My Favorite Halloween Game.

I have this game I play whenever I’m testing students around Halloween. It’s called “Halloween or Emotional Disturbance?”* Around this time of year, when I ask students to draw for me, I often get some pretty disturbing stuff—zombies eating people, ghosts, headless horsemen—and it begs the question, “Is the child emotionally disturbed or just thinking about Halloween?” I was reminded of this problem in assessment when a friend of mine posted this picture on her Facebook and asked, “Should I be concerned?!?”



She of course was not concerned because she knew her little treasure was going to be a vampire for Halloween. Yes, yes, that makes a difference in context. Now if her kiddo made that drawing on a random Tuesday in March, it would be a different story, no?

I have a memorable assessment from last Halloween time to illustrate the point…I was walking this kiddo to the testing room, when I spotted a huge spider web and a spider was chilling in the middle. I am not a huge spider fan, but I do anthropomorphize every spider into being that nice spider from Charlotte’s Web, so I said, “Oh look! That spider made us a web for Halloween!” The child turned to look at the spider’s web and then started spitting on the spider, yelling “Die! Die! Die you mother*#(%#@!” Whoa. I did not see that coming. Later, when I asked him to draw a picture of a person, he drew a vampire with a machine gun, blasting all the spiders in the world. Soooooo, you’re not a fan of spiders, eh?

Kids’ drawings are awesome. They are one of my favorite parts of the assessment process. Aside from the comorbidity of creepy drawings and Halloween, drawings can reveal a lot about our students. I especially love the Kinetic School Drawing, which is basically a way to see how the kid feels about school. You just ask them to draw a picture of themselves at school at any time of day and see what they come up with. I wish I had kept this drawing of this 10th grade student I was assessing for ADHD (who later cornered me on the streets of SF with his pack of friends yelling, “Hey, that’s the lady that put me in special ed! Thanks lady, special ed is way easier!”). His drawing was a cartoon-style sequence of him getting in trouble (“Here’s where my pencil accidently flies out the window, then here is me getting kicked out, and here’s me going down the stairs to the dean’s office, and here’s the dean saying to get a pass, and here’s me going back up the stairs, and here’s the teacher saying I can’t go back to class without a pass, and here’s me going back to the dean’s office…”).

Another kiddo who I was assessing for Asperger’s syndrome drew the most literal interpretation of the drawing I’ve ever seen. He started drawing every facet of the school building, including the irrigation system out front. When I asked him to draw a picture of himself in the drawing, as if I had a camera and took a picture of him at school, he drew a picture of me jumping out of a locker with a camera, taking his picture. HA! I love it.

My absolute favorite drawing was actually of me (not a Me-Monster story, I promise). The kid was 6 years old and in a school for students with emotional disturbance. The kid hated testing so much, it was torture to get anything done. After daaaaaays of trying to get something out of the guy, I finally asked him to draw a picture and tell me a story. He drew this monsterously fat and ugly person and said, “This is Dr. Fat, no I mean, Dr. B. She was a horrible fat person who made kids do stuff. She has a timer and her pencils and a monster ate her.” Soooooo, how do you feel about testing, little buddy?

So, as you go forth and test students on Monday on Halloween, look out for ghosts, goblins, spiders, and creepy drawings! You might also want to look out for REDRUM as the answer on a spelling test. Now that's a scary reversal...

*My friends and I also played a related game around Halloween when we were in grad school at Berkeley called “Normal dress or Halloween costume?” So, when a cloaked man entered the “Games of Berkeley” store, was he normally dressed for his fantasy board game club, or was it a Halloween costume? Is that a hippie costume or an actual hippie?

Lazy Dogs…and Children?

I don’t know why I continually find myself writing about my dogs over summer break. But it has been a while since I had to use my “children aren’t dogs” disclaimer, so I thought I’d dust it off for olde timey’s sake.*

Since I’m home now, being a lady of leisure, I have had the chance to observe my dogs closely. I used to feel badly about leaving them all day for work, but it turns out they actually just sleep all day. This morning, I thought I’d be a good puppy mama and take them on a walk, and I got out the leash for my greyhound, and he didn’t even get up off the couch. I called to him, and he closed his eyes, as if to say, “Please. I’m sleeping in.” This dog is LAZY. In fact, greyhounds are nicknamed “the 45 mile an hour couch potato” because they are really lazy animals. I guess they are storing up for the big sprint, but still, what dog doesn’t want to go on a walk? I used to be alarmed by his lethargy. I even took him to the vet once because I thought something was wrong with him (clinical depression? Thyroid problem?) , and after $300 of lab tests, the diagnosis? Greyhound. Awesome.

I only bring this up my lazy dog because a) he’s right next to me, being lazy, and I’m out of school so what else can I write about? And b) because it burns my soul when kids, parents, or teachers use the word “lazy” to describe a student. To me, the word lazy is used not as a transient state of being (see Bruno Mars’ “Lazy Song” for detail--Today I don't feel like doing anything), but it is often used as a personality or character trait in a student. It kills me when kids describe themselves as lazy in school, as it suggests the whole problem is a motivation or personality issue.

I was working with this teenager a while back who ended up having a pretty severe language-based learning disability that had gone undiagnosed until high school. During the social-emotional section of the testing, I asked him if he had one wish, what would it be. He said, “To not be lazy. I’m super lazy.” *soul burns* I ended up asking him, “Were you born lazy?”** and he laughed and said, “No.” I took it a step further. “When you were a toddler, did you sit around on the couch and not do anything?” He laughed again and said, “I don’t think so!” So I asked, “When did being lazy start for you?” He then really opened up and said that it started in 5th grade when school work got “really hard and they moved too fast.” He went on to explain he ended up not studying because he felt he couldn’t learn anyway.

I had my “aha moment” and so did he—it wasn’t that he was personally a lazy person, it was that he was struggling with his learning disability and didn’t have the tools or support to push through it, so he avoided studying. I sealed the deal: “So if you were a lazy person, would you have just spent the past 3 hours doing really hard tests with me and not giving up, so we can figure out how you learn best?” He said, “I guess not. Can I go now?” I will take that as a teenager version of a resounding, “you are right.”


*Dogs are not children, and children are not dogs. See Psychologist vs. Puppy for more information.

**I love this question. It can be adapted for all things. Were you born hating school? Were you born hating math? Were you born being angry at your parents? You can really start to pinpoint when attitudes and feelings about things started for students. I tip my hat to Ross Greene, of the Collaborative Problem Solving model for this one. It’s a gem.

Pay Attention.

Lately, I find myself giving the same speech. It takes me a while to get the language right in explaining difficult concepts about child development, so when I do, I like to make it count and use my new speech whenever possible (apologies to people who attend meetings with me on a regular basis and get to hear me say the same thing). Anyhoo, I think my latest speech/analogy is a fairly decent one, so I will share it with you.

At my school sites, I have been getting a lot of requests for assessment for Attention Deficit Hyperactivity Disorder (ADHD) that sound a little like this: “So and so is inattentive and hyper. Does she have ADHD?” It’s a legitimate question, but it is not an easy answer. As in previous posts, like the one where I went to a Circus School to assess a student for ADHD (true story), ADHD is a complex assessment. Especially if you yourself are distracted by trapeze artists during your “school observation.” But I digress.

My new speech/analogy is:

“Attention is the ‘fatigue’ of the psychology field.”

Here is what I mean by that. I want you to imagine you have fatigue and you go to your doctor and say, “Doc, I have fatigue. Do I have Chronic Fatigue Syndrome?” The doctor (if they are any good, of course) would have to investigate all the potential causes for fatigue before concluding anything. Offhand, (and I’m not that kind of doctor), I can think of about a hojillion reasons for fatigue besides Chronic Fatigue Syndrome: the flu, cancer, pregnancy, working in a school district, depression, hyperthyroidism, hypothyroidism, anemia, seizure disorders, poor sleep…..and it goes on and on. “Fatigue” is a non-specific symptom.

The same is true for attention. Offhand, the “causes” of inattention can be: (um, all medical conditions above), ADHD, difficulties focusing because of a learning disability, anxiety, depression, low IQ, high IQ, autism, social-emotional distraction, situational factors, psychosis…..and it goes on and on. So, when people ask me if I will “test for ADHD”, they are really asking me to test for everything else as well. I enjoy ADHD evaluations. I feel like a detective looking for clues and hitting a bunch of dead ends until I get to the bottom of the inattention symptoms.

That is why it burns my soul just a little bit when I get reports from outside professionals who give one rating scale to the parent, and if it is elevated in attention problems, they get the diagnosis. They don’t interview the teachers, they don’t observe the kid at school, and they don’t rule out the other causes of ADHD-like symptoms. Really, it gives “my people” a bad name to do an incomplete evaluation like that.

