Doctors prescribing Educational Services

Why would a parent whose child’s needs were being met by the school feel the need to go for outside testing? My personal experience with two high functioning, high IQ LD children is that they can maintain on grade level, but only at enormous emotional cost. I don’t like having to drug my child so that he can handle the anxiety of keeping up at school.

Karen

My child was tested by the school—nothing is found wrong, even though teachers from two years knew there were problems with my daughter in her ability to handle school. We had one year in which she had a sick stomach every day for months. I finally got outside testing from a developmental pediatrician who did list many services my daughter would need in school because of her diagnosis and her giftedness. The school psyc. had barely heard of my daughter’s diagnosis, let alone have any suggestions on how to mitigate her problems. The school staff told me I wanted services for my daughter just because a doctor said so, and that is not enough for the distict. After I got an advocate, more private testing, my daughter qualified for services and had an iep 10 months after the private doctor’s assessment. the doctor’s list of supports is still right on the money as far as the help my daughter needs in school. Because of my daughter’s giftedness, and because she is very verbal, she does not look like she is failing at anything.
Forward three years. My daughter had an in place iep for 6th, 7th and now 8th grade. The school district has never inplemented her iep, has not given her the sufficient services listed and we have already been through one due process and won and are looking at the next due process since the school district is again out of compliance and my daughter has documented evidence of no progress on her goals over the last two years.

Why do we rely on our outside experts, including doctors? Maybe if the school staff were all well trained, funded and not overwhelmed with large case loads and if school districts weren’t on the outset so hostile to parents and children, we as families wouldn’t feel this way. My child was listed as resource for two years—the resource teacher never even knew my child—or bothered to see that anyone else in special ed did. My child’s failure to progress on her goals was a big oh well,I’m too busy to help her and she doesn’t fit into our program.

Dear Resource Teacher,

Learning disabilities and ADHD are neurological disorders and are properly diagnosed by medical professionals. I see absolutely nothing wrong with such professionals recommending that a child receive protection under 504 or an IEP. You are correct that the school needs to assess whether the diagnosed disability is having an adverse affect on the child’s educational process, but there are a number of physicians who specialize in the diagnosis and treatment of these disabilities as well and can offer very specific guidance for remediation and accomodation. Parents consult these outside experts when schools don’t respond to their request for help for their children. Whens schools deny there is a problem, the outside experts tell those parents what they really need to know in order to help their children. How do you know the outside physician knows nothing about the child’s academic profile? Psychoeducational testing is a large part of a good evaluation by a physician or psychologist who specializes in diagnosing ADHD and LD. For that matter, just knowing that the child has made average scores over the years is hardly proof that his or her academic performance is not affected by LD or ADHD. In order to make that judgment you must first know what the child’s aptitude for learning is. A high-IQ child with LD or ADHD may well use their strengths to compensate for their weaknesses, so that the child with exceptional abilities and LD appears just average to those who have not looked further. We are all in big trouble if schools start believing that average performance is all that anyone is entitled to expect, regardless of the native ability of the child. In short, I don’t think the us vs. them attitude you are espousing is fair and it certainly doesn’t further what I assume is your goal as a resource teacher to provide help to children in need.

Andrea

I understand everything (and agree with most) that the previous people have posted; however, I didn’t see Resource Teacher’s question about the involvement of medical or clinical professionals as an “us vs. them” situation. When parents come with outside evals recommeding services, that of course is taken as a referral and in some cases additional information needs to be gathered to determine eligibility under IDEA. A diagnosis alone is usually not sufficient under the law. But even this is really not what I thought Resource Teacher was asking. In my experience, most outside professionals are great, but I have seen some clinicians who give the same diagnosis and recommendations for every single student they encounter. In this small minority, those that include testing, give the same diagnosis even when the testing evidence is contrary. And others recommend things that their testing would suggest would be a bad idea. It’s so common with two or three clinicians practicing where I live that once I hear what professional the child went to, I can guess the diagnosis and recommendations without even seeing the report. That’s the situation I thought resource teacher was presenting. In my district, when we have permission, we have tried to talk to the doctors to get a better idea of their concerns and to share information of what resources we already have available in the schools. Some of them weren’t aware that we can offer inclusive services and were appreciative to learn of the variety of options now available to provide services to kids with disabilities. Others agreed that their recommendations may not be the best way to support students (one example is a doctor who “ordered” books on tape for a student he diagnosed with auditory retention problems - and later said, “Well it was worth a try”). So anyway, I’ve gone on too long, but wanted to just to add that some medical prescriptions for special ed services, or more specifically the types of services, can be inappropriate. This can lead to a difficult situation for schools and parents to negotiate and unfortunately often leads to the parents having lowered trust for the schools.

