Navigating DSM-5 Diagnoses & School Support Services for Your

ChildDebra B. Huss, Ph.D.

Licensed Clinical Psychologist&

Brandon D. Huss, M.A.Certified School Psychologist

Objectives

• What an Evaluation consists of in a school compared to community clinic

• Brief overview of DSM criteria for ASD, ADHD, and Anxiety Disorders

• Criteria for School Services• Pros & Cons of an evaluation in the

community versus within the school system

School vs. Community Clinic Evaluations

School Evaluations• Determine if the child meets criteria for a

disability under the Individuals with Disabilities Education Act (IDEA).

Private Evaluations• Determine if a child meets DSM-5 criteria for a

mental health diagnosis

Child with a Disability (IDEA)

What is required to be a “child with a disability” under IDEA?• Appropriate evaluation• Meets eligibility criteria• Adverse effect• Need for special education/specially designed

instruction due to the disability

Appropriate Evaluation

• Appropriate instruction and interventions must be provided before the referral or as part of the referral/evaluation process

• Instruction and intervention services must be research-based

• Data-based documentation of repeated measures of achievement and/or behavior

• Data is collected and evaluated at reasonable intervals reflecting systematic assessment of student progress

• Parents are provided with results

Appropriate Evaluation

School Evaluations include information and data from a variety of sources, including but not limited to…• Social-Developmental History/Medical History/Parent Interview• Direct Observations • Teacher Interview/Reports• Student Records (i.e. grades, enrollment history, attendance, discipline, etc.)• Response to Intervention (RtI) records and data• Behavioral Intervention Plan (BIP) records and data• Assessment Data (cognitive, achievement, behavioral, adaptive, K-PREP, neuro-

psychological, etc.)• Functional Behavior Assessment (FBA)• Records or evaluations from private therapists, physicians, psychologists, etc.

Evaluations have to use multiple data sources to substantiate the existence of the disability (triangulation of data).

Evaluation in a Community Clinic

• Detailed interview with parents and child– Developmental and medical history– Family mental and medical health history– Academic history– Social/Peer history– Specific symptoms of DSM disorders, comorbid & differential diagnoses (structured

interview)– Stressors or significant life events– Strengths of the individual

• Standardized individually administered tests– Intelligence, achievement, neuropsychological tests

• Standardized parent, teacher, self-report questionnaires– Have reliable results over time & measure what they intend to measure

• Clinical observations of the child in office setting and possibly home & school setting

Special Education Eligibility

Evaluation information confirms……• …there is an adverse effect on educational

performance (must be present for eligibility)• …that lack of instruction in reading and/or math

was not a determinant factor in the eligibility decision.

• …that limited English proficiency was not a determinant factor in the eligibility decision

Special Education Eligibility

Adverse Effect• means that the progress of the child is

impeded by the disability to the extent that the educational performance is significantly and consistently below the level of similar age peers.

• The Admissions and Release Committee (ARC) determines the significance of the disability’s impact on the child’s educational performance

Autism under IDEA

The student…..• …has a developmental disability, generally evident

before age 3, significantly affecting verbal and nonverbal communication (must be present for eligibility), and…

• …has a developmental disability affecting social interaction (must be present for eligibility), and…

• The student’s deficits are not primarily the results of an emotional-behavior disability.

Autism Eligibility Form

DSM-5Autism Spectrum Disorder (ASD)

A. Persistent deficits in social communication & social interaction across multiple contexts as manifested by the following, currently or by history:

1. Deficits in social-emotional reciprocity2. Deficits in nonverbal communication behaviors used for social interaction3. Deficits in developing, maintaining, and understanding relationship

ASD Criteria continued

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least 2 of the following (by history or currently):1. Stereotyped or repetitive motor movements, use of objects, or speech 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior3. Highly restricted, fixed interests that are abnormal in intensity or focus4. Hyper-or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

ASD Criteria continued

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. Symptoms not better accounted for by intellectual disability or global developmental delay

Other Health Impairment

• means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that…

• …is due to a chronic or acute health problem, such as acquired immune deficiency syndrome, asthma, attention deficit disorder, attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, tuberculosis or Tourette Syndrome;

DSM-5 Attention-Deficit/ Hyperactivity Disorder

A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development as characterized by (1) and/or (2)

1. inattention: 6 or more symptoms present for at least 6 months; inconsistent with developmental level & negatively impacts social and academic/occupational activities

a. Lack attention to detail; careless mistakesb. Difficulty sustaining attentionc. Does not listen when spoken to directlyd. Does not follow through on instructions & fails to finish schoolwork, chores, workplace

dutiese. Difficulty organizing tasks and activitiesf. Avoids, dislikes or reluctant to engage in tasks that require sustained mental effortg. Loses things necessary for tasks or activitiesh. Easily distracted by extraneous stimuli (includes unrelated thoughts)i. Forgetful in daily activities