Second pet peeve about ADHD evaluations is when a doctor then “prescribes” an IEP or Section 504 plan based on their results, without seeing if the inattention is really having an educational impact that requires special education or accommodations. I have had students with ADHD on the honor roll, earning all As and Bs, and the outside professional recommends an IEP. I always wonder what service they think the kid needs. Then I have a fantasy of calling them up and telling them what psychopharmacological medications to prescribe. Because you know, if they’re going to tell me what to do in my school without knowing what their talking about, surely I can pretend I’m a medical professional and tell them what to do. It’s only fair.

I realize that doctors and outside professionals are only trying to help. But I think that school psychologists are the ones best equipped to assess for ADHD (given they have had training and aren’t super old school psychs who should have retired during the Clinton administration or sooner). In some districts, school psychs are not allowed to assess for ADHD, and in some they are. In some, they do screenings and send the information to a doctor. In my private practice as a clinical psychologist, I do ADHD evaluations all the time. In my role as a school psychologist, it has gone back and forth about whether or not I am allowed to do them, even though I have the training. I feel bad for parents, whose doctor says to go to the school for an evaluation and the school says to go to the doctor. It’s confusing, and then the kids with legitimate issues get bounced between professionals.

I am curious how other school psychologists and districts handle referrals for ADHD. I find that it varies from district to district, school to school, and even by school psychologist comfort level in assessing for ADHD. I would be curious from other school psychologists what your district policy is on how ADHD evaluations are handled in your district. Discuss amongst yourselves...and feel free to try on the fatigue analogy at your next meeting!

Modeling. So Hot Right Now.

I gotta get out of my Ides of March funk, so here’s a jaunty little post on modeling. My husband and I are the face of Lenscrafters. I realize this is very random and totally not related to school psychology or education, but I’m gonna make the case that it is.

What is advertising all about anyway? Basically, putting people like you with a product and selling an idea that the product is fun, sexy, exciting and you NEED it. Doesn’t our pic here just make you want to run out to Lenscrafters and get yourself some Burberry specs so you can have as much fun as husband and I? Don’t pretend like you don’t ride piggyback on your spouse on the weekends in Union Square in San Francisco loving your life and perfect vision.



Funny thing is, this came out on the first day of our Honeymoon, and we saw it on a billboard in Santa Monica. I hoped it wasn’t too symbolic of our marriage to come, what with me on his back and growling at him (but see how he thinks its fun?).

As I work with kiddos and teachers and parents in the school, I see modeling in action every day. I see kids who are saucy and fun and then I meet their mom, and she is saucy and fun. I see angry kids who blame everyone for their problems, and then the parent does the same thing in a conference. We know that kids learn by watching, but we sometimes forget. I read a great quote once that we shouldn’t be afraid our kids aren’t listening to what we say, we should be afraid that they are watching what we do. TRUE DAT.

Sometimes, I see irony. I hear teachers screaming at kids to use their inside voices. I see staff freaking out and telling their kids to calm down. I see staff treat kids with disrespect and then they are shocked when they get disrespect back. I’m no angel myself, though I pride myself on being pretty unflappable (unless I’m planning a wedding, when I go from Bride-Chilla to Bride-Zilla in the span of a day). I tend to remain calm in most situations, and pride myself on being the calm in the storm. But even I lose it once in while, and I am not a good model (of calmness, not designer glasses).

I saw myself in action yesterday. I was working with a student who was one of those guys who working with feels like working with molasses. Angry, angry, molasses. He was so slow in his processing, and that made him really mad and want to give up. I tried to model enthusiasm and put on a “learning party” to fool him into thinking testing was fun. I even called testing “activities” and then he called me out on it and said, “These aren’t activities! You lied! These are tests!” I managed to get through about 45 minutes of testing before my Oscar ™ performance for Best Actress in a Pretending this is Fun Role was done. We agreed to reconvene after a break, mostly for me.

After the break, he was worse. And I had the most slow-moving test in the world left to give (TAPS-3, anyone?). It’s torture. For me. And I think he knew that. But I had to do it that day, because of course, the IEP meeting was in 2 days and I had driven about 30 miles to work with the kid. I couldn’t give up.

Unfortunately, my exasperation was contagious. I initially presented it as a task he had to “just get through to be done forever with my activities” and he ended up falling asleep during the sound blending task. Like, snoring asleep. I woke the young man up, and proceeded with my Oscar ™ worthy performance that he had just slept through the BEST PART! And you know what? He totally finished it and said at the end that it was “kinda fun.” So the moral of the story is if you approach testing as drudgery, you model that testing is a drag, and the kid responds. Model enthusiasm and their mind-set shifts. And if you are bored or unenthusiastic about testing, especially if it is the test that makes you want to cry every time you have to give it for the squillienth time, fake it ‘till you make it.

And the Oscar goes to….The lady in the Burberry specs.

The Dreaded Plank.

It didn’t take me long in my career to realize that one of the best things I could do for my students was to practice what I preach and use good coping skills. You know, modeling how to put on your oxygen mask before assisting others and whatnot. I soon learned that if I didn’t exercise regularly, I wasn’t releasing the endorphins I needed to counteract bureaucracy monsters, crises, and vicarious trauma of the job. So I married a personal trainer.

Okay, fine, that’s not why I married him, but it sure was a fantastic bonus prize. Even though he has since changed careers and is now a professional photographer, I still make him make me work out from time to time. At first, it’s weird to have your husband telling you to drop and give him 20 pushups, but once you get over that, it’s awesome. I mean, free in-home training! With a dreamy trainer! Wait, where was I? Oh yes, coping skills.

This morning I had a session with my hubby and he told me to start with a plank. For those of you who don’t know, a plank is an evil yoga move that basically makes you hold your body weight up in a high pushup until your stomach and arms burst into flames. So I get in the plank position and hubby starts telling a story. After about 10 seconds, I am starting to feel the burn. Hubby continues with his story. 10 or 20 more seconds go by. His story goes on. I freak out on him: “You can’t just leave me here in plank position without a road map! I need to know how long I have to suffer!,” I cry out. Taken aback, he said, with encouragement, “10 more seconds, honey. You can do it.” And I did.

It reminds me so much of the kid during testing who always asks, “How much longer do we have?” after every single subtest. Learning is difficult for these kids. It doesn’t come easy and it is hard to persist without a road map. They want to know how long they have to suffer, just like I did in the dreaded plank. So today, when testing a kid with a severe learning disability and emotional disturbance, he immediately asked, “How long do I have to stay here?” I showed him the protocol and how many we were going to do, and had him check them off after each accomplishment. He tried to quit several times. I went back to the roadmap, and encouraged him to continue. He did. It was the most I’ve gotten out of one of my severe needs students in a long time.

Thank you, dreaded plank. And thank you, patient hubby. Now I can only adopt a growth mindset and hope that the plank gets easier for me with practice, and learning to persist with challenging tasks gets easier for my kiddos with practice too...

Did You See The Memo About…Interventions?

I’m starting a new series on this blog, called “Did You See The Memo?” because there are so many things I have to say in my job in urban public schools over and over and over and over and over again. And then one more time after that. And again. You get the point. Like that annoying boss in Office Space, I am that person asking if you got the memo about [insert special education referral process question] more than I would like to be. In the public schools, school psychologists are often the "gatekeepers" to special education assessments, deciding who can proceed for testing and who cannot. It is a role I hate, because all that energy could be spent on doing interventions with kids instead of fighting off inappropriate referrals. I know, I know, it's my job, but after 10 years of saying the same thing, you start to wonder if you have turned into a psych-bot-info-kiosk. It's one of the reasons I started this blog. You know, to mix it up. At times, I’ve fantasized about recording a conversation I have repeatedly, and then playing it back to people as needed instead of saying things again and again. Or, I could just type up the script and hand it over as a memo. That would create a lot of crying trees though, and like that fairy in Fern Gully, can’t you feel its pain?

The good news is (you know me, all about the silver lining) is that I’ve gotten pretty good at some of my schpeals (sp?) and I now get to share them with you. If you are a school psychologist, you will be nodding your head and saying, “YES. This sounds familiar.” If you are a teacher or parent who has been on the receiving end of this memo, know that I hate saying it as much as you hate hearing it. I get it. You want help for the student, and special education seems like a reasonable place to start. It can't start there for a number of reasons.*

The conversation that follows is one I have had 6, maybe 7,000 times, and it's time to convert it to a memo. It’s called:

“You can’t refer a child for special education without trying general education interventions first.”

How many of you have heard or given this speech?

Here’s the logic behind it. If you have a student struggling in reading, and he or she is not responding to the general education curriculum, standard teaching practices, or even extra help in the classroom, you begin to wonder why. Fair enough. I do too. Now let’s say I test this student (we’ll call her Sally), for a reading disability. Let’s say she has one. The intervention is to target her reading deficits and help her learn strategies. Let’s say Sally does not have a reading disability. The intervention is to target her reading deficits and help her learn strategies. Whoa! They’re the same. That’s right. There is no magical reading dust in special education, it is really just targeted intervention in the area of need with ongoing progress monitoring. A lot of the time, special education is basically just good teaching.

