Medical and Graduate Students with Learning Disabilities: Recognition, Accommodations and Assessment

1. Medical and Graduate Students with Learning Disabilities: Recognition, Accommodations and Assessment Penny Cox, PhD Special Education-College of Education University of Florida Duane Dede, PhD Clinical & Health Psychology University of Florida Kenneth J. Osfield, EdD ADA Compliance Office University of Florida Sponsored by the University of Florida, College of Medicine, Society for Teaching Scholars

2. Program Divided into 3 Parts • Part I: Recognition • (Dr. Penny Cox, PhD) • Part II: Assessment • (Dr. Duane Dede, PhD) • Part III: Accommodation • (Dr. Ken Osfield, EdD)

3. Recognizing Students with LD • Part I • Penny Cox, PhD • College of Education • Special Education

4. Definitions of LD Disorder of one or more of the basic psychological processes involved in understanding or in using language, spoken, or written, which may manifest itself in an imperfect abilityto listen, think, speak, read, write, spell, or to do mathematical calculations…. The term does not include … learning problems which are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage.” U.S. Department of Education, 2006

5. Definitions of LD “…heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematic abilities. These disorder are intrinsic to the individual, [are] presumed to be due to central nervous system dysfunction, and may occur across the lifespan. Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. Although learning disabilities may occur concomitantly with other handicapping conditions…..or with extrinsic influences…they are not the result of those conditions. National Joint Council on Learning Disabilities, 1998

6. Definitions of LD “…disorders that affect the ability to understand or use spoken or written language, do mathematical calculations, coordinate movements, or direct attention….” National Institutes of Health, National Institute of Neurological Disorders and Stroke, 2007

7. Common Elements of Definitions of LD Disorder affecting abilities related to: • Using language • Spoken or written • Doing mathematical calculations • Operations and concepts • Reasoning • Integrating thoughts • Organization • Directing attention • Focusing on appropriate stimuli • Maintaining attention • Self-regulation • Social perception and interaction U.S. Department of Education (2006) National Institutes of Health, National Institute of Neurological Disorders and Stroke (2007) National Joint Council on Learning Disabilities (1998)

8. Learning Style and LD • Learning style accounts for ways individuals • Concentrate • Process information • Retain what is learned • Elements of learning styles include • Environment • Emotionality • Sociological preferences • Physiological preferences • Cognitive processing inclinations Dunn & Dunn, 1993 Dunn, Honigsfeld, & Doolan, 2009

9. Recognizing LD in the Classroom • Common profile of students with LD • Unexpected underachievement • Ability and achievement are discrepant • Reading difficulties • Speed and fluency • Comprehension • Mathematics difficulties • Problem solving • Resistance to treatment • Non-respondent to typical instruction

10. Recognizing LD in the Classroom(cont) • Other characteristics • Non-strategic • Inefficient / incorrect processing • Difficulty generalizing and transferring • Poor social skills • Negative attributions

11. Other Characteristics of Medical Students with LD • High intelligence • Lower reading comprehension • Poor spelling and handwriting • Reluctant to disclose LD or seek assistance • Loss of self-confidence; feelings of isolation • History of difficulty with standardized tests • Learning problems increase with increased demands of medical curriculum • Previously adequate strategies no longer effective Brinckerhoff, 1996

12. Facilitating Appropriate Educational Experiences for Students with LD • Achieved through accommodations designed to meet specific student needs • Coordinated through the Disability Resource Office • Role of Learning Specialists • Help identify appropriate accommodations for identified students • Coach students in learning strategies

13. Assessment • Part II • Duane Dede, Ph.D. • Clinical Professor • Clinical & Health Psychology • University of Florida • Health Science Center

14. Why Neuropsychological Testing? • Assess the cause of academic underachievement • Rule out neurodegenerative disorder • Diagnoses psychiatric disorder • Develop specific recommendations that capitalize on the individuals strengths and develop weaknesses

15. Attention Deficit Hyperactivity Disorder • 3 Types (DSM-IV; 1994) • Hyperactivity-Impulsivity • Higher in boys; Symptoms decrease with age; • Inattentive • Most common adult manifestation • Combined • ADHD is very often comorbid with LD (10 to 32%-Biderman et al, 1991; Riccio et al., 1994)

16. Diagnosis and treatment of ADHD(NIH Consensus Conference 11/98) • Impact on individuals, families and society • academic difficulties, peer rejection, disruptive behaviors, marital discord, divorce, disproportionate share of resources and attention from the health care system, criminal justice system, schools and social service agencies

17. Diagnosis and treatment of ADHD(NIH Consensus Conference 11/98) • Effective treatments • Medication plus behavioral therapy is the best. • Mediation alone produces little improvement in social skills • Social skills and associated comorbid LD symptoms need to be the target of treatment

18. Executive Dysfunction in ADHD • Ability to attend (Mirsky, 1989) • Ability to sustain and shift attention • Ability to regulate behavior • Ability to plan & organize • Ability to solve problems/adjust (flexible)

19. Example of ADHD problems • Individual may appear inattentive, but actually have difficulty inhibiting ongoing behaviors or to delay responding (manifests as poor organization). A failure to shift attention appropriately results from failure to interrupt an ongoing response.

