Anonymous wrote:Thank you PP for all your help!! You've truly given me a lot to think about and opened up a whole new avenue of potential help for my DD. I read through all her reports with a new eye toward speech issues and I was shocked at how much was there once I was looking for it! Many, many pragmatic issues throughout the evaluations and some dysfluency concerns as well.

We had the IEP meeting today and in many ways it was just a formality. We walked through the criteria for OHI and ED. They found her eligible for special education in both categories. The school psychologist felt strongly about making the ED primary, and after consulting with DD's therapist (who used to be a school psychologist in FCPS) I was OK with that. There was really no discussion or argument that she might not need services. They seem eager to give her support for the executive function and ADD issues as well as the anxiety, so I was pleased with that.

We meet in 2 weeks to discuss goals. The school SLP said she wants to be at that meeting and she wants to add speech goals and services even though she was not identified under speech, so I feel pretty good about that. The summer will be a good time for us to explore various avenues for further speech evaluation and services.

Thank you again. I appreciate you taking the time to read through my novels and helping us out!

I'm glad to hear your school is being cooperative and that the speech therapist thinks she has a contribution to the situation. And, it's good that you are getting this in place now, so it will be ready to go at the beginning of the next school year.

IMO, pragmatic speech issues are difficult because pragmatic speech is something that we process without really even thinking about it. Speech/language pathologists can be good about uncovering the pragmatic difficulties and explicitly teaching what pragmatic language behavior should be taking place. But, IME, in the classroom, teachers often totally miss the existence and impact of pragmatic difficulties. Peers are often the same -- they recognize and react to odd disjunctures between a message's spoken and pragmatic aspects, but don't know what is really going on (i.e. the underlying speech/language dysfunction). Pragmatic speech difficulties can be a tough kind of "hidden" difficulty to cope with. Which isn't to say it won't get better, just that dealing with it is not as obvious and straight forward as say, a reading or spelling difficulty.

Good luck!

Thank you PP for all your help!! You've truly given me a lot to think about and opened up a whole new avenue of potential help for my DD. I read through all her reports with a new eye toward speech issues and I was shocked at how much was there once I was looking for it! Many, many pragmatic issues throughout the evaluations and some dysfluency concerns as well.

We had the IEP meeting today and in many ways it was just a formality. We walked through the criteria for OHI and ED. They found her eligible for special education in both categories. The school psychologist felt strongly about making the ED primary, and after consulting with DD's therapist (who used to be a school psychologist in FCPS) I was OK with that. There was really no discussion or argument that she might not need services. They seem eager to give her support for the executive function and ADD issues as well as the anxiety, so I was pleased with that.

We meet in 2 weeks to discuss goals. The school SLP said she wants to be at that meeting and she wants to add speech goals and services even though she was not identified under speech, so I feel pretty good about that. The summer will be a good time for us to explore various avenues for further speech evaluation and services.

Thank you again. I appreciate you taking the time to read through my novels and helping us out!

You can definitely ask for more testing. Do so in writing. The team may not agree.

The scores are interesting. It's not possible to draw conclusions without a GAI to compare to. But, looking at the lowest score -- math fluency @ 111, plus one standard deviation would be 126 and plus two standard deviations is 141. Although 1 std deviation is "clinically significant," IME in MCPS, the system really doesn't view that as indicative of any kind of adverse impact. Closer to 2 std deviations, and the system starts to acknowledge the adverse impact, but even with scores 2+ std deviations from IQ, if the achievement scores is above average (which a 11 std score is), the system doesn't really view a need for special ed. I'm not saying that's right, but in practice, that's what I've seen. YMMV in your own school system. Despite that, IMO, you clearly have a lot of anecdotal data about the adverse impact of her ADD and anxiety in the classroom in terms of her behavior and, I presume, inability to independently complete some assignments, that would seem to qualify as "adverse impact on educational performance" and needing "special education" to address the executive function.

I find it interesting that the lower scores cluster mostly around language issues (word attack, letter-word identification, passage comprehension, writing samples, writing fluency) which seem to be her "relative weaknesses". In a high IQ child, I would wonder whether the child high IQ was masking language difficulties. Yet, you say that your child doesn't have a problem with writing in terms of spelling, grammar, semantics, etc., just in terms of organization. That is something that I would want to check out more thoroughly with an independent speech/language assessment.

