Minnesota Chapter of the American Academy of Pediatrics

Amanda Hyatt Fields, PhD

<p dir="LTR" align="LEFT">By Amanda Hyatt Fields, PhD, LP, pediatric neuropsychologist at Park Nicollet&#8230;</p>
<p dir="LTR" align="LEFT">Identifying learning disabilities and determining eligibility for special services can be both confusing and frustrating. The reason, in part, may be attributed to differences between school and medical definitions of what constitutes a learning disorder.  To identify a student as learning disordered in the schools, the child must meet specific criteria for a specific disability as outlined by the federal government in IDEIA 2004, whereas the medical model focuses on statistical differences using a variety of different measures.</p>
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<p dir="LTR" align="LEFT">SCHOOL: When a child struggles at school, a committee meets to develop an intervention plan (RTI). If the interventions are ineffective, the child may be referred for a special education evaluation. The evaluation includes formal testing, parent and teacher reports, classroom observations, and other sources of information (medical reports, etc.) and must be completed within a prescribed amount of time (varies from state to state). Once completed, the committee meets to determine eligibility using a regression table which supplies correlations between ability and achievement.</p>
<p dir="LTR" align="LEFT">MEDICAL: The neuropsychological (medical) model uses a differential diagnostic approach to determining the presence of a learning disorder. This model employs a battery of tests designed to determine the source and nature of the child’s difficulties by assessing pertinent neuropsychological domains, including executive function, visuo-spatial, language, sensorimotor, and memory. Social-emotional functioning often will be assessed as well. Although specific learning disorders may be identified through this process, the neuropsychological model is especially geared toward those children with known and/or suspected deficits who do not qualify for special education using the traditional ability/achievement discrepancy model.</p>
<p dir="LTR" align="LEFT">Which behaviors warrant neuropsychological assessment?</p>
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<div align="LEFT">Unable to break down complex tasks into a series of simpler tasks, thus allowing the student to work through the steps necessary for task completion</div>
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<div align="LEFT">Difficulty understanding concepts such as time, space, and money</div>
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<div align="LEFT">Unable to solve puzzles or build models</div>
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<div align="LEFT">Impaired sense of space, orientation, or directionality (using maps, following multi-step verbal directions)</div>
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<div align="LEFT">Difficulty learning/remembering information in sequence of isolation (math facts)</div>
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<div align="LEFT">Difficulty learning/remembering printed words.</div>
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<div align="LEFT">Confuses vowel sounds; problems with reading/spelling</div>
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<div align="LEFT">Difficulty with written expression (expressing ideas)</div>
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<div align="LEFT">Fine motor difficulty in writing</div>
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<div align="LEFT">Difficulty learning names of letters or numbers, and associating letter/sounds</div>
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<div align="LEFT">Oral reading is choppy and labored</div>
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<div align="LEFT">Did not enjoy rhymes as a preschooler</div>
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<div align="LEFT">Learns a skill one day, and forgets it the next</div>
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<div align="LEFT">Understands math concepts, but has trouble showing work</div>
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<p dir="LTR" align="LEFT">When should a child be referred for neuropsychological testing?</p>
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<div align="LEFT">Degenerative/neurological disorders</div>
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<div align="LEFT">Neurological impairment (including acquired and/or developmental brain injury)</div>
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<div align="LEFT">Pre-post operative procedures involving the neurological functioning of the child</div>
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<div align="LEFT">Research studies</div>
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<div align="LEFT">In utero trauma (exposure to substances; etc.)</div>
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<div align="LEFT">Complex cases</div>
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<div align="LEFT">Child is not responding to current set of interventions</div>
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<p dir="LTR" align="LEFT">Who does neuropsychological testing in the metro area?</p>
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<div align="LEFT">Alexander Center/Park Nicollet (952.993.2498)</div>
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<div align="LEFT">Pediatric Neuropsychology Clinic at the University of MN Medical Center (612.365.6777)</div>
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<div align="LEFT">Fraser (612.861.1688)</div>
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<div align="LEFT">Visit MNAAP’s website at <span style="color: #1c91ff; font-size: small;"><span style="color: #1c91ff; font-size: small;"><a href="http://www.mnaap.org/earlybraindevhelpfultoolsandresources.htm">www.mnaap.org/earlybraindevhelpfultoolsandresources.htm</a></span></span></div>
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<p dir="LTR" align="LEFT">Which services are available to children/adolescents?</p>
<p dir="LTR" align="LEFT">When a child meets school criteria for a specific learning disorder (SLD) in reading, math, and/or writing, an Individual Education Plan (IEP) is developed. The IEP identifies areas of need, describes an intervention plan, identifies goals and objectives, and provides mastery criteria. Generally, schools are required to re-evaluate the child every three years to determine ongoing eligibility. The IEP is a document that allows parents to oversee the services provided, and to pursue legal remedies (through due process) if they disagree with school personnel’s conclusions/plans and are unable to resolve their differences.</p>
<p dir="LTR" align="LEFT">Even if a child is found to have a learning disorder per the neuropsychological model, they still have to meet school criteria for services. The MN Regression Table used by schools sets a more stringent standard for identifying learning disorders than does the neuropsychological model. In the neuropsychological model, criteria for learning disorders are met when standard scores between ability and achievement are at least one standard deviation apart. For example, if the child’s IQ is 100 and the standard deviation is 15, then achievement scores of 85 or below meet diagnostic criteria.  Using the MN Regression Table, however, that same child would have to obtain achievement scores of 79 or lower to qualify for services under school criteria.</p>
<p dir="LTR" align="LEFT">If a child is not eligible for special education, s/he may qualify for a 504 Accommodation Plan. The 504 Plan is considered a civil rights document that prohibits discrimination against people with disabilities. It provides the child with accommodations salient to her/his disability (i.e. a child with ADHD may be allowed extended time to complete tasks); however, it does not provide direct instruction as does an IEP. Disabilities that may qualify a child for a 504 Plan include: ADHD; depression; Dyslexia; PTSD to name a few.</p>
<p dir="LTR" align="LEFT">How can you advocate on your patients’ behalf?</p>
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<div align="LEFT">Determine if the child qualifies for services under a different category from Specific Learning Disability (SLD), such as Other Health Impaired (OHI), and Emotional/Behavioral Disorder (E/BD). Also, neuropsychological testing may identify learning disorders such as dyslexia and Dysgraphia that are missed by traditional school-based assessments.</div>
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<div align="LEFT">Providers may obtain a copy of the child’s IEP or 504 Plan in order to be cognizant of the services the child receives at school.</div>
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<div align="LEFT">Providers may wish to attend an IEP meeting at school.</div>
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<div align="LEFT">PACER  Center (952.838.9000; 800.53.PACER) is an excellent resource for parents who need support regarding their child’s educational programming; especially when parents and school personnel do not agree.</div>
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<p>Resources addressing learning disorders include</p>
<p><span style="color: #1c91ff; font-size: small;"><span style="color: #1c91ff; font-size: small;">www.Idaminnesota.org</span></span><span style="font-size: small;"> and </span><span style="color: #1c91ff; font-size: small;"><span style="color: #1c91ff; font-size: small;">www.schwaublearning.org</span></span>		</p>

Learning Disorders: Identification and Eligibility of Services

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Amanda Hyatt Fields, PhD Category