School Evaluation Starting Right After Medication Improvements

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This topic contains 11 replies, has 2 voices, and was last updated by  Devon Frye 2 years ago.

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  • #39837

    ADHDmomma
    Keymaster

    This discussion was originally started by user spazzyjanet in ADDitude’s now-retired community. The ADDitude editors have included it here to encourage more discussion.

     

    Does anyone have any sources that I could go to that discuss how to handle an evaluation for a child that begins medication just prior to the school’s evaluation (and as a result has seen significant improvements in behavior, focus, and Connors K-CPT)?

    I’d like to see guidance on how to factor in tests and evaluations performed BEFORE medication in order to determine whether a 504 or IEP is appropriate.

    I know that technically they are not supposed rule out “mitigating factors such as medication” in making a determination, but if all of the new evals come out great since medication, how do they NOT?

  • #41252

    Devon Frye
    Keymaster

    This reply was originally posted by user adhdmomma in ADDitude’s now-retired community.

    They are evaluating current performance. They don’t need to accommodate a problem that no longer exists. A private psychologist would be similar.

    Penny
    ADDconnect Moderator, Author on Parenting ADHD, Mom to teen boy with ADHD, LDs, and autism

  • #41255

    Devon Frye
    Keymaster

    This reply was originally posted by user kt1023 in ADDitude’s now-retired community.

    I’m in a similar situation; my son has a 504 plan, but it is no longer has the impact/interventions needed for the increase in social-emotional and behavioral issues. At the same time, he has been on medication for over 7 years; with it, he is able to focus for a period of time, carrying on insightful conversations with adults/teachers. He is also very bright. I think it will be difficult for the team of evaluators to ‘not’ rule out the primary symptoms of his ADHD — as I found in the past, when he went from an IEP to a 504 plan once on meds. As much as I do not want to do this to him and I will seek additional counsel — I may cut meds in half.

  • #41259

    Devon Frye
    Keymaster

    This reply was originally posted by user KarenI in ADDitude’s now-retired community.

    My son’s psychologist advised us to not give him his meds on the days of the evaluation, so the evaluators see his real needs.

  • #41263

    Devon Frye
    Keymaster

    This reply was originally posted by user Dr. Eric in ADDitude’s now-retired community.

    Discuss with the evaluator.

    D/Cing for one day may be an option for a stimulant, but not for other meds like Straterra.

    Also, rating scales should capture what the parents and teachers were seeing prior to the initiation of meds.

  • #41273

    Devon Frye
    Keymaster

    This reply was originally posted by user spazzyjanet in ADDitude’s now-retired community.

    Actually, the instructions we got were to fill out the rating scales “for the 30 day period prior to the Evaluation Team Meeting” during which he will be on meds.

    I have decided to keep him on meds for the testing, there is just too much at stake when he is off meds to gamble, and I don’t even know on which days he will be pulled for testing.

    I basically made them promise that they wouldn’t put him on anything less than a 504 and I expect that they will stay true to that or they may be looking at an OCR complaint.

    I also negotiated a BIP in advance of the 504/IEP, which I will insist on continuing.

  • #41275

    Devon Frye
    Keymaster

    This reply was originally posted by user Dr. Eric in ADDitude’s now-retired community.

    It depends on the rating scale. Some are 30 days (not the ones I prefer), some are 3 months.

    Although an OCR complaint is certainly within your rights, getting them to promise something before collecting the data and having a team review it is, at best, harmless, at worse, one of the top 3 procedural violations in the law.

    A BIP is based on behaviors that prevent educational access that was drafted based on an understanding of the duration, severity, antecedents, and consequences of the behavior.

    Unless they had a great level of MTSS/RTI/Prereferral intervention data, they are responding to your threats more than their assessment of needs.

    Ultimately, test scores need to be given real-world context. So whether I test a student on their medication or not, I should have a timeline of curriculum-based measurement, academic impact, attendance, discipline, and informal observations/documentation of the time leading up diagnosis and medication. Especially given that the final decision is based on functional impact, not assessment scores.

    In an IEP, the final question is the necessity to access educational benefit through special education and not a modification or related services through general education: http://idea.ed.gov/explore/view/p/,root,regs,300,A,300.8,

    For a 504, the team has to establish that the disability “substantially limits” a major life activity such as learning: http://www2.ed.gov/about/offices/list/ocr/504faq.html

    In either case, the ability to measure the level of educational real-world functional impact, is often not measured by psychometric results alone.

  • #41284

    Devon Frye
    Keymaster

    This reply was originally posted by user spazzyjanet in ADDitude’s now-retired community.

    I hear what you are saying.

    For what it’s worth, I did get an FBA prior to settling the BIP, but the FBA was pretty much useless. All it told me was that there was “no clear pattern by time of day or antecedent” and that behaviors got better after medication. There was no attempt to figure out the real underlying cause of anything.

    So… the BIP ended up being a negotiated set of rewards and consequences, limited choices, brain breaks, and what steps to take if it looks like a meltdown is about to occur, or has already begun to occur. It was largely based on my own research and experience of what works, more than any actual FBA results, but it was better than nothing, which is what I would have gotten if I hadn’t fought for it.

    For the record, I haven’t “threatened” an OCR complaint, but my son has an independent ADHD diagnosis, and continuous performance tests taken at the school prior to meds, along with a pattern of behavior issues support that diagnosis.

    If the school psychologist shows me a CPT and says the words, “significant ADHD” in a meeting yet then comes back and tells me later due to testing after meds that he doesn’t qualify for a 504 that sounds alarm bells to me that our use of medication as a “mitigating factor” is clearly influencing his newfound opinion that there is no disability present. That is grounds for an OCR complaint, based upon my reading of Section 504 as well as the dear colleague letter that was sent out last summer.