20. The Impact of LDs Academics/ Learning Emotional/ Behavioral Functioning Work Performance

21. Emotional & Behavioral Functioning • Self Concept • Maturity level • Supportiveenvironment • Impulsivity • Adjustment problems • Personality Disorder • Depression/Anxiety • Primary or secondary

22. What should a good assessment do? • ANSWER THE REFERRAL QUESTION!!!!!

23. Neuropsychological Assessment • Comprehensive Clinical Interview • Domains • Intelligence • Language • Memory • Executive Functioning • Attention/Concentration, Organization, Problem Solving • Achievement • Personality • FEEDBACK

24. Meet with student to explain the results and recommendations Facilitate an understanding to increase the prognosis Answer questions “Destigmitize” any diagnoses Feedback

25. Cher Tom Cruise Albert Einstein Danny Glover Whoopi Goldberg Charles Schwab Jay Leno Greg Louganis James Earl Jones Nelson Rockefeller George Washington Robin Williams Mark Twain James Carville Anderson Cooper Magic Johnson Famous People with LDs or ADHD

26. Accommodations • Part III • Kenneth J. Osfield, Ed.D. • ADA Compliance Office • University of Florida

27. UF Students with Disabilities • Campus Demographics • Important to know the history of the growing population of students with disabilities • 1989-1990 – 202 students with disabilities registered • 25 self-indentified as LD • 2007-2008 – 1505 students with disabilities registered • 770 self-identified as LD • Why the huge increase in the number of registered students with disabilities? • ADA • Better informed K-12 staff (guidance, teachers, parents) • 1989 – 1990 ADA not in effect but instead the 1973 Rehabilitation Act (not as well known, though more specific to HE)

28. Numbers Nationally • Nationally – approximately 10% of students have some sort of disability and of that number approximately 40-60% have LD • There are many more students at UF with unreported disabilities. Only 3% have registered with disability resource center • Why? • Afraid to tell anyone for fear that they will be treated differently • Others, who do not need to know, will find out • Will impact their references and career in the future • Will not have same options as others in class (scholarships, internships, placement, etc.)

29. Students with Disabilities • Rehab Act opened door a crack but with ADA the door opened gradually & steadily until open • With the combination of ADA and 504 students are very well served on the UF campus • 2 offices providing specific service • ADA Office (compliance aspect) • Disability Resource Center • Direct classroom support

30. Support Offices • ADA Compliance Office • Bldg 179 Newell Drive • www.ada.ufl.edu • 392-7056 • Ken Osfield • Oversee UF’s Compliance aspect of ADA/504 • Disability Resource Office • Reid Hall • http://www.dso.ufl.edu/drc/ • 392-8565 • Jim Gorske • Responsible for “ALL” classroom related accommodations

31. UF Procedures • Faculty are encouraged to work with all students, however! • When students are suspected of having a disability we ask that they be referred to the appropriate staff • First to Medical College ADA Office (Amy Jaworski) • Ms. Jaworski would then refer to the Disability Resource Center (DSR) at Reid Hall (392-8565) • Student will work directly with DSR for accommodations • For students with documented disability, if there are questions • Contact the Disability Resource Center directly to discuss the accommodation letter. If you do not contact them it will be assumed that the accommodations are accepted and in place • For those faculty that work with all students without question we ask that when a student requests some sort of accommodation based on disability that you follow either referral step mentioned above. This is for the protection of all parties (student, faculty and university).

32. Referral • LD assessments can be very costly • LD assessments are the responsibility of the student, unless as a requirement for readmission or some sort of condition by the academic progress committee. • Many students at UF, with disabilities don’t know they have a disability. Many don’t find out until they hit a road block (e.g. pathology). • To receive accommodations they will need to show proof of disability

33. Referral Continued • Evaluations – the Disability Resource Center does provide need based scholarships to fund the cost of Psycho-Educational LD Assessments (completed by staff at the UF college of Ed). The number is limited. • Evaluations – the UF speech and hearing clinic in Dauer Hall will also provide evaluations for students with auditory processing issues. Their evaluations are based on students financial status. DSO will also cover cost for some students based on financial need. • Evaluations – the Disability Resource Center will refer other students to either a local provider (agreement for reduced fee) and the UF Clinical and Health Psychology (Neuropsychology).