Now that you have mentioned that the 504 was given in 3rd grade on the basis of diagnosed "generalized anxiety disorder," I can see why the IEP team wants to hang an ED label -- it's basically how they have viewed her over the last 3 years. If she's showing the same kinds of anxiety outside school in family and non-academic extra-curricular life, then the focus on anxiety per se may be more understandable.

But, even so, I see many indications in your previous posts of how un-addresssed ADD is impacting her at school. There are some indications to me that language may also be an issue, but I don't think you have a full enough language assessment to understand that part clearly (IMO). Given that, I would think that an OHI label (for the ADHD) would be more appropriate than ED, but with support for the anxiety/emotional aspects.

Further language assessment is difficult to think about because $$ is always a consideration. You probably have enough data already, especially if you have a supportive IEP team, to get an IEP and some goals for the ADD/executive dysfunction and anxiety management.

Good luck on your IEP meeting. I'd be curious to hear how it goes.

1) Look for significant discrepancies both within the IQ, between the IQ and various achievement tests (WISC vs. WJ comparison) and between the various achievement tests (WJ vs. WJ comparison -- like how can a child score high in WJ -- reading comp but have a significant discrepancy with WJ - Reading Fluency? this would suggest a problem in one specific area of reading that should be addressed even if the overall reading composite does not have a significant discrepancy from IQ.

It's pretty clear that anything requiring speed is a weakness for her. On the WISC, her Processing Speed subtests were by far her lowest scores, and the Working Memory subtests were also relatively low. This was noted in the report and also by the school pyschologist.

I honestly don't really know how to interpret the WJ subtests. You're welcome to see if you can make some sense of these. I have bolded the discrepancies I find illustrative of her issues.

SUBTEST, Standard Score, Age Eguivalent
Letter-Word Identification, 116, 16-2
Reading Fluency, 122, >30
Story Recall, 124, >20
Understanding Directions, 142, >21
Calculation, 145, >23
Math Fluency, 111, 15-1
Spelling, 133, >30
Writing Fluency, 115, 18-11
Passage Comprehension, 113, 21
Applied Problems, 127, >30
Writing Samples, 116, >30
Word Attack, 113, >30
Quantitative Concepts, 127, >30

If your tester would not give a FSIQ that is VERY significant (and not in a good way...) The tester should have calculated a "general ability index" or GAI that you can use instead of the FSIQ to compare for "significant discrepancies"

Yes, she did give a GAI. And she did suggest the school test for speech. Unfortunately that recommendation came after the LSC meeting and the school already had a test list. They had speech on the list, so they did what they did, but it was truly an after thought at the Local Screening Committee meeting to even put it on the testing list. Our IEP qualification meeting is this week. I am wondering if I can request additional testing at that meeting?

I don't understand something -- you said your child had an IEP early on for speech, then was dismissed from that to a 504 plan in 3rd grade, and now the school is suggesting an IEP. Did the school system do an IQ test when your child had a IEP for speech? Did they do an IQ test in 3rd grade? If so, how were the results different from the recent test?

Sorry, that was confusing. She had an IEP for expressive language delay from Child Find. That was from about 20 months to age 3.5, when she was "cleared", or whatever it is called, from services. IN retrospect, I can see we didn;t fully understand all her issues around speech. Then in third grade, she got a 504 plan for generalized anxiety disorder. She had that through this year (7th grade) and it is still in effect. A few months ago, the MS school counselor suggested testing to qualify her for an IEP. Her most recent testing was indicative of ADHD-combined. She has always struggled with organization, but it really wasn't until this year that it became a problem. We've implemented several new org systems and that is helping. Her grades are still good (As and Bs) but the school recognizes that there is a definite discrepancy vs. testing levels.

To be more clear, her 504 accommodation to leave the room is MEANT to be used before she melts down. We have had a great deal of trouble convincing her to actually use this accommodation. And often she doesn't realize that she is ramping up, until she's already there. Several teacher have commented that part of the issue in the classroom is that it seems to come on very fast. She will seem fine (to them) and then without warning (to them), she's under the desk or on the floor crying. That is something she is working on with her therapist. And unfortunately, one of her teachers made a disparaging comment about this accommodation (and of course, it's the class she REALLY should be using it in) and that has made her even more reluctant.

"Feeling overwhelmed at the complexity of a task." is CLASSIC ADD/Executive dysfunction marker! Students with executive dysfunction need "special instruction" in how to breakdown a task.

