Barbara Kapetanakes, PsyD.
Approximately 14% of New York State students receive special education. Since 1976, when the law went into effect that provides free and appropriate education for all, this number has nearly doubled. Even more children receive accommodations through what is known as a 504 Plan. In this case, the student may not qualify for special education classification due to the lesser impact of a disability, but does qualify for modifications such as extra time on exams or having directions read to him.
Parents often wonder what to do if their children are struggling. While it’s true that children develop at different speeds regardless of the interventions, there are also some issues that can be better remediated with intervention that is earlier rather than later. Speech and language lags seem particularly amendable to early treatment. Even students with serious learning disabilities benefit from getting support early on—if not to “cure” the disability, which is often not feasible—then to help the child learn strategies early so he can use his strengths to mitigate his weaknesses.
The balance between allowing a child to develop at her own pace and jumping in to provide remediation early is a tough one for parents and teachers alike. It’s not always clear that a child is just lagging behind and will catch up on her own, and no one has a crystal ball to anticipate what impact any intervention might have. I once knew a man who had been a late talker as a child. Allowed to go at his own pace, he eventually became such a talkative adult that people who knew him were shocked to hear of his delay, and in fact, he made his career as a school teacher—speaking all day for a living. An awkward child who seems to be covered in bruises from his clumsiness or one who can’t seem to learn to tie shoes or hold a crayon properly may eventually mature into a graceful athlete or a visual artist given the time to blossom. But for every story of a child who lagged behind and caught up when the time was right are stories of children who could never catch up because the intervention was too late or not the appropriate type.
So when should interventions be considered, and what types of interventions are there? Sometimes the answers are easy. If your child is not progressing at all or very little, if she is unable to meet even the basic requirements of her grade, if the teachers have tried classroom interventions and strategies and are still being met with frustration and failure, your child should be tested for a learning disability. Chances are, if the teachers are witnessing your child’s frustration, the school will be on board and do an evaluation in anticipation of possible special education classification. Generally, you will be asked to give permission allowing the school to test your child, and about a month or so later there will be a meeting of the Committee of Special Education, including the parents, where all the test results, intervention strategies, classwork, etc., will be discussed. If your child is deemed eligible for services, the Committee will discuss the options that seem appropriate, and the parent will be asked to sign permission to begin to provide these services.
That’s how it goes when it works smoothly. Sometimes parents are more or less concerned than the teachers. Sometimes, for various reasons, the parents feel that the school can’t be objective in assessing the child. At other times the school and parents may both feel that the school is ill-equipped to test because of more serious issues than they are used to dealing with. At these times, a parent may need to go outside of the school system. It is rare that a school district will cover the cost (I can count on one hand how many times my evaluation has been paid for by a school), so generally if parents want to go outside for a private evaluation, they should expect to pay out of pocket, although insurance will often pick up part of the cost once a claim is made.
There are a few ways to handle getting an outside evaluation. One is to wait for the school evaluation and see what comes of it. It is free, it covers some of the same tests and areas of functioning as a private evaluation, and adequate decision making can often result from the school evaluation. If not, and you want to pursue further testing, you have certainly saved money by allowing the school to do the cognitive and academic measures at the very least. I have often supplemented a school evaluation with different tests, looking into different areas of functioning, so by working together the child has gotten more specialized supports that would hopefully be more helpful. The main reason to do this is financial. The school will most likely use the same cognitive battery, do a thorough academic assessment, observe her in class, talk to the teachers, and incorporate as much information as possible. Of course some districts are better than others, some are understaffed and underfunded, and these issues should be considered when making a decision, but for the most part, at least some of the testing would be the same as with a private practitioner. Often it is not that the school psychologist is lacking in what he can provide in an evaluation, it is simply a matter of not having the time to be as thorough as he would like, or not having as many different tests available to him. I was a school psychologist for several years. You’d be surprised how quickly a school day flies by; you can only do so much.
For various reasons a parent may choose to pursue a private evaluation from start to finish. While the State allows the school thirty school days to complete the evaluation, thirty school days can be a long time if there’s a vacation or holiday. Often a private practitioner has the time to see you sooner and you can get a report back more quickly. Meanwhile, you can ask the school district to schedule a CSE meeting for your child, to be held after you have the report and can bring the evaluator’s findings and recommendations to the meeting. Another reason to seek an outside evaluation from the beginning is that the same person is evaluating your child for the entire assessment rather than interpreting other people’s reports. Some reports are very thorough and informative, while others are brief and don’t provide enough to truly understand the child’s performance.