34. Referral • Learning specialist – the DSO does have learning specialist available to work with students to develop learning strategies as a result of their specific learning issues.

35. Accommodation Process • Eligibility for classroom accommodations • Student must formally request academic accommodations as a result of a disability in order to be recognized as a person with a disability under the ADA • Prior to receiving any accommodations students must provide appropriate documentation to show they have a disability. • Documentation is kept on file at “only” the disability resource center.

36. Accommodation Process • Once documentation is presented, reviewed and authenticated a letter of accommodation will be written for the student. • The letter will address the fact that the student is registered, what accommodations are appropriate, but will not state what the specific disability is. • Students are not required to show their individual documentation to anyone outside of disability resources. • The information is confidential and protected (FERPA, HIPAA)

37. Accommodation Process • Once student has accommodation letter they should do the following: • They should inform the department so the department is aware of the situation and can act on behalf of the student when necessary • Share the letter with each faculty member they are requesting accommodations from • At this point if there are any questions about the accommodation the faculty member should contact the author of the letter to discuss • e.g. - the faculty member believes that one of the accommodations will not work but has a suggestion for something more appropriate.

38. Disclosure in the Accommodation Process • FERPA (Federal Family Educational Rights and Privacy Act of 1974) or the common name “The Buckley Amendment”. • Purpose to protect the privacy of students’ records • Allow students access to their educational records • HIPAA applies as well (student records but also medical)

39. Disclosure in the Accommodation Process • All records with regard to a student’s disability are kept in one central location (disability resources office). • Those records are not shared with anyone. The only thing disclosed is that the student is registered with the office and documentation has been validated. • Need to know – strict standard – only thing a provider needs to know is that the student has a disability and is registered and has been approved for specific accommodations.

40. Disabled Info is not Disclosed? • Why such a strict standard? • To protect the student at all costs. • The student comes first. • UF does not reveal the specific disability, but at times early in the accommodation process on campus, when the powers that be thought it was a need to know basis, some disclosure was made (most cases revolved around students with hidden disabilities – LD, ADHD, TBI, etc.). Since 1991 we haven’t disclosed any medical or disability related information to anyone on campus. • Disclosure does take place only when a serious threat or health safety issue arises.

41. Disabled Info is Not Disclosed • Example of why – student with a documented disability presents accommodation letter to faculty member. The faculty member proceeds to inquire as to the nature of the disability to a point where the faculty member tells the student that he doesn’t look disabled. After considerable browbeating the student gives in and reveals the disability. In this case the student had HIV. After a couple of hours I received a call from the Dean of the College’s office letting me know that faculty were talking about this student and his condition. The faculty member began to mention it to other faculty and they in turn spread the information (pre – HIPAA). Within a couple of hours the entire college knew of the student and his health related condition.

42. Accommodations • Some common accommodations • Note takers • Extended time on exams • Access to power point slides used in classroom • Permission to tape record lectures • Large print copies of handouts, exams and other written materials • Priority seating • Adaptive equipment • Reduced course load • Captioning, interpreters • Alternate format exams • Approval to use scribe for writing assignments • Reduced course load (difficult with med students but available)

43. Advocacy • On the UF campus there are many advocates to assist both the student and the faculty member. • The accommodation process has worked on the UF campus since 1975. Over time it has developed and improved. • Though the Disability Resource Center has the final say in what is a reasonable accommodation they are open to discussion. • Complaints related to disability go to the ADA compliance office.

44. Advocacy • Advocates • ADA Compliance office • Work with students, faculty, staff and the general public on disability compliance related issues • Oversees all UF policies, procedures that impact students, faculty and staff with disabilities • With the exception of classroom related accommodations all disability related issues should be referred to the ADA Office • All complaints (student, faculty, staff and public)

45. Advocacy • Disability Resource Center • Work with students, faculty and staff on all classroom related accommodations • LD specialist on staff to assist students with learning strategies and available to explain what is available to them and how the disability may impact learning • Will assist student in cutting through the red tape associated with classroom related accommodation issues

46. Advocacy • University Ombudsman • Available to work on issues between: • Student – student • Student - faculty

47. Treating the Whole Person Who will you be? The person with the correct tools but doesn’t use them to listen? The person with the magic potion for the current ailment? Their waiting for you! The key is at your disposal! Use it. With the right tools you can assist all your students Or someone who comes prepared to care for the whole person no matter what the issue?

48. Reference Material • www.ada.ufl.edu • Resources on web • UF publication on “Providing service and access to students and employees with disabilities in higher education: Effective and reasonable accommodations • Document provides information on issues specific to disability: UF policies, procedures, services, state and SUS rules and regulations, suggestions on working with students with various types of disabilities (LD, hearing, visual, physical, other) • Also available on website • Resource material on what services are available at all Florida State 4 year institutions and 2 year institutions.