Evaluation status so far....

[Ltlredhen]

Here is a time line for all of those who have forgotten.

December 2004 - difficult child diagnosis'd with Early Onset Bi-Polar (EOBP), ADHD and Sensory Integration Disorder (SID) by neuropsychologist at large teaching hospital.

Dec 2004 - Nov. 2005 treated by pediatrician psychiatric in large metropolitan city for mood disorder -not otherwise specified and ADHD combined(how ins was billed)

December 2005 moved to new psychiatrist that was closer and still seeing---diagnosis'd and treated by pediatrician psychiatric for mood disorder -not otherwise specified. (how ins is being billed)

March 2006 had difficult child evaluated (I thought was an evaluation)by school dist and he was given psychological exam by the SD psy and found diagnosis of Pervasive Developmental Disorder (PDD) - not otherwise specified. difficult child was placed in a PPCD class for next 3 months. Last day of school, difficult child was "dismissed" from SE and referred to mainstream preK.

August 2006 asked the new elem to re-evaluation and they stalled, saying take wait and see approach. Sent cert. letter, got full evaluation. done.

Sept 2006 exact same SD psychologist re-evaluation. and this time report says he is essentially normal. No need for placement of any kind, does not meet criteria for TEA severely emotionally disturbed or TEA criteria for handicapping of Pervasive Developmental Disorder (PDD).

I've been hesitant discussing this on the board due to concerns the SD is following my posts (if you are, then shame on you).

I believe I've been given good advice on what my next step will be...just would like to hear what anybody else has to say.

ARD meeting is this coming Monday. Guess one of my big questions will be--- since when did Lithium/Abilify become the cure for Pervasive Developmental Disorder (PDD)?

Anybody know of documentation that I can cite that proves you don't get cured from Pervasive Developmental Disorder (PDD) in 6 months? Seems like the psy reports cancel each other out to me.

Need all the input you guys got in the next few days.

Thanks,

Donna

 

[Sheila]

Did you get a full copy of the report?

Anybody know of documentation that I can cite that proves you don't get cured from Pervasive Developmental Disorder (PDD) in 6 months?

Yale Developmental Disabilities Clinic
http://medicine.yale.edu/childstudy/index.aspx#prognosis

What is the prognosis for my child with autism/Pervasive Developmental Disorder (PDD)?

Clearly it is impossible to make a generalization about how any individual child will grow and progress. All children continue to develop, despite delays or the presence of deviant behaviors. Information that we have currently about the progress of adults with autism is based on the treatments these individuals received twenty or thirty years ago. Our knowledge base about what educational strategies are most effective with these children has increased tremendously over the last ten to twenty years. A child diagnosed with autism will receive much different intervention beginning at an earlier age than was possible many years ago. This means each child's chances for remediating behavior are greater today than years ago.

What is the best intervention for my child with autism/Pervasive Developmental Disorder (PDD)?

Although it has no cure, autism does respond to behavioral and educational treatment. Research suggests that early intervention is especially effective in achieving growth in cognitive and communication skills. There are a variety of intervention programs that have been designed specifically to work with children with autism. Parents may hear that one or another of these (such as "Floor Time," "FastForWord," "ABA," "Auditory Integration Training," or "Social Stories") is THE intervention that a child must have to make progress. Unfortunately, there is little evidence to support the claim that any one intervention program will guarantee progress for all children with autism. Like children everywhere, children with autism differ from each other. Like all children, they differ in terms of their IQs, their interests, their strengths, and their educational needs. An intervention program must be individually designed, with the help of experienced professionals, so that it is tailored to the strengths, interests and needs of each child with autism. In general, operant behavioral programs, such as ABA, are often helpful in initiating behaviors the child does not show spontaneously. But operant programs will need to be supplemented by more naturalistic approaches that encourage the child to use newly learned behaviors in real life situations. Successful intervention programs usually involve a mix of highly structured and more naturalistic activities and have the following properties:

Individualized
Specialized curriculum for children with autism
Strong communication component
Family involvement
Systematic, structured teaching
Intensity of engagement (at least 20 hours/week)
Developmentally appropriate practice
Some contact with typical peers
Parents should be wary of any intervention that promises a cure or suggests that its method is the only effective approach. Parents should also suspect any program that requires parents to personally pay high fees. Children with autism are entitled to public educational services and legitimate services should be provided by public agencies. Parents should not be obligated to pay for educational services themselves.

Next Steps - A Guide for Families New to Autism by Autism Society of America
https://web.archive.org/web/2009041...m-society.org/site/DocServer/nextsteps06.pdf?
How Can Autism
Be Treated?
There is currently no cure for
autism. However, continued
research has provided a clearer
understanding of the disorder
and has led to better treatments
and therapies. Studies have
shown that appropriate educational
intervention can lead to better
outcomes for children with autism.
Early intervention can significantly
improve the quality of life for
individuals with autism, however,
the majority of individuals with
Autism Spectrum Disorders (ASD) will continue to exhibit
some symptoms in varying
degrees throughout their lives
and may require lifelong care
and supervision.
The most effective programs share
an emphasis on early, appropriate,
and intensive intervention.

