2010 Special Education Hearing Officers and Mediator Training (San Diego) The Nexus Between the DSM & IDEA: Social M

1. 2010 Special Education Hearing Officers and Mediator Training (San Diego) The Nexus Between the DSM & IDEA: Social Maladjustment v. Emotional Disturbance Mary Schwartz, Impartial Hearing Officer, Illinois

2. DO THEY GO TOGETHER? • DSM-IV • IDEA

3. DIFFERENT PURPOSES … IDEA DSM-IV Official nomenclature for professionals Differential diagnosis based on medical model Treatment planning Third party reimbursement • Determine eligibility for special education and related services • Develop educational program to meet unique needs of individual student

4. DIFFERENT CRITERIA … IDEA ELIGIBILITY DSM-IV AXES AXIS I: Clinical Disorder AXIS II: Personality Disorders and Mental Retardation AXIS III: General medical conditions AXIS IV: Psychosocial and environmental problems AXIS V: Global Assessment of Functioning (GAF) • Child must have at least one of disabilities defined in regulations • Disability must adversely affect child’s educational performance • Because of above, child needs special education and related services

5. 16 DSM-IV DIAGNOSTIC CATEGORIES Those most likely to appear in due process complaints/hearings • Disorders usually first diagnosed in infancy, childhood or adolescence • Mood Disorders • Impulse Control Disorders • Anxiety Disorders • Schizophrenia and Other Psychotic Disorders • Personality Disorders • Substance Abuse Disorders • Somatoform Disorders • Eating Disorders • Sleep Disorders • Adjustment Disorders

6. DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • Intellectual and Cognitive Impairments • Mental Retardation • Learning Disorders • Motor Function Impairments • Motor Skills Disorder • Tic Disorders • Stereotypic Movement Disorder

7. DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • Disruptive or Self-Injurious Behavior Disorders • Attention Deficit Disorders • Conduct Disorder • Oppositional Defiant Disorder • Feeding and Eating Disorders of Early Childhood • Elimination Disorders • Separation Anxiety Disorder • Reactive Attachment Disorder of Infancy or Early Childhood • Information Exchange Disorders • Pervasive Developmental Disorders • Communication Disorders • Selective Mutism

8. MOOD DISORDERS • Predominant Feature: Disturbance in mood • Mood episodes are building blocks for diagnoses of mood disorders • Divided into: • Major Depressive Disorder • Dysthymic Disorder • Bipolar Disorders • Cyclothymic Disorder

9. IMPULSE CONTROL DISORDERS • Conduct Disorder • Oppositional Defiant Disorder (ODD) • Intermittent Explosive Disorder (IED) • Pyromania, Trichotillomania

10. ANXIETY DISORDERS • Panic Disorders • Phobias • Post Traumatic Stress Disorder (PTSD) • Generalized Anxiety Disorder • Substance-Induced Anxiety Disorder

11. SCHIZOPHRENIA & PSYCHOTIC DISORDERS • Schizophrenia • Psychotic Disorder NOS • Brief Psychotic Disorder PERSONALITY DISORDERS • Narcissistic Personality Disorder • Borderline Personality Disorder

12. SUBSTANCE ABUSE DISORDERS • Substances include alcohol, illegal drugs, medications • Categories • Substance Dependence • Substance Abuse • Substance Intoxication • Substance Withdrawal

13. SOMATOFORM, EATING & SLEEPING DISORDERS • Somatization Disorder • Body Dysmorphic Disorder • Anorexia Nervosa & Bulimia Nervosa • Breathing Related Sleep Disorder • Sleep Walking Disorder ADJUSTMENT DISORDERS • Emotional or behavioral symptoms in response to identifiable stressor (symptoms are not bereavement)

14. DSM-IV IS RELEVANT…… • Symptoms per above diagnoses provide information that may be relevant to determination of emotional disorder • Expert testimony may reference and discuss DSM-IV symptomatology BUT NOT SUFFICIENT

15. THREE PART ANALYSIS REQUIRED • One or more of the characteristics listed • Over long period of time and to marked degree, and • Adversely affects educational performance

16. E.D. CHARACTERISTICS • Inability to learn that cannot be explained by intellectual, sensory, or health factors • Inability to build or maintain satisfactory interpersonal relationships with peers and teachers • Inappropriate types of behaviors or feelings under normal circumstances • General pervasive mood of unhappiness or depression • Tendency to develop physical symptoms or fears associated with personalor school problems • Includes schizophrenia • Does not apply to social maladjustment unless it is determined that chihad emotional disorder per above.

17. SOCIAL MALADJUSTMENT “Teenagers, for instance, can be a wild and unruly bunch. Adolescence is, almost by definition, a time of social maladjustment for many people.” Springer v. Fairfax County School, 134 F.3d 659,664 (4th Cir. 1998). Characterized by: • Intentionality • Little remorse • Lack of empathy • Failure to take responsibility for behavior

18. ADVERSE IMPACT • Parameters of educational performance • Quantity of impact • If adverse impact, must still determine that student needs special education and related services

19. FURTHER CONSIDERATIONS … • Does it matter when emotional disorder is raised – at case study evaluation stage or at MDR? • If a parent is pro se, do we approach questioning of experts differently when DSM-IV diagnosis is raised in testimony? • If we hold a degree and/or certification as clinician, can we use that expertise (and opinions formed thereupon) as part of our decision? • If decision is for district, what about commenting in decision on difficulties faced by family due to student’s emotional problems?