Educational Educational Needs and Needs and

Services for Services for Children with Children with

EpilepsyEpilepsyDavid H. Salsberg, Psy.D., DABPS David H. Salsberg, Psy.D., DABPS ©©

Rusk Institute of Rehabilitation Rusk Institute of Rehabilitation The Stephen D. Hassenfeld Children’s Center The Stephen D. Hassenfeld Children’s Center

for Cancer and Blood Disordersfor Cancer and Blood DisordersNYU Langone Medical CenterNYU Langone Medical Center

When to become concernedWhen to become concerned What professionals do you consult What professionals do you consult

withwith What evaluations are availableWhat evaluations are available How to prepareHow to prepare What to do with the informationWhat to do with the information Special Education or notSpecial Education or not InterventionsInterventions

Parents and Parents and ProfessionalsProfessionals

Myriad of Labels/Diagnoses, Myriad of Labels/Diagnoses, Tests, Scores, and Tests, Scores, and

InterventionsInterventions

WPPSI-III, WISC-IV, WIAT-II, NEPSY-WPPSI-III, WISC-IV, WIAT-II, NEPSY-II…II…

LD, PDD, ADD, ADHD, SI, ED, APD, LD, PDD, ADD, ADHD, SI, ED, APD, TBI…TBI…

PT, OT, ST, IEP’s, EI, CPSE, CSE, 504 PT, OT, ST, IEP’s, EI, CPSE, CSE, 504 ……

Educational Implications for Children with

Epilepsy Etiology of Seizuresunderlying causes/conditions

Seizures frequency/control Medications and effects Age at Onset Secondary effects

missing schoolavailability for learningemotional/family/psychological

All can contribute to a variety of learning and attentional difficulties in children.

Issues in Educational Planning

Seizure plan Nurse Health paraprofessional Medications and effects Effects on learning

AttentionFatigue

Stigma and Social Considerations Dietary or activity restrictions Emotional and family issues affect

educational planning

When to take notice Developmental lags noted Discrepancy between skill area and

“norm” or expected Discrepancy between child’s own

individual strengths and weaknesses Signs/expressions of frustration; low self-

esteem Social skills difficulties Mood/behavior changes Academic and achievement difficulties

Birth to 3

Start with Evaluations – specific or more comprehensive?

Early Intervention – funded Private therapists Need team – integrated approach Center-Based Program / Home

program

When in doubt refer for evaluation Need to refer early If too early to qualify – need to

monitor Need to intervene earlier or can

miss developmental window of opportunity

Imperative in language skills development

Ages 3 - 5

Start with Evaluations – Specific or more comprehensive?

Therapy specific treatments CPSE – Board of Education/District Preschool options SEIT Crucial to evaluate early enough to

make decisions prior to Kindergarten.

School Age Schools start with pre-referral interventions Evaluations – specific or more

comprehensive? Committee on Special Education (CSE)

Pros and cons of evaluations, classifications,Section 504, legal issues

Therapies School Placement considerations

Primary EvaluationsPrimary Evaluations

PsychologicalPsychological

PsychoeducationalPsychoeducational

NeuropsychologicaNeuropsychologicall

HistoryHistoryIntelligence TestingIntelligence TestingBehavioral AssessmentBehavioral AssessmentEmotional/PersonalityEmotional/Personality

PsychologicalPsychologicaland Full Academic and Full Academic AchievementAchievement

All of the above and All of the above and further exploration of further exploration of areas of strengths and areas of strengths and weaknessesweaknesses

Developmental EvaluationsDevelopmental Evaluations

Developmental snapshots to guide Developmental snapshots to guide current treatment planning and current treatment planning and diagnosisdiagnosis

Needs ongoing monitoring and Needs ongoing monitoring and reassessment of treatment planreassessment of treatment plan

Not correlated with later IQNot correlated with later IQ Limitations of diagnoses/labels at an Limitations of diagnoses/labels at an

early ageearly age

Goal of Neuropsychological Goal of Neuropsychological TestingTesting

Go Beyond IQ and academic scores to Go Beyond IQ and academic scores to provide a complete picture of the provide a complete picture of the child’s cognitive, learning and child’s cognitive, learning and social/emotional functioning across social/emotional functioning across many domains related to brain many domains related to brain function. function.

Should beShould be functional perspective with functional perspective with clear and practical recommendations.clear and practical recommendations.