So I say, why not give Sally intervention in the first place, when she first shows signs of difficulty, way before she is so far behind that we spend 6 months in a bureaucratic-laden process to call her “disabled”? If after 6 months of intervention and good data collection, you will have a lot of information to work with if you end up doing an evaluation. But logic will get you nowhere in a school district that is under-resourced or hasn't bought into a response to intervention(RtI) framework yet.

All too frequently, special education becomes the only intervention, and that is just sad. There has to be an intervention before you can make a case that you need special intervention. Also, not all students with disabilities need special education. They may just need modifications in the general classroom. That is why I am repeatedly asking what interventions have been done in general education before I will entertain the need for a special education evaluation. I need to be convinced the problem can’t be remediated with targeted intervention in general education before I suspect a disability or a need for special education. Nevermind that you could go through the whole special education testing process and find there is no disability and that whole time you could have been doing something for the student.

Also, one of the “rule outs” of learning disability is that the problem isn’t due to other factors (second language acquisition issues, hearing or vision issues, poor instructional opportunities, poor attendance, etc). You can’t find out if the problem is truly neurological unless you rule out the environmental causes. The best way to do that is to provide the intervention and see if the student responds to it.

Now let’s make an important distinction between supports and interventions. I have sat in many student success team meetings (they are called several different names, but they are basically strategic parent-student-teacher-specialists meetings where interventions are generated for a struggling student.) At these meetings, ideas are generated about how to help students. Nine times out of ten, the “interventions” are actually supports. Here’s what I mean. Let’s play “spot the intervention” in the list below:

1) Sally will do her homework at a special desk at home
2) Sally will remain on task during silent reading
3) Mom will read with Sally 20 minutes a day
4) Mom will peak in the classroom from time to time to make sure Sally is working
5) Sally will not flirt with boys during silent reading time.

Ha! Trick question! There are no interventions in that list. There are only supports and expectations for Sally. So let’s put yourself in Sally’s shoes through an analogy. Let’s say you are in a foreign country and you are having difficulties reading in that language. Let’s say it’s Mandarin. Let’s say you get the 5 “interventions” above. Will this help your reading? Meh. Maybe? Or if you don’t know what you’re reading and you don’t have the skills, you might just sit at your special desk at home or during silent reading and just stare at the books you can't read. And as an added bonus, your mom is checking in on you and you can’t do fun stuff like interact with others. Now let’s say the intervention is a 6 week program with a Mandarin reading tutor who teaches you vocabulary, sound-symbol correspondence, Mandarin pronunciation, and does guided reading with you to give you corrective feedback. Will this help your reading? Um, I’m pretty sure it would.

The bonus is you can also do intervention PLUS supports. Just don’t leave out the intervention and then expect a school psychologist to take your referral for testing a student for a disability seriously. My eyes hurt sometimes from holding back the eye-rolling when I see only supports on pre-referral paperwork. I know the referrals come from a place of caring for the student and wanting to see progress. But let’s not be surprised when students have no intervention and do not progress. Friends, it’s not that your school psychologist doesn’t want to test the student for a disability, it’s that s/he doesn’t have any evidence that the problem can’t be remediated with a decent targeted intervention. And this is a clause that is in the law that we have to consider. It's a two part deal: 1) Have a disability, 2) Need special education. So if the students needs can be met in general education, no matter what their processing and IQ scores are, they don't qualify for special education. You can't find that out if you haven't tried targeted interventions first.

Sadly, here’s the rub. At some school sites, there are no decent targeted interventions because the school can’t afford a reading specialist or intervention specialist. Not all parents can afford outside support either. And here we have the perfect example of theory and practice being at odds. I totally get why special education is so popular as an "intervention." And I know teachers are doing their best with the resources they (don't) have. I get that they get blamed if the student is not progressing. And parents worry that their child will slip through the cracks. I'm with you. But I fear if urban public schools don't shift to RtI soon, I will have to bust out my memo for years to come. And nobody likes the person with the daily memo that says the same thing. Yeah....


*It can start there in the private sector. There is nothing stopping any interested parent from getting a private evaluation to undercover a student's learning strengths and areas of need and if there is disability causing academic or social challenges. In the public schools, its a whole another ball of legal and procedural wax. So to speak.

Special Education, IEPs, and Due Process, Oh My.

For those of you who missed it, here's my appearance on Learning and Laughter with Louise on the topic of special education. I did this radio appearance at 6:00 am on my summer break, since Louise is on east coast time. That means I had to get up at 5:30 to make a coffee the size of my head to be somewhat normal by 6am. I did it for the children.

We talked about a variety of topics, from the basics of Individual Education Plans (IEPs) to warning signs for Autism. At the end, there is a Q and A with parents who want to know if their child's behavior is typical, or a sign of a disability.

Also, may I note that I never want to hear myself laugh on the radio again, even if it is on a show called Learning and Laughter. I checked the url to make sure it was the right episode and I managed to skip right to the part where I laugh at my own joke. I die of embarrassment.

Enjoy!

Click here to download the episode onto iTunes. I tried for 2 days to embed a media player in this post so y'all could just listen here, but alas, FAIL. I guess if I were one of those fancy Web2.0 education people, I could do it. And if I even knew what Web 2.0 was, that would be even better.

Kittens, Sheep, and Wolves. Oh My.

As many of you who follow me on Facey Face know, I have been that poor kitten holding onto the branch. I have been swamped with my spring Testival and IEPooloza, in which I test kids for learning disabilities and hold Individual Education Plans (IEPs) to chart their course. Well, well, well, look at me now!



Only I’m not really sleeping because I know that round 2 is about to begin. This is the round of testing that happens right around spring break….

Dun. Dun Dun.

ED Testing. ED stands for “Emotional Disturbance” and it is one of the categories of disability in special education law. It is basically reserved for a small group of students who are exhibiting such severe emotional and behavioral problems that they cannot be taught in a general education setting. That being said, it is a very popular assessment because there are many students who by springtime, have worn out their teachers with their shenanigans, or many of the attempted interventions have not been sufficient.

To illustrate: I used to work at a school I called Haides Middle School, in which many of the students had emotional and behavioral challenges. Students threatened teachers, weapons were on campus frequently, and it was not uncommon for windows, doors, and walls to be punched. At times, fecal matter was left as a "present" for the Principal, and my vocabulary of offensive things one could say to others exploded (in several languages.) Now one might call this whole school ED, but it was not supposed to be. In fact, there was a group of students who were learning, but I never got to see them. Weird.

Anyhoo, the types of behavior I saw at this school were systemic because of the school’s location and demographic, and sadly poor leadership by administration, but the only intervention in town was special education. So I got ED referral after ED referral. These are pretty intensive assessments, so I was never the kitten on top of the paper at this school. My task was to figure out if the problem lied with the student (if he or she was emotionally disturbed enough to be “disabled”) or if the problem was circumstantial. I mean, I might be depressed and anxious and not able to focus on my work if I saw my dad murder my mom. I also might be acting out if I had chronic PTSD from witnessing violence in my community. Would I be “disabled?”

This is the job of the school psychologist—to sort through all the data, observations, history, observer reports, and individual assessment with the student to determine if the child is eligible as a student with an Emotional Disturbance. Yes, our job is to see if a student is disturbed enough to be disabled. It sounds crazy when you type it out. To complicate, there are a series of rule-outs and conditions that quite frankly, get second prize to the dumbest special education criteria (1st prize? I’m looking at you “significant discrepancy”).

For example, you must show that the unusual behavior is not a straight up behavior disorder (e.g. Oppositional Defiant Disorder, Conduct Disorder), but it comes from an emotional disturbance (e.g. depression, anxiety, psychosis). So, in essence you have to show that the kid isn’t just choosing to climb up a flagpole and wield a knife on his own free will, but it comes from an emotional place. (Um, how do you assess that?)

For me, I have framed it in a different way. I think it’s almost impossible to prove where unusual behavior is coming from, so I just focus on assessing for depression, anxiety, or psychosis first and worry about the explanation of the behavior later. I also look at what is the main reason the kid isn’t learning. If the child has cognitive limitations, that might be a better explanation for why the kid is not being able to manage emotions. As I write this, it just gets more and more complex. Each case is so unique, and you have to look at all the angles at once. There are few straightforward ED assessments. In general, I find it best to think of a few different types of students referred for ED.

Now I have compared kids (and husbands) to animals before, so here you go. I just love me a good metaphor. I know it’s oversimplifying, but blog posts aren’t supposed to be 8 hojillion pages long, I’m told.