Yes, I agree and I plan to ask for this in the IEP.

"Feeling like she isn't doing well on a test/quiz" can be a speech issue -- not understanding the question or finding it hard to articulate an answer in writing or not finding the answer the way you would express it as one of the answer choices.

I would agree, except it happens before she even sees the test! Or when the teacher is handing back the test, but before she sees how she actually did. I think it is the combo of anxiety and ADD at work here.

Her writing issues also seem to stem around planning her work. How to structure her responses, and lay them out on the page. When she actually writes, it's fine. But she definitely needs a lot of help around planning what to say and how to say it. But once that is clear to her, she has no problem.

ways to structure the class so that the panic triggers are minimized. There also needs to be a supported approach to dealing with panic.

To clarify again, her 504 says she can leave to pull herself together and if she can't do it on her own, she can go to the counselor or school psychologist. With the IEP we can add the spec ed teacher and hopefully there will be a push in spec ed teacher who can be a resource for her in classes that are a particular issue. This year there is one class that is particularly problematic and no surprise it's a class where the teacher is a very scattered herself and communication about assignments is lacking in general. This class is very stressful for her.

The school hasn't even acknowledged that she needs any special instruction to figure out how to manage her work, and instead is just giving her accommodations like extra time.

I do think this is partly why they want the IEP. They want to provide that support. Some teachers do this for her already just because they know it's what she needs. But it would be great to have this as part of an instructional plan for her.

Again, thanks for all your help!

OP, this is 15:10 again. Re your post above:

1) Look for significant discrepancies both within the IQ, between the IQ and various achievement tests (WISC vs. WJ comparison) and between the various achievement tests (WJ vs. WJ comparison -- like how can a child score high in WJ -- reading comp but have a significant discrepancy with WJ - Reading Fluency? this would suggest a problem in one specific area of reading that should be addressed even if the overall reading composite does not have a significant discrepancy from IQ.

If your tester would not give a FSIQ that is VERY significant (and not in a good way...) The tester should have calculated a "general ability index" or GAI that you can use instead of the FSIQ to compare for "significant discrepancies"

I don't understand something -- you said your child had an IEP early on for speech, then was dismissed from that to a 504 plan in 3rd grade, and now the school is suggesting an IEP. Did the school system do an IQ test when your child had a IEP for speech? Did they do an IQ test in 3rd grade? If so, how were the results different from the recent test?

2) re figuring out the meltdowns and the ED label:

Examine both speech and/or ADD/executive dysfunction as possible underlying reasons for these meltdowns. IMO, it sounds like you don't have enough assessment on the speech/language side yet to search for and connect any possible weakness on assessment with adverse impact in the classroom. "Feeling like she isn't doing well on a test/quiz" can be a speech issue -- not understanding the question or finding it hard to articulate an answer in writing or not finding the answer the way you would express it as one of the answer choices. It can also be an indication of underlying executive dysfunction issues -- realizing that one didn't study enough, didn't study the right material, can't get the answers out fast enough to get through the test, or can't attack the test in an effective way (eliminating answers, working backwards, etc.). "Feeling overwhelmed at the complexity of a task." is CLASSIC ADD/Executive dysfunction marker! Students with executive dysfunction need "special instruction" in how to breakdown a task. For example -- first I will circle and number each part of the prompt I have to answer 1)tell what the character did to solve a problem 2) support with examples from text and 3) tell what you would do to solve a similar problem. Then I will take 5 minutes to brainstorm in each of these categories. Then I will order my ideas in an outline. Then I will write my answer without worrying about spelling or grammar. Then I will edit my answer. Etc. You also mention struggling with group work and feeling like the group doesn't understand what she is saying -- these are def speech issues and can be related to expressive speech issues and/or pragmatic speech issues.

IMO, a 504 plan that "allows her to leave the room when this [crying, panicking, feeling overwhelmed, etc.] starts to happen" is wholly inadequate. Allowing a student to leave the room after they have already panicked, with little or no support to deal with that panic and return to class, is closing the barn door after the horse has bolted. There needs to be a clear understanding of what leads to panic and ways to structure the class so that the panic triggers are minimized. There also needs to be a supported approach to dealing with panic. A student should be encouraged to come to the teacher or go to another room where there is a sped teacher and say, "I'm feeling really uncomfortable about this part of the assignment, can you help me?" Or be able to put aside an assignment for later help without negative repercussions. An IEP team should be brainstorming these solutions, not just allowing her to leave the room by herself.

