here in person. These are the objectives I sent
out I’m regarding the talk. We’re gonna try and navigate the various definitions
of learning disabilities that are out there. What the clinical definition of
learning disabilities are in the Diagnostic and Statistical Manual is
different than sometimes what we find in special education, and so it’s it’s
sometimes it is difficult to get those two worlds to sometimes talk together,
We’re going to talk about what the process of an evaluation might look like,
given different models in Kentucky. We have two distinct models that special
education and regulations give us the opportunity to use, and we’ll talk about
what that looks like. And then we will talk about steps to take if there are
any concerns about a kid’s academic skills. To give you just a little
background on me I went to Grinnell College which is a small college kind of
smack in the middle of Iowa. I went there with intentions to go into neuroscience,
but I also studied sociology and I was interested in the achievement gap. So I
taught special education for Teach for America. I taught in st. Louis Public
Schools for two years. And honestly I probably would have continued on the
path to being a teacher, except for my husband was in graduate school in
Chicago, and I wanted to move there to be with him.
And I applied to graduate school in school psychology and a teaching
positions and I just kind of decided to go to graduate school. I became
interested in school psychology and applied to those programs because I was,
in teaching special education, I was interested in how some of the decisions
were made that led to students kind of being in my care. I got my doctorate in
school psychology from Loyola University Chicago. And this is important for this
talk because A) Loyola University of Chicago has a explicit social justice
mission that permeated throughout our graduate program. And also it was housed
you know it’s in Illinois and at that time in Illinois a lot of research
was coming out regarding response to intervention, and a lot of the leaders in
response to intervention were in the Chicagoland area.
So I kind of grew up in school psychology in a response to intervention
world. Then, I did my internship at a high school in Highland Park, Illinois. And
that is relevant to this talk in that the translation of response to
intervention to the high school level is quite difficult. So you know my training
and response intervention was quite strong.
But then I went in to try and practice that at the high school level, I was met
with several barriers. Then, my husband got a position at Transylvania
University, here, just prior to my internship year, so that’s how I landed
in Kentucky. And I started off here as a school psychologist at Lincoln County
High School, so I have some experience in the school psychology world in the state
of Kentucky. And then I ended up, I also became licensed clinically, as a clinical
psychologist, so eventually I moved into practicing clinically at the University
of Kentucky in adolescent medicine. So basically when I taught, I taught
teenagers, when I got my internship I worked with teenagers, and now I talk to
teenagers all day long, so teenagers are kind of my people. When it comes to
learning disabilities, though, there’s, in response to intervention, it’s just
incredibly challenging how to figure out how to make all that work together,
especially when kids start to demonstrate impairment in the in the
upper grades in middle school and high school, and we’ll talk a bit more about
that. Also about my background that’s kind of influencing my talk this week. I
had a professor at Loyola who was an advocate for kids. She was a formal
former hearing officer for special education and she had children with
disabilities and she was a fierce advocate. She taught our special
education law class and I also TA’ed with her to teach that class one year. And she
passed away this Saturday of cancer and so, I feel like I would not be doing her
justice if I didn’t talk a little bit first about special education law. She
also was the kind of person who would, in her advocacy, she didn’t really work too
hard… Well, how to phrase this in a way?
She stood up for what she believed in, even when it was unpopular. And so you
know I’m gonna try and do that a bit with this talk too. There’s a lot of
controversy around learning disability diagnosis, and I know some people who are
listening will you know, not agree with everything I say, because it’s it’s
confusing and it’s convoluted, and I’m ready for that. So in order to do Dr.
Marty Wynn justice we will just lay a foundation for what we are talking about
with just a quick background in the principles of law or of special
education law. So right now we have the individuals with Disabilities Education
Improvement Act. We still call it IDEA even though it’s IDEIA because it’s
just easier than having an extra letter. And it was reauthorized in 2004.
So how I conceptualize special education is by thinking about these three circles.
And I’m not gonna, for the purposes of this talk I’m not going to get into 504.
But the three questions I think are helpful to ask is: A) is there a
disability? B) Is there significant interference academically? And a
non-academic interference is a whole nother ballgame. And we’ll focus kind of
on academics today. And then 3) Is the interference so significant that we need
specialized, individualized instruction? So if the answer to all three of those
questions are ‘yes’, then we end up in special education. So the purpose of IDEA
is to make sure that all children, and that means all children with
disabilities, have a free and appropriate public education. Well that seems pretty
straightforward but it’s really not. And we’ll talk about this in just a couple
slides, but even the definition of what is appropriate has changed over the
years. And this education is designed to meet their unique needs both in school
and beyond right? So we consider in special education employment and
independent living beyond the school-aged years. And part of this also
is to ensure the rights of children and their parents are protected. And then
another part of the law is to provide states and localities with guidance, and
to make sure that we’re being being effective in meeting the needs of
children with disabilities. And then when you sit at a table in the school this is
sometimes what it feels like for a parent, when you explain kind of what
special education is like. Its alphabet soup and you’re handed all of this
paperwork, and it’s hard to kind of really figure out how to sort through.
