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Free & Appropriate Public Education

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Free Appropriate Public Education under Section 504

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Free Appropriate Public Education under Section 504 for Students with Disabilities

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.

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Individualized Education Program

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From the U.S. Department of Education Assistance to States for the Education of Children With Disabilities and the Early Intervention program for Infants and Toddlers With Disabilities; Final Regulations (regarding the Individuals with Disabilities Education Act), March 12, 1999.

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Individualized Family Service Plan

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Least Restrictive Environment

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Least restrictive environment, or LRE, means a child who gets special education should learn alongside general education peers as much as possible. Learn more.

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Americans with Disabilities Act

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New on ADA.gov

Explore the new content we've added to ADA.gov

This document discusses and explains the requirements of the ADA's integration mandate and the Supreme Court's decision in Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (1999), as applied to segregated employment settings and facility-based day programs. In addition, this document provides a link to the Department's Federal Register notice, which provides more information about this guidance.

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Disability rights are civil rights. From voting to parking, the ADA is a law that protects people with disabilities in many areas of public life.

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A 504 plan is a blueprint for how the school will support a student with a disability and remove barriers to learning. The goal is to give the student equal access at school.

504 plans are formal plans that schools develop to give kids with disabilities the support they need. That covers any condition that limits daily activities in a major way.

504 plans often include accommodations. These can include:

Changes to the environment (like taking tests in a quiet space)

Changes to instruction (like checking in frequently on key concepts)

Changes to how curriculum is presented (like getting outlines of lessons)

Accommodations don't change what kids learn, just how they learn it. The goal is to remove barriers and give kids access to learning.

While it's rare, 504 plans can provide modifications . Unlike accommodations, modifications do change what a student is taught or is expected to learn. Students might get fewer homework assignments, for instance. Or they may be graded in a different way than their classmates.

The process for getting a 504 plan is different, and simpler, than the process for getting an IEP. But it varies from school district to school district

With 504 plans, schools look at information about a student from a few different sources. One source might be a medical diagnosis. Schools might also look at the student's grades, test scores, and teacher recommendations.

Families or schools can request a 504 plan through the school district's 504 coordinator. This person may also be the IEP coordinator. (Ask the principal if you're not sure who to contact.) The request must be in writing. The school will then hold a meeting to decide if the child qualifies and what supports are appropriate.

The 504 process has fewer protections than the special education process. But families can still play an important role by staying involved and making sure kids with disabilities get the same education as kids who don't.

504 plans are designed to help kids with disabilities learn alongside their peers.

A 504 plan isn't the same as an IEP.

There are fewer safeguards in the 504 plan process than in the IEP process, so it's important to be proactive.

About the Author

About the Author

Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Melody Musgrove, EdD served as director of the Office of Special Education Programs (OSEP) in the U.S. Department of Education.

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A 504 plan is a blueprint for how the school will support a student with a disability and remove barriers to learning. The goal is to give the student equal access at school. 504 plans are formal plans that schools develop to give kids with disabilities the support they need.

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Family Educational Rights & Privacy Act

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The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.

FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students."

Parents or eligible students have the right to inspect and review the student's education records maintained by the school. Schools are not required to provide copies of records unless, for reasons such as great distance, it is impossible for parents or eligible students to review the records. Schools may charge a fee for copies.

Parents or eligible students have the right to request that a school correct records which they believe to be inaccurate or misleading. If the school decides not to amend the record, the parent or eligible student then has the right to a formal hearing. After the hearing, if the school still decides not to amend the record, the parent or eligible student has the right to place a statement with the record setting forth his or her view about the contested information.

Generally, schools must have written permission from the parent or eligible student in order to release any information from a student's education record. However, FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions (34 CFR § 99.31):

School officials with legitimate educational interest;

Other schools to which a student is transferring;

Specified officials for audit or evaluation purposes;

Appropriate parties in connection with financial aid to a student;

Organizations conducting certain studies for or on behalf of the school;

Accrediting organizations;

To comply with a judicial order or lawfully issued subpoena;

Appropriate officials in cases of health and safety emergencies; and

State and local authorities, within a juvenile justice system, pursuant to specific State law.

Schools may disclose, without consent, "directory" information such as a student's name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. However, schools must tell parents and eligible students about directory information and allow parents and eligible students a reasonable amount of time to request that the school not disclose directory information about them. Schools must notify parents and eligible students annually of their rights under FERPA. The actual means of notification (special letter, inclusion in a PTA bulletin, student handbook, or newspaper article) is left to the discretion of each school.

