OT: anyone have experience with neuropsychological assessment?

[deerhart]

For original poster, please PM me if you need any info about an evaluation done in the school setting, which IS completely appropriate, legal, valid, and entitled to your child. I simply cannot read any more on this thread with someone trying to tell me that I am wrong about MY own job. It IS a role of the school to diagnose ADHD, autism, learning disabilites, asperger's, etc. Sure a doctor can also do it, but if we do it free, why put that expense on the parent. And yes, I have taken plenty of post-graduate classes regarding these laws. And, we do have lawyers on staff dealing specifically on 504's. And, just so you know above poster, we don't do evals just for educational purposes. We have entire free-standing health clinics (also operated by our school system--that are on school properties at 4 of our area schools--which are also free of charge), that have--shocker--medical doctors and nurses.

I never told you how to do your job. I never told you what tests to run, how to interpret the behaviors your seeing etc.

Instead, what I said is that it is not the schools job to diagnosis and there is good reason for that. It is a huge conflict of interest to have the same school do the diagnosis who is ALSO doing the evaluation to determine if the child qualifies for an IEP or a 504 plan. If the school denies the 504 plan or the IEP, the parents are left with NO expert who has seen the child at the same time when the case goes into litigation. Further, they are left with the person who did the diagnosis WORKING for the same school that the parents are now suing.

Its not about cost, its about having an opinion SEPARATE from the bias and pressure of a school system that has a CONFLICT against the interest of the individual child.

It is a huge mess to go into a due process hearing or federal court and the expert who diagnosed the child is under the control of the opposing side and can only be spoken to through opposing counsel because they are employees of the school system.

The first words out of any decent advocates mouth will be NOT to let the school do any diagnosis. It will always be in the parents best interest to have a medical provider diagnosis the child and who is on the parents side, instead of n the employ of the school.

 

[disneymom2one]

I never told you how to do your job. I never told you what tests to run, how to interpret the behaviors your seeing etc.

Instead, what I said is that it is not the schools job to diagnosis and there is good reason for that. It is a huge conflict of interest to have the same school do the diagnosis who is ALSO doing the evaluation to determine if the child qualifies for an IEP or a 504 plan. If the school denies the 504 plan or the IEP, the parents are left with NO expert who has seen the child at the same time when the case goes into litigation. Further, they are left with the person who did the diagnosis WORKING for the same school that the parents are now suing.

Its not about cost, its about having an opinion SEPARATE from the bias and pressure of a school system that has a CONFLICT against the interest of the individual child.

It is a huge mess to go into a due process hearing or federal court and the expert who diagnosed the child is under the control of the opposing side and can only be spoken to through opposing counsel because they are employees of the school system.

The first words out of any decent advocates mouth will be NOT to let the school do any diagnosis. It will always be in the parents best interest to have a medical provider diagnosis the child and who is on the parents side, instead of n the employ of the school.

I completely agree. We have a 14 year old with multiple issues and I chose to have her privately evaluated (first at eight and then again at 13). I want my evaluator working for me and my child - not for the school system. Period.

 

[jodifla]

I never told you how to do your job. I never told you what tests to run, how to interpret the behaviors your seeing etc.

Instead, what I said is that it is not the schools job to diagnosis and there is good reason for that. It is a huge conflict of interest to have the same school do the diagnosis who is ALSO doing the evaluation to determine if the child qualifies for an IEP or a 504 plan. If the school denies the 504 plan or the IEP, the parents are left with NO expert who has seen the child at the same time when the case goes into litigation. Further, they are left with the person who did the diagnosis WORKING for the same school that the parents are now suing.

Its not about cost, its about having an opinion SEPARATE from the bias and pressure of a school system that has a CONFLICT against the interest of the individual child.

It is a huge mess to go into a due process hearing or federal court and the expert who diagnosed the child is under the control of the opposing side and can only be spoken to through opposing counsel because they are employees of the school system.

The first words out of any decent advocates mouth will be NOT to let the school do any diagnosis. It will always be in the parents best interest to have a medical provider diagnosis the child and who is on the parents side, instead of n the employ of the school.

The other aspect is that a lot of school "experts" don't have the training and knowledge to accurately assess someone, particularly in the area of differential diagnsoses. And most don't know the actual federal laws, they only know what their district typically does, and then they THINK it's the law.