While the behavior you describe is part of the ED definition, it misses the most important part of the ED definition, which I am bolding --

Inappropriate types of behavior or feelings under normal circumstances as shown by reports and information from multiple
sources. Provide time frame for inappropriate behavior or feelings, such as anxiety, attention issues, excessive crying, curling
up in fetal position, hiding under furniture, paranoia feelings of persecution, verbally and/or physically attacking others
without any apparent reason, etc.

The school CAN ONLY consider these behaviors inappropriate if they are occurring in the context of a NORMAL situation. Your child's intra-WISC and WISC/WJ discrepancies are NOT "normal circumstances". Significant discrepancies and problems such as these usually are present from a very early age and only grow wider and wider without special instruction and as the demands of the classroom increase with age. Since the school has only provided a 504 since 3rd grade, it is clear that your child has gotten no "special instruction" (because "special instruction" is only provided via IEP) that would have helped her manage the increasing demands of the classroom.

If you look at it from her perspective, crying, becoming anxious, crawling under a desk, panicking, etc. are NORMAL reactions to an ABNORMAL situation. Each year the demands of school have become increasingly complex, and she is expected to master these demands even though she has expressive, attentional and executive dysfunction weaknesses. The school hasn't even acknowledged that she needs any special instruction to figure out how to manage her work, and instead is just giving her accommodations like extra time. In fact, by sending her out of the room when she panics, the school is telling her that the real problem is that she is unhappy that she can't succeed and that she just has to stop being unhappy about it. How would you feel if you had an office job producing widgets and despite having a boss who repeatedly produced a widget in front of you, you still couldn't produce the required quality and number of widgets on time? All your colleagues can do so with ease and each year the gap between you and your colleagues grow. None of them want to eat lunch with you. None of them understand why you have questions about widgets. None of them want to be on your widget-building team. Your annual raise and job are threatened. You'd probably break down crying too. Maybe if somebody broke down widget construction and let you practice step by step, you'd be a better widget producer. Or maybe if you got to practice each step in isolation, you'd be able to get your widget construction speed up. But, no one is giving you that help. They just get angry and send you out of the room to "calm yourself down" and expect that you will magically get the widget construction right when you come back.

This is why I really hate the ED label. Schools fail for years to give appropriate help to kids with SLDs, OHIs or other disabilities, and then stigmatize them when, after years of inadequate help, the student is finally breaking down in tears or anger in class (which takes a LOT given how taboo it is to cry at school). I say this as a parent to a child refused an IEP despite an early language disorder diagnosis. By 2nd grade, he began crying and calling himself stupid. As a family member of someone with mental illness, believe me, there is a difference between anxiety that arises from a sucky situation and anxiety to a degree that is inappropriate to a situation. Sure, a student who has been in this cycle of non-assistance and failure for awhile may have such entrenched negative self-thought beliefs and coping responses that they need help from a counselor or psychologist to re-think their self-image and how to get more effective assistance, but that's very different from being ED, IMO.

FWIW, my DS, who was experiencing increasing anxiety, sadness, negative self-esteem, withdrawal from the classroom and insubordination to the teacher, found HUGE relief when I sat down and explained his neuropsych testing, strengths/weaknesses, and ways that we were going to put in place supports. One year later, the happy, optimistic child I had is back. Knowing that there is a real difference (and a reason for it) between him and his peers, is actually a huge help. Normalizing that difference in terms of emphasizing that everyone has unique strength/weakness profiles is also hugely helpful. Being exposed to useful, explicit, repetitive instruction and seeing that over time, with a different approach, he can learn the same things as other kids, is a huge relief. It also opened the door for him to tell us MUCH more about how he felt in school and what was difficult. If you don't feel comfortable doing this, ask the neuropsych if he/she will spend an hour explaining to your DD what is going on, what she might need that is different from most other kids, and how there are other kids like her and that she is not dumb or doomed to failure.

Were all of these within 1 std deviation of IQ and each other -- no significant discrepancies? I would expect, based on what you describe that some of the fluency tests might be lower than ability, but still in the "average" range.

Do you mean in just the achievement tests? There were some significant discrepancies, especially in the tests with "fluency" in the name. She also had very large discrepancies in the WISC subtests, enough that the tester would not give a FSIQ.

You mention that your DC is often melting down in class and requiring the intervention of outsiders. Do you have any details on that? Often a very complete description can identify triggers that are causing the outbursts.