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policy; privacy; academic records; technical assistance; parent rights; student rights; ferpa

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Family Educational Rights and Privacy Act (FERPA)

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Family Educational Rights and Privacy Act (FERPA) Home Page.

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Hearing Impaired

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Definition

The Individuals with Disabilities Education Improvement Act of 2004, formerly the Education of the Handicapped Act (P.L. 94-142), includes "hearing impairment" and "deafness" as two of the categories under which children with disabilities may be eligible for special education and related service programming. While the term "hearing impairment" is often used generically to describe a wide range of hearing losses including deafness, the regulations for IDEA define hearing loss and deafness separately.

Hearing impairment (called auditory impairment in Texas) is defined by IDEA as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance."

Deafness is defined as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification."

Thus, deafness may be viewed as a condition that prevents an individual from receiving sound in all or most of its forms. In contrast, a child with hearing loss can generally respond to auditory stimuli, including speech.

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 1.2%, or 71,903 students, received special education services based on a classification of hearing impairments.

Characteristics

There are four major types of hearing loss that are categorized by the site of the disorder in the auditory system. These hearing disorders can be caused by genetic or hereditary factors, infections, developmental abnormalities, or environmental/traumatic factors.

Conductive Hearing Loss is caused by damage or obstruction in the external or middle ear that disrupts the efficient passage or conduction of sound through those chambers. Most conductive losses can be treated medically; however, repeated conductive losses can affect children's language development.

Sensorineural Hearing Loss is caused by damage to the inner ear (cochlea) or auditory nerve that transmits impulses to the brain. Sensorineural hearing loss tends to be more severe, permanent, and usually affects oral language development.

Mixed Hearing Loss is a combination of both a conductive and a sensorineural hearing loss.

Central Hearing Disorders are the results of a disorder or dysfunction in the central auditory system between the brain stem and the auditory cortex in the brain.

It is useful to know that sound is measured by its loudness or intensity (measured in units called decibels, dB) and its frequency or pitch (measured in units called hertz, Hz). Impairments in hearing can occur in either or both areas and may exist in only one ear or in both ears. Hearing loss is generally described as slight, mild, moderate, severe, or profound, depending upon how well a person can hear the intensities or frequencies most greatly associated with speech. Generally, only children who cannot hear sounds generating less than 90 decibels (dB) are considered deaf for the purposes of educational placement.

Impact on Learning

Variations in causes, onset, degree, and type of hearing loss, as well as family and educational situations, result in a widely diverse hearing impaired population. However, students with auditory impairments characteristically experience significant issues with regard to social and intellectual development, speech and language, and educational achievement.

Social Development: Social-emotional development in children with hearing impairments follows the same developmental pattern as those without a hearing loss. However, since social-emotional development relies so heavily on communication, the student with a hearing impairment may not participate in cooperative play or learning activities. Without a common communication system, the ability to develop friendships is negatively impacted.

Intelligence: Research has determined that individuals with hearing impairments have normal cognitive ability, in the absence of any coexisting disability. Any difficulties in performance appear to be closely associated with speaking, reading, and writing the English language, not the level of intelligence.

Speech and Language: Speech and language skills are the areas of development most severely affected for those with a hearing impairment, particularly for children who are born deaf. For individuals with mild or moderate hearing loss, the effect may be minimal, especially with early diagnosis and treatment. Children with more profound hearing impairments and deafness are unable to access auditory feedback, impairing the normal development of speech and language.

Educational Achievement: The educational achievement of students with hearing impairments may be significantly delayed in comparison to that of their hearing peers. Students with a hearing impairment have considerable difficulty succeeding in an educational system that depends primarily on the spoken word and written language to transmit knowledge.

Teaching Strategies

Students with auditory impairments are provided special education services by a variety of professionals. These include the following specially trained individuals:

Audiologists are professionals who diagnose, treat, and manage individuals with hearing loss.

Teachers of the Hearing Impaired are specially trained educators who provide educational support to the student, the family, and other educators.

Speech-Language Pathologists provide treatment for speech and language disorders.

Interpreters are specially training individuals who relay to the student anything that is said in the class by employing communication processes such as repetition, sign language, fingerspelling, body language, and verbal expression.

