TSHA Convention Short Course March 25, 2010 Leslie Armbruster, MA, CCC-SLP

1. Language Disorders in Children with Other Disabilities:Autism, Mental Retardation &Multiple Severe Disabilities TSHA Convention Short Course March 25, 2010 Leslie Armbruster, MA, CCC-SLP Alison Barton, MA, CCC-SLP

2. OUTLINE OF TRAINING • Mental Retardation/Multiple Severe Disabilities • SI as a Related Service • Key Components – MDT Assessment • Determining Disability Condition (SI) • Stage 1 – Communication Disorder • Stage 2 – Adverse Effect • Report Recommendations • Stage 3 – Need for SLP Services

3. OUTLINE OF TRAINING • Autism Spectrum Disorders • SI as a Related Service • Key Components – MDT Assessment • Determining Disability Condition (SI) • Stage 1 – Communication Disorder • Stage 2 – Adverse Effect • Report Recommendations • Stage 3 – Need for SLP Services

4. SI (Language) withMental Retardation and/or Multiple Severe Disabilities

5. Definitions • Mental Retardation • DSM IV-TR • IDEA 2004 • Multiple Disabilities • IDEA 2004 • Texas Commissioner’s Rules • Speech Impairment

6. Mental Retardation – DSM-IV-TR • Significantly sub average general intellectual functioning AND significant limitations in adaptive functioning in at least two areas: • Communication, self-care, home living, social/ interpersonal skills, self-direction, functional academic skills, work, leisure, health, safety • Presenting symptoms are in the areas of adaptive functioning

7. Mental Retardation – DSM-IV-TR • Adaptive functioning: how effectively an individual copes with common life demands and how well s/he meets the standards of personal independence expected for age, sociocultural background and community setting.

8. Interesting Trivia • The recent draft of the DSM-V changes the term “mental retardation” to “intellectual disabilities” • Watch for the wording change in the next reauthorization of IDEA and/or Texas Commissioner’s Rules!!!

9. Mental Retardation – DSM-IV-TR • Prevalence: 1% of general population • Mild MR – 50-55 - approx 70; 85% of MR pop • Mod MR – 35-40 – 50-55; 10% of MR pop • Severe MR – 20-25 – 35-40; 3-4% of MR pop • Profound MR - <20-25; 1-2% of MR pop

10. Mental Retardation – IDEA 2004 “Mental retardation means significantly sub average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.” i.e. adverse affect on academic achievement and adverse affect on functional performance

11. Multiple Disabilities – IDEA 2004 Multiple disabilities means concomitant impairments (such as mental retardation-blindness, mental retardation-orthopedic impairment, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments. The term does not include deaf-blindness.

12. Severe Multiple DisabilitiesTypical Student Profile • Measured IQ in the severe to profound range • Often non-ambulatory • Often limited use of hands/arms for self-care purposes • Often does not have a symbol system in place • Often nonverbal • Often – procedures in place (feeding tube, trach, etc.)

13. Multiple Disabilities – Texas Commissioner’s Rules A student who meets the criteria for multiple disabilities in IDEA and who meets all of the following: disability is expected to continue indefinitely disabilities severely impair performance in two of the following: psychomotor skills, self-care skills, communication, social and emotional development, cognition

14. Mental Retardation Section – DSM-IV-TR “A Communication Disorder can be diagnosed in an individual with Mental Retardation if the specific deficit is out of proportion to the severity of the Mental Retardation.” (p. 47)

15. This means… • A communication disorder co-occurs with mental retardation when specific communication skills are out of proportion with the severity of the mental retardation • Tip: compare communication skill levels to over-all functioning, especially adaptive behavior • Tip: stay away from IQ score and language score comparisons

16. Speech-Language ImpairmentIDEA Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance[emphasis added] 34CFR 300.101 (c)(11)

17. Critical Concepts • Communication Disorder such as… • Adverse effect on educational performance = • Adverse affect on academic achievement • Adverse affect on functional performance • Per IDEA 2004

18. SI with Other Disabilities When SI is a second or third disability condition, speech-language services become a related service provided to help the student benefit from his/her special education program

19. Speech-Language Therapy • Instructional Service • When SI is only disability • Purpose: progress in the general ed curriculum • Related Service • S-L Therapy is a related service when there are other disabilities • Purpose: benefit from special ed program

20. Speech-Language TherapyRelated Service • ARDC considers eligibility categories • ARDC outlines specially designed instruction/special education program • ARDC determines whether related services are needed to help student benefit from special education (including speech-language therapy) • ARDC determines frequency, location, duration, and type (direct or indirect) of all IEP services

21. Speech-Language TherapyRelated Service • Purpose of S-L Therapy as related service is to help student benefit from special education program • When student has MR or Multiple Severe Disabilities, specially designed instruction focuses on • Work based learning outcomes • Independence: self-care, communication, interpersonal • Functional academics

22. Speech-Language TherapyRelated Service • How does Speech as a related service change… • Goals and objectives? • Frequency of services? • Location of services? • Duration of services? • Description of direct & indirect services?