Some may be speech related, but certainly not all. Generally they have to do with her feeling like she isn't doing well on a test/quiz or having forgotten some kind of assignment. Or she feels overwhelmed at the complexity of a task. She starts to panic and then spirals and can't calm herself down. Her current 504 allows her to leave the room when this happens, but often she can't "catch" herself in time before she's out of control. Then she tends to cry (remember, she's in MS, so NOT acceptable) and in the worst cases has hidden under desks. I think this is the behavior that makes the school want the ED classification because it is an explicit category in the ED label:

Inappropriate types of behavior or feelings under normal circumstances as shown by reports and information from multiple
sources. Provide time frame for inappropriate behavior or feelings, such as anxiety, attention issues, excessive crying, curling
up in fetal position, hiding under furniture, paranoia feelings of persecution, verbally and/or physically attacking others
without any apparent reason, etc.

All of the bolded have been an issue.

Sometimes there are what could be speech related issues. She struggles with group work and is very easily frustrated by what she perceives as the group not understanding what she is trying to say.

For my kid with expressive difficulty good accommodations in the classroom involve reducing the demands for quick, immediate replies and giving a chance to use notes while speaking.....

Thank you very much for these explicit examples of accommodations. They were very helpful and have given me many good ideas. I appreciate your help.

Anonymous wrote:OP here again. 9:50, thank you, that was extremely helpful. I have been thinking more and more about the speech issues and I am starting to think that we do need more testing in this area.

Neuropsych did WISC and WJ. There was also a lot of testing for anxiety, depression, and executive function. The ADHD-Combined diagnosis is new and that is mainly what we were looking at. She did do the VMI also. The achievement subtests included:

Letter-Word Identification
Reading Fluency
Story Recall
Understanding Directions
Calculation
Math Fluency
Spelling
Writing Fluency
Passage Comprehension
Applied Problems
Writing Samples
Word Attack
Quantitative Concepts

I'm not certain what the school speech person tested, I don't have that report in hand yet. I know it included things like rapid naming of colors, naming things related to a picture cue, etc.

She did have an IEP for speech in preschool, for expressive language delay. She only had about 20 words until about age 3 when her language completely exploded and she began using complete sentences. I honestly never really thought much about these other speech issues until recently when I began to suspect that her continued struggle to get words out or to orally re-tell an event began to seem less age normal, KWIM?

I appreciate your help and detailed info.

Were all of these within 1 std deviation of IQ and each other -- no significant discrepancies? I would expect, based on what you describe that some of the fluency tests might be lower than ability, but still in the "average" range.

Unfortunately, I don't see any testing on your list that really goes to higher level language function. I think you really need some speech/language testing from an SPL and/or neuropsych that goes to higher level oral expression. The story recall is mostly memory and organization, not much complex expressive function. Rapid-naming may go to difficulty with word-finidng and slow-processing, but just on the one word level. Naming things related to a picture can also be very "low-load", i.e. not testing complicated expression just one word level. Ask the school SPL specifically about each test she did or google for yourself to find what they test. Ask specifically which tests go to higher level linguistic functioning, or language processing, or language tasks with a higher "meta-cognitive load". You can also call the neurospsych who did your testing and explain that you are more interested in her complex expressive language ability and which tests did he/she do that go to that or are there any additional tests they would recommend in that area (and how much it will costs to do a few additional tests & report).

IME, bright kids with language issues can often test near their IQ/ability range on one word or sentence level assessment, but fall apart as the complexity rises, either in terms of length (i.e. paragraph level and higher) or in terms of the "meta-linguistic" level or in terms of the number of tasks necessary to complete to respond to the same question. My MERLD child can have a conversation (if you ignore a lot of the ummms, wrong word use, awkward grammar and wandering) about anything he is interested in. But, when asked to respond to a prompt which has multiple requirements, it becomes much tougher. Participating in a dialogue of several exchanges of question and answer is excruciating and exhausting for him. He can write a poem if the prompt is open, but if the poem prompt is "write an acrostic poem on an assigned subject including 3 of the following vocabulary words," he will have a melt-down.