Many parents call me for an evaluation and want to know what’s involved and how things will proceed. They also want to know what to tell their children about why they are going to be tested and how to assuage any anxiety. Interestingly, it is more often the parents who have anxiety—the testing materials are generally colorful and stimulating, the tasks can be fun and interesting, and once rapport is established, most children feel comfortable engaging in the activities with a relative stranger. In 25 years of testing children I can only recall one child who became frustrated, crawled under the desk, and cried, “Dr. K, I thought you loved me” (breaks the heart!). Most of the time, even if a child gets frustrated with the tasks, he will complete them. Behavioral observations, meanwhile, can be just as meaningful as the score obtained. For example, a lack of frustration tolerance is often seen in children with learning challenges, and can lead to acting out behaviors that teachers see in the classroom. Seeing this play out in the confines of a quiet, individual testing situation can often help to pinpoint the areas of weakness and/or the triggers for the behaviors.
Generally an evaluation will start with a cognitive measure, commonly known as an “IQ test.” This gives us a good estimate of a child’s general cognitive functioning, looking at several areas with what I call a “broad brush.” We don’t go too deeply into these areas on this particular test, but we can get a good feel for the strengths and weaknesses and then look more deeply into some areas with different tests. Depending on the concerns, I may then look more into attention and executive function, reading and/or pre-reading skills as well as other academic skills, language processing, visuospatial skills, memory, anxiety, or other area. With a closet full of tests most private evaluators can choose the tests that will help answer the questions adequately. As for what to tell your child—you child probably already knows she is struggling with certain things. She realizes that the kid at the next desk can read better or pays closer attention. Sometimes acknowledging this is actually a relief, because there is now some explanation and intervention that’s possible. I usually tell children, “We are going to do a bunch of activities together. Some will be easy for you, some you’ll find harder, but it’s important to do them all, because I’m going to try to figure out how you think and learn so that I can make suggestions to your teachers that will help you do the best you can do.” Kids understand this and take it at face value. Also, because most of the tasks start easier and get progressively more difficult, I point this out as well, letting the child know that some items are going to be easy (or “for little/younger kids”) and some will be harder (“for big kids”) but that it’s important to do some easy and some hard items so I can see what he can and cannot do. Again, they take this at face value and it alleviates some anxiety about having to get everything correct.
I usually break testing up into two or three sessions of two or three hours apiece, although it generally takes less time to test a younger child and more to test the older kids. We can take breaks as needed during the sessions, but having a big block of time to get a lot done is important. Once the testing is done, the results are analyzed and a report is written up that includes history (provided by parents and records), observations, test results, and recommendations for home and school. We go over the report together, and parents can then take the report to the school, go for further testing if necessary (e.g., a speech and language evaluation, neurological workup, etc.,), and use the suggestions at home when doing homework.
Even when testing does not result in a special education classification or school support, it can still be valuable. All of us have strengths and weaknesses, and having some of that spelled out in a report, with suggestions of how to maximize one’s strengths and remediate the weaknesses can be helpful in general. Sometimes I test students before college, and the goal is to help with planning for a major that fits their strengths, trying out some study strategies, or deciding whether going part time might help an individual who is a slow reader but otherwise good student. Testing can rule out disorders such as attention deficits or learning disabilities, allowing the child and family to focus on other areas of concern. Many times I have helped parents prioritize their concerns, for example, it may not be clear if a child has a reading disability until the attention problems are addressed, because he is so clearly not paying attention to the materials that he can’t possibly be understanding what he’s reading.
Bottom line is that every child is different and the decision to test or not is a personal one. It’s perfectly fine to talk to the school, to call a psychologist and discuss possible testing options, or to consult with your pediatrician before making a decision. Think about what the goals are, and what would be different if you got your child tested. It’s generally not harmful and can usually be helpful if your child is struggling in one area or another.
Dr. Kapetanakes is a psychologist in private practice in Sleepy Hollow, NY. She provides therapy, evaluations, and divorce mediation.
Disclaimer: Although Dr. Kapetanakes is a board member of the Westchester County Psychological Association (WCPA), the views in this article are hers and not the views of WCPA.
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