Types of Students Referred for “Emotional Disturbance” Assessments

1) Sheep. These students are a slam-dunk when it comes to assessment, because their emotional disturbance is fairly obvious. These are vulnerable students who have crippling anxiety that keeps them from coming to school, deep depression that keeps them from being able to complete work, or psychosis that interferes with daily functioning. These students often have suicidal or homicidal ideation and have histories of hospitalization. Despite years of counseling and intervention support, they continue to be highly vulnerable and cannot manage a typical school environment. You could also call them “internalizing” students, meaning the manifestation of the disturbance is inward.

2) Wolves. These students tend to be highly disruptive and kinda predatory. I know, I know, wolves are shy in the wild and only prey on others for food or if frightened, but let’s pretend for a moment that wolves are aggressive. And pretend that they argue with teachers, break the rules just to see what will happen, defy authority, and generally run with packs of other similar students.* These students are also suffering, in their own way, since they likely have a high need for control, have poor role models, and in general have difficulties with true relationships that aren’t manipulative. They are charmers and you can show them a video of themselves tagging the school wall and they will still stay it wasn’t them. You could call this group “externalizing” students, meaning the manifestation of their school problems is acting out. This group, in the absence of an underlying emotional problem (anxiety, depression, psychosis) is typically not eligible for special education services under “Emotional Disturbance.” But they still need help to break the coercive and aggressive pattern of interacting with others so they can succeed in school.

3) Sheep in Wolves Clothing I would say these students represent the majority of my ED referrals and are the most difficult to assess. These are students who pretend to be super tough and act out, but when you get them one-on-one for assessment, you find a deep emotional problem that is likely causing them to act the way they are. These students have both internalizing and externalizing problems. In these cases, you have to also look at eligibility from a response to intervention perspective. Are they acting out because they had a recent emotional trauma? Then, it would not be “abnormal” or “pervasive” to say a child is disabled because they are acting out. It’s circumstantial. If there were few signs of problems prior to the trauma, then it’s probably not ED. Are they acting out because they have never had counseling or behavioral interventions? Then you can’t show that they need special education to be successful because you haven’t tried anything yet in the general education setting (suspending a kid doesn’t count as an intervention). I also feel for the Sheep in Wolves Clothing because they too need intervention and they may or may not qualify for services with the way the law is written.

The length of the post shows the complexity of assessment for ED. Part of me feels like rather than trying to sort out if a kid is “disabled enough” to qualify for special education, I should spend that time doing actual interventions. Whether kids be Sheep, Wolves, or Sheep in Wolves clothing, they still need psychological help, and the families and teachers need support.

To close, the other day, I saw a student at my school rip up and throw away a referral he got in the teacher’s face, screaming “MERRY CHRISTMAS!” To her credit, I’m sure she wanted to throw it back and say “HAPPY NEW YEAR! You’re suspended!” but she was calm and professional and redirected him to my office. If you don’t see blog posts for a while, you know why. It’s that time of year.

*How to deal with these students? Here you go, a video demonstration

March Madness Comes Early This Year

Ha Ha! All you basketball sports fans who googled “March Madness” got to my blog about how grade retention and social promotion decisions have come early this year in my school. Fooled you! Sorry, I get my entertainment where I can.

Every March, I get a slew of new referrals for testing students for learning disabilities, ADHD, and other disabilities, as the sheer panic of “What is going to happen to this student in X+1 grade???” (Where X is the child’s current grade, plus one. See? Algebra is useful after all.) I hear parents and teachers wonder out loud how the kid who is not meeting grade standards is going to make it next year. I hear murmurs in the teacher’s lounge about retention. And I cringe.

I don’t mind the referrals for testing.* As a parent or teacher, I would want to know if the student had a learning disability before I made a big decision about retention or promotion. No, I don’t cringe because of the 8 hojillion referrals I will be getting. I cringe because Over 100 years of research does not support retention as an effective intervention for kids who are not learning, missed a lot of school, or are socially immature. That’s right, I said it, and I italicized it too. The research does not support retention.

Before you write me with your anecdotal evidence saying it worked for so-and-so, I have to prefend (pre-defend? New word?) my position on the matter. Ironically, I will also cite my own anecdotal evidence. I’m above the law. But I will also cite the National Association of School Psychologist’s position statement on the resarch as my source as well.**

1) Social promotion without any other intervention is not effective either. I never subscribe to the “Let’s do the same thing that didn’t work twice!” model. The research shows that “promotion plus” (i.e. Combining grade promotion and effective evidence-based interventions) is more likely than retention to benefit children with low achievement or behavior problems.

2) Initial academic improvements may occur during the year the student is retained. There is celebration and validation of the retention. We made the right decision! However, many research studies show that achievement gains decline within 2-3 years of retention. This means that kids who are retained do not end up doing better than similar children who were not retained, but were experiencing similar academic problems.

3) In adolescence, retained students are more likely to experience behavioral and self-esteem problems, and are 5-10 times more likely to drop out of school. I get to see the long-term effects of retention, and it is not pretty. Retention is one of the most powerful predictors of high school drop out. Plus, anecdotally, I am working with a student who is in 8th grade and is ALMOST 16 YEARS OLD. He was retained twice and now can almost drive himself to middle school. Seriously. It’s not right. He is not doing well.

4) A study of 6th graders’ perceptions indicated that they consider retention as one of the most stressful life events. I have consoled many a crying student on the first day of school when they are told they are still in the same grade as last year. It’s devastating.

5) Retention may help students who have missed many days of school, but only if their attendance improves and if the child will not be considerably older than the other students.

The take home message is: At this time, however, there are no specific indicators that predict which children could benefit from retention. So yes, maybe a few kids here and there could benefit, but by and large, we don't know which ones, and the research is pretty clear that overall, retention doesn't work and it may be harmful in the long run.

Not convinced yet? Throw some counter research my way. I’ll read it. It might be in June, because I'm in the middle of a Testival (festival of testing) right now. But I will read it.

I should also note that I am equally adamant about not retaining students with IEPs (students with disabilities). Why? Because the whole reason they are behind grade level is because of their disability, and there is a 8 hojillion page plan on how to support them in the next grade. Special educators help the kid access whatever grade level curriculum they are doing in the general education environment anyway. If the student is making progress toward their IEP goals, then I don’t think they should be retained. Plus, did I mention one hundred years of research doesn’t support it? I think I did…

I'm a bit feisty tonight, as you may be able to tell. I just want parents and educators to have the research in their minds as they come to March Madness decisions. I get it. I am in the same meetings you are in, where you just can't imagine how a kid is going to make it in X+1 grade. Especially for the students with really poor attendance. It's really hard to come up with a promotion plus plan, I know. But that's what our job as school psychologists is--to inform, educate, and roll up our sleeves to help figure out what to do for these struggling students.

*Okay, I mind a little bit, only because they all come at once. But I've finally just accepted the cyclical nature of these things.
**Grade Retention and Promotion: Information for Parents. By Shane Jimerson, Ph.D., Sarah M. Woehr, & Amber M. Kaufman, M.A. University of California, Santa Barbara. Available on the NASP Website.

The Non-Glamorous Side of School Psychology

You know what is not interesting about being a school psychologist? Writing up psychoeducational reports. Sure, at first it was exciting, trying to figure out new and exciting ways to explain results from the Differential Abilities Scale, but now, not so much. And you know what I never write about on my blog? The boring stuff (you're welcome). There are some parts of my job that make me want to poke my eyes out (thanks, Mrs. Mimi, for that phrase!) Writing reports and filling out paperwork are in that category, and it is a huge part of my job.

Sorry to break the news to all the eager people who email me asking if school psychology is the right career for them, but it’s not all warm fuzzies. And contrary to my headshot photo, I do not typically stand in front of school busses with perfectly coiffed glamorous hair. If you picture yourself in warm, fuzzy, cable knit sweater that makes students feel comfortable in your presence, safe to share, as you sip on your green tea in your cozy office with one of those squeezy balls, let me paint you another picture.*

Every time I come to my office, it is pitch black in the hallway so I can’t find the keyhole, and there are new piles of stuff/unidentified liquids or food/fresh graffiti in front of the door. It’s typically a degree in there and I spend the first few minutes of my day orchestrating an elaborate tripwire heater situation because there is no electrical outlet. I plan to do a photo collage for my Facebook Fan page at the end of the school year. The series will be entitled, “Crap In Front of My Janitor's Closet..oops...Office.”

I have digressed. My point is that like in any job, there are pros and cons. There are also going to be undesireable tasks in every job. I tried so very hard to change my job description in my previous school district so I could do more than write reports, but the Bureaucracy Monster was too big for me to fight. Instead of quitting, my mantra ended up being, “Free Yourself of Why” (as in: “Why do I have to log the same information in 5 places?” “Why do I have to test a student with a 4.0 grade average?” “Why is my caseload so high?” “Why are you giving me another school to serve when I am already drowning?” “Why did I get a Ph.D. to sit in an elevator shaft in San Francisco when I will surely die if there is any seismic activity?”)

