The Next Big Thing

As the school year started, I spent time thinking about the trends in special education. To be specific, I was thinking about how certain diagnoses become the de rigueur diagnosis; it seems like everyone is seeking the diagnosis during each evaluation. During 90's, ADHD (Attention Deficit Hyperactivity Disorder) was diagnosis that everyone was getting, and still is. Last decade, we saw an increase in students getting a diagnosis of Autism Spectrum Disorders, and those continue to grow. Some figures estimate that 1 out of 160 children born have Autism. Now as we move into the '10s, there is a diagnosis that has gotten some press recently and I predict it will increase in prevalence. We'll be talking about over the next decade.

Drum roll....

Traumatic Brain Injury (TBI). This will impact schools in the coming years, especially as parents and physicians become more aware of the symptoms and implications of having the disability. The media and sports have become more aware of it. Concussions are now a major concern for the NFL and the NCAA. This will trickle down to high schools, junior high schools, and Pop Warner football in the coming years, if not sooner. Also, the wars in Iraq and Afghanistan have led to more soldiers returning with TBI and doctors are now correctly diagnosing it. Before, it was thought to be PTSD, but doctors are starting to see the subtle differences. One distinction is the cognitive impairment that results from TBI. This will be a big diagnosis, and I expect school psychologists will be dealing with it more in the coming years.

BBC

Percy Jackson

I'm not sure how I existed this long without reading Percy Jackson and the Olympians: The Lightning Thief by Rick Riordan. My school is completely enthralled with this series. I dare say, my school is more into this book than Harry Potter or Twilight. It probably helps that our school librarian is into the books as well. I'm a big Greek mythology fan, so this book was a delight. I know a movie was recently released, but like all adaptations, there are some differences between the novel and the film.

Although the book was printed in 2005, there may be some of you out there that haven't read it yet. Well, I suggest that you do. It's a great story for kids with disabilities. From a school psychologist standpoint, there is a lot to like about the story. Percy is dyslexic and has ADHD. But when he finds out that's he's a demigod, or half-blood (half-god, half-mortal) he learns that his impairments are actually strengths and by-products of his "godliness". His dyslexia stems from the fact that he was meant to read ancient Greek, not English. (clever!) And his ADHD symptoms are in fact his battlefield reflexes that allow him to respond to his opponents' moves (hyperactivity) and see things that others cannot (inattention). It's very clever and gives those that have these disabilities a hero that they can identify with. As a plus, Percy also has some absentee father issues, and I know I have plenty of students that can relate to that. The Percy Jackson series is intriguing and I can't wait to read the next one.

BBC

Adios, Amigo?

Friday, we had what was ostensibly a case conference to learn how a student's medication change was working, however it turned into a full-blown PPT with a discussion for change of placement. Alejandro (see previous post "The Package" from 9/23/08) has been problematic for most of the year, so it doesn't come as a big surprise, but this was a student that we gave so many resources- manpower and brainpower. When those kids leave you can't help but feel a sense of loss. It's not a matter of attachment, it's a matter of commitment. Once you decide that you're going to stick it out, it is a bit confusing when it becomes apparent that you have done all that you could and it's time for someone else to try. That's what I had to tell our principal, because she was wondering what else could be done. We worked with him for over a year and a half. He had significant issues, but we were somewhat successful at dealing with them. We were winning, dammit! But then it became too much for us to deal with.

He was on a very effective medication that controlled his impulsive behavior, but it was causing weight gain. At his mother's request, the medication was switched and he has never been the same. He has been obstinate, defiant and aggressive. This isn't the same child we worked with all of last year. It's unfortunate, because we made all sorts of accommodations to help him and we never took into consideration just how much the medication was contributing to his success.

The meeting culminated with a recommendation that he attends an alternative school that specializes in children with behavior issues. His outside therapists were the first to recommend it because at this point, a therapeutic school setting would be best.