You mention that your DC is often melting down in class and requiring the intervention of outsiders. Do you have any details on that? Often a very complete description can identify triggers that are causing the outbursts. IME, when my DC has a problem in class, it is almost impossible to get him to explain fully about it (due to expressive difficulties and his emotional take on the situation). It can take a week and several conversations to get the details about a particular incident from him, and then I have to also talk to the teacher and the person who intervened from outside the classroom. Often, once I get all those pieces, it becomes more clear that expression was a clear part of the problem. Teachers often think oral expression is "fine" because they think in general terms whether the student can talk and communicate needs which is a pretty low bar. They also have so many students that it's hard to notice a pattern of expressive difficulty in the classroom over time in one student, plus they are often mischaracterizing the problem as shyness, lack of self-confidence, lack of motivation, etc.

It's hard to know whether the oral expression problems are a language processing problem in their own right or a part of the ADD/executive dysfunction. The more complex language tasks require the brain to pay attention to several things at once, and that may be more problematic for kids with executive dysfunction. Plus, the pragmatic (i.e. body language, conventions of expression) part of language is yet another task to pay attention to while thinking about the actual expression itself. In any case, whether the problem is ADD/exec. dysfunction or Speech/language impairment is a differential diagnosis that might not actually be that easy (or necessary to make) and may be irrelevant if the ways of coping/treatment/therapy would be the same.

For my kid with expressive difficulty good accommodations in the classroom involve reducing the demands for quick, immediate replies and giving a chance to use notes while speaking. So, those stupid math fact tests that require immediate oral response are just anxiety provoking and shouldn't happen with my kid. Telling the whole class "I'm going to read you a story, but before I do, I want you to know that I am going to ask you which character you think is most important and why. Use some paper if you want to take notes while I"m reading" instead of reading the story and pointing to a kid and asking a question for an on the spot response works much better. Or saying, "Students X, Y, and Z, please give me three reasons why the character made his choice", and then letting the kid with expressive difficulty know privately he/she will always be the last in the set to answer so he/she has extra time to find words, etc. Also, alternate presentation of responses can be good accommodations -- the students can be given a choice whether they want to stand up and give a speech, or create a video on the same topic. The video has the advantage that the language impaired child can do more planning, and shorter bits of speech, and more editing, rather than standing up and speaking in public.

OP here again. 9:50, thank you, that was extremely helpful. I have been thinking more and more about the speech issues and I am starting to think that we do need more testing in this area.

Neuropsych did WISC and WJ. There was also a lot of testing for anxiety, depression, and executive function. The ADHD-Combined diagnosis is new and that is mainly what we were looking at. She did do the VMI also. The achievement subtests included:

Letter-Word Identification
Reading Fluency
Story Recall
Understanding Directions
Calculation
Math Fluency
Spelling
Writing Fluency
Passage Comprehension
Applied Problems
Writing Samples
Word Attack
Quantitative Concepts

I'm not certain what the school speech person tested, I don't have that report in hand yet. I know it included things like rapid naming of colors, naming things related to a picture cue, etc.

She did have an IEP for speech in preschool, for expressive language delay. She only had about 20 words until about age 3 when her language completely exploded and she began using complete sentences. I honestly never really thought much about these other speech issues until recently when I began to suspect that her continued struggle to get words out or to orally re-tell an event began to seem less age normal, KWIM?

I appreciate your help and detailed info.

Anonymous wrote:OP here. The testing we did was a combo of private neuropsych that we provided to FCPS and their own internal testing. The speech testing was done by the school and it was very brief. All testers and even teachers have noted that her lack of speech fluency and slow processing does create anxiety for her. And she will occasionally stutter when trying to get the words out. I do exactly the same thing, but was able to "train" myself as a young adult to consciously slow down my speech patterns. I will think about specific speech testing. Who would do that type of testing? Any SLP or is there a specific type of tester? What do I even ask for?

I feel like I need to clarify that the relationship with the school in our case is not at all adversarial. I could not be happier with the school or their responsiveness to my DC's needs. They are the ones who actually suggested an IEP to us. Academically DC does very well, but there are definite classroom issues. She often has to leave the room or the counselor or school psychologist has to be called. We've had a 504 in place since third grade and would never have considered an IEP was feasible but they really are the ones who pushed for it. The school is also an ED center, so I do wonder if part of the reason they suggest the ED classification is because they have more resources to support that.

I really am just trying to understand if there are specific advantages or disadvantages to DC having an IEP under the OHI vs. the ED classification.