Free yourself of “Why” in a large urban school district or you will go clinically insane. I finally changed my attitude (and districts) and I am so much happier. My new strategy is to be super efficient at the low desirability tasks to get to do the high desirability tasks** So after 9 years of working as a school psychologist in the San Francisco Bay area, I have finally worked out a few tricks to getting reports done faster without sacrificing quality. These tips come from the girl who loves a good multitasking solution. I dry my hair in the morning with my car heater on blast, saving ones of minutes each morning. I double-down on New Years Resolutions (do more cardio and learn more Spanish) by listening to Spanish podcasts on the elliptical. I hope a few work for you, and I hope that you can all contribute more to share with other readers. Teachers, feel free to chime in some time-saving strategies for paperwork—I know you have mounds of paperwork too.

1) After you assess a child, the second that kid is back in class, take 10 minutes to write up your testing observations. Sure, you jotted down some notes on the protocol, but trust me, you will forget the nuances when you go to write it up 3 weeks from now. Every time I do this, I save myself time going back through the protocol and looking through notes and trying to remember, “was this the kid who rushed through stuff or took forever?”

2) Attend pre-referral meetings (e.g. Student Study Teams, Parent-Teacher Conferences, support staff meetings) if you can and have with you copies of developmental histories and behavior rating scales in every language possible. When the conversation inevitably turns to whether or not a psychoeducational assessment is needed, whip out those papers and give them to the parents right there to fill out and bring to your next meeting. Tell them this is the first step in getting more information for the assessment to guide the process toward their concerns/questions. I know, it’s ideal to sit with them and do it together, but if it is a pretty straightforward case/family dynamic, you can have them get started on remembering when the kid spoke his first sentence or learned to ride a bike.

3) Get really good at scoring stuff up while the kid works on other subtests. I usually have most of the cognitive assessment scored up by the time the kid is finishing up with the last subtest. This is a natural process that will occur after giving the same test over and over again. And over…and over….

4) Spend some time really working on your templates so that you have a good structure to work from. Borrow other colleagues’ templates and take the best parts from each one. Write all your recommendations into the template and then delete the ones that do not apply to the student you assessed at the end. Add new ones that occur to you that are particular to that student and add it to your master list. Also, in your template, use “Xx” as the child’s name and then when you find and replace “Xx” for the name, it will have proper capitalization.***

5) Write up background history before testing the kid. You will thank yourself later when you are all done with testing and don’t have to go back and do that part. Also, it guides your selection of assessments. When I first started, one time I didn’t look carefully at the kid’s English language testing scores and did the whole assessment before realizing it should have been a bilingual assessment. So mad at myself (for not looking, and also for not being bilingual. Hence, the podcasts).

As I am wrapping up this post, I realize that this post is kind of boring. I may or may not have just fallen asleep for a second at my own post. But welcome to the world of report writing. It doesn’t give you that same warm fuzzy feeling as working with a kid who has a breakthrough, helping a parent or teacher really understand how the student learns best, or hanging around in your frumpy second sister wife sweater, waiting to transform the lives of the yoots. But reports have their own value when done well. And when you’re done, you can get back to the “fun and glamorous" part.

*I do have this scenario in my private practice office twice a week. It’s lovely. Also, I appreciate having an office at all at my school sites. I used to have to carry around 40 lbs of testing materials, my purse, and my lunch wherever I went and begged people for testing space. I tested a student in an elevator shaft once. Klassy.
**Sound familiar, class? Anyone? Anyone? Premack Principle.
***A note about templates. Use them as a skeleton for your reports, but elaborate to tell a story about that child’s approach to tasks. Scores can always be imported into a template, but your reports will be more useful to people if you supplement with qualitative information. And for the love of Pete/Phil/Patty, don’t use the wrong kid’s name over and over, like Frau Psychologist. Dead giveaway for over-reliance on templates.

Awkward Conversation #249: Telling a Parent Her Teenager Has Mental Retardation

It never really gets easier. I get better at my schpeal, but telling a parent their child tested in the retarded range is never easy. It can lead to some very awkward and emotional moments, especially when a parent is getting the news for the first time and the child is FOURTEEN years old. I present to you, Awkward Conversation #249 (get a fresh cup of coffee, it’s a long one...)

Scene: Parent’s home (this parent refused to come to a school meeting, as every school meeting for the past, oh 8 years, has been people telling her that her daughter is behind, acting out, and in trouble). Blaring in the background is Jerry Springer-esque show, where every other word is bleeped out. We’re not going to turn that down, just to add to the awkwardness of having to yell the words, “Mental Retardation.” Good times.

Me: Thank you for allowing us in your home today. I look forward to sharing how Julia learns best and developing a school program that works for her. Before we start, how do you think things are going at school for her? (Knowing full well things are NOT going well. She wanders around the class and yells at teachers every day and is currently suspended).

Mom: I think she just needs tutoring.

Me: Hm…okay, so you are concerned about her academics (BTW, she tested in at the 2nd grade level in reading, math, and writing and she’s a 7th grader).

Mom: Mmm.

Jerry Springer Guest (in background): You think my baby mama gonna BLEEEEP BLEEEP BLEEEP BLEEEEEEEEEP

Me: Right. So let’s have a look at some of the possible reasons why Julia may be struggling academically. I tested her on how she solves brand new problems. This is a test that she can’t study for, as it is a set of new problems, both verbal and visual. (Read: IQ test). I give her very little help in solving them, and it is a good way to measure her thinking skills.

Mom:

Me: Okay. So here is a chart of where most students score. If she were just the same as her peers, she would fall here (points to average range). On both visual and verbal problem-solving, Julia scored here (points to 70—cut off for mental retardation). For example, when I asked her how a banana, apple and orange are alike, she said, “pear.” That’s not quite…erm…it’s related to what I said, but she misses the main point, that they are all fruits. Do you ever notice that sometimes she has difficulties expressing herself to you, or when telling you a story?

Mom: (Noncommittal grunt)

Me: Um. Okay. So you can imagine in the class, where she is currently learning about the Mayan empire, she might have a hard time making connections on her own without help. In head: Not to mention she can’t read the 7th grade text at all. She also might start to wander the class and get angry and yell, because most teenagers would rather look dumb than stupid.

Jerry Springer Guest (in background): BLEEEEPidy BLEEEPin’ BLEEEP!

Me: May I ask if this sounds like Julia? Am I describing her accurately?

Mom: (Stony silence).

Me: (In head: Is she getting this? Is it sinking in where I’m going with this?). I know this must be difficult to hear.

Mom: Not really.

Me: Um…erm..so what are your thoughts so far?

Mom: I think she needs tutoring. I’m not into labels. A student can get special education without being labeled.

Me: While tutoring is a good option, we also want to make sure that Julia’s teachers really understand her, and that she struggles so much with her thinking skills on her own. She can learn, but she requires a lot of support, repetition, and presentation of the material in simple ways. I don’t like labels either, but if they get her better services, then we should think about what is best for Julia. Without a label, you will continue to get calls every day and Julia will likely be misunderstood by her teachers and blamed for things she can’t help. Okay, self, time to just spit it out. She qualifies as mentally retarded. Here goes my “13 Doors Schpeal”.

Um, when we think about special education, we think of 13 “doors” into the program. Each “door” is a disability and with each disability there is a program. (To spare you all, I then go into the process of elimination of doors---not learning disability, not physical disability, not emotional disability—until we reach the “door” that in our district is called Mental Retardation)*

DEEP BREATH.

Ms. Parent, I’m going to use a term that is often kind of hard to hear, but I would be doing Julia a disservice if I didn’t use a term that we can all understand. Knowing what is causing her academic difficulties is the first step to giving her what she needs. The only “door” to services that is left is Mental Retardation. Now, there are several kinds of Mental Retardation. Julia is not in the severe range (points to bottom of chart), so we would not put her in a class with students who cannot take care of themselves, have physical challenges, or are learning only basic life skills. Julia has mild mental retardation (points to 70 on chart) and she has some typical life skills, so she would be in a class that would give her practical academic skills, like making change at the store, and reading and writing in the real world.**

Family Feud Guest (blaring in background): The Movies! Teenagers make out at the Movies! Buuuuuzzzzzz.

Mom: (Mumbles) Lover’s Lane.

Me: Excuse me? (Oh dear she is answering the Family Feud game). Right. So this must be difficult to hear that Julia has mild mental retardation, but the good news is we can find her a classroom where her needs can be met. Does this information surprise you? What are your thoughts?

Mom: I’m not surprised. Oh, and we’re probably moving out of the district next month.