And you know even some friends of mine who are school psychologists who have
kids with disabilities, you know, when they’re in a school meeting environment
they talk about – even with all the knowledge they have – just feeling
overwhelmed. It’s very overwhelming. Which is why, you know, as from the school
psychologists perspective, it’s always kind of intimidating when a parent
brings in an advocate right? But then at the same time, from a parent perspective,
it totally makes sense why you would want an advocate at the table. Because in
Kentucky we called it admissions and release committee and ARC. On that
committee you have to have a special ed teacher, a regular ed teacher, an
administrator or somebody, you know, who could make administrative decisions, a
school psychologist, a speech language pathologist, an occupational therapist,
and anybody else who’s kind of involved in the child’s education. And it’s just
you know, a lot of people in the room, and then you kind of have you know the
parent. And that can be a really scary seat to sit in. So there are six key
principles of IDEA that guide the law. That’s we talked about a Free
Appropriate Public Education, Identification and Evaluation, the IEP.
Educating kids in the Least Restrictive Environment. Do you process safeguards
for the children and the parents? And then parent and and for the schools as
well? And then parent and student participation and shared decision-making.
So again faith means that the nature and the severity of the disability does not
exclude a child. It’s our responsibility to educate them. What is appropriate used
to be what would allow the child to benefit educationally. And now due to a
recent Supreme Court case from 2017, appropriate is appropriately ambitious.
Which is great because that’s you know, a higher-level, but then again we’re also
defining appropriate with appropriate, so that’s kind of confusing
as well. So I think you know where some parents feel frustrated is, you know,
as a parent, we want our child to maximize their potential. But that is not
the job of special education. The job of special education is to help them
progress and learn at, you know, an appropriately ambitious rate, whatever
that means right? But it’s not to maximize their potential, and that that’s
hard, because for parents we want our kid’s potential to be maximized. If it’s
not provided, you know, parents maybe entitled to compensatory education or
private school reimbursement. So with evaluation, and I think this is important
in the context of the talk, in that evaluations need to be multidisciplinary.
They need to be multifaceted, and they need to be unbiased. And all of these key
components of evaluations become challenging with the way learning
disabilities are defined. It is also our responsibility that if we feel that, you
know, a child may have a disability that that we evaluate for that. And well,
and I’ll talk a bit about this, while RTI does a great service to children,
sometimes that gets in the way of Child Find. The IEP is basically the roadmap. It
is the document that outlines all the program and services for the child. It is
a legal document. It’s developed by the Admissions and
Release Committee and it needs to be followed. It’s reviewed annually, but
parents or teachers or anybody are always welcome to call a meeting to
update and revise the document.The Least Restrictive Environment is so sometimes,
you know, when I’m evaluating a kid, either now kind of, in the clinical
setting or when I was in the school setting, parents were nervous.”Well if my
kid is identified or they’re gonna be put off in some special classroom away
from everybody else?’ And no LRE says that we don’t do that. Special Education is
not a place. Special Education is a continuum of services and the preference
is always to have the child in the general education environment as much as
possible. So what this looks like for children with learning disabilities, in a
lot of schools, is that you know they’re in a general education environment but a
special education teacher may be co-teaching in that classroom. And this
is actually how I functioned as a special education teacher when I taught
in st. Louis. I co-taught English with a regular education English teacher. I was
a special education teacher. We developed the curriculum together and then my job
was to figure out how to modify that curriculum and specialized that
curriculum in order to meet the needs of my students with disabilities.
Co-teaching though, it serves the least restrictive environment. It’s also a
challenge, it’s a marriage. You’ve got to really be able to get along with your co-
teacher. You’ve got to be able to jive well. A lot of times it ends up looking
like a teacher and an assistant. So it’s it’s a really challenging thing to get
to work well in the classroom, but when it does, it’s beautiful. So this is a way
you know, to kind of conceptualize the Least Restrictive Environment. We want to
stay towards the bottom of that triangle as much as possible. And then due process
safeguards come into place for both schools and parents and children,
because education is considered a property right, and is protected by the
Constitution. Which is why we have due process safeguards for special education.