23. Key Components Multi-Disciplinary Team Evaluations

24. Key ComponentsSLP’s Role in MDT Evaluations • Evaluation Procedures for the Multi-Disciplinary Team Evaluation Plan Evaluation Tips • Evaluation Flow Chart • Communication Model – for consistent decision making • Adverse Effect Rubric Academic achievement Functional performance

25. General Principle (IDEA) • The assessment of language and communication status for students with other disabilities is one part of a comprehensive, multi-disciplinary team evaluation §300.532 (h) • Communication and interpersonal skills are areas of adaptive functioning that must be addressed for MR

26. Note to MDT… Evaluation of students with significant disabilities often includes reliance on informal measures rather than on standardized tests

27. Other Notes to MDT… • Adaptive behavior/functioning level is the determining factor in identification of mental retardation • Use scores from language standardized tests to corroborate adaptive behavior standard scores and cognitive ability scores • Use data from informal measures, observations, functional communication profile to identify a language/communication disorder

28. Multidisciplinary Teamwork • Balanced work distribution • Active participation – all team members • Evaluation Action Plan – spells it out • Parents and Teachers – partners in the process

29. Evaluation Plan • Consistently provide comprehensive evaluations • Address/Assess all areas • Reminds team to answer the evaluation question/s • Delegates responsibility for data collection • Allows for individualized evaluations (vs. “boiler-plate” approach)

30. Evaluation Team Action Plan Specify who will do what by when Review existing information Teacher interview Other school staff interviews Parent interview Classroom observation Other observations Direct Testing Parent Conference School Team Conference IEP Team Meeting

33. Quality Evaluation:Assumptions • Useful • Clear • Guides instruction/intervention • Identifies learning targets • Includes broad based information • Includes reports from parents • Is completed over multiple occasions

34. IDEA 2004 Flex Points • Comprehensive evaluations • Variety of tools and strategies • Gather functional, developmental, academic information • Assess in all areas related to suspected disability • Must include information from parent

35. Comprehensive Evaluations • Provide sufficient information for academic and functional goals • Specify supports for school personnel: Should be listed specifically in the IEP – including staff development, AT/AC training for teachers and paraprofessionals, other indirect services and activities needed for full IEP implementation • Identify all special education and related services needs (i.e. don’t fragment evaluation among assessment professionals) • One child: One evaluation report: One IEP

36. Comprehensive Evaluations • Variety of assessment tools and strategies • Standardized instruments • Naturalistic observation • Language sample • Communication sample • Parent interview • Teacher interview • Clinical interview • Play-based assessment • Records review • Consideration of student’s learning profile • Responsiveness to interventions

37. Variety of Evaluation Instruments • Norm-referenced • Criterion-referenced • Dynamic evaluation • Ecological evaluation • Rating Scales • Observation Notes • Screening Scales • Interview Notes/Anecdotal Information • Medical and Developmental History

38. Dynamic Evaluation(measure teachable moments) • Considers learning demonstrated during evaluation process • Variations of the test – teach – test – teach model • Observations in functional context-bound activities in multiple settings • What the child is able to do with some adult support • Similar to Patterns of Strengths and Weaknesses

39. Dynamic Evaluation Categories(Highly important in autism evaluations) • Attention • Discrimination • Planning • Self-regulation • Transfer • Motivation • Interaction

40. Ecological Evaluation(Highly important for developing IEP and BIP) • Informal testing • Effects of context on performance • Observe child in daily activities • Includes insights, knowledge, impressions of parents and professionals who know the student • Helps team identify supports and compromises faced by child/family in areas most important to them

41. Ecological Evaluation Categories • State • Environment • Posture • Sensory Motor/Integration • Social • Exploration/Play • Communication • Response to Cues • Performance Facilitated • Performance Compromised

42. Flowchart See Handout

43. Communication Model See Handout

45. SI Eligibility GuidelinesDisability Condition & Adverse Effect • Develop MDT Evaluation Plan to answer referral (or re-eval) questions • Gather Assessment Data • Analyze Assessment Data • Complete Summary Profile of Performance • Cognitive/intellectual abilities • Adaptive Behavior levels • Communication levels • Language levels

46. SI Eligibility GuidelinesDisability Condition & Adverse Effect • If Cross Battery Analysis is used • Look for low scores across all cognitive processes • Look for Gc lower than other processing areas • XBA can help determine if language is a relative weakness, aligned with other areas, or a relative strength

47. SI Eligibility GuidelinesDisability Condition & Adverse Effect • Compare communication and language level/s with adaptive behavior levels and over-all functioning level • Interpret data and document presence/ absence of communication disorder • See Handout

48. Adverse Effect Rubric See Handout