From US Dept of Education
http://www.ed.gov/legislation/FedRegister/announcements/2006-4/111706c.html

Autism Spectrum Disorders (ASD) is a complex developmental disability that affects individuals
in the areas of communication and social interaction. In addition,
unusual learning, attention, and sensory processing patterns are often
present. Autism Spectrum Disorders (ASD) includes autistic disorder, pervasive developmental
disorder--not otherwise specified (Pervasive Developmental Disorder (PDD)-not otherwise specified, including atypical autism),
and Asperger disorder. The increased number of children diagnosed with
Autism Spectrum Disorders (ASD) is a serious concern for families, service providers, and policy-
makers, as existing education and other service delivery systems
struggle to respond to the educational and other service needs of this
population in a comprehensive manner.

The increased incidence of Autism Spectrum Disorders (ASD) among children has greatly increased
the demands placed on early intervention and educational systems due to
the complexity of Autism Spectrum Disorders (ASD), including the unique ways children with Autism Spectrum Disorders (ASD)
process and respond to information, the variability of how Autism Spectrum Disorders (ASD) affects
each child, and the often extreme and unusual communication and
socialization challenges of children with Autism Spectrum Disorders (ASD).

Results from Office of Special Education Programs' (OSEP) funded
projects and related research have demonstrated that children with Autism Spectrum Disorders (ASD)
who receive intensive early intervention and educational services from
skilled personnel often make very significant functional improvements.
A growing body of intervention and service research points to the need
for greater use of evidence-based practices by school and early
intervention personnel.

We'll be hovering over your shoulder.

 

[Ltlredhen]

I'm going to go to the district office today and see if there is copy of the Occupational Therapist (OT) report in his file. I had put in the letter when I requsted the evaluation. that I wanted a copy of all reports sent to me so that I could review them before the meeting. Guess the school sorta looked over that statement.

Thank you so much for the information you sent. That's just what I was looking for. by the way, I made contact with the person we spoke about. Thanks for the input.

Had a light bulb moment last night, school psy saying difficult child does not meet criteria to have him diagnosis'ed with Pervasive Developmental Disorder (PDD) or other severe emotional disturbed at this time. She didn't say he didn't have it, just not enough to meet the TEA qualifications. Is that how you see it? The words OHI never entered for the bipolar diagnosis.

Ok, so the school gives and takes away a diagnosis of Pervasive Developmental Disorder (PDD). What to do with the OHI diagnosis (given by real medication docs) and how that affects difficult child on daily basis. That's the question I need to have them answer. I've asked about the bipolar diagnosis all along, they are the ones that keep bringing up the Pervasive Developmental Disorder (PDD). It's sorta funny (NOT!), it is like they have a sensor that bleeps out that word when it is spoken out loud. The pretend not to hear it and dance all around it when it comes up in conversation.

How about getting myself a sweat shirt with the word BIPOLAR IS REAL printed on the front and wear it to the ARD

Donna

 

[Sheila]

You are correct. difficult child can be identified as OHI.

The IDEA Classification Debate: ED or OHI?
by Donna Gilcher, Ruth Field and Martha Hellander

What is the most appropriate classification for students with bipolar disorder under the Individuals with Disabilities Education Act (IDEA)? Parents and schools face this question each time they meet to develop a student’s Individual Educational Plan (IEP). Although IDEA states that special education services are not categorically driven but must instead be driven by student need, parents often are told that appropriate accommodations for behavioral issues are not possible without an Emotionally Disturbed classification. This belief may arise from a misunderstanding of how IDEA defines these categories.

IDEA defines Emotionally Disturbed (ED) as follows:

“Emotionally Disturbed means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:
(a) An inability to learn that cannot be explained by intellectual, sensory, or health factors
(b) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers
(c) Inappropriate types of behavior or feelings under normal circumstances
(d) A general pervasive mood of unhappiness or depression
(e) A tendency to develop physical symptoms or fears associated with personal or school problems.


The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance” (IDEA sec. 300.7c4).

IDEA defines Other Health Impaired (OHI) as follows:

“Other Health Impaired 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—
(a) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and
(b) adversely affects a child’s educational performance” (IDEA sec300.7c9).

Looking at the above guidelines, it is apparent that children with pediatric bipolar disorder are most appropriately categorized as OHI. Pediatric bipolar disorder is a medical condition that can be explained by intellectual, sensory, and general health factors, in contrast to the definition of ED. All of the symptoms of ADHD, a condition specifically named under OHI, are also seen in bipolar disorder.