PP with the MERLD child here. Again, the speech issues raise a major red flag and an even bigger one given that your child is in honors classes. For GT kids with impairments (LD, speech, ADD, etc.) The mismatch between what's going on in their heads intellectually and what they are able to produce academically causes a LOT of anxiety, depression and lack of self-esteem. This can start building as early as the written and oral demands of class start increasing which is usually around 3rd grade. The lack of speech fluency must be addressed through treatment/therapy. The "slow processing" can be an issue with word-finding and difficulty with expressive language, semantics and/or pragmatic language. Speech/language therapy can help with these, but likely not SPL provided through school if all the school has been willing/able to do is brief testing.

Any SPL should be able to do testing, but, frankly, with a GT kid I would look for someone very experienced in testing and writing school reports. The specific tests differ depending on age, but I would guess the following -- testing to check articulation and physical formation of speech, assessment of the stutter, receptive and expressive language testing such as the Comprehensive Expressive and Receptive Vocabulary Test, the Test of Language Development, Language Processing Test, Clinical Evaluation of Language Fundamentals, Social Language Development Test, Test of Narrative Language Test of Word Reading Efficiency, Oral and Written Language scales, etc. Some of these may overlap or be appropriate for a different age, but you can look them up and read what they test. We used the Lab School in DC, and I thought they did really good with both the testing and report writing. Several former Lab SPLs have moved to Continuum in McLean, Virginia to provide services, so you might check there.

What language testing did the neuropsych do or did they only do achievement based testing like the WJ or WIAT? Do you have a WISC or other IQ test and some achievement testing like WIAT or WJ? Did they do any Oral Expression testing? Common is the Test of Language Comprehension which has various subtests for oral expression, ambiguous sentences, figurative language, etc. If task completion is a problem, there should have also been neuropsych testing like the OWLS--II Listening Comprehension or WJ--III Understanding Directions. If writing is time consuming there should have been a VMI and the WIAT Writing including subtests in spelling, sentence composition, writing fluency, alphabet writing, etc.

You are looking for disparities of more than 15 points (aka 1 standard deviation) between IQ and Achievement or speech testing. Such gaps indicate problem areas. Anything 2 or more standard deviations is indicative of a "significant discrepancy" which could qualify a student for an SLD (in oral or written expression or other sub-categories). Commonly in school meetings, a kid with a 99% IQ and speech/language scores (or any scores) at the 50%ile will be referred to as "average" or having "no problem", but in reality the difference between 99%ile IQ and 50%ile language testing is 3 standard deviations and indicative of a big struggle for the child.

Has she always had the speech and expression issues? I'm guessing "yes", since it's not really normal that these issues arise for the first time in middle school. I know you said that you have a good relationship with the school and they have suggested the IEP to you, which you feel makes them proactive, but IMO, your situation is a common one where a child struggles in elementary school, but the school initially only provides a 504 which does not address the real underlying issues/lack of skills that are causing problems, and then the problem worsens over time to the point at which even the school finally admits that an IEP is necessary. I don't really view that as being "responsive to the child's needs". GT kids are often victims of this cycle because their strong intellectual functioning allows them to compensate for their problem areas for a long time and the school often says, "but their grades are good" in denying or refusing to consider/suggest an IEP. It's very common for anxiety issues to increase as it becomes harder and harder to compensate for the disordered areas and the ability to compensate often breaks down either in 3rd grade when academic demands increase, or in the beginning of middle school when the organizational and academic demands take another leap.

As a matter of principle, I object to an ED label when there are clearly underlying issues caused by non-ED problems like speech, ADD, executive dysfunction, etc. By law, a label cannot be used to deny particular services. There should be nothing "more" or "extra" your child can get if he/she has an ED label instead of OHI or SLD, etc. Once a child qualifies for an IEP, he/she is entitled to all necessary services regardless of IEP code. For example, if a SLD child also has anxiety and/or depression and needs emotional services, psychiatric or psychological support, those must be provided. I agree with what other PPs have said -- the coding is a short-hand way of understanding a child and many teachers never read the full assessment profile to get beyond the ED label. I also think it sends the wrong message to the system. At a systemic level these codes are used to understand the county-wide profile on special needs. When kids are coded ED when they are really SLD, OHI, or SLI, it is sending the wrong message to the system about what the needs are for teacher training, support staff, etc.