Children who are hearing impaired will find it much more difficult than children who have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication. For children who are deaf or have severe hearing losses, early, consistent, and conscious use of visible communication modes (such as sign language, fingerspelling, and Cued Speech) and/or amplification and aural/oral training can help reduce this language delay.

By the age of four or five, most children who are deaf are enrolled in school on a full-day basis and practice special work on communication and language development. It is important for teachers and other professionals to work together to teach the child to use his or her residual hearing to the maximum extent possible, even if the preferred means of communication is some type of visible communication. Since the great majority of deaf children (over 90%) are born to hearing parents, programs should provide instruction for parents on the implications of deafness within the family.

Other specific strategies and services include:

regular speech, language, and auditory training from a specialist

the use of amplification systems

services of an interpreter for those students who use one or more visual communication modes

favorable seating in the class to facilitate speechreading

captioned films/videos

the assistance of a notetaker who takes written notes so that the student with a hearing loss can fully attend to instruction

instruction for the teacher and peers in alternate communication methods such as sign language

People with hearing loss use oral or manual means of communication or a combination of the two:

Oral communication includes speech, speechreading and the use of residual hearing

Manual communication involves sign language, fingerspelling, and/or cued speech

Total Communication as a method of instruction is a combination of the oral method plus sign language, fingerspelling and cued speech

Assistive Technology

Modern technology has provided opportunities for students with hearing impairments to access the general curriculum. These include:

Hearing Aids and Auditory Training Devices: Hearing aids are one of the most well-known types of devices used by individuals with hearing impairments. There are a great variety of hearing aids, but all are intended to amplify sound. Auditory training devices include devices such as FM systems. FM systems are more simplistic than hearing aids. To use a FM system, the teacher speaks into a microphone and the student would use headphones or speakers.

Computers: There are many special software programs for students with hearing impairments. The programs can supplement instruction by providing speech drills, auditory training, sign language instruction, and reading and language instruction.

Alerting Devices: Many everyday devices have been adapted for individuals with hearing impairments, including items such as watches, doorbells, fire alarms, school bells, and alarm clocks. Instead of using noise, these devices use vibration and light to alert the individual.

Captioning: Televisions are equipped with the ability to provide captioning for individuals with hearing impairments. Closed-captioning makes television and film accessible for individuals with hearing impairments.

Telecommunication Devices: In order for individuals with hearing impairments to communicate using the telephone, they may use a telecommunication device for the deaf (TDD). A TDD is a small keyboard with a display and modem. In order to use the TDD, the individual must relay information to an operator. Text messaging has recently become a very useful avenue for individuals with hearing impairments to relay messages without using the TDD.

Cochlear Implants: The cochlear implant is a surgically implanted device designed to make sounds audible for individuals with sensorineural hearing loss.

Organizations

Texas School for the Deaf

The Texas School for the Deaf provides educational and related services to students who are deaf and hard of hearing at their residential campus in Austin. In addition to serving its residential students, TSD serves as a resources center on deafness for students, parents, professionals, and others throughout the state.

1102 S. Congress Avenue
Austin, TX 78704-1728

Web: www.tsd.state.tx.us

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Education Resource Center on Deafness (ERCOD)

The Education Resource Center on Deafness provides information, referrals, resources, workshops, summer programs, distance learning, and interpreter training for students, families, and professional service providers.

Statewide Information at Texas School for the Deaf
1102 S. Congress Avenue
Austin, TX 78704-1728

Sorenson Communications

Sorenson Communications is a pioneer of industry-leading communication services for the deaf and hard-of-hearing community. The company's offerings include Sorenson Video Relay Service® (VRS), the line of high-quality videophones (VP), and Sorenson IP Relay Service TM (siprelay). Sorenson VRS enables deaf and hard-of-hearing callers to conduct video relay conversations with hearing friends, business colleagues, and family members through a qualified American Sign Language interpreter

4192 South Riverboat Road, Suite 100
Salt Lake City, Utah 84123

Web: www.sorensonvrs.com

Services for the Deaf and Hard of Hearing

Deaf Services manages the operation of the Agency's Regional Day School Program for the Deaf, performs all activities required to maintain a statewide program for students who are deaf or hard of hearing, and provides leadership to local regional day schools for the deaf in the planning, implementation and operation of comprehensive education programs for students who are deaf or hard of hearing.