End Scene

I don’t know how things will go for Julia in her new district. I know that I did my best to make it clear that Julia will not be able to keep up in a general education class, and that our meeting documents (the famous “IEP” which is an “Individualized Education Plan”) would carry over to anywhere in the country. I just hope she gets a seasoned teacher who understands that Julia's “defiance” is a largely a defensive avoidant behavior. I hope she gets to experience success. And I hope that there aren’t a bunch of “Julias” out there who could have been getting early intervention services for 8 years had there been a more concerted effort to have the school psychologist have a look at why she continually acted out.

We will return to our regularly scheduled Tomfoolery and funny stories next week. Promise.

*Some districts say “Cognitive Impairment” some “Developmental Disability” and some “Mental Retardation.” I don’t know if one term is better over another. The only benefit I can see of calling it Mental Retardation is that parents know what you are talking about. I have had parents who never really understand that Cognitive Impairment is really MR until their kid is in late middle or high school. Again, sometimes I get to break that news, and usually the reaction is, “Why didn’t someone tell me this earlier?” There is another school of thought that saying MR is not PC.

**And because of No Child Left Behind, some outrageous Algebra goal.

The Greatest Assessment on Earth!

For those of you who don’t know what a school psychologist does, a big part of our job is to assess children for disabilities. A popular referral question is: “Does my child have Attention Deficit Disorder?” An assessment for ADD is often the most complex of all assessments because there is no “test” for ADD. It is a process where you assemble of tons of data, including psychoeducational assessment, executive functioning tasks, observations, interviews, and rating scales to see if signs point toward other disabilities, or if it is a true disorder of attention.

You have to show there are severe behavioral symptoms such as lack of focus, disorganization, memory difficulties, difficulties with sustained attention, distractibility, and the like, that are unusual for the age (a 3 year old is distracted all the time and that's normal). The symptoms need to have started before school entry, and need to be pervasive (meaning you can’t have ADD only during math class, or only in school and not at home). Sounds pretty straightforward until you think of all the other reasons you could have symptoms of inattention:

-A learning disability that makes it difficult to concentrate, organize, or learn
-Emotional or social problems that deflect your focus (ever try to do work when you’re really upset?)
-Situational factors such as being in a disorganized environment
- Auditory processing/language deficits that make it hard to focus (just think of having to be in a foreign language class all day when you don’t know what the heck anyone is saying. Hard to stay focused.)
-Anxiety (you are preoccupied with worry thoughts, and thus can’t focus)
-Depression (you don’t have the energy to focus)
-Being gifted (you get bored easily!)

And the list goes on. But testing for ADD is one of my favorite assessments to do, because it is like being a detective.

One time, I was asked by my school district to assess a student for ADD during my spring break. At first, I resisted. I mean, it’s called a “break” for a reason, right? Then, I found out that the child was not enrolled in the public school, but was in Circus School, and happened to live in our district. There was a time crunch, and it would have to be done ASAP. I thought about saying I couldn’t do it, but c’mon, it was Circus School!

Now, you’re probably thinking (as was I), “How on earth do you test a kid for symptoms of inattention in Circus School?” What would that write up look like?

Caroline appeared distracted by the TIGERS JUMPING THROUGH FLAMING HOOPS.

I couldn’t wait to see what this Circus School was all about. It was worth sacrificing my spring break. Caroline was a 9-year old girl, specializing in contortionism.* She was indeed quite flexible, but she did kind of seem like she wasn’t listening to her trainer. But seriously, what child could focus in this environment?

I ended up testing her and she came up fine on every test, with some difficulties in visual-motor planning and impulsive answering. No anxiety or social-emotional problems. Her focus was fine one-on-one, but that’s not too unusual, even for kids with ADD. Her circus teachers* rated her “at-risk” for attention difficulties, and her mom rated her as the most unfocused child on the planet. Ug. I didn’t have enough data to say for sure what was going on.

Then I hit the jackpot. I found her cumulative folder that included teacher comments from preschool through 2nd grade, prior to enrolling in Circus School. And there were comments all over the report cards about her lack of focus, distractibility, and not meeting her potential. There was enough data to tentatively diagnose her with ADD, with ongoing monitoring of symptoms.

So for all you teachers out there, who are spending this week writing a zillion report cards, seek comfort that years from now, you will be helping some school psychologist make better diagnoses! Here’s where I normally would pull this posting together with a lovely metaphor about contortionism and circus arts, but it’s Sunday and I haven’t had my coffee yet. I guess there would be something about “disentangling” symptoms or "jumping through assessment hoops."

Please excuse me, I’m going to need to go to Peet’s Coffee now.

*I feel like I’m making this up as I write, but I swear I am not.

Psychoeducational Part VI – Visual Processing

I see a group of fuzzy hairs attached to a medium sized four-legged creature. A large pink object attached to a smaller portion of the figure is approaching my face. And it is my dog, licking my face at 7am.*

What I’ve just described is the process of visual perception. I see a bunch of parts and assimilate them to make meaning of them. The same process goes for learning to read. I see little squiggles and perceive them to be letters, combining into words. When you think about the process of visual perception in depth, it is actually quite complex. The same goes for assessing if a student has a “visual processing deficit” that constitutes a learning disability. I have never seen two children with the same “visual processing deficit.” That term is really an umbrella for a number of processes, in the same way “auditory processing” encompasses so many different things.

At the risk of oversimplification, here are the main things a school or educational psychologist may look for when assessing this area of processing:

1) Accurate Vision: One would think that is goes without saying that if a student has not passed a vision screening test that it would be impossible to accurately measure their visual perception. One would be wrong. I constantly refer families for vision evaluations before I test their child’s perception. Remember, you must be able to accurately see something in order to perceive (make meaning) of it. To take it to the extreme, it would be like showing a Rorschach ink blot to a blind person and asking them what it looks like to them.

2) Visual Perception: This one is the fodder for every Intro to Psychology course. What do you see in this picture:



If you said a young woman, you are correct. If you said an old woman, you are correct. Depending on what features you look at, it can be either. Go on, try again. Finding the old woman always takes me a minute. I’m not ageist, I promise.

So basically, visual perception is taking the parts and assimilating into a whole in order to make sense of it. A student with visual perception problems may take more time to perceive visual stimuli. To simplify, a student may misperceive a “b” for a “d,” have difficulty reading a graph, struggle with taking in lots of visual information, have difficulty putting together puzzles, and/or have to exert more mental energy to scan for important pieces within the whole (such as locating something on a map, finding the section in the book you need, or finding that stupid little Waldo guy in the midst of many similar Waldo-esque objects). There are a number of tests that one might use to discover which aspect of visual perception is impaired.**

3) Visual Memory: Okay great, let’s assume your brain has accurately registered what you are seeing. But can you remember it? Can you remember the details of a picture in your mind and call it up later? Can you remember that this thingy b is called “b” and it’s a line with a bubble on the right? If you can’t, then your visual memory may be impaired. Visual memory is usually measured by showing a student a shape s/he has never seen before and then showing a bunch of similar shapes and asking her/him to find the one they saw.

4) Visual Sequential Memory: This is the same as visual memory, only you not only have to remember what you saw, but also in what order. So I would typically show a student several shapes in a row and then ask them to remember the order in the midst of several choices with similar orders. If you think about it, this process can be involved in reading, as you must remember that these squiggles bed mean something different than theses squiggles deb.

I should note that though most “classic” learning disabilities are auditory in nature, at times, visual processing is the processing deficit that is preventing reading. More often, visual processing deficits affect math and science. Why? Because there are a lot of symbols involved as well as visual representations without language (think of those plotting numbers on the X and Y axis). Sure, it has a verbal label, but the process involved in doing something like this correctly involves far more visual processing skills.

And because nothing is ever straightforward when it comes to psychoeducational assessment, visual processing deficits taken to the extreme, can affect social perception (is that a mad face? What does shrugging shoulders mean?). When there are social impairments too, one has the unique challenge of figuring out if the student also has a Nonverbal Learning Disability, which is sometimes considered a disorder on the Autism Spectrum.

* Puppy apparently did NOT get the memo that it is summer break and mommy doesn’t have to get up at 7 every day.


**For those interested, send me an email and I’ll tell you my favorites. rebeccabell@studentsgrow.com

An Ounce of Prevention costs $2650

Now that it’s summer break, I have time to do those pesky little things that get shoved to the bottom of the to-do list. I took my car in for an oil change and was informed that I needed a full service that would cost $395. I smugly said, "the warranty should cover that." She said, “Okay, let me just check my computer, clickity-clack clickity-clack, right, your preventive maintenance warranty expired when your car turned 50,000 miles and clickity-clack your odometer is at 50,325.” Awesome. The good news is you can extend your maintenance program another year for click-click-click$2650. That’s the good news?!?