We've run into this more than once. Despite having 4 independent evaluations, the school psych and social worker THOUGHT they knew better at our last school. And they harangued, harangued and harassed us into trying to accept their evaluation. Since in every meeting it was clear I knew more about the DSM-IV AND the federal laws than they did, I declined their "professional" opinions. Their "knowledge" of disorders was shallow and wrongheaded. (Interestingly enough, the social worker at the new school dropped this and accepted the outside evaluations, saying they were accurate.)

Labels are useful tools IF THEY ARE ACCURATE!!! IF they are wrong, they are harmful. To parents that say "I don't care what they call it, as long as my child gets services" I respond: Would you want to be treated for Parkinson's if you had cancer? You need the RIGHT treatment for the best outcome.

So my cautionary tale is to make sure the professional understands differential diagnoses, and has EVERY Dx on the table. Know their TRACK RECORD -- how often are they actually correct? How often do they actually help children? Most school workers have NO accountability. If they're wrong, oh well!

As a parent of child with special needs you have to be a very responsible consumer of services. And FREE can be VERY, VERY COSTLY if the opinion is incorrect.

 

[miknminniesfriend]

I have had students have NP assessments, usually done outside of the school system. They did take atleast a full day, sometimes more than one. The kids I talked to after said it was fine- they played games and did some "work". The parents were pleased with the information they gained. I recieved 8-10 page reports which included the actual issues and what specifically can be done to help the child. It was helpful. Having the school system do it would be free, but the success is dependent on the person doing the assessment (as is anywhere, but outside the school you, as the parent, choose).

 

[JUJU814]

I completely agree. We have a 14 year old with multiple issues and I chose to have her privately evaluated (first at eight and then again at 13). I want my evaluator working for me and my child - not for the school system. Period.

Same here. We had our son evaluated privately. We personally choose to have nothing to do with the public school system.

Thankfully, we have good insurance which covers all his services from medical, OT, psychological, neurology, neuropsych eval etc.

Not everyone has the luxury of good insurance that covers it all.

 

[SnowWhite12]

The other aspect is that a lot of school "experts" don't have the training and knowledge to accurately assess someone, particularly in the area of differential diagnsoses. And most don't know the actual federal laws, they only know what their district typically does, and then they THINK it's the law.

We've run into this more than once. Despite having 4 independent evaluations, the school psych and social worker THOUGHT they knew better at our last school. And they harangued, harangued and harassed us into trying to accept their evaluation. Since in every meeting it was clear I knew more about the DSM-IV AND the federal laws than they did, I declined their "professional" opinions. Their "knowledge" of disorders was shallow and wrongheaded. (Interestingly enough, the social worker at the new school dropped this and accepted the outside evaluations, saying they were accurate.)

Labels are useful tools IF THEY ARE ACCURATE!!! IF they are wrong, they are harmful. To parents that say "I don't care what they call it, as long as my child gets services" I respond: Would you want to be treated for Parkinson's if you had cancer? You need the RIGHT treatment for the best outcome.

So my cautionary tale is to make sure the professional understands differential diagnoses, and has EVERY Dx on the table. Know their TRACK RECORD -- how often are they actually correct? How often do they actually help children? Most school workers have NO accountability. If they're wrong, oh well!

As a parent of child with special needs you have to be a very responsible consumer of services. And FREE can be VERY, VERY COSTLY if the opinion is incorrect.

I think most people are HIGHLY wrong about what a School Social Worker is. I am a Licensed Clinical practitioner, who is eligible to have my own practice, just like psychs. Doctors here put much more stock in our diagnoses than others. We are just as "professional and knowledgable". So I humbly disagree, and feel really sorry for those of you who do not take advantage of free services offered by the school. Actually, most respected pediatricians here send THEIR patients to us for the evals for ADHD. And I have PLENTY of accountability. Do you not understand due process? If parents disagree with the DX, they are entitled to outside assessment (at their cost of course). And, just so you know, here in TN schools, outside diagnoses are NOT accepted to qualify any child for 504 or IEP. An evaluatation must be done in the school, even if a doctor sends a health cert form. Because around here, so many doctors and psychiatrists will diagnose almost anyone as ADHD or autistic, without any real proof or evaluation. And those, my friend, are the inaccurate diagnoses! They don't even see the child in a school setting for true symptoms.