Testing ProfessionalsTesting Professionals

PsychologistsPsychologistsSchool/Educational (Master’s, School/Educational (Master’s, Doctorate)Doctorate)Clinical Ph.D., Psy.D.Clinical Ph.D., Psy.D.

NeuropsychologistsNeuropsychologists

Other Disciplines/TeamOther Disciplines/Team Neurology Neurology Pediatrician/Developmental Pediatrician Pediatrician/Developmental Pediatrician NursingNursing Psychiatry Psychiatry PhysiatryPhysiatry Physical TherapyPhysical Therapy Speech and Language Therapy Speech and Language Therapy Occupational TherapyOccupational Therapy Special Educators/learning specialistsSpecial Educators/learning specialists

All have specific scopes of practiceAll have specific scopes of practice

Pediatric SpecializationPediatric Specialization

ExperienceExperience RapportRapport Knowledge of educational systemKnowledge of educational system Limits of overly specialized, Limits of overly specialized,

diagnosis focused evaluations, diagnosis focused evaluations, clinicsclinics

Specific Issues in Specific Issues in EpilepsyEpilepsy

All of the aboveAll of the above Experience with Epilepsy and range Experience with Epilepsy and range

of learning, attentional and of learning, attentional and psychological issuespsychological issues

Timing and locations of evaluationsTiming and locations of evaluations Reason for referral may dictate or Reason for referral may dictate or

limit evaluation (i.e.: pre-surgical limit evaluation (i.e.: pre-surgical evaluation)evaluation)

District/School vs. District/School vs. Independent EvaluationsIndependent Evaluations

Independent evaluation:Independent evaluation: Parental controlParental control Timing/flexibility of evaluationTiming/flexibility of evaluation Goal should be to evaluate the child Goal should be to evaluate the child

holistically not just to get an evaluation doneholistically not just to get an evaluation done Specific recommendationsSpecific recommendations No conflict of interestNo conflict of interest

Needs to provide appropriate documentation Needs to provide appropriate documentation and recommendations to be accepted and and recommendations to be accepted and usefuluseful

Be sure to understand timing/procedural Be sure to understand timing/procedural issuesissues

Variability in ReportsVariability in Reports

Tester:Tester:TrainingTrainingStyleStyleOrganization/SettingOrganization/Setting

Tests usedTests used Who person is writing forWho person is writing for Referral QuestionReferral Question

Variability in Tests UsedVariability in Tests Used

Examiner’s choice/comfort levelExaminer’s choice/comfort level Availability of TestsAvailability of Tests Age of childAge of child Clinical JudgmentClinical Judgment

Preparation for Evaluation Preparation for Evaluation - Parents- Parents

Educate yourself regarding learning issues Educate yourself regarding learning issues and processand process

Delineate areas of concern/goals of evaluationDelineate areas of concern/goals of evaluation Understand clinician’s scope of experience Understand clinician’s scope of experience

and practice and ability to assess with a teamand practice and ability to assess with a team Should not focus primarily on single labelShould not focus primarily on single label Expect written report with practical Expect written report with practical

recommendations that is also geared toward recommendations that is also geared toward specific goal (ie: funding, admission…)specific goal (ie: funding, admission…)

Assure ongoing communication/follow-upAssure ongoing communication/follow-up Parents should receive feedback and then Parents should receive feedback and then

written report before school, districtwritten report before school, district

Preparation for Evaluation Preparation for Evaluation - Child- Child

Present evaluation in non-threatening, relevant Present evaluation in non-threatening, relevant and developmentally appropriate mannerand developmentally appropriate manner

Coordinate terminology and evaluation process Coordinate terminology and evaluation process with clinicianwith clinician

Consider classroom/therapy observationsConsider classroom/therapy observations Discuss specific behavioral/stylistic issues with Discuss specific behavioral/stylistic issues with

clinicianclinician Provide work samples, book bag, outside of Provide work samples, book bag, outside of

school examples of concernsschool examples of concerns Child should receive some form of feedback at Child should receive some form of feedback at

the endthe end

Factors Impacting TestingFactors Impacting Testing Why referred?Why referred? Motivation/AttitudeMotivation/Attitude RapportRapport Time Frame of testingTime Frame of testing DisabilitiesDisabilities Need to know what each test measures/doesn’t Need to know what each test measures/doesn’t

measuremeasure AgeAge Culture/LanguageCulture/Language Qualitative information necessary with scoresQualitative information necessary with scores MedicationMedication Seizure statusSeizure status In hospitalIn hospital

Overall Cognitive FunctioningOverall Cognitive FunctioningIntelligence Testing - IQIntelligence Testing - IQ

In neuropsychological and/or In neuropsychological and/or educational evaluation IQ test is educational evaluation IQ test is used as starting pointused as starting point

Normative ComparisonNormative Comparison Limitations of overall scoresLimitations of overall scores Limitations of IQ as a constructLimitations of IQ as a construct

IQ ScoresIQ Scores

IQ scores are often used as marker – IQ scores are often used as marker – need to make sure it is a good one!need to make sure it is a good one!