So no child should be deprived of an education without the opportunity to
protest. And children are children right? They don’t know necessarily how to
protest themselves, so they rely on adults to be their advocates to protest
for them. So due process safeguards include surround both consent. Or all four
these categories: consent for evaluation, placement, and reevaluation. They mean
that parents get adequate notice of when their you know child is identified, a
place going to be evaluated, what services are going to be provided. And
also includes and we’ll talk about this a bit later, that parents are entitled to
an independent educational evaluation. And how you go about that can kind of
depend. And they also these safeguards also kind of outline how complaints and
due process hearings will proceed. And then the fifth principle, or the sixth
principle is parent and student participation and shared decision-making
right? Parents and students should be part of the process. And at a minimum,
students should be part of the process at age fourteen, which is when transition
planning should be required. But you know, I think sometimes, adults want to
protect children from understanding that they have disabilities. Yet, at the same
time, I mean can you imagine going into high school learning that you have a
disability for the first time? And you know to be a part of these meetings, so I
think it is important also for kids to be a part of this process. Parents in
terms of the law, it’s called parents, but it includes birth, adoptive, foster, legal
guardians, surrogate parents. And parents are full participating members of the a
ARCT meeting. And I think personally Briggs’s best practice is that student
input and participation starts occurring at least in middle school,
maybe even 5th grade, but the law says 14 and up. Okay so that is just kind of a
quick, very quick foundation, and kind of the principles of IDEA. Again, a lot of
these things I’m gonna be covering could each in and of themselves be a semester
long course. And when I did my school psychology training each and of these
things were a semester long course. So I took a semester in just IDEA, right? So
it’s a lot of information coming at you and I’ll give you some resources at the
end to where to kind of go and do some more research on your own. So what is a
learning disability? What can we agree on? That is the
question. So just some brief context in history. Learning disabilities became a
concept in education around the 1960s. There’s been a lot of research, a lot of
legislation, a lot of improved practices, but our definition of a learning
disability has gotten murkier and less unified. The issue is, before we can
accurately and adequately assess for learning disabilities, we need
a valid common definition. Yet I don’t think we really have one. And I think
that’s one of the reasons why this road to learning disability diagnosis is
pretty murky and muddy. What we do know when it comes to learning disabilities,
is that there is some unexpected underachievement.
And that it is likely the result of impaired cognitive processes, but even
saying that it is the result of impaired cognitive processes is up for debate. We
can’t really quite demonstrate whether those processes are a cause, a correlate,
a result. So we just don’t have enough neuroscience knowledge I think to really
tease that out. We do know that learning disabilities are heterogenous, so their varied right? They occur across multiple academic areas. You could
have a kid who really struggles in decoding and basic reading, that can do just
fine when it comes to math. You can have a kid who can’t do math calculations but
if you give them calculator, every thing is mostly okay. You can have a kid who
could give a beautifully coherent verbal presentation but not be able to present
you with an organized and coherent paper right? So they’re heterogeneous,
they vary from child to child. What we do know though is that the vast majority of
learning disabilities occur in reading. And because of that, that is where most
of our research is – as well so we have a lot more research in learning
disabilities and reading than in math and writing. So all the dyses. So in school psychology practice, according to our National Association of School
Psychologists and also according to the Diagnostic and Statistical Manual, we’re
kind of advised that dyslexia is a specific learning disability or disorder
in reading. Those two terms are one and the same, but to prevent confusion or
advised to use the specific learning disability because that’s kind of what’s
unified across special education and the DSM. But if you look in the DSM you know,
it breaks out specific learning disability in reading – difficulty with
fluency – difficulty with word identification – difficulty with using
phonemes – difficulty with comprehension. And so there’s opportunities to kind of,
specify the different types of learning disabilities you see in reading. Same
thing goes with math and writing. So dyscalculia, oh we’re advised to say specific
learning disability or specific learning disorder inmath. And dysgraphia we’re
advised to say specific learning disability or disorder and written
expression. So when I say a specific learning disability or
learning disorder, I’m not meaning to do a disservice to dyslexia, dyscalculia, or
dysgraphia. Kind of the way my mind works is that we’re talking about the same
thing. And the reason why I’m saying disability/disorder, is that IDEA
Special Education says disability. The DSM says disorder. The DSM used to say
disability and now it says disorder. We’ll talk a little bit about that in a
second. So there are three different definitions of learning disabilities out
there, and if you put these different authors in a room together, it would be very
entertaining I think. They do not agree. I’m sure we could help find some common
ground but you know there are arguments between them and the literature. So the
camp I was trained in, is Response to Intervention. And that is basically, you
know, you have a dual discrepancy. You have unexpected underachievement and
then you have, despite evidenced based interventions, that child is just not
moving at a rate of progress that is going to get them caught up. You have the
Patterns of Strengths and Weaknesses model, which according to Hale, is
distinct from the Ability and Achievement Discrepancy.