We have this situation occur at our school. This is NOT about the outside evaluation performed by a licensed psychologist or neuropsychologist. This is about the M.D. who is a general practitioner or a family practitioner or pediatritian who has diagnosed ADHD and is treating the child with medication. This doctor who had found the condition then takes it upon himself, without ever consulting the school or gathering any achievement test data, to write a letter “prescribing” an IEP.

We have also dealt with a local medical hospital that treats children for certain conditions telling us to give a child an IEP for OHI.

I don’t think this is an us vs. them issue. I think this is an issue of each member of the treating team doing their job within their expertise. A medical doctor may diagnose certain conditions and certify to the school that the condition is present. The medical doctor may advise the parents of their right to request an evaluation under IDEA. The school then must take the medical diagnosis and perform the educational evaluation to determine whether or not the the condition is causing the child to suffer academically. The doctor (medical doctor) cannot know that eligibility is present w/o having all the relevant data.

At the school, we do not tell medical doctors that a child is ADHD or bi-polar. We do furnish them with data that we have collected, under IDEA or 504, to assist them in making the diagnosis. The doctor owes us the same courtesy of sticking with his field of expertise and documenting a condition.

Clearly not all children who have health impairments qualify for or need IEPs. A few do, however and the school must conduct an educational evaluation to make this determination. This is not determined by a physician (who did not perform educational assessments) in his office. On eductional issues that pertain to educational progress the physician may document and advise.

REcommendations (that is the correct word) obtained by parents who sought private psychoedcational evaluations are another situation entirely. This individual would have the right to diagnose processing deficits and make educational recommendations. However, only the IEP team with the necessary documentation can make the determination that a child needs to be in the resource program. The M.D. does not have a license or a legal right to tell the school to write an IEP. Too many try to do this. Part of the “doctor is God” syndrome too prevalent in a nation where doctors are over rated and over paid.

” Part of the “doctor is God” syndrome too prevalent in a nation where doctors are over rated and over paid.”

Anitya,

I usually think that your posts are helpful and make a lot of sense, but what you’ve said here really does sound like “us against them,” at least to me. Its a hard thing when a child’s difficulties present at the intersection of medicine and education. In those circumstances, wouldn’t it benefit us all if doctors and teachers worked together to further the interests of the child? Doctors who diagnose without performing the proper tests or who lack the expertise to make a valid diagnosis, or who don’t give data to support their diagnosis are a problem, I’ll agree. It is unethical to work that way and unhelpful too, because in the end, the kid does not get what he needs because what he needs has not been properly considered. Schools that insist that doctors have no business recommending that a child receive remediation or particular accomodations due to LD or ADHD that a competent doctor has diagnosed are a problem too, IMHO. Less focus on whose “right” it is to decide what to do and more emphasis on figuring out ways to help children is what is needed.

Andrea

Shelby,

You make some good point. Bad doctors who make bad diagnoses (or the same diagnosis for every child) do nothing to further the interests of children who need help. Doctors with special expertise in LD or ADHD who conduct appropriate evaluations, however, ought to be listened to by schools. When those doctors suggest that a child’s disability is sufficient, in the doctor’s view, to warrant consideration of a 504 plan or IEP, and when those doctors make specific recommendations about how to deal with the child’s difficulties in the school setting, they are providing valuable information that should be (and, I think, usually is) considered by schools that are really interested in giving children what they need to learn.