 

[SnowWhite12]

unsubbing

 

[jodifla]

I think most people are HIGHLY wrong about what a School Social Worker is. I am a Licensed Clinical practitioner, who is eligible to have my own practice, just like psychs. Doctors here put much more stock in our diagnoses than others. We are just as "professional and knowledgable". So I humbly disagree, and feel really sorry for those of you who do not take advantage of free services offered by the school. Actually, most respected pediatricians here send THEIR patients to us for the evals for ADHD. And I have PLENTY of accountability. Do you not understand due process? If parents disagree with the DX, they are entitled to outside assessment (at their cost of course). And, just so you know, here in TN schools, outside diagnoses are NOT accepted to qualify any child for 504 or IEP. An evaluatation must be done in the school, even if a doctor sends a health cert form. Because around here, so many doctors and psychiatrists will diagnose almost anyone as ADHD or autistic, without any real proof or evaluation. And those, my friend, are the inaccurate diagnoses! They don't even see the child in a school setting for true symptoms.

Of course, if you've done your research, you KNOW this isn't true of many states. In many states, schools CANNOT Dx and only can offer educational assessments.

Also screwing things up is many states have extremely broad guidelines for what is considered autistic, for example, which is why the rates in some states are sky high. A simple look at a bar graph tells you that.

I belong to a message board where parents are routinely hounded and harassed by school psychs and social workers to mislabel their children. I chose to stay and fight, many just pull their kids out and homeschool them.

Oh, I know about due process. Most parents are too intimidated to go that far. It's expensive and draining. We didn't need due process, because it was easy for us to prove that the social worker and school psych were clueless.

Your "my friend" quote says all about you.

 

[jodifla]

unsubbing

Frankly, this figures. The school types I dealt with who were so sure of themselves couldn't stand any kind of dissension.

 

[SnowWhite12]

Classy. Amazes me when people offer friendly advice to posters seeking help then are attacked.

 

[jodifla]

Classy. Amazes me when people offer friendly advice to posters seeking help then are attacked.

Because your advice is potentially harmful. Perhaps you are totally qualified to make these assessments. But do you really think every social worker across U.S. school districts has this training and background?

It's clear from my conversations with parents across the U.S. that they don't. And what about the one social worker who says your child has A, while the other says it's B? Or the school personnel who turn a blind eye to four previous assessments (Even one of which, THEY ordered)?

I see too many parents thrown into turmoil because of "checklists" done at EI or at school, or by school personnel that have little to no training. One parent's child was assessed by a Realtor doing the assessing for extra money on the side!

Parents need to know that not everyone doing assessments is qualified, and just because they work for the school district doesn't mean they have actual expertise in your child's area of difficulty...it could be well beyond their area of expertise.

Again, free can be very, very costly to your child's future.

 

[deerhart]

By Federal law, the school MUST consider the outside eval or diagnosis, but (just like I tell many a parent) they are also free to consider it and completely ignore it (which many do).

I find it interesting that you claim that Tennessee school systems will not accept outside diagnosis, yet I know a professor, who works at the Universty of Vanderbilt, who not only does outside evals but also assist parents with the IEP process to get his recommendations implemented.

Further, the requirement for an ADHD diagnosis has nothing to do with school. It only has to occur in two separate settings. Some people with ADHD (myself included) had NO ISSUES with school, it was elsewhere that problems arose.

As for due process, I understand it FAR better then I am sure you do, since I do due process type hearings all the time. What you don't understand is that the parent that is now forced into due process because they have no other source and is getting an IEE STILL doesn't have an independent diagnosis. There is an REASON its called an Independent EDUCATIONAL EVALUATIONAL and not an independent diagnosis evaluation. Further, your wasting valuable time.

And yes, the licensed psychologist who did my son's 2 triannual reviews was qualified to diagnosis my child, she was qualified to read all the reports we have an offer her expert opinion. But it was not her job to diagnosis him, it was her job to determine his educational needs. She sees him in the SCHOOL setting, but she doesn't see him at Grandmas, home, the mall, a docs office etc..

As for the definition of Educational Autism, that is set again by Congress and the Department of Education through its rules creation for IDEA. To be classified for educational autism for Special Education services does NOT require an autism diagnosis. I am sure some will disagree and state that it absolutely does, but then again, my son is classified as Educational Autism for SPED services and does not carry an autism diagnosis and in fact has a diagnosis that specifically rules out autism.

