School Psych PLC December 5, 2013

1. School Psych PLCDecember 5, 2013 Brian Lloyd Ed.S., NCSP

2. 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

3. 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)

4. DSM-5 Overview • Non-Axial • NOS replaced with other specified disorder and unspecified disorder • GAF is dropped

5. Specific Learning Disorder (SLD)

6. 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.)

7. 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.

8. 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.

9. 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

10. 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. 

11. 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).

12. 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.

13. 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.

14. 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.

15. 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!)

16. 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: 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. 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. Onset of intellectual and adaptive deficits during the developmental period.

17. 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.

18. 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)

19. DSM-5 Autism Spectrum Disorder Criteria • 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) • 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. • 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. • 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.

20. 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) • 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).

21. 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

22. DSM-5 Autism Spectrum Disorder Criteria 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). Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. 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.

23. DSM-5 Autism Spectrum Disorder Changes Source: https://www.regonline.com/custImages/250000/250066/DSM5_PTI_2013.pdf • Diagnostic Labels Were Merged– No more Asperger's • 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 • Require more of restricted, repetitive patterns of behavior, interests, or activities (used to be one, now two) • Social (Pragmatic) Communication Disorder: • Focus on communication, but not repetitive/ restrictive behaviors • May cover those excluded by requiring 2 criteria

24. DSM-5 ADHD Criteria • A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2). • 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: • 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.

25. DSM-5 ADHD Criteria Continued… • 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. • 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.

26. DSM-5 ADHD Criteria Continued… Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings. There is clear evidence that the symptoms interfere with, or reduce the quality of social, academic, or occupational functioning. 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

27. 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 Attention-Deficit/Hyperactivity Disorder • Symptoms are bad, but don’t meet ADHD criteria.

28. 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.

29. 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

30. 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.

31. 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.

32. Big Point!!!!! Instruction Changes Neurology!

33. Overcoming Dyslexia

34. 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 False

35. 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). False

36. 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 True

37. 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. False

38. 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 True and False

39. 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 False

40. 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. True

41. 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

42. 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 True

43. 10. Placing children in classrooms based on their specific disability is permissible by federal law. False, False, False 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

44. Eligibility Decision Tells us whether or not interventions require special education resources. Tells us how unique the student is compared to peers. Tells us what accelerates learning. Tells us what and how to teach. = Discrepancy Educational Progress Educational Needs Eligibility Decision = + +

45. Impact of Focus on Evidenced-Based Practices John Hattie

46. Evidenced-Based Practices Feedback .75 Teacher-Student Relationships .72 Teacher Clarity .75 Classroom Management .52

47. Evidenced-Based Practices Explicit Instruction .75 Questioning .46 Reciprocal Teaching .74 Spaced vs. Massed Practice .71

48. 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?

49. 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.

50. DISCUSSION?