  • #41297

    Devon Frye
    Keymaster

    This reply was originally posted by user Dr. Eric in ADDitude’s now-retired community.

    “Continuous performance tests taken at the school prior to meds, along with a pattern of behavior issues support that diagnosis.”

    That should alleviate any concerns you have about being medicated during current testing, provided that the assessor has the data and cites it.

    However, this is still a symptom and assessment data issue…which is in the realm of of the first prong…has a disability.

    The crux of the decision is almost never in the area of having a disability, but in the evidence of functional impact.

    The CPTs won’t tell you the impact on homework completion, grades, disciplinary referrals, etc.

    If they said, “We dispute the diagnosis of ADHD because of the scores received when tested while medicated.” Then, that would not just be an issue of the mitigating factor…it would probably just be bad psychology.

    However, if they say, “We don’t dispute the ADHD diagnosis, but our review of the past couple of years (that includes the time before medication) shows no evidence of measurable impairment.” Then, they may be right or wrong…you can agree or disagree…it should not be considered a violation of mitigating factors.

    Ultimately, it will be a matter of the quality of the assessor (and/or their caseload to spend adequate time reviewing the data and writing a quality analysis). I would not lose sleep over the quality of the data they collect in direct testing if there is adequate data and analysis…like a complete Functional Behavioral Analysis and prior assessment data. Especially if communication lines are open and all data is shared/presented.

    Let me use a non-personal example…

    Let’s say that we have two students with a psychotic illness that includes auditory hallucinations. In this hypothetical, both students could have the same exact hallucinations, in the same voice, saying the same things, in the same frequency/pattern/duration.

    Their symptoms are identical.

    However, if one had no observable or measurable impact academically, socially, or in ability to care of for oneself…one would qualify, and the other would not.

  • #41300

    Devon Frye
    Keymaster

    This reply was originally posted by user spazzyjanet in ADDitude’s now-retired community.

    So the good news is that it looks like they will grant a 504, even though they are going the “no visual sign of an impairment” route.

    His W-J achievement tests are now in the average range, and his teacher is reporting pretty much NO signs at all of executive functioning impairment in the classroom. He also jumped two reading levels shortly after starting meds.

    His updated composite IQ score went up as well. He now qualifies as “gifted.” His visual/spatial and verbal, etc. were high before but his low working memory pulled him down. When that went up the composite went up.

    My concern now is that even though the school is satisfied, there is still quite a gap between his achievement and capabilities. I am concerned that his high intelligence may be masking his difficulties resulting in an “averaging out” that will end up disqualifying him for both special ed AND gifted services.

    What is your experience? Can I expect that his achievements will continue to climb without any academic supports in the class or an IEP? If he continues to hover around average and cannot get access to gifted is it possible to re-evaluate whether an IEP might be needed down the line?

  • #41308

    Devon Frye
    Keymaster

    This reply was originally posted by user adhdmomma in ADDitude’s now-retired community.

    Hi spazzyjanet!

    I think time will tell. The good news is that he’s doing much better in school now that he’s taking medication. An improvement that big doesn’t happen for many.

    The fact that the school is willing to give him accommodations is good news as well, especially seeing that he tested well.

    I totally agree with you that one-on-one testing in a quiet and controlled environment doesn’t equate to achievement potential in the everyday classroom, but that is still the measure used. My son is also gifted, tests pretty well on eval tests, but barely gets by in school, despite an IEP and special help.

    Intelligence is not the sole measure of capability. Few teachers and school administrators recognize that. I have been fighting it for years. I feel like being twice exceptional is worse than having ADHD/LDs and average intelligence, because far more is expected of 2e kids than they have the capability of meeting. It’s really hard: https://www.additude.com/adhdblogs/11/8613.html

    My son’s school (middle, 7th and 8th grades) agreed that my son could be in inclusion classes to get the extra help, despite a high IQ, and that he could participate in the weekly gifted pullout, despite being the only SPED kid to get any gifted instruction. That was last year, but the gifted pullout was during something he really enjoyed, so he dropped out of the pullout. It’s a shame most mainstream schools don’t support 2 e kids—they will support the special needs or the gifted IQ, but not both. 🙁

    I say, while he’s doing well, keep with the flow. If he begins to struggle at school again, request another evaluation. My son was denied IEP and SPED in 1st grade, despite dysgraphia being very apparent. When the gap widened between his capability and expectations more by 3rd grade, I requested a new evaluation and he got SPED and an IEP that time. Since then, he’s been additionally diagnosed with autism and significant executive function deficits. He needed SPED 1,000%, but it wasn’t apparent enough until school expectations grew and his skills and achievement didn’t.

    Penny
    ADDconnect Moderator, Author on Parenting ADHD, Mom to teen boy with ADHD, LDs, and autism

  • #41317

    Devon Frye
    Keymaster

    This reply was originally posted by user spazzyjanet in ADDitude’s now-retired community.

    Thanks. Honestly, it’s reading so many stories of so many issues and diagnosis not being caught in the first evaluation that worries me.

    I don’t want to wait until 3rd grade or later to find out that there IS another underlying issue that we didn’t discover the first time around. In his post-med tests he did score uncharacteristically low in spelling and in a WJ achievement sub-test that deals with memory for names. His handwriting also seems poor to me.

    I sent the school psychologist an article on stealth dsylexia and he assured me that he was aware of the term and that he didn’t think it applied.

    So this is my “take a deep breath” moment. With all of these evaluations it’s time to trust that someone with enough schooling to earn an “ologist” after his name is making the right call.

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