The category is written broadly enough that all it requires is emotional, behavioral, and speech issues combined in the same child. It "fit" better for my child's needs in the classroom then a speech/language disorder or OHI. Special Education labels are NOT diagnosis specific, but you are to place the child in the label that best fits the needs of the child and the behaviors etc they exhibit in the school setting.

Your not being attacked. You have your opinion based on what you know. But by following your opinions, parents can find themselves in a very bad and expensive place without the support of the person who did the original diagnosis.

So what if they save a few hundred dollars on the diagnosis by using a free service, it may save them several 10's of thousands later on paying an attorney to take a case to federal court.

 

[4forMe]

Thank you so much for all the responses. I feel better knowing others have children in similar circumstances.

We are having the neuropsych eval. done privately at a very well known hospital near us. We thankfully have excellent insurance which will cover the neuropsychological evaluation. I also learned from a friend who has a child receiving services at our school that they do tend to accept outside evaluations.

I do not trust the school system to correctly diagnosis DS, especially since he appears to have symptoms that overlap (ADHD, Asperger's, Sensory Processing Disorder). I had assumed that SPD would be included in the evaluation; however, it seems through my research that an OT would have to evaluate for Sensory Processing Disorder - can anyone verify if this is correct?

I am still having problems with DH accepting this, even though DS had 3 major meltdowns last week. He feels that DS is just immature and is throwing tantrums to manipulate us. Last Friday, DS had a major meltdown since his friend, who was supposed to come over for a playdate, was out for the afternoon. There was an obvious miscommunication between the mother and I since I had confirmed this playdate the day before. Anyhow, DS had a MAJOR meltdown. DS does not deal well with transitions or things not going according to planned.

Here is the kicker - DH had major difficulties in school and most likely had undiagnosed ADHD and Dyslexia. Even though he has his doctorate in a science related field, he still can't spell or write well. His feeling is that he got through school OK, so his son should be fine. My statement to him is, "YOUR SON IS NOT YOU!!!" Also, I told him there is a lot more competition to get into college than when we went. There also wasn't a writing component required on the ACT at that time like there is now. I absolutely want DS to get the accomodations he needs to be successful in school (ie. extended time for tests, quiet environment, AT, etc.). I also feel like we can't address the emotional issues until we have a diagnosis.

Dealing with my DH's attitude has added to the stress of this situation. Compunding the issue is that DH is completely against any type of medication for ADHD - we have been gone head to head on this topic numerous times. Anyone else have a spouse/SO who was not supportive in evaluating and seeking services for their child? I am taking DS for the neurological evaluation whether DH agrees or not.

 

[deerhart]

the neuropsych may be able to touch on some SID issues, but an OT eval would be better option. I would ask the place doing the testing to see if they will/won't touch on it. You may find that an OT eval is one of their recommendations at the end of the testing.

 

[HicksWDW]

In Texas specifically North Texas ADHD does get you a 504.

ADHD diagnosis doesn't qualify one for a 504 in NW FL. Generally, a student must be exibiting academic difficulties. At that point possible screening may occur along with many Gen Ed interventions. If student continues to exibit academic difficulties, he/she may qualify for ESE services provided in an IEP under OHI eligibility. This is an eligibility, not a diagnosis. But, again this is only if the student is experiencing academic difficulty after attempted interventions.

 

[princessmom29]

Of course, if you've done your research, you KNOW this isn't true of many states. In many states, schools CANNOT Dx and only can offer educational assessments.

Also screwing things up is many states have extremely broad guidelines for what is considered autistic, for example, which is why the rates in some states are sky high. A simple look at a bar graph tells you that.

I belong to a message board where parents are routinely hounded and harassed by school psychs and social workers to mislabel their children. I chose to stay and fight, many just pull their kids out and homeschool them.

Oh, I know about due process. Most parents are too intimidated to go that far. It's expensive and draining. We didn't need due process, because it was easy for us to prove that the social worker and school psych were clueless.

Your "my friend" quote says all about you.

I think it is sad that so many parents have such a negative relationship with thier children's school. I would be absolutely horrified to hear any of my parents describe thier experience in these terms. Good schools and school systems want what is best for the individual children invloved, not what is more convinent for them. It makes me sad to think that there are school systems out there that actually operate this way and would make a parent so bitter about thier experiences. We truly try to help and do what is best for the children in our care, at least at my school. That includes everyone. We are all advocates for the best interests of the children. Please konw that nto all school systems are out to get kids and parents.

