The Disconnect: Syndromes, Disorders, and Special Education

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The Disconnect between syndromes, disorders, and conditions on the one hand and placement in Special Education on the other is sometimes hard to explain to parents. This is a look at why...
February 21, 2006 - It is not always easy to explain to a parent why their child with Attention Deficit Hyperactivity Disorder (ADHD), or Fetal Alcohol Spectrum Disorder, or Dyslexia, etc. is assigned to a particular special education placement and someone else's child with the SAME DISORDER or condition is assigned to a DIFFERENT placement. The explanation becomes even more difficult when the parent's child is denied special education services and someone else they know has a child with the same disorder that IS placed in special education...

Special education law and practice places students in a special education environment based on a variety of factors. While some special education placements are straightforward (a blind child is, after all, blind and a deaf child is deaf - though in either case those may not be their only problems), others are not so clear cut. Special education law places students in particular categories based on educational issues, not as the result of a medical diagnosis. So, for example, in my state (West Virginia) a doctor would generally conclude that a patient with an IQ of 69 was mildly mentally impaired (or retarded). But IQ ALONE is not a sufficient factor to have such a student placed in the special education environment. West Virginia's Regulations for the Education of Exceptional Students (Policy 2419) says that the student must also have "limitations" in two "adaptive skill" areas - areas like the ability to communicate, to care for themselves, to relate well with their peers, or to look out for their own health and safety. Academic performance, their ability to adapt to their academic environment, is one of the areas. The point is that just because your family doctor says that Johnny is mentally impaired from a MEDICAL standpoint, that doesn't AUTOMATICALLY make him mentally impaired from an EDUCATIONAL standpoint.

The situation can get more confusing. Consider some condition that may not affect IQ per se and can vary in severity. The International Dyslexia Association says in its Frequently Asked Questions section that "Dyslexia is a specific learning disability that is neurological in origin..." Well, maybe. Testing would have to determine that -- on a child by child basis. A specific learning disability is defined in most states as a discrepancy between IQ and academic performance. When a student with an average or better IQ doesn't achieve well we change the way he's being taught. Eventually, if that doesn't work, we consider the possibility that he has a learning disability. The learning disability IS (at the moment at least, in most states' policies) the discrepancy between achievement and intelligence (not the dyslexia). And plenty of students with dyslexia end up responding to changes in the way they are taught in the regular education setting before the process reaches the point of placing the student in special education.

ADHD provides an even more complicated set of problems when trying to decide how (and whether) to place a child in special education. ADHD is not always easy for a doctor to diagnose. If it is properly diagnosed and the child is successfully treated for the disorder before it becomes a long term educational problem, the child may never be placed in the special education setting. If it is diagnosed but NOT treated, the child may be placed as Other Health Impaired (OHI). If ADHD is suspected but never diagnosed by a doctor, the student may be placed as having a specific learning disability (LD). Or in those circumstances the student may be placed as having what some states call an emotional disturbance (ED) and other states call a behavior disorder (BD). Why the differences? Because each child is different and the question is not one of what medical condition or disorder the student has. The question is this: How does this particular child's medical problem affect its education.

Parents often find the process confusing. They think their doctor has already told them what their child's problem is. But while the doctor may be right, medically speaking, the consideration at school is not medical. The school has to consider how a medical condition effects the way a child learns. And it has to consider that question one child at a time...