I explained to her I already bought a very expensive 4 year extended warranty, but then she said that it didn’t cover prevention, only mechanical failure. I asked her, “So if I wanted my brakes checked, that’s not covered. But if I was on the highway and the brakes went out, as I was careening towards a guard rail over a cliff my last thought could be that my brakes would then be covered.” She said, straight faced, “Yes. They would be covered in that situation.”

I got to thinking, this is how a parent might feel when I present to them my assessment for special education findings that their child isn’t "behind enough" to qualify for services. In special education, you don’t get services for prevention, only failure. Sorry, your child is only one grade level behind in reading, so the law doesn’t recognize them as “disabled” yet. No resource support yet. Sorry, your child is depressed, but not depressed enough under state and federal law to be “disabled” so they don’t get any services under special education. That would be like going to the dentist and having them say they wouldn’t clean your teeth because technically, there aren’t any cavities yet.

We are waiting for our children to fail enough to get help, meanwhile, some are metaphorically heading toward the guard rail with no brakes and gingivitis. Okay, mixed metaphors and drama aside, I hope our school district makes strides toward the Response to Intervention model next year, so we can change the way we allocate services to all students in need, even those who don’t “qualify” for help.

And if you see me on the highway, rest assured I did get my brakes checked. Because I do believe in prevention in theory and in practice.

Auditory Processing (Psychoeductional, Part V)

This next post in the series on Psychoeducational Assessments (Background History, Testing Observations, Intelligence/Cognition, and Visual-Motor Integration,) has been extraordinarily daunting for a number of reasons:

1) I have a hojillion actual psychoeducational assessments to complete before my darlings all leave school for the summer.*

2) Every single area of “processing” is so much more complex and multidimensional than it seems at first glance.

3) Low scores on measures of “Auditory Processing” can sometimes not be due to “Auditory Processing Deficits” but rather attention, social-emotional distraction, second-language acquisition, phonemic instructional casualties, motivation, hearing loss, etc etc etc.

4) An “Auditory Processing Disorder” is an umbrella term used by a hojillion* different professions in a hojillion* different ways. Sometimes, the diagnosis falls in the realm of a Speech Language Pathologist (especially when called "Central Auditory Processing Disorder", or CAPD), though a multidisciplinary approach is the best for these reasons.

With those caveats, here’s my best attempt. I’ll start with the “classic” cases I see as a school psychologist working under the guidelines for Special Education law. I’ll explain them like I do in my everyday job, to students and parents. It’s just what I’m used to.

Phonological Processing: This is the way the brain hears the sounds in words and is able to take them apart and put them back together again. For example, you use phonological processing to hear that the word “Cat” is three different sounds, or when I say three sounds (/c/ /a/ /t/), you can tell me that the word is “Cat.” When you have a “phonological processing deficit,” it can look like a number of other things, such as not hearing the difference between “card” and “cart.” So when a teacher is helping the student look at an unfamiliar word and says, “Sound it out!” it is very difficult because the student doesn’t hear the sounds the same ways as others. It can also be hard to remember which letters make which sounds. This is why it takes students with this problem longer to read.

Short-Term Auditory Processing (aka Auditory Working Memory):**This is the ability to hear and remember what is said long enough to do something with it. It’s the same process we all use when someone gives us a phone number and have to remember it long enough to dial it (without the benefit of pencil/paper or punching it in your cell phone), or doing mental arithmetic at the store. You also need your auditory working memory to listen to directions, especially multi-step directions, such as “Get out your book, turn to page 247 and start on section B.” Kids with auditory memory problems may get out their books and have forgotten what to do next.

Language Processing: Language processing can be subsumed under “Auditory Processing” for the purpose of IDEA definitions, but certainly is more in the realm of Speech and Language. Please refer to “Notes from the Speech Pathologist,” if it exists. What? It doesn’t? Okay, here goes, from a School Psychologist’s perspective: Difficulties with overall language processing can be as varied as taking a long time to come up with the word you need (“Lexical Access”) to not being able to make links between verbal concepts (“Abstract Verbal Reasoning”).

For example, a student with language processing problems might have a hard time coming up with answers to inferential questions, where the answer is not stated, but implied. This type of learning happens all the time in reading comprehension or listening comprehension tasks (e.g. Why do you think the character did that? What do you think will happen next? Who do you think is the bravest in the story?). If it wasn’t exactly stated that the bravest character was Judy, the student may not make the connections between all the other bits of information needed to make that assumption, like “Judy raced out of her house as soon as she heard about the crisis” and “Judy had a card up her sleeve.” Sometimes the student has difficulties interpreting the non-literal language, as in the “card up her sleeve” idiom. It does not explicitly say that Judy is brave, but one can infer it. This type of verbal reasoning can be impaired in students with language processing problems.

Overall, “Auditory Processing Deficits” are the hallmark of traditional “Learning Disabilities” sometimes referred to as “Dyslexia.” Contrary to popular belief, reading disabilities are not typically visual in nature (e.g. seeing “b” for “d”) but are typically a problem with the auditory processing channels. And as the length of this post suggests, the variations in what constitutes an “Auditory Processing Deficit” is not exactly cut and dry.

And if I ever want to finish my actual psychoeducational reports I need to write, I might want to look into abandoning the blog for Twitter, where there each post is required to be 140 characters or less. Somehow, ”Auditory processing is complex. It involves sounds, memory, and language” doesn’t really satisfy me.

*Hojillion (hoh.jill.eee.on). (Adj.) A large and exaggerated number somewhere between a hundred and a million, typically used at the end of the school year to purport an overwhelming sense of a ticking time table for work completion.

**Ug. Such a huge topic. So much overlap with other disabilities, such as Attention Deficit Hyperactivity Disorder. Distilling it to a paragraph makes me queasy, but here goes.

Visual-Motor Integration (Psychoeducational Part IV)

So far, this series has addressed the following components of a Psychoeducational assessment:

1) Background History
2) Testing Observations
3) Intelligence/Cognition

In this post, the psychological process of “Visual-Motor Integration” will be addressed. Loosely defined, visual-motor integration is eye-hand coordination, and is required for tasks such as writing and copying material, handwriting/cursive, pencil-paper tasks, copying from the board, and drawing. As the name suggests, the student can have difficulties with the visual aspect, the motor aspect, or integrating/coordinating the two together. Often students with such deficits can have even more difficulties when the task is timed (sometimes, this will be called “Processing Speed” on intelligence tests, but that can be a general term as one can slowly process auditory information too.)

Students with visual motor integration difficulties are often impaired in their ability to keep up with written work. It would be like using your non-dominant hand to write. You can do it, but it is mentally taxing. If you want to simulate this, go ahead and write left-handed all day (if you’re a righty). Also, get someone to hover over you and ask if you’re done yet and encourage you to hurry up because everyone else is moving on. Let me know how that goes!*

I am reminded of a student I worked with who was 13 at the time, and “refused” to do any written work. Upon testing him, he had a severe visual-motor integration deficit, despite above average intelligence. He couldn’t even copy a triangle, let alone take notes from the board with speed and accuracy. I can see why he refused to work. It’s better to look bad than dumb when you are 13.

I was presenting the results of this student's testing to the parent, school staff, and an outside therapist (the student had some emotional difficulties related to his poor achievement as well) and as I like to do, I showed them the picture of the triangle he was supposed to copy and then what he produced. His triangle was like a rectangle with one side missing, so the triangle would never connect if he continued the lines. The therapist gasped and said, “Oh my, it’s so phallic! Look what he drew. He took the triangle and made it phallic. Very disturbing.” And she went on and on with a psychoanalytic interpretation.

What was actually disturbing was that she missed the entire point. He had visual-motor integration issues and was trying to copy the triangle picture that the test developers made up. She will have to take up the obscene triangle stimulus with PsychCorp. In my head, I imagined them saying to her, “Lady, sometimes a triangle is just a triangle.”

*Most teachers, once they find out the student has a visual-motor integration deficit, will accommodate such that the student gets more time to complete written work, or the task demand is reduced for quality, not quantity. Teaching computer skills is also a good compensatory bypass strategy.

Psychoeducational, not Psycho-Educational—Part III

This post could be an entire blog, book, or career. I will try to do it justice. The cognitive/intelligence portion of the pychoeducational assessment is the keystone to determining whether or not a student has a learning disability, understanding the potential for learning, and/or knowing how the student learns best.*

First, lets start with some definitions. Try this activity. I want you to think about the word “LOVE” and try to define it. Go ahead….do it in your head.

Now, quick quiz. What is LOVE?

a) Never having to say you’re sorry
b) A deep, tender, ineffable feeling of affection and solicitude toward a person, such as that arising from kinship, recognition of attractive qualities, or a sense of underlying oneness.
c) Something people whom play tennis do not like.
d) A variety of different feelings, states, and attitudes, ranging from generic pleasure to intense interpersonal attraction.
e) Blind
f) Determined at first sight

The answer is: g)Yes. “Love” is a psychological construct that can be defined in any number of ways, depending on the context, culture, and what aspect you want to measure. The same goes for “Intelligence.” It can be defined in any number of ways, depending on your theoretical orientation. Each intelligence test given by a psychologist has a slightly different way of defining and measuring the construct of “intelligence.” In general, school psychologists will look at two to four aspects of intelligence.**

1) Verbal Reasoning
2) Nonverbal (Visual-Spatial) Reasoning
3) Working Memory
4) Processing Speed

Each one of these deserves a new post. Each one of these areas can also be described as areas of “Processing.” A low score in any one of the categories can be called a “Processing Deficit.” To confuse matters, the above processing areas do not necessarily map onto what special education law calls “Processing Deficits,” the presence of which is one criteria for eligibility for a student with a “Learning Disability.” The law defines “Processing Deficits” as Auditory Processing, Visual Processing, Visual-Motor Processing, Attention Processing, Conceptualization/Association.*** Each of these loosely map on to dimensions of “Intelligence” as measured by IQ tests, and also have their very own test.

A school psychologist’s job is to carefully examine the results of the IQ test and do further testing in “processing” areas to confirm that low results on one type of learning are due to actual deficits in cognition, rather than any number of factors such as fatigue, low effort, poor attention, malingering, social-emotional distraction, test anxiety, depression, etc. One cannot look at an IQ test and determine anything without testing observations and the larger context.

One word of caution for parents about seeking an assessment for a Learning Disability: Make sure the person is qualified. There are a number of inadequately trained people diagnosing Learning Disabilities whom are not psychologists and do not have the larger picture. Some have only bachelor’s degrees and took a summer or two of courses and call themselves “therapists.” They give an IQ test and a test of academic achievement, and based on scores alone diagnose disabilities. I have seen gross misinterpretation of scores, such as clearly average scores being called “deficits” and normal variations in processing called “disabilities.” I have seen computer printouts of scores as a “report” and no other factor is taken into consideration. Meanwhile, the parent has forked over thousands of dollars for a potentially wrong diagnosis. Think of it this way. It would be like taking your kid to the hospital with a symptom of “fatigue” and having someone with a B.A. in Biology who has had a little extra training in one specific medical problem diagnose him/her. You might not get an accurate diagnosis, because the symptom of “fatigue” can be caused by any number of medical problems, but they only have training in one.

Be sure that the person who is assessing your child is at minimum a Licensed School Psychologist or (in California) a Licensed Educational Psychologist (not “Educational Therapist”). Clinical Psychologists are the “gold standard” of assessors if you are also concerned that your child has a potential psychiatric disorder in addition to learning challenges. I would argue that a School Psychologist or Educational Psychologist would be more school/context/practically oriented and a Clinical Psychologist might be more psychological/interpersonal focused, though there is overlap depending on the person’s training. This was a bit of a digression from defining “Intelligence” and how to assess it, but I believe a diagnosis is only as good as the assessor’s clinical skills to interpret the test results.

*Cognitive=intelligence=IQ=ability=potential depending on what test you give. Same idea, used interchangeably in most psychoeducational reports. In California, it is state law that IQ tests cannot be used with African American students, but I think that is wrong. That is another post.

**Sorry, forget about “Multiple Intelligences” such as musical, interpersonal, kinesthetic, etc. Schools may give lip service to multiple intelligences, but the only ones that “count” grade-wise are basically Verbal and Visual reasoning, heavily emphasis on the Verbal learning. Sorry kids who think outside the box. Get your creative musical self back in that box if you want to graduate and go to college.

***If you find one school psychologist who knows what “Conceptualization/Association” is, I will give you a prize. It is barely used to qualify students as “Learning Disabled” because no one has really defined it well. That’s what you get when the law doesn’t match the research.

Psychoeducational, Not Psycho-educational—Part II

I started a series on psychoeducational assessment to help clarify the information in school psychologists’ highly specialized reports that are presented when students are tested for special education. In Part I, the importance of the background information section was detailed. Enjoy.

It is so tempting to jump ahead to the good stuff, like the cognitive and processing skills or the social-emotional and behavioral assessment. But I would be remiss if I didn’t talk about another favorite section of the report that is probably just as important: Observations. I have done a few prior posts on observations in the classroom, but this is more about observations during testing.

Consider these two students, both earning the exact same score on an IQ test. Note use of third person. That is because “The examiner observed the student to make facial expressions at a peer” sounds much more objective than “I saw him making faces at his friend.” That’s just how we school psychologists roll. We try to be as objective as possible. We now come back to our students earning the same IQ score:

In the one-on-one setting, Student X presented as an energetic, eager, curious, and friendly eight year old boy. He readily engaged in conversation and appeared eager to please with the examiner. For example, on the way to the first testing session, he reported that he was a gymnast and did a cartwheel into the splits in the middle of the hallway. During the testing situation, his effort and attention to tasks was variable. On easy items, he guessed quickly. When items became more difficult, he engaged in a variety of behaviors, including asking the examiner personal questions, dancing around, pretending to fall out of his chair, or showing the examiner his cat impersonation by crawling on the floor and meowing. At times, he also showed positive techniques, such as talking through difficult items and refocusing himself by closing his eyes to think.

***

Student Z is a eight year old boy who came accompanied by his teacher to the testing room. When Student entered the examiner’s office, he was observed to slump in a nearby chair and mumbled negative comments about his teacher in front of her (that she was fat and mean). When she left, he stated that he had been up all night before playing video games and was tired. He also reported that he had a headache, and would periodically put his head down on the table and close his eyes. A low energy level was predominant during testing, with the exception of during timed tasks, when he appeared to be more engaged with the task. Student did not respond positively or negatively to praise. One strategy that appeared useful for Student was verbalizing his thought processes on more difficult items.

So despite getting the same scores on their IQ tests, the interventions will be extremely different for Student X and Student Z. And that, my dear readers, is why I didn’t jump ahead to explaining Cognitive/IQ score section of the psychoeducational assessment without talking about the testing observations. Observations during testing are arguably the most important part of the assessment and a good psychoeducational report will tell a “story” about the student’s approach to learning and problem solving in addition to the scores.

Psychoeducational, Not Psycho-Educational

Okay, it’s really the same thing, but when you hand a report to a parent, it’s unsettling to see the word “Psycho” in isolation like that. If I had a nickel for every time I have typed the word “Psychoeducational,” I would have not that much money because a nickel isn’t really that much. But, I have done hundreds of Psychoeducational Evaluations and while they make perfect sense to me, a common complaint is that they are not reader-friendly.

A Psychoeducational Evaluation is a school psychologist’s bread and butter. It is the culmination of all background information and current testing in a lengthy report that in the end makes a statement about special education eligibility. Ideally, it should also detail how the student learns and how s/he thinks and feels about school, and provide recommendations tailored to a student’s needs. I say “ideally” because it is often completely unreadable to non-school psychologists. It really is its own genre of writing that blends educational jargon, obscure psychological terms, carefully crafted wording of facts and interpretation, and of course, special education legalese.

This begins my 5782975983475893 part series on explaining the contents of a Psychoeducational Evaluation for the real world.

Let’s start with the background history. This section takes one million years to write if you are testing a high school student.* A good background history details the developmental, medical, health, school, mental health, and family history of the child. It’s always a bit weird to ask a parent of a 17-year old about the child’s birth weight and when they said their first words or if there were problems in toilet training, but it really does need to get that specific. Why? Because you never know. Some of the most interesting things come up when you delve into a developmental history, and the child’s history culminates into who they are as a student.

The types of questions I ask about the child’s history depends in part on the referral question. If the referral question is Autism, I ask about social communication, and if its ADHD, I always ask about injuries or hospitalizations (many of my little ADHD friends have broken many a body part in their joie de vive for trying things without thinking). If the student is bilingual, I ask about learning in the native language. If the child is suspected of having an emotional disturbance, I ask about family history of emotional problems. The list goes on.

The point I’m trying to make is that the history is one of the most important parts of the assessment. I learn all kinds of things about the kid and build rapport with the parent too.

Zzzz…oh sorry I just fell asleep at my own post about Psychoeducational Evaluations. Maybe that’s why no one reads these reports in detail except other school psychologists and lawyers**


*I am envious of psychologists who work with preschoolers because their history is “They were born and had a cold when they were 2.”

** Lawyers who are armed with red pen, ready to sue the hell out of the school district (who can barely afford teachers), resulting in one child getting a $60,000 a year nonpublic school, OT, PT, private therapy, speech therapy, transportation and compensatory education, and kids at the less litigious areas of town get 30 minutes a day of help a week, if that. I have some strong feelings on the inequity of service delivery in special education. Don’t get me wrong, I’m all for giving each kid what s/he needs, but in a system set up with inadequate resources, it can widen the gap between the haves and the have-nots.

[steps down from virtual soap box]