Overall scores do not take into Overall scores do not take into account variability in scores, account variability in scores, especially Full-Scale IQespecially Full-Scale IQ

Discrepancy Based LD Discrepancy Based LD EvaluationEvaluation

Discrepancy between IQ and achievementDiscrepancy between IQ and achievement Discrepancy between child and same Discrepancy between child and same

age/grade peersage/grade peers *Discrepancy between child’s own *Discrepancy between child’s own

abilities and what should be expectedabilities and what should be expected

What is clinically meaningful should What is clinically meaningful should translate to what is educationally and translate to what is educationally and legally relevantlegally relevant

IQ ScoresIQ Scores

In an effort to broaden the construct of In an effort to broaden the construct of IQ newer IQ measures incorporate IQ newer IQ measures incorporate numerous skillsnumerous skills

Most notable – WISC-IV – can have high Most notable – WISC-IV – can have high “traditional” IQ areas (Verbal, “traditional” IQ areas (Verbal, Performance) and have Full-Scale IQ Performance) and have Full-Scale IQ lowered by Processing Speed and lowered by Processing Speed and Working MemoryWorking Memory

General Abilities Index – not always used General Abilities Index – not always used but should be in many casesbut should be in many cases

PreschoolPreschool

Wechsler Preschool and Primary Wechsler Preschool and Primary Scale of Intelligence-III (WPPSI-III) Scale of Intelligence-III (WPPSI-III)

Ages 2:6 – 7:3Ages 2:6 – 7:3

Limitations of ERBLimitations of ERB

School Age IQSchool Age IQ Wechsler Intelligence Scale for Children-Wechsler Intelligence Scale for Children-

Fourth Edition (WISC-IV)Fourth Edition (WISC-IV)Ages: 6 – 16:11Ages: 6 – 16:11

Stanford Binet Intelligence Scales – 5Stanford Binet Intelligence Scales – 5thth EditionEditionAges 2:0 – 89:11Ages 2:0 – 89:11

Wechsler Adult Intelligence Scale-Fourth Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)Edition (WAIS-IV)Ages: 16 and upAges: 16 and up

Wechsler Abbreviated Scale of Intelligence Wechsler Abbreviated Scale of Intelligence (WASI)(WASI)Ages: 6 and upAges: 6 and up

Speech and LanguageSpeech and Language

Neuropsychologists screen these areas in Neuropsychologists screen these areas in relation to full battery – gather from Speech-relation to full battery – gather from Speech-Language EvaluatorsLanguage Evaluators

Speech/Oral-Motor not the same as LanguageSpeech/Oral-Motor not the same as Language Need to gather audiological testing informationNeed to gather audiological testing information Look at expressive and receptive skills in a Look at expressive and receptive skills in a

variety of contextsvariety of contexts Auditory Processing - APDAuditory Processing - APD Adds valuable information to IQ scoresAdds valuable information to IQ scores Augmentative CommunicationAugmentative Communication

Visual-Motor/Visual-Visual-Motor/Visual-PerceptualPerceptual

Parts of evaluations overlap w/ OT, Parts of evaluations overlap w/ OT, especially in neuropsychological especially in neuropsychological evaluationevaluation

Visual-PerceptualVisual-Perceptual Neglect / InattentionNeglect / Inattention Visual-MotorVisual-Motor ApraxiaApraxia Sensory IntegrationSensory Integration Assistive TechnologyAssistive Technology Gross-Motor - PTGross-Motor - PT

Other Areas of Other Areas of Neuropsychological EvaluationNeuropsychological Evaluation Attention and ConcentrationAttention and Concentration

(In 1:1 structured testing setting)(In 1:1 structured testing setting) MemoryMemory

visual; verbal; procedural; recall vs. visual; verbal; procedural; recall vs. recognitionrecognition

Executive Functioning: Executive Functioning: Planning, organization, sequencing, Planning, organization, sequencing, working efficiently, flexibility, working efficiently, flexibility, impulsivityimpulsivity