Andrea

The fact is that the doctor almost certainly does *not* have the whole “school picture.” The reason the IEP is done as a team is because even the folks at the school — who at least see the kid in that setting — don’t individually see the whole picture. So when a doctor basically “prescribes” to the IEP, the doc is overriding the team.

andrea wrote:
>
> ” Part of the “doctor is God” syndrome too prevalent in a
> nation where doctors are over rated and over paid.”
>
> Anitya,
>
> I usually think that your posts are helpful and make a lot of
> sense, but what you’ve said here really does sound like “us
> against them,” at least to me. Its a hard thing when a
> child’s difficulties present at the intersection of medicine
> and education. In those circumstances, wouldn’t it benefit
> us all if doctors and teachers worked together to further the
> interests of the child? Doctors who diagnose without
> performing the proper tests or who lack the expertise to make
> a valid diagnosis, or who don’t give data to support their
> diagnosis are a problem, I’ll agree. It is unethical to work
> that way and unhelpful too, because in the end, the kid does
> not get what he needs because what he needs has not been
> properly considered. Schools that insist that doctors have
> no business recommending that a child receive remediation or
> particular accomodations due to LD or ADHD that a competent
> doctor has diagnosed are a problem too, IMHO. Less focus on
> whose “right” it is to decide what to do and more emphasis on
> figuring out ways to help children is what is needed.
>
> Andrea

You don’t understand my point, perhaps I am not clear.

Parent takes child to the M.D. The M.D. diagnoses a condition like ADHD. The M.D. never performs psychoeductional assessments. The M.D. is not privvy to the child’s educational records. The M.D. then writes a letter telling the school to give the child an IEP. The M.D. is out of line and has stepped outside his expertise and his area of licensing.

What can the M.D. do? The M.D. can document a medical condition. The M.D. can state the manifestations that are likely (as if we at school don’t know what ADHD looks like, far better than M.D.s who only see child 1:1 in their office) and the M.D. can inform parents that SOME ADHD children have been found to be eligible for services under IDEA or for a 504 plan.

That is where the M.D.s expertise ends.

We do have more than one child who is seen by an M.D. in an office setting, being returned to school with a letter telling us the child needs an IEP or a 504 plan. These services are always determined by an assessment process that the diagnosing M.D. has little role in outside of making the diagnosis.

Note, I am differentiating the M.D. from the private neuropsych or psych who has performed psychoeducational assessments or neuropsych. assessments and who can document a specific processing deficit that MAY be contribute to an LD. I have no problem with a good outside evaluation. We have gotten them and we have always honored them.

The process of determining eligibility for a service requires an educational assessment and the convening of the IEP team to look at all the data, including the medical diagnosis made by the M.D. The M.D. sitting in his office with his medical degree, his Jaguar, beach house, mountain chalet and multi-million dollar home on the hill does not have in his possession enough evidence to prescribe an IEP to be implemented at school.

Excuse me, we deal with this every year and it is really difficult. I had to deal with this two different times in the case of children with sickle cell anemia who are performing fine in school (average kids, average scores, average intelligence) trying to get the parents to understand that just because the hospital told them to get an IEP for OHI, their child has good attendance and plenty of energy and is learning just like the rest of his or her peers at school.

Doctors who tell every family they are entitled to an IEP for OHI are overstepping their boundaries and cause real difficulties for us when we have to explain that the child is learning and progressing and does not need an IEP.

It is not us against them, just try standing in our shoes. We are dealing with yet another one right now. There is no evidence for an IEP at this stage in the child’s education, but the hospital is agitating the situation and making it unpleasant for all of us.

Funny how the team meeting that was held and decided that my son was not eligible for services contained 8 people from the school. Of those, only the classroom teacher had had more than casual contact with him, and she had had him in the classroom for 3 weeks, during which time he’d been medicated. The rest had read our private Neuropsych report, and two had done brief, (half hour) informal observations in the classroom. One of these in an area that we had not suggested that he had any deficits.

As far as I can see, the only reason this group was assembled as a “team” was to make sure that the SPED dierctor had enough “votes” on her side of the table to deny him eligibility. They certainly didn’t have any direct knowledge of my child.

Karen

Sorry, Sue, but I just don’t see it that way. We may just be talking past each other, but I’m not understanding what is wrong with a doctor who specializes in diagnosing and treating LD making recommendations to school staff about the doctors opinion on what the child needs in an IEP? Obviously school staff may think that something different is needed, but I think they ought to give serious consideration to such recommendations and not reject them merely because they are coming from a doctor rather than a school-employed psychologist. In my own experience, my child’s school accepted outside testing (not an IEE, just an evaluation that I wanted performed by the very best in the field) and implemented the suggestions made by the diagnosing physician.

Andrea

I think we agree. Doctors should not make IEP suggestions without having conducted a thorough evaluation that includes psychoeducational testing. When such testing is performed by a doctor, schools should give serious consideration to it.

Andrea

I am so glad we agree. I know I beat this matter quite a bit, but I suspected that I was, despite my wordiness, not clear the first time.

