2010 Special Education Hearing Officers and Mediator Training (San Diego)
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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. DO THEY GO TOGETHER?. DSM-IV. IDEA. DIFFERENT PURPOSES …. IDEA. DSM-IV.

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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


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DO THEY GO TOGETHER? Training (San Diego)

  • DSM-IV

  • IDEA


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DIFFERENT PURPOSES … Training (San Diego)

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


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DIFFERENT CRITERIA … Training (San Diego)

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


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16 DSM-IV DIAGNOSTIC CATEGORIES Training (San Diego)

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


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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


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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


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MOOD DISORDERS ADOLESCENCE

  • 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


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IMPULSE CONTROL DISORDERS ADOLESCENCE

  • Conduct Disorder

  • Oppositional Defiant Disorder (ODD)

  • Intermittent Explosive Disorder (IED)

  • Pyromania, Trichotillomania


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ANXIETY DISORDERS ADOLESCENCE

  • Panic Disorders

  • Phobias

  • Post Traumatic Stress Disorder (PTSD)

  • Generalized Anxiety Disorder

  • Substance-Induced Anxiety Disorder


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SCHIZOPHRENIA & PSYCHOTIC DISORDERS ADOLESCENCE

  • Schizophrenia

  • Psychotic Disorder NOS

  • Brief Psychotic Disorder

    PERSONALITY DISORDERS

  • Narcissistic Personality Disorder

  • Borderline Personality Disorder


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SUBSTANCE ABUSE DISORDERS ADOLESCENCE

  • Substances include alcohol, illegal drugs, medications

  • Categories

    • Substance Dependence

    • Substance Abuse

    • Substance Intoxication

    • Substance Withdrawal


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SOMATOFORM, EATING & SLEEPING DISORDERS ADOLESCENCE

  • 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)


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DSM-IV IS RELEVANT…… ADOLESCENCE

  • 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


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THREE PART ANALYSIS REQUIRED ADOLESCENCE

  • One or more of the characteristics listed

  • Over long period of time and to marked degree, and

  • Adversely affects educational performance


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E.D. CHARACTERISTICS ADOLESCENCE

  • 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.


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SOCIAL MALADJUSTMENT ADOLESCENCE

“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


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ADVERSE IMPACT ADOLESCENCE

  • Parameters of educational performance

  • Quantity of impact

  • If adverse impact, must still determine that student needs special education and related services


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FURTHER CONSIDERATIONS … ADOLESCENCE

  • 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?


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