IDEA Coordination
Texas Education Agency
1701 N. Congress Avenue
Austin, TX 78701-1494

Office for Deaf and Hard of Hearing Services

The DARS, Division for Rehabilitative Services, Office for Deaf and Hard of Hearing Services (DHHS) works in partnership with people who are deaf or hard of hearing to eliminate societal and communication barriers to improve equal access for people who are deaf or hard of hearing. DHHS advocates for people of all ages who are deaf or hard of hearing to enable them to express their freedoms, participate in society to their individual potential, and reduce their isolation regardless of location, socioeconomic status, or degree of disability.

Department of Assistive and Rehabilitative Services
P. O. Box 12904
Austin, TX 78711-2904

Telecommunications Relay Services for Individuals who are Deaf, Hard of Hearing, or with Speech Impairments

Phone: 800-735-2991 (ASCII); 877-826-6607 (Speech to Speech)

Alexander Graham Bell Association for the Deaf, Inc.

The Alexander Graham Bell Association for the Deaf and Hard of Hearing helps families, health care providers and education professionals understand childhood hearing loss and the importance of early diagnosis and intervention. Through advocacy, education, research and financial aid, AG Bell helps to ensure that every child and adult with hearing loss has the opportunity to listen, talk and thrive in mainstream society.

3417 Volta Place, NW
Washington, DC 20007

American Society for Deaf Children

The American Society for Deaf Children supports and educates families of deaf and hard of hearing children and advocates for high quality programs and services.

P.O. Box 3355
Gettysburg, PA 17325

American Speech-Language Hearing Association

The American Speech-Language-Hearing Association is the professional, scientific, and credentialing association for more than 130,000 members and affiliates who are speech-language pathologists, audiologists, and speech, language, and hearing scientists in the United States and internationally. Empowering and supporting speech-language pathologists, audiologists, and speech, language, and hearing scientists by: advocating on behalf of persons with communication and related disorders; advancing communication science, and promoting effective human communication

2200 Research Blvd. # 325
Rockville, MD 20852

Laurent Clerc National Deaf Education Center and Clearinghouse, KDES PAS-6, Gallaudet University

The Clerc Center has been mandated by Congress to develop, evaluate, and disseminate innovative curricula, instructional techniques and strategies, and materials. The aim of the Clerc Center is to improve the quality of education for deaf and hard of hearing children and youth from birth through age 21.

800 Florida Avenue N.E.
Washington, DC 20002-3695

Email: Clearinghouse.Infotogo@gallaudet.edu
Web: clerccenter.gallaudet.edu

National Institute on Deafness and Other Communication Disorders Clearinghouse

NIDCD is mandated to conduct and support biomedical and behavioral research and research training in the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. The Institute also conducts and supports research and research training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with people who have communication impairments or disorders; and supports efforts to create devices which substitute for lost and impaired sensory and communication function.

31 Center Drive, MSC 2320
Bethesda, MD 20892-2320

Hearing Loss Association of America

The HLAA mission is to open the world of communication to people with hearing loss through information, education, advocacy, and support. HLAA provides cutting edge information to consumers, policy makers, business professionals and family members through our dynamic website, www.hearingloss.org, an award-winning publication, Hearing Loss, an online newsletter, ENews, message boards. In addition, we bring consumers and policy makers together to learn about hearing accessibility issues at our national and regional conventions

7910 Woodmont Avenue, Suite 1200
Bethesda, MD 20814

Web: www.hearingloss.org

References

Gargiulo, R.M. (2006). Special education in contemporary society: An introduction to exceptionality. Belmont, CA: Thomson Wadsworth.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives: Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

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The Individuals with Disabilities Education Improvement Act of 2004, formerly the Education of the Handicapped Act (P.L. 94-142), includes "hearing impairment" and "deafness" as two of the categories under which children with disabilities may be eligible for special education and related service programming.

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Response to Intervention

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RTI aims to identify kids who are struggling in school.

It uses targeted teaching to help them catch up.

An important part of RTI is measuring progress and providing more support to kids who need it.

If you look inside any general education classroom, chances are good that you'd see different students struggling for different reasons. It can be hard for a teacher to tell right away which students are struggling or why.

Response to intervention (RTI) aims to identify struggling students early on and give them the support they need to thrive in school. The word intervention is key to understanding what RTI is all about. The goal is for the school to intervene, or step in, and start helping before a student falls really far behind.