We always consider a private evaluation, however some are quite good and others really marginal in terms of what we typically do at my school site. We don’t toss them aside if they are given by credentialed individuals.

Maybe parents are fustrated with the school system and turn to a Dr. for help.Schools have budgets that restrain them from testing every child.I heard a parent told once your child has ADHD..it is medical not academic..sorry no IEP.

Most parents I have known,ask the Dr.for a referral to Children’s Hospital.Then they present the school with a full evaluation.Sad to say but 95% of the children tested..deserve services.Parents that I have contact with realize budgets and incorrect diagnosis can keep children from getting the proper services.Where do they turn…to a Dr.’s note.

I think that learning is a very complex issue and we all learn differently. Kids that require accommodations, special programs etc. need them and should have them.

I have indeed heard from many parents who have either been told or hinted to that their kids should be medicated. O.K. so in that case who is overstepping.

A child’s doctor can be very helpful especially if they have known that child from birth. They have the information regarding physcial problems, birth problems etc. Parents may also share school information with their doctor. I certainly do.

Parents can’t expect a doctor to leave sick patients to attend and IEP or school meeting. However, if the doctor takes the time to send their opinion they should be treated with respect.

The schools certainly have no problem calling whomever they want to an IEP meeting. Even people who don’t know the child. A parent legally can bring anyone they want to an IEP even though they usually don’t. Why not an opinion of someone who knows the child.

No doctor, pediatritian included, that I every took my own children toKNEW my children in a school setting. The doctor could not know the child needs resource services.

A doctor might KNOW a child has ADHD and the doctor might know what the manifestation of ADHD tends to look like. HOwever, unless the doctor has assessed the child with various and sundry tests of academic achievement, this doctor cannot KNOW the child needs the resource program in order to learn and progress.

A medical doctor is most welcome to write letter documenting a medical condition. The letter may even tell us what this condition might look like at school. Once again, unless this doctor has observed this child in school, his letter cannot be any more than speculative about what the child’s behavior and learning actually looks like in a classroom.

This is why we have IEP teams. We need people who have worked with the child at home and school. Parents know what doing homework is like and the teachers know what the child is like all day in school, assessment data confirms whether or not learning has occurred. It is entirely possible that learning can and does occur when work production is holding down grades. The appropriate approach to this situation (when learning has occurred) is creating a behavior intervetion plan and reducing the length and number of assignments to get SOME work being completed. The resource program is not always what every ADHD child needs. Some do, but the medical doctor who sees the patient in his office several times per year is NOT in a position to assess this.

I have to admit that at times I have gotten by “backfur” raised, when handed a prescription to write an IEP from a general practitioner. I would think, “How dare they?”, they saw the kid for 10 minutes, read the history the nurse took, diagnosed the child with ADHD and now write this prescription for the school to fill, like a pharmacist? My reaction to this has been tempered over the years. I actually have more respect in a way for pediatricians and general practice physicians that are aware of educational services that are possibly available for their patients and for them to take the time to direct the parent in that direction. Regardless of any “prescription” , the school still has to have a child study meeting to determine if further testing is necessary, and later (if testing is determined to be needed)to determine if the child is eligibile under the law. Sometimes it can be a problem if the doctor doesn’t understand the process we are required to go through and the parents come in with the expectation that we can write an IEP on the spot because the doctor ordered it. I have found that some doctors didn’t understand this and after talking with them they have changed their wording to tell the parents that special ed services may be appropriate or to refer them to the child study committee. But I think the bottom line is the title of this message. We have to work together, so we need to communicate with each other and it’s true that sometimes doctors don’t care and think their diagnosis should equate to an IEP, without futher imput from the schools, but even then we must include their recommendations into our process of determining eligibility. And just so everyone doesn’t think I’m just this wimpy person, I sometimes dream about being able to show the parents who go to the two or three clinicians I referred to in a previous message (who charge big bucks for pitiful evaluations that give the same diagnoses and recommendations for every child), how their child’s report is just a cut and paste version of every other report written by the “expert”. I’ve actually adressed this with a few of the clinicians as the first step in the process of making a compliant to the medical or psychological boards. We’re here for the kids. Sometimes that means to advocate for those who are disabled and sometimes it’s to advocate for those who aren’t.

Shelby

What’s with all the CAP letters can’t someone else have an opinion without you getting balistic?