The biological nature of bipolar illness as a disorder of the brain like epilepsy or ADHD is manifestly clear from research published in leading medical journals. Both structural brain development and the functioning of neural networks are affected. For example, recent studies have demonstrated regional volume reductions, enlargements, or other abnormalities in the temporal lobes, caudate nuclei, amygdala, hippocampus, neocortex, and other structures of the brain in patients with bipolar disorder (El-Badri et al, 2000; Cecil et al, 2002). Recent work done by Husseini K. Manji, M.D., Chief, Laboratory of Molecular Pathophysiology at the National Institute of Mental Health, and colleagues has demonstrated that cellular plasticity and resilience is also abnormal, with accumulating evidence showing alterations in the mitochondria, reduced brain cell growth factor, and accelerated brain cell atrophy and death. Some of these abnormalities appear to be reversible by treatment with lithium and other medications used to treat the illness in adults.

Bipolar disorder is clearly a disability, as defined by OHI, that demonstrates “having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that result in limited alertness with respect to the educational environment.” The physical energy and alertness of a child with bipolar disorder can fluctuate dramatically by season, by cycles (which may last from days to months) and even several times over the course of a single day. Children with this disorder typically have a disturbed sleep/wake cycle that includes low arousal and difficulty awakening from sleep in the morning (much more so than a normal child of the same age), and may include increasing energy throughout the day with extreme hyperactivity in the late evening that prevents normal sleep. During hypomania or mania, the child may move very quickly with heightened concentration and focus, during which time academic progress may occur in leaps and bounds. An outpouring of creativity may occur during mania in some children, with attention hyper-focused upon topics that engage the child’s interest. When depressed, the child may move extremely slowly and experience fatigue, reduced concentration and alertness, during which time little or no academic progress may occur. Disturbances in endocrine functioning, which affect body weight, growth, puberty, and energy, are also common.

Cognitive abilities are also impaired. Attention, shifting tasks, verbal learning, declarative memory and visuospatial memory are often found to be impaired on neuropsychological testing of bipolar students (Dickstein et al, 2004). A lack of ability to easily recall information or process it correctly within the classroom, which in some children may be a constant trait but seen in others only during acute episodes, often leads students to experience distress and failure on academic testing. Executive functioning difficulties are common in students with bipolar disorder, leading to poor organizational skills (Clark, 2001; Chowdhury et al, 2003). Stress exacerbates these cognitive problems. Such deficits can lead to impulsivity, distractibility, and poor decision-making, just as they do in ADHD, which is specifically listed under OHI.

Some children appear to lose cognitive abilities as the illness progresses, although some do not, and recovery between episodes is possible. A study examining school functioning in bipolar adolescents showed a significant decline in academic abilities after onset of the illness. Researchers at the Sunnybrook Health Science Center in Toronto, Canada, concluded that the “onset of bipolar illness negatively impacts a child’s ability to function effectively in the school environment and that very specific program modifications are required in order to optimize the child’s success at school” (Quackenbush et al, 1996). Medication to control symptoms of the illness may impair or improve cognition and have other unavoidable side effects. Difficult treatment decisions must be made by physicians and parents.

Behavioral symptoms that impair learning are often produced by the illness. Rages, negative peer relationships, and the inability to interpret social situations and react appropriately, are common. Some children with the illness experience powerful social anxiety that at times prevents them from attending regular school. Impulsivity can lead to verbal outbursts that the child may not be able to control. Some children manage to contain their behavioral symptoms during school but are unable to do so at home. Some children (more often boys but some girls) will show more externalizing behaviors, while others (more often girls but some boys) will internalize their distress. Children with bipolar disorder tend to interpret neutral facial expressions as negative, which affects relationships. Since no two children are alike, behavioral symptoms vary widely both between students, and in each child, during different episodes of the illness.

Full text here: http://www.bridges4kids.org/phprint.php

 

[Sheila]

Don't let their terminology confuse you. The criteria for the ED category is the same whether it's Texas citations or Federal citations.

Pertinent citations regarding ED. Note that it contains Federal and State regs.

State: Eligibility definitions.
(4) Emotional disturbance. A student with an emotional disturbance is one who has been determined to meet the criteria for emotional disturbance as stated in 34 CFR, §300.7(c)(4). The written report of evaluation shall include specific recommendations for behavioral supports and interventions.

Federal 34 CFR, §300.7(c)(4) :

Emotional disturbance is defined as follows:

(i) The term means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.
(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
(C) Inappropriate types of behavior or feelings under normal circumstances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symptoms or fears associated with personal or school problems.

(ii) The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.

 

[wincha]

I would request an IEE at their expense. He would most likely benefit from being under the autism label to get more services.