So the pattern of Strengths and Weaknesses model is that you know, there
there’s unexpected academic underachievement
again, but that this is related to a processing weakness. So some kind of
processing weakness, whether that be the deficit and visual
spatial processing, whether that be a deficit in working memory, that you know,
could be in many different areas. But we were able to pinpoint some sort of
processing deficit. The Ability Achievement Discrepancy is that there is
significant difference between cognitive or intellectual ability, or some measure
of ability, and academic achievement. If ability achievement discrepancy could
work it would be lovely, because it’s just so it’s just so clear-cut, if it could work.
The trouble is, is that in terms of the literature, it’s the least supported
method. If you interview school psychologists, they’ll tell you that they
rarely prefer it. And that it leads to over identification of racial and ethnic
minority children. So if you’re an Ability and Achievement Discrepancy
person, maybe by the end of this talk I will have changed your mind.
If not, I apologize because I have I can find benefits of it, I can, but and we’ll
talk about that, but it’s hard for me. So and again I come from the RTI camp, so
keep that in mind as well. That’s how I was trained.
But so Response To Intervention really is a form of dynamic assessment. So what
this means is that, you know, instead of bringing a kid into my office and giving
them a four-hour battery of tests, you know, we’re really kind of examining
their achievement in their response to different interventions and
problem-solving over a period of time. So really, as a clinician in a clinic, as
much as I love RTI, I can’t really do it right? I have to rely on collaboration
with the schools in order for RTI to happen. RTI is multi-tiered, and we’ll
talk about that in a minute. But the idea is that we increase the intensity. And
that could be in frequency of the intervention, how long the kid gets an
intervention, what size group the kid has pulled out into, whether it’s a group of
five or even just one on one instruction. And the expertise of the person
providing that intervention. There are two options
for this process: there’s the problem-solving approach, where you know
you identify that the child’s underachieving. You review different
sources of data. You determine the best research based approach to use. You
implement it and you evaluate their responses and then kind of go on you
know through that cycle. Or there is the standard treatment protocol approach,
which is what you’ll see more often at the high school level, just because of
the way high schools are structured. And that is you know, this kid did it meet
the college and career readiness benchmark on the ACT so we are going to
send them to an extra math intervention class. And see if we’re able to boost
their you know their readiness score on the ACT. And that would be kind of a
standard treatment protocol that they get, you know, this evidence-based
intervention for this amount of time and we’ll see how they respond to that. But
it’s not really an individualized problem-solving approach. But with
Response To Intervention, data, data, data, data is the driving force. The hard part,
well, there’s many challenging parts the Response To Intervention. One of the
challenging parts is that it requires us to really define what responsiveness and
non responsiveness is, and there is a lot of debate between different
professionals, between different school districts, different states. I mean
wherever you go you may find a different operationalization of what
non-responsiveness is. One that you could use, is that non responders are those
who’s a slope and level of performance is at least one standard deviation below
their class mean, or that could be a district mean, it could be a national
mean. So let’s say you know, on one assessment of reading fluency, the class
mean you know, was at a certain level, the district mean was at a certain level, the
national mean is at a certain level, and you know the child is false one standard
deviation below that. And they also, if you kind of
look at how they did on this particular measure over time, that slope, that line,
would be one standard deviation below kind of the class slope. And there’s a
variety of different measures that could be used to assess this. There’s a variety
of different curriculum based measures and I’ll show you kind of a resource for
finding those. So you know I I’m on the Facebook, and that there’s a group
called, I’m part of two groups, one is ‘Said No School Psychologist Ever’ and one
is ‘School Psych Moms” but anyway. Sometimes my the school psychology
friends post these memes. I guess you’ll leave this talk being like, ‘Wow Briggs is
really on Facebook an awful lot.’ But anyway so anyway these are some of my
favorite school psychology memes. If you’re going to show up to a meeting
with the school psychologist and you’re concerned about a learning disability,
and the district is an RTI district, you’ve got to show up with some data. So why RTI? The one thing
that people in those three different camps can agree on I think, is that it
does have value. In that, we don’t really have the luxury of waiting. I don’t think
anybody really says, ‘We want to wait until this kid fails enough to qualify
them as having a learning disability.’ I don’t think people really want
that. Sometimes that ends up being what’s happening, but I don’t think anybody goes
into education wanting that. And so if we intervene early in any area, and speech
in OT and mental health, the earlier we intervene, the better outcomes we have.
And that goes for reading. So early intervention, we can get poor readers,
most of the poor readers up to the average range. If we wait until age nine
to do something differently, we’ll have 75% of those kids
experiencing lifelong impairment. So we, RTI just make sense from that
perspective alone. We have, it’s our responsibility to intervene, if we want
children to leave our schools being proficient.

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