ADHD criteria continued

2. Hyperactivity and Impulsivity: 6 or more symptoms lasting at least 6 months; not at developmental level & cause impairment

a. Fidgets with or taps hands or feet or squirms in seatb. Leaves seat when expected to remain seatedc. Runs about or climbs where inappropriate (feels restless for older

adults)d. Unable to play or engage in leisure activity quietlye. On the go or driven by a motorf. talks excessivelyg. Blurts out answers before question completed (completes people’s

sentences; cannot wait turn in conversation)h. Has difficulty waiting turni. Interrupts or intrudes on others

ADHD criteria continued

B. Several symptoms of inattention or hyperactive-impulsive symptoms present before 12 years of age

C. Several symptoms present in 2 or more settingsD. Clear evidence symptoms interfere with or reduce

quality of social, academic, or occupational functioning

E. Symptoms do not occur exclusively during course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder

Emotional Behavior Disabilitymeans that a child, when provided with interventions to meet instructional and social-emotional needs, continues to exhibit one (1) or more of the following, when compared to the child’s peer and cultural reference groups, across settings, over a long period of time and to a marked degree:• (a) Severe deficits in social competence or appropriate behavior, which cause an

inability to build or maintain satisfactory interpersonal relationships with adults or peers;

• (b) Severe deficits in academic performance which are not commensurate with the student’s ability level and are not solely a result of intellectual, sensory, or other health factors but are related to the child’s social-emotional problem;

• (c) A general pervasive mood of unhappiness or depression; or• (d) A tendency to develop physical symptoms or fears associated with personal or

school problems.• This term does not apply to children who display isolated (not necessarily one (1))

inappropriate behaviors that are the result of willful, intentional, or wanton actions unless it is determined through the evaluations process that the child does have an emotional-behavioral disability.

DSM-5Anxiety & OCD Disorders

I. Social Anxiety Disorder: marked fear/anxiety about social situation(s) where individual is exposed to scrutiny by others; fear doing something that will result in negative evaluation;

II. OCD: presence of obsessions, compulsions or both that are time consuming or cause distress/impairment

III. Separation Anxiety Disorder- excessive distress when anticipation or experiencing separation from major attachment figure; developmentally inappropriate or more extreme than expected

Specific Learning Disability

means a disorder that adversely affects the ability to acquire, comprehend, or apply reading, mathematical, writing, reasoning, listening, or speaking skills to the extent that specially designed instruction is required to benefit from education. The specific learning disability (LD) may include dyslexia, dyscalculia, dysgraphia, developmental aphasia, and perceptual/motor disabilities. The term does not include deficits that are the result of other primary determinant or disabling factors such as vision, hearing, motor impairment, mental disability, emotional-behavioral disability, environmental or economic disadvantaged, cultural factors, limited English proficiency, or lack of relevant research-based instruction in the deficit area.

Specific Learning Disability

SLD Areas• Basic Reading• Reading Comprehension• Reading Fluency• Math Calculation• Math Reasoning• Written Expression• Oral Expression• Listening Comprehension

Specific Learning Disability

Methods of Eligibility Determination• Discrepancy Model (Regression Estimated True Score

Method for KY)• Response to Intervention Model– Consistent lack of progress to research-based instruction

and interventions verified by repeated measures of progress

– Consistently low rate of improvement – Verified by evaluation data

Specific Learning Disability

RtI Data Example3rd Grade Student• Vertical Axis is Words

per Minute (WPM)• Horizontal Axis is Week

of School• Top data points are

Average 3rd Grade student progress

• Bottom points show 3rd grade student in RtI not making progress

DSM-5Specific Learning Disability

A. Difficulties learning & using academic skills (at least 1 symptom lasting >=6 months) despite interventions targeting the deficit1. Inaccurate or slow & effortful word reading2. Difficulty understanding meaning of what is read3. Difficulties with spelling4. Difficulties with written expression5. Difficulties mastering number sense, number facts, or calculation6. Difficulties with mathematical reasoning

Specific Learning Disability Criteria continued

B. The affected academic skills are substantially and quantifiably below those expected for individual’s chronological age, cause interference in academic, work, or daily living as confirmed by individually administered standardized achievement measures & comprehensive clinical assessment

C. Learning difficulties began during school age years but may not become fully manifest until demands for those affected academic skills exceed individual’s limited capacities

D. Not better accounted for by intellectual difficulties, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction

Factors to consider when seeking an evaluation

• Treatment recommendations• Time Frame• Cost• What assessment instruments are being used• Training and Experience of Evaluator• What information will I actually receive in the

psychological report• Confidentiality

Contact Information

Debra Huss, Ph.D.Licensed Psychologist

Mindpsi Psychological Services859-361-9617debrabhuss@yahoo.comMindpsi.net

Brandon Huss, M.A.Certified School Psychologist

Jessamine County SchoolsEast Middle (859-885-5561)Red Oak Elem (859-885-0616)Brandon.huss@jessamine.kyschools.us

www.jessamine.kyschools.us

ReferencesJessamine County Special Education Procedures

http://www.jessamine.k12.ky.us/dept/18/KY Special Education Forms and Policies

http://education.ky.gov/specialed/excep/Pages/default.aspxDiagnostic Statistical Manual 5th Edition (2013). American Psychiatric Association