Very Christian

Anonymous wrote:

OP - you answered the questions I had so I would stay with OHI as that seems truly the most appropriate one for your daughter since some of the manifestations of her emotional issues are displayed as you have indicated in her speech, even if the school does not pick up on them. You see to be addressing her issues well privately and within the context of school services. Much better than to have things first really surface sophomore year in college when you are told that more or less you sent "a 12 year old" to college. One can be very bright academically, but delayed in natural social, coping or general independent life skills.

One suggestion I would have is in a year or two to see if you can help her explore a place or a program she might do some volunteer work with once an option presents itself at the appropriate age. Volunteering would give her a positive outlet to relate to others through language beyond the realm of just academics and her peers.

Another program that operates in our area with the area high schools is Young Life - run by college students. I have observed is very, very positive programming with area college students and even high school volunteers in a monthly special program for area teens and many young adults with cognitive disabilities called Capernaum. I can't help but think that if there is a YL program for high school students in your area it would be worth encouraging your daughter to try it out in high school. It just seems to be on positive self-esteem building, whole some fun and with the context of values that really apply to all kids without focusing on one particular faith system. And the positive if done right is that there are college students running the group rather than just a bunch of teens themselves.

Isn't Young Life a Christian organization?

OP - you answered the questions I had so I would stay with OHI as that seems truly the most appropriate one for your daughter since some of the manifestations of her emotional issues are displayed as you have indicated in her speech, even if the school does not pick up on them. You see to be addressing her issues well privately and within the context of school services. Much better than to have things first really surface sophomore year in college when you are told that more or less you sent "a 12 year old" to college. One can be very bright academically, but delayed in natural social, coping or general independent life skills.

One suggestion I would have is in a year or two to see if you can help her explore a place or a program she might do some volunteer work with once an option presents itself at the appropriate age. Volunteering would give her a positive outlet to relate to others through language beyond the realm of just academics and her peers.

Another program that operates in our area with the area high schools is Young Life - run by college students. I have observed is very, very positive programming with area college students and even high school volunteers in a monthly special program for area teens and many young adults with cognitive disabilities called Capernaum. I can't help but think that if there is a YL program for high school students in your area it would be worth encouraging your daughter to try it out in high school. It just seems to be on positive self-esteem building, whole some fun and with the context of values that really apply to all kids without focusing on one particular faith system. And the positive if done right is that there are college students running the group rather than just a bunch of teens themselves.

My consultant said that FCPS does not do a good job with ED and to avoid that category if possible. If she qualifies in another category, which it sounds like she does, the services are the same.

OP again. They aren't going to change her educational placement. She's in Honors classes and they want her to stay there. What the psychologist discussed was increased accommodations for homework reduction, alternative work modes (computer vs. writing), more hands on help for planning assignments, push in services with a special ed teacher, and more direct teacher/para help with social interactions. They also want her to do a class that works on social and executive function skills that is only available to kids with an IEP.

I feel like I need to clarify that the relationship with the school in our case is not at all adversarial. I could not be happier with the school or their responsiveness to my DC's needs. They are the ones who actually suggested an IEP to us. Academically DC does very well, but there are definite classroom issues. She often has to leave the room or the counselor or school psychologist has to be called.

OP - it would seem that you have been proactive in trying to help your daughter deal with her emotional issues through the years but - if she has to leave the classroom at times - or the counselor or school psychologist has to be called - this may indicate a greater need for something?

-- If so what support could be done with an IEP that was not provided before needs to be asked? Is it that the school division needs to have documentation of the kinds of students taking the counselor or school psychologist's one-to-one time?

-- Is it that if she can't function in the mainstream classroom setting all the time, so she would have some subjects in a smaller class setting?

-- If the above is the case, this would honestly be my greatest concern because ED can have a very wide spectrum - and she may see cases of real violence or continual acting out.

-- Also, for students with ED in more self-contained settings, the quality of academics can be very different than in a regular classroom setting, especially if there are the continual need to discipline students.

I think it is important that you present the options on the IEP label, the supports which would be offered, the possible options on instructional placement to her private psychologist and possibly her psychiatrist to see what they would recommend.

This post strikes a nerve because had we dealt with the inner angst of our oldest as a youngster or definitely in high school, it would have made the college and grad school years a lot easier on all of us. As you probably know, it can be both a combo of chemical imbalance and behavior - and if it was difficult for a college student to deal with terminology, meds and learn to curb "how she handled things" I can only imagine the struggle at times for your daughter. I think it is most important to give her the skills to learn how to regulate her feelings and whatever you need to do for that is the key despite any label.