 

[jackskellingtonsgirl]

In Texas specifically North Texas ADHD does get you a 504.

Yes and no.
DS was diagnosed with moderate inattentive ADD in 4th grade. We had him tested at our pediatrician's office by the diagnostician they have on staff. We met with the school and implemented a 504. So far, so good.

In 7th grade I requested a meeting to review his modifications, see if we needed to adjust anything, etc. The guidance counselor talked with the teachers, the teachers said they saw no issues in class, and that was it. They REVOKED his 504. He is now in the 2nd semester of 8th grade and I can't get it reinstated.

He had a horrible 2nd semester of 7th grade. HORRIBLE. We took him for a private evaluation by a neuropshych at the children's hospital because I KNEW something was not right. The school kept telling me it is just a 7th grade boy thing, they all do this, etc.

Long story short, the Dr. believes DS's issues are NOT ADD, but the long term effects of a brain lesion that was diagnosed in 2nd grade. (The myelin is stripped away from an area of the cells, and now those cells don't transmit information the way they should.) Now, even with a 10 page diagnostic report from the Dr. I STILL don't have the 504 back because DS does NOT show educational impairment. He is A/B honor roll with a full load of pre-AP courses, so the counselor refuses to consider a 504.

He will go to high school in the Fall and I will take it up with them. My concern is how much time we will lose trying to get the 504 back if he DOES start to show educational impairment.

 

[princessmom29]

Yes and no.
DS was diagnosed with moderate inattentive ADD in 4th grade. We had him tested at our pediatrician's office by the diagnostician they have on staff. We met with the school and implemented a 504. So far, so good.

In 7th grade I requested a meeting to review his modifications, see if we needed to adjust anything, etc. The guidance counselor talked with the teachers, the teachers said they saw no issues in class, and that was it. They REVOKED his 504. He is now in the 2nd semester of 8th grade and I can't get it reinstated.

He had a horrible 2nd semester of 7th grade. HORRIBLE. We took him for a private evaluation by a neuropshych at the children's hospital because I KNEW something was not right. The school kept telling me it is just a 7th grade boy thing, they all do this, etc.

Long story short, the Dr. believes DS's issues are NOT ADD, but the long term effects of a brain lesion that was diagnosed in 2nd grade. (The myelin is stripped away from an area of the cells, and now those cells don't transmit information the way they should.) Now, even with a 10 page diagnostic report from the Dr. I STILL don't have the 504 back because DS does NOT show educational impairment. He is A/B honor roll with a full load of pre-AP courses, so the counselor refuses to consider a 504.

He will go to high school in the Fall and I will take it up with them. My concern is how much time we will lose trying to get the 504 back if he DOES start to show educational impairment.

If he does not show educational impairment he is not entitiled to a 504 plan unless the conditon makes it necessary for school personell to do something outside the norm to provide for his health and safety. According to the law,he does not need any accomadation it would provide if his academic performance is not being impacted by his medical condition. If he is preforming well academically, I am not sure what you could hope to get out of having a 504 for him. It is designed to provide accomodations to allow students with medical challenges that interfere with academic perfromance to be accomodated, or for accomodations made for the health and safety of a medically impaired student. It sounds like it would be pointless for him to have a 504 as he is doing better than the average student already, unless he has some kind of medical need that should be addressed during the school day such as medication, monitoring ect.

 

[gandycat]

I was going to suggest to you to have an OT eval for SPD. My son was diagnosed at 3 by an OT and has gone to OT and PT off and on for several years. We also had a full work up with a nuerologist including an MRI of his brain and lots of other blood work and physical exams to rule things out. Our school district provided OT to him at school from K on and we didn't ask for an IEP until the end of second grade (b/c the hand writing demands increase a ton in 3rd grade and we wanted accomodations made). We had our eval done by the school psychologist and everything went fine.

I understand the 'labeling' issue, I think every parent goes thru that a bit and it's a process to work thru. But I always think that if our kid was drowning, we wouldn't think twice about throwing a life preserver to them. Getting the label and a better understanding of what their needs are allows you to throw them that life preserver. Good luck with everything!