I was warned about this: My director told me that as soon as Alejandro found out about the school change his behavior would deteriorate. Well, guess what happened today? It was pretty awful. Part of his plan was to have a check-in time with me in the morning. I am supposed to gauge his mood and see how his day will go. He was off this morning, but I hoped that he would get it together in time for class. I hoped in vain. He didn't even make it an hour. He had absolutely nothing to work for. My principal was very perceptive, she picked up on something that he said during his fit of stubbornness. In his stilted English, Alejandro said that he was angry with us. As she asked him to tell me what he said, it dawned on me that he knew about the school change. And of course, we have his mother to thank for that. His mother is not a good mother, and this was definitely something she would tell him. I think her words were that he's been misbehaving and he's being sent to another school because of it. Thanks, mom. We're still working on the paperwork now. This should happen fairly soon.

Alexander

One of my goals this year was to increase my consultation cases. I wanted to get into the real nitty-gritty of working with teachers on issues they are having in the classroom. Of course, when it comes to consultation, it also means that I evaluate the teacher to see what changes she can make to address the target behaviors. Over the past 3 weeks Alexander had floated to the top of the "Children that require extra attention" list. He was noticeably from the first day of school, but now he's been attracting my attention.

He's classically ADHD. He calls out. He can't stay seated. He sings and hums at his desk. He plays with his pencil and eraser when he should be doing classwork. I had started working with his teacher to address his behavior. We came up with different plans, one plan was to address his frustration. It was designed to give him a way to release his frustration. There was also a plan to reward him for positive behavior. The teacher just started to use these plans in conjunction, sometimes.

Yesterday afternoon, I was called to deal with Alexander three times in about an hour and a half. It was getting ridiculous because I was trying assess a student. I knew that I could have been on call, so I was only conducting an interview. The student got to see some of the things I have to do in school, and he marveled at how often my intercom phone rang. After dealing with Alexander and seeing how frustrated his teacher was, I knew that I had to develop some ideas. I felt like I was stuck in the "No Idea" corner. I knew I had to kick it old school and hit the books. It was the first time in a while that I wished I was still in grad school; just to be able to brainstorm with my classmates. I really needed to talk to them last night. My SO told me to email them, but that would take to long. I would have to spell out all of the details in order to get an adequate response. So I hit the books and the internet and found some inspiration. I had to remember what the goal of consultation is. At the moment all I wanted was a peaceful day without having to report to this classroom multiple times a day to remove Alexander to another room. After some thought, I remembered the goal of consultation: empower the teacher. With that, I knew what I had to do.

To start, I really needed to see what was going on in the classroom, because by the time I got there, I ended up witnessing the tail end of a long spiral of behavior that went from bad to worse. Multiple incidents usually started with Alexander getting frustrated and instead of leaving the classroom to cool-off, he would have a stand-off with his teacher and refuse to leave. She would request someone to come to the room, to escort him to a neighboring class to cool-off. And of course, he would still refuse. I would ask what happened, and I wasn't able to get a clear answer to what set him off. I decided that an observation would give me the opportunity to see what led up to Alexander's removals.

I sat in the classroom for about 2 hours this morning, and what I saw was jaw-dropping. This kid was non-stop. He was a constant ball of energy; all over his desk and chair, seriously sitting upside down in his chair, I didn't think that was possible. He was singing and talking to himself. He was calling out for no real reason. All of his behavior was attention-seeking. To her credit, his teacher ignores a huge amount of it, but that may be part of the problem. Most of the students were ignoring him, which was remarkable on their part. But Alexander wouldn't be denied, he kept pushing and pushing until someone was going to notice him. The students eat breakfast at their desks in the morning, so they eat breakfast while they complete their morning work. Alexander was focused on eating and playing with his breakfast, and decided that he could use his milk to gain the attention of his classmates.