Executive Functioning/Attention and Executive Functioning/Attention and ConcentrationConcentration

Impulse controlImpulse controlDistractibilityDistractibilityAttention: Focused; selective; sustained/vigilance Attention: Focused; selective; sustained/vigilance Auditory/VisualAuditory/Visual

Not only attention – but organization, Not only attention – but organization, consolidation, etc…consolidation, etc…Planning, organization, time managementPlanning, organization, time managementMental flexibilityMental flexibility

May not manifest until olderMay not manifest until older

MemoryMemory

Most common complaint – but influenced Most common complaint – but influenced by attention/executive functioning skillsby attention/executive functioning skills

VisualVisualVerbalVerbalProceduralProceduralRecall vs. recognitionRecall vs. recognitionShort-term vs. long-termShort-term vs. long-termLong-term – usually intact – but retrieval Long-term – usually intact – but retrieval strategies may be impactedstrategies may be impacted

Academic Achievement Academic Achievement Tests:Tests:

Limitation of brief screening of single-Limitation of brief screening of single-word reading, spelling and arithmetic in word reading, spelling and arithmetic in diagnosing learning problems.diagnosing learning problems.

Reading: decoding, sight words, Reading: decoding, sight words, comprehension, speed, fluency…comprehension, speed, fluency…

Need different tests for reading Need different tests for reading comprehensioncomprehension

Teacher estimates are too subjective.Teacher estimates are too subjective. Importance of, but also limitations of Importance of, but also limitations of

Grade-Equivalents.Grade-Equivalents. Standard Scores may be based on age or Standard Scores may be based on age or

grade – very important.grade – very important.

Problems in Diagnosing LDProblems in Diagnosing LD

Discrepancy analysisDiscrepancy analysis

Qualitative/subtleties of difficultiesQualitative/subtleties of difficulties

Structured 1:1 settingStructured 1:1 setting

Difficulties do not always manifest Difficulties do not always manifest themselves yet or on certain tests.themselves yet or on certain tests.

Personality/Emotional Personality/Emotional TestingTesting

ProjectivesProjectivesRorschach (Exner Comprehensive System Scoring)Rorschach (Exner Comprehensive System Scoring)Thematic Apperception TestThematic Apperception TestRoberts Apperception Test – 2Roberts Apperception Test – 2Sentence CompletionSentence Completion

Clinical InterviewClinical Interview Objective measuresObjective measures

MMPI-A or MMPI-2MMPI-A or MMPI-2BASC-2BASC-2

PIC/PIYPIC/PIY All dependent on cognitive skillsAll dependent on cognitive skills Rating Scales – limitations but widely used – be Rating Scales – limitations but widely used – be

careful – needs to correspond with clinical careful – needs to correspond with clinical observation, other data….observation, other data….

DepressionDepression AngerAnger AnxietyAnxiety Reality TestingReality Testing DefensesDefenses Coping abilities/styleCoping abilities/style MotivationMotivation Self-esteem/confidenceSelf-esteem/confidence Frustration toleranceFrustration tolerance

Emotional functioning needs to be given Emotional functioning needs to be given more concern before behavioral more concern before behavioral manifestationmanifestation

Family/Developmental Family/Developmental issuesissues

Independence/DependenceIndependence/Dependence Depending on age of onset may not Depending on age of onset may not

have a goal of returning to previous have a goal of returning to previous level of independence and level of independence and autonomy/achievement.autonomy/achievement.

Parents often more protective ‑ Parents often more protective ‑ furthering these difficultiesfurthering these difficulties

Fantasy of all-protective parent/safe Fantasy of all-protective parent/safe world potentially impactedworld potentially impacted

Social IssuesSocial Issues

Adaptive FunctioningAdaptive Functioning

Activities of Daily LivingActivities of Daily Living Measures:Measures:

Vineland-2Vineland-2ABAS-IIABAS-II

ObservationObservation InterviewsInterviews Needed for diagnosis of Mental Needed for diagnosis of Mental

RetardationRetardation

Individuals with Disabilities Individuals with Disabilities Education Improvement Act of Education Improvement Act of

2004 (IDEA 2004)2004 (IDEA 2004)Purpose:Purpose:          To ensure that all children with To ensure that all children with disabilities have available to them a free disabilities have available to them a free appropriate public education that appropriate public education that emphasizes special education and related emphasizes special education and related services designed to meet their unique services designed to meet their unique needs and prepare them for further needs and prepare them for further education, employment, and independent education, employment, and independent living. 20 U.S.C. Sect. 1400(d)living. 20 U.S.C. Sect. 1400(d)

Individuals with Disabilities Education Act

All children with disabilities receive a free appropriate public education (FAPE)

A school district must provide special education and related services (PT, OT, Speech, Special Education, Counseling, Health paraprofessional) at no cost to the child or his/her parents.

