Navigating DSM-5 Diagnoses & School Support Services for Your Child

1. 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

2. 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

3. 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

4. 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

5. 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

6. Appropriate Evaluation School Evaluations include information and data from a variety of sources, including but not limited to… • 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, neuro-psychological, 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).

7. Evaluation in a Community Clinic • Detailed interview with parents and child • 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

8. 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

9. 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

10. 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.

11. Autism Eligibility Form

12. DSM-5Autism Spectrum Disorder (ASD) • 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

13. 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

14. 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

15. 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;

16. DSM-5 Attention-Deficit/ Hyperactivity Disorder • 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 • 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

17. ADHD criteria continued 2. Hyperactivity and Impulsivity: 6 or more symptoms lasting at least 6 months; not at developmental level & cause impairment • Fidgets with or taps hands or feet or squirms in seat • Leaves seat when expected to remain seated • Runs about or climbs where inappropriate (feels restless for older adults) • Unable to play or engage in leisure activity quietly e. On the go or driven by a motor • talks excessively • Blurts out answers before question completed (completes people’s sentences; cannot wait turn in conversation) • Has difficulty waiting turn • Interrupts or intrudes on others

18. ADHD criteria continued B. Several symptoms of inattention or hyperactive-impulsive 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

19. 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 aninability 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.

20. DSM-5Anxiety & OCD Disorders • 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; • OCD: presence of obsessions, compulsions or both that are time consuming or cause distress/impairment • Separation Anxiety Disorder- excessive distress when anticipation or experiencing separation from major attachment figure; developmentally inappropriate or more extreme than expected

21. 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.

22. Specific Learning Disability SLD Areas • Basic Reading • Reading Comprehension • Reading Fluency • Math Calculation • Math Reasoning • Written Expression • Oral Expression • Listening Comprehension

23. 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

24. 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

25. DSM-5Specific 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

26. 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

27. Factors to consider when seeking an evaluation • 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

28. Contact Information Debra Huss, Ph.D. Licensed Psychologist Mindpsi Psychological Services 859-361-9617 debrabhuss@yahoo.com Mindpsi.net Brandon Huss, M.A. Certified School Psychologist Jessamine County Schools East Middle (859-885-5561) Red Oak Elem (859-885-0616) Brandon.huss@jessamine.kyschools.us www.jessamine.kyschools.us

29. 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