Teachers can provide targeted teaching - called interventions - to help struggling students catch up. A big part of the RTI process involves closely monitoring student progress. That way the school can see which students need more academic support.

RTI isn't a specific program or type of teaching. It's a proactive approach: RTI measures students' skills and uses this data to decide which interventions to use.

Dive deeper

The RTI process begins with a teacher assessing the skills of everyone in the class. This helps the school's RTI teams tell which students need instructional interventions. That's the term for focusing on specific skills in trying to improve them.

Interventions can be part of class-wide instruction. The teacher may break students into small groups. These groups are tailored for different skill levels or learning interests.

Students who don't make enough progress getting this kind of help during class may start to work on skills in small groups that meet during enrichment activities like music or art.

As part of the RTI process, schools help struggling students by using teaching interventions that researchers have studied and shown to be effective. Many of them deal with reading. But there are also some proven methods of improving writing and math skills. Some schools also use research-based behavior interventions.

Read more about instructional interventions .

Another essential component of RTI is called progress monitoring. That means that teachers frequently assess students' skills to decide whether an intervention is working.

During an intervention, a teacher or other member of the RTI team uses an assessment tool that measures certain skills. They assess the skills every week or every other week. That may sound like a lot of testing. But each assessment only takes a few minutes to complete.

Learn more about progress monitoring .

There's no single way of doing RTI, but it's often set up as a three-tiered system of support. Some school districts call this framework a multi-tiered system of supports, or MTSS , instead of RTI.

Think of this tiered system as a pyramid, with the intensity of support increasing from one level to the next:

Get deeper information about the three tiers of support .

RTI isn't a special education program. But it can help general education teachers pick up on early signs that kids are struggling. It also plays a key role in helping schools figure out who qualifies for special education.

Federal law says that when deciding if a student is eligible for special education, the school district can use a "process that determines if the child responds to scientific, research-based intervention." That's one of the reasons many states use RTI.

If a student qualifies for special education, the RTI interventions used can help the school decide which services and supports to include in the IEP .

There are a few other key things to keep in mind about the relationship between RTI and special education:

RTI can't be used to reduce a student's workload. That kind of modification may be used for some special education students, but not for general education students.

If a student is getting extra help through RTI, it doesn't mean a family has to wait to request a special education evaluation. They have the right to ask for an evaluation at any time.

As part of the evaluation, the school can gather information from the RTI process, like screening and progress monitoring data. But they still have to follow the time frame of completing an initial evaluation within 60 days of getting parent consent.

Learn about evaluations for special education .

RTI is effective for lots of reasons. For one, it can help more kids thrive in general education classrooms.

It can also help schools save special education resources for kids who truly need them. Many students performing below grade level don't have disabilities. Through the RTI process, they can make progress without special education services.

Here are some other reasons why RTI is beneficial:

Students continue to get their core instruction in the general education classroom with their peers.

It's not a "wait and see" approach. Students can start to get extra help before falling so far behind that they have to go to summer school or repeat a grade.

If a student is referred for special education services, there's already documentation about which type of instruction has not been helpful.

If a school doesn't use RTI, families can still ask for extra help . But it might not be provided as extensively or as systematically as it would in a school that uses RTI.

Schools aren't required to give families a written intervention plan. All the school needs to tell families about RTI is:

But many schools provide much more information. That's because they know that parent involvement plays a big role in helping kids thrive in school. In fact, some schools are already in the habit of giving parents a written intervention plan.

If the school doesn't automatically provide a written plan, families can ask for one. It might include:

A description of the skills the child struggles with, and documentation about these challenges, like assessment results or work samples

A description of the research-based intervention the child is getting

Details about how often the intervention will be provided and for what length of time - how many minutes per day over how many weeks

Details about who will be providing the intervention and in which schoolroom

The criteria for determining whether the intervention is successful

A description of how progress monitoring works and how often progress will be measured

Get answers to other common questions about RTI .

Requesting a written intervention plan can help you take an active role in RTI. But there are other ways you can be involved in the process:

Remember that RTI is a fluid process. At any time during the school year, you can talk to the teacher and find out which interventions are available to help your child.

Ask the school for more information about the intervention your child is receiving, like which studies show it is effective.

Ask the school to give you a copy of your child's progress monitoring graph after every assessment.