Only required to provide what’s appropriate – not optimal or best

Parental Referral to Local Parental Referral to Local Education AuthorityEducation Authority

Write a letter to the Chairperson of your Committee Write a letter to the Chairperson of your Committee on Special Education requesting an evaluation for on Special Education requesting an evaluation for possible special education needs.possible special education needs.

Federal and New York State law requires that Federal and New York State law requires that Districts complete the evaluation process within 60 Districts complete the evaluation process within 60 school (business) calendar days.  school (business) calendar days. 

All communication with your district should be in All communication with your district should be in writing, and you must have proof of delivery of all writing, and you must have proof of delivery of all communication.communication.

Your School District cannot refuse to evaluate your Your School District cannot refuse to evaluate your child upon your request.child upon your request.

EvaluationEvaluation

Parents must consent to an initial evaluation.Parents must consent to an initial evaluation.  A variety of assessment tools and strategies must A variety of assessment tools and strategies must be utilized to gather relevant functional, be utilized to gather relevant functional, developmental, and academic information about developmental, and academic information about the child.  This includes information provided by the child.  This includes information provided by the parent.the parent.

No single measure or assessment may be used as No single measure or assessment may be used as the sole criterion for determining whether a child the sole criterion for determining whether a child is a child with a disability or to determine an is a child with a disability or to determine an appropriate educational program.appropriate educational program.

Must be appropriate to be used with that child.  Must be appropriate to be used with that child. 

Copies of results of all assessments performed Copies of results of all assessments performed must be provided to the parents, at no cost.  must be provided to the parents, at no cost. 

Identification/Development of Identification/Development of an IEPan IEP

Determination of eligibilityDetermination of eligibility

ClassificationClassification

Program RecommendationProgram Recommendation

Present Levels of Academic PerformancePresent Levels of Academic Performance

Goals/ObjectivesGoals/Objectives

Related ServicesRelated Services

ClassificationClassification

Section 504 - Section 504 - Section 504 of the American Section 504 of the American with Disabilities Act requires recipients to with Disabilities Act requires recipients to provide to students with disabilities provide to students with disabilities appropriate educational services designed appropriate educational services designed to meet the individual needs of such to meet the individual needs of such students to the same extent as the needs of students to the same extent as the needs of students without disabilities are met. A students without disabilities are met. A 504 Accommodation does not require an 504 Accommodation does not require an IEP, but simply provides for classroom IEP, but simply provides for classroom modifications and/or related servicesmodifications and/or related services

CPSE – Preschooler with DisabilityCPSE – Preschooler with Disability CSE – 13 ClassificationsCSE – 13 Classifications

Classification AutismAutism DeafnessDeafness Deaf/BlindnessDeaf/Blindness Emotional DisturbanceEmotional Disturbance Hearing ImpairmentHearing Impairment Learning DisabilityLearning Disability Mental RetardationMental Retardation Multiple DisabilitiesMultiple Disabilities Orthopedic ImpairmentOrthopedic Impairment Other Health ImpairmentOther Health Impairment Speech or Language ImpairmentSpeech or Language Impairment Traumatic Brain InjuryTraumatic Brain Injury Visual Impairment including BlindnessVisual Impairment including Blindness

*Can have very different implications for services and placement

PlacementPlacement

This is performed at the CSE meeting, This is performed at the CSE meeting, except in New York City, where this is except in New York City, where this is done by the placement office.done by the placement office.

You do have the right to view any You do have the right to view any placement proposed for your child.placement proposed for your child.

Charge and goal is for the least restrictive Charge and goal is for the least restrictive environment (LRE)environment (LRE)

School PlacementSchool Placement Section 504 – Not CSESection 504 – Not CSE Public School General Education with related Public School General Education with related

servicesservicesTherapiesTherapiesSpecial Education Teacher Support Services Special Education Teacher Support Services (SETSS)(SETSS)ParaprofessionalParaprofessional

Inclusion /Co-teaching/CTTInclusion /Co-teaching/CTT 12:112:1 12:1:1, 8, 6….12:1:1, 8, 6…. NPS – approved schoolsNPS – approved schools

http://www.vesid.nysed.gov/specialed/privateschoolshttp://www.vesid.nysed.gov/specialed/privateschools//