As I sat only four feet away from him, he proceeded to shake his milk carton, open it and giggle like a 4 year old, and stick his hand up to his wrist into the milk. Then, he started to fling his hands around in order to spray anything in his vicinity with milk. A couple of his classmates felt the milk hit them and started to say something. At this point I intervened because it was obvious that his teacher wasn't paying attention to this either. That was the perfect opportunity for the teacher to address his behavior and she didn't. When I intervened, I wished I had a camera, because my words cannot do justice to what I was watching. Alexander turned to me, his face, hands, and forearms dripping with milk. At that moment I wanted a camera. Before he could deny his involvement in the situation or question mine, someone announced that the principal was coming. Alexander looked bewildered and when the principal walked in, I had never seen a kid try to get his act together so quickly. He became a completely different child. (I wanted to tell someone about his unbelievable behavior and I realized that with my wireless laptop, I could email the principal, who was most likely sitting at her desk at that moment. However, I never imagined that she would actually come in for an observation.)

So my principal found a seat and it just so happened that the class was transitioning to group reading activity. This required them to sit on the floor while the teacher read them a short passage. As the students gathered on the floor, Alexander worked on cleaning off his desk and the floor around him. When he made it to the group, he was the model student; sitting with his legs crossed, hands in his lap, looking forward, and raising his hand to answer questions. He was a different student. The principal left after a short time and Alexander managed to maintain his appropriate behavior. When the class made it back to their seats, Alexander's good behavior lasted for about 5 minutes. Then the noises and movement around his desk returned.

What I had witnessed for those 2 hours provided me with many ideas to help the teacher. I left with a better picture of what occurs in the class. I met with the teacher and gave her some ideas. My principal and the social worker also had some ideas. I was worried at first because I didn't know where to go, so I went back to the basics. It's amazing what a good ol' observation can do.

BBC

Hot Mess

This was Friday's story that I never got to write about. There's this kid, let's call him Tony. Well, Tony has ADHD and he has his good days and his bad days. It first started with Tony jumping off the bus and running into the school. That was the beginning of a rough day for him. The social worker, her interns and I set up a system that allows breaks for Tony from the classroom. Around 10 o'clock someone goes to Tony's classroom and gives him a walking break. We just walk around the building for about 10 minutes and then he returns to the classroom. The unfortunate thing about Tony's situation is that A) we never know if he's actually on meds or not. His mother claims that she gives him his pill every morning. Some mornings he's okay, others, like this past Friday, he's the Tasmanian Devil. B) his former teacher contaminated his current teacher by telling her all of the things that Tony doesn't do well, but nothing about what his strengths are. His teacher now has a very negative attitude towards him. It's to the point where I avoid her because I don't want to hear her negative comments.

Friday, Tony was a hot mess. His entire day was a long, drawn-out episode of what happens when a kid with ADHD is bored with school. After getting off the bus, his morning got off to a rocky start. I got a phone call in my office from his teacher telling me that I was needed in the music room. I arrived to find him sitting in his seat following what the teacher said. (This is interesting, because for the past two years whenever I've been called to someone's room I'm usually greeted by a sobbing child who won't leave the classroom and can't tell me what's wrong. So far this year, I've walked into classrooms and couldn't immediately tell what the big emergency was.) Anyway, I called Tony out of the room and asked him if he knew why I was called there. He told me something about classmates laughing at him. We discussed why they may have been laughing and what that had to do with me being called to the room. I didn't get much out of him and I was ready to send him back to the room when he asked if he could use the restroom. I sent him in and told him he had 2 minutes. He has become notorious for spending extraordinary amounts of time in the restroom. While he was in there another student went in there and then left. I knocked and went in. He was washing his hands. He was probably playing around in there, but I was able to retrieve him from there.

Later that day, I saw him twirling in the lunch line. I ignored him because I know that he really can't contain himself. About an hour later I made my way down to the main office to look at someone's permanent record. I passed by the table where children who lose recess have to sit and noticed it was unoccupied but there was paper strewn all over the floor and table. I said, "what's going on here?" The receptionist simply said, "Tony." So then I chatted with my principal, and went looking through the files and then made a couple of phone calls in the conference room. I probably spent 15 to 20 minutes there. As I was about to leave to go back to my office I noticed that the table was still unoccupied. I asked my principal, "Where's Tony?" She thought he was still sitting at the table. The receptionist finally turned around from her chair to see that he was no longer there as well. she just assumed that he was sitting there when I passed through the first time. The principal remembered that he went to the restroom in the nurses office, so she sent me to get him.

When I walked into the nurse's office, she told me that he was still using it because she could hear water running. I shook my head and knocked on the door. It was unlocked and when the nurse opened it we saw that the entire mirror and counter were covered in sudsy water as if he was cleaning the bathroom. Meanwhile, his hands were soapy and his clothing was wet. My immediate thought was, "You're a hot mess." The nurse couldn't believe it, but I did. He has been using the bathroom as an escape from the classroom since school started. Now he found another way to occupy his time in the bathroom. What else could he get into by the end of the day? The principal was not happy and she made him clean up the mess. Friday was definitely not a good day for him.

BBC

First Day 2008-2009 - Positivity is the word of the day!

Guess who's back for another school year. After a nice summer vacation that evaporated like drops of water on hot asphalt, I'm back. Today was the first day of school and it marked my first time starting the year as the school psychologist. My former supervisor is now in her new position at the high school full-time and I'm on my own now. I'm happy. This fresh start also features new digs. Not only did I get a new office, but I got new carpet and new paint on the walls. That was cool, although the new carpet was giving me a headache today, and I don't get headaches often so that had to be the reason.

Anyway, the mantra for today and for the rest of the school year is positivity. At first I was starting to feel apprehensive about the upcoming year. I've got a lot of new players to work with in my school. I've got parents requesting PPTs before the school year even started and the pressure of being the only one started to get to me. I started to wonder if I could pull this off. Would I have any ideas or strategies to offer? Would any of them work? Then I realized that I was thinking about this in the wrong manner. I need to look at these possible situations and these new cases as opportunities to gain experience and add strategies and ideas to my repertoire.

For some reason the negative vibes from teachers were really affecting me today. I was told to pay attention to 1st grade today because there are some new children there and some former kindergarteners with behavioral histories. I used to think that the new students had it rough, because we would get all this information about them before they enrolled: the IEP, the reports, the discipline records, and we would have this profile of the kid before we even met him or her. Now I feel sorry for the children who are already in my school and move up a grade the following year, because they don't always get the chance to make a fresh start. This is especially true when they move from one "negative" teacher to another one the following year. There's this kid who's classic ADHD. The kid can't sit still to save his life, and he's on meds. His kindergarten teacher last year had a hard time adjusting her own attitude towards the student. Now she's contaminated the attitude of the student's new teacher. When the first grade teacher walked into the conference room to talk to the support staff, the first words out of mouth were, "I had to talk to him 5 times this morning." She already wants something implemented for him. So much for an adjustment period. I could feel the negative vibes coming from her end of the hallway, but I refuse to be drawn in. I need to maintain a positive outlook, for my sanity's sake.

BBC

Dreaming About Work

For the first time I had a dream about work. It started with me working on an evaluation of a child that will likely qualify as Intellectually Disabled (ID) and a mother who is resistant to that label. Everyone on the team knows the history and knows that the mom doesn't want this label. I've been working on building a solid case for having this child properly labeled. He's in middle school and is currently labeled ADHD. I'll admit there is some evidence of attention problems but the child is having all sorts of difficulties. I think his current IEP has close to 10 academic goals alone!

I've been thinking about this for a while because I accepted the challenge of pushing for appropriate services and diagnosis for the child. I just feel that the mother thinks that her child just needs intense instruction and that he's easily distracted. It's so much more than that.

So I was working on scoring adaptive scales before I went to sleep, then I dreamed about the upcoming meeting, and then woke up and continued to think about it. I'll be glad when its over. After checking his records today, I found that a neuropsychologist had made a similar diagnosis years ago, so I know that another qualified person tried to approach the diagnosis. Maybe I could use that to my advantage.

BBC