Give the intervention time to work. To know if it's helping, the school needs data. Wait at least a few weeks before you ask the school if it's time to try something different.

Ask the school how you can help your child at home.

If you think your child's skills aren't improving, you may want to request an evaluation for special education. Remember that you can make this request at any time.

Use this list of questions to learn about your school's RTI process .

About the Author

About the Author

worked as a classroom teacher and as an early intervention specialist for 10 years. She is the author of Amanda Morin The Everything Parent's Guide to Special Education. Two of her children have learning differences.

Reviewed by

Reviewed by

Elaine M. Niefeld, MA, MBA is a consultant and former associate director of the RTI Action Network.

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RTI aims to identify kids who are struggling in school. It uses targeted teaching to help them catch up. An important part of RTI is measuring progress and providing more support to kids who need it. If you look inside any general education classroom, chances are good that you'd see different students struggling for different reasons.

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Speech Language Pathologist

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School-Based Service Delivery in Speech-Language Pathology

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This resource is designed to provide information about the range of service delivery models in schools, considerations for providing these services, and relevant resources. Information included will assist speech-language pathologists (SLPs) in meeting the tenets of the Individuals with Disabilities Education Act (IDEA; 2004) by delivering a free and appropriate public education program (FAPE) in the least restrictive environment (LRE) for students with communication disabilities in schools.

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Local Education Agency

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Definitions | U.S. Department of Education

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College- and career-ready standards: Content standards for kindergarten through 12th grade that build towards college- and career-ready graduation requirements (as defined in this document) by the time of high school graduation.

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Office of Civil Rights

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HHS enforces federal civil rights laws that protect the rights of individuals and entities from unlawful discrimination on the basis of race, color, national origin, disability, age, or sex in health and human services.

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Occupational Therapy

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My Child was Recently Referred for an OT Evaluation. Exactly What is OT and What Will It Do For My Child?
School-based occupational therapy is designed to enhance the student's ability to fully access and be successful in the learning environment.

This might include working on handwriting or fine motor skills so the child can complete written assignments, helping the child organize himself or herself in the environment (including work space in and around the desk), working with the teacher to modify the classroom and/or adapt learning materials to facilitate successful participation.
How Do I Get OT for My Child?
Occupational therapy (OT) is a related service under Part B of the Individuals With Disabilities Education Act (IDEA), and is provided to help a student with a disability to benefit from special education. As such, OT is a supportive service.

If your child has a disability, as defined by IDEA, and needs special education and related services to meet unique learning needs, then he/she might be eligible for OT services. Your child must be eligible for special education before being considered for OT services in the schools under IDEA.

Eligibility for special education does not mean automatic eligibility for related services, including OT. The final determination is made by the multidisciplinary team in concert with the OT evaluation.

My Child Needs OT. The District Wants to Use An Adapted Physical Education (APE) Teacher, Certified Occupational Therapy Assistant, or Classroom Aide to Provide the Therapy. Is This Legal?

According to the IDEA, occupational therapy is to be provided by qualified and trained practitioners. Occupational therapy practice is regulated in 51 jurisdictions, including the District of Columbia and Puerto Rico, and each jurisdiction defines who can legally provide OT services.

In many cases, OT can only be provided by an OT practitioner (as defined by state law). Certified occupational therapy assistants (COTAs) are qualified occupational therapy practitioners who work under the supervision of occupational therapists.

In certain circumstances, an aide can perform specific tasks as delegated by and under the direction of and with intense, close supervision by an OT practitioner.

My Child Was Recently Evaluated by an OT, and I Have Some Concerns About the Test Used. Are There Particular Tests That Should Be Used?

Occupational therapists are responsible for determining the need for OT services. This is done via the data collection (evaluation) process, of which administering a particular test is only one part.

The therapist may use screening, standardized or non-standardized tests, depending on the need and type of information sought, which in this case should be directly related to your child's ability to function and be successful in school.

While there is not one particular assessment tool that "should be used," the therapist should be familiar with a variety of methods to gather the necessary information and to make an informed decision.

We Live in A Rural Area and Have to Travel Great Distances to Have Our Child Receive OT in the Nearest Hospital Because the District Does Not Have Therapists. How Can We Get More OTs in Rural Areas?
Your situation is not unusual. Many rural communities have had difficulty recruiting and retaining OT practitioners. Because of this districts often have to contract with therapists or other agencies which are located some distance away.