Carter FundingCarter Funding

Dispute ResolutionDispute Resolution Independent Educational Evaluation (IEE)Independent Educational Evaluation (IEE)

Parent has the right to an IEE if they disagree with an Parent has the right to an IEE if they disagree with an evaluation obtained by the districtevaluation obtained by the districtUpon request by a parent for an IEE, a District must Upon request by a parent for an IEE, a District must either file a due process complaint to show that its either file a due process complaint to show that its evaluation is appropriate or ensure than an IEE is evaluation is appropriate or ensure than an IEE is provided at public expenseprovided at public expense

MediationMediationVoluntary; must be conducted by a qualified and Voluntary; must be conducted by a qualified and

impartial mediator; must be paid for by the District, impartial mediator; must be paid for by the District, who maintains a list of qualified mediators that are who maintains a list of qualified mediators that are assigned on a rotational or random basis; It is binding assigned on a rotational or random basis; It is binding

Impartial Hearing – Impartial Hearing OfficerImpartial Hearing – Impartial Hearing Officer

Appeals – State level firstAppeals – State level first

ADHD/ADDADHD/ADD

HyperactivityHyperactivity ImpulsivityImpulsivity DistractibilityDistractibility

Issues to ConsiderIssues to Consider DevelopmentalDevelopmental Gender BiasGender Bias Overly diagnosed/overly simplifiedOverly diagnosed/overly simplified Medication issues in EpilepsyMedication issues in Epilepsy

PDDPDD

AutismAutism Rett’sRett’s Childhood Disintegrative DisorderChildhood Disintegrative Disorder

Asperger’sAsperger’s PDD-NOSPDD-NOS

Wide variability in presentationWide variability in presentation

Learning DisabilitiesLearning Disabilities

SpecificSpecificDyslexia, Dysgraphia, DyscalculiaDyslexia, Dysgraphia, Dyscalculia

Non-Verbal Learning DisabilitiesNon-Verbal Learning Disabilities More GeneralMore General Gaps in abilities/IQ and achievementGaps in abilities/IQ and achievement DevelopmentalDevelopmental Track over time/different demandsTrack over time/different demands

Sensory IntegrationSensory Integration

Organizing, integrating and Organizing, integrating and interpreting sensory input in a variety interpreting sensory input in a variety of modalities including: touch, of modalities including: touch, movement, body awareness, visual, movement, body awareness, visual, and auditory information.and auditory information.

DevelopmentalDevelopmental Does it impact functioning?Does it impact functioning? Overlaps and/or interacts with other Overlaps and/or interacts with other

diagnoses conditionsdiagnoses conditions

Auditory ProcessingAuditory Processing

Difficulties in processing orally Difficulties in processing orally presented information even though presented information even though hearing is within normal limitshearing is within normal limits

Beware of “knee-jerk” labelBeware of “knee-jerk” label Audiologist needs to diagnoseAudiologist needs to diagnose Age expectations – These skills Age expectations – These skills

develop between ages 5-7.develop between ages 5-7. Interventions/recommendationsInterventions/recommendations Overlap with other diagnosesOverlap with other diagnoses

RecommendationsRecommendations School placement School placement Therapies/InterventionsTherapies/Interventions Compensatory techniques and strategiesCompensatory techniques and strategies Modifications in the EnvironmentModifications in the Environment Accommodations/ExpectationsAccommodations/Expectations Assistive TechnologyAssistive Technology Medication/TreatmentsMedication/Treatments Some sound good but may not help (e.g. Some sound good but may not help (e.g.

tape recording lectures requires >2x to tape recording lectures requires >2x to listen and transcribe; laptop in class – only listen and transcribe; laptop in class – only if great/fast typist…)if great/fast typist…)

SummarySummary

Need to incorporate all objective Need to incorporate all objective data, scores from testing, data, scores from testing, observations, outside therapists, observations, outside therapists, history, emotional/personality history, emotional/personality variables, family, and school data in variables, family, and school data in order to make well thought out order to make well thought out decisions for children.decisions for children.

Need to know rights and law as well.Need to know rights and law as well.

Parents Know BestParents Know Best

Trust your instinctsTrust your instincts Be involved / carry-overBe involved / carry-over Educate yourselves Educate yourselves

(pros and cons of internet)(pros and cons of internet) Work closely with medical teamWork closely with medical team Know your rights Know your rights

(Advocacy/Lawyers)(Advocacy/Lawyers)