Rural and other communities might consider highlighting the attractiveness of their areas when trying to recruit OTs and other needed staff. Contact the OT association in your state to find out what you can do to help make sure OTs know about job opportunities available in your area.
I Have Asked The District To Provide Sensory Integration Therapy for My Child. The School OT Seems Unwilling to Do This. What Can I Do?
Sensory integration is one frame of reference or perspective which might be used in the occupational therapy intervention process. The service or therapy that school districts are mandated to deliver is occupational therapy.

In the schools, the focus of OT is on the child's ability to function in the educational environment.

As long as the child's educational needs are being appropriately met, the school-based OT is operating within his/her scope of practice and training.

Each occupational therapist, using professional judgment, evaluation data, and expected outcomes, selects a particular frame of reference which will guide the intervention. You are encouraged to discuss your concerns with the school therapist to help you understand the reasoning used to guide the intervention.
Where Can I Find More Information About Occupational Therapy for My Child?

the principal of your child's school

the special education director or coordinator for your child's school district

the occupational therapy association in your state

Copyright 2000 American Occupational Therapy Association, Inc. All Rights Reserved. This page may be reproduced and distributed without prior written consent.
Resources

OT Tips for Health and Success in Schools - pdf

OT Tips for Homework Success - pdf

School Tips for Parents: Academic Success and Social Participation - pdf

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My Child was Recently Referred for an OT Evaluation. Exactly What is OT and What Will It Do For My Child? School-based occupational therapy is designed to enhance the student's ability to fully access and be successful in the learning environment.

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Multi-Tiered System of Support

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Functional Behavior Assessment

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Victoria was in the third grade when her teacher noticed a problem when it was time for the children to gather into reading groups. While the other kids would calmly go to their assigned places, Victoria would become agitated and start hitting her classmates. When she could finally be convinced to take her place in the group, it always seemed that she managed to forget to bring her materials with her. Returning to her desk to collect things, she would fumble through her stuff and scatter it across the floor, causing even more disruption.

In the old days, the teacher would have chucked a piece of chalk at Victoria every time this happened and that would have probably been the extent of it. Today, behavioral interventions are slightly more systematic: they start with a functional behavior assessment (FBA) to get at the root of disruptive behaviors and provide a solid basis for building an effective behavior intervention plan (BIP).

By observing each of Victoria's behaviors and analyzing them together with the environment and the outcome, it soon became obvious to the teacher that she was acting out in order to avoid going to her reading group. Probing even further, the teacher was able to determine that Victoria was nervous about having to read out load-her behavior was designed to avoid the nerve-wracking experience of having all eyes in the room trained on her.

It was until her teacher finally figured all this out that she could start giving Victoria the help she needed. The exact time and purpose of the reading groups would be explained to her ahead of time... she would be required to be the first student to get up and move to the meeting place, so that she would have no opportunity to hit anyone along the way. Nothing would start without her being prepared. Further, positive reinforcement would be given after her participation, praising her for a good job.

ABA Is Driven By Evidence and Analysis

One of the key ideas behind the science of applied behavior analysis is that it is driven by direct observation and experimentation. Actual changes in behaviors are the critical measure of any ABA therapy. And change cannot be assessed unless observations can be made of those behaviors.

Functional behavior assessments are the way applied behavior analysts develop a baseline and determine whether future interventions are actually resulting in measurable changes.

ABAs aren't psychic-they can't just watch a patient and know what is going one with behaviors by sheer intuition. As they perform an FBA, what they are doing is forming hypotheses about what drives certain behaviors and attempting to test them to figure out which is the correct theory.

The observations fit into three categories:

Antecedents, or the environmental prompts leading to the behavior.

Behavior, or the actions themselves resulting from the antecedent.

Consequences, the outcome of the behavior that tends to reinforce it.

Together, these so-called ABCs of ABA provide the information required to intervene in behavioral problems.

FBAs Start With Paperwork

It's rare for an ABA to come to a patient without any existing case information available. An important part of their assessment will start with reviewing previous case history and discussing the patient's behavior with other medical professionals, teachers, family, and caregivers. If previous interventions have occurred, the ABA will study them to gauge their effectiveness and glean any clues from the outcomes.

The FBA is not all about negative behaviors. In fact, most ABAs will seek to play to the patient's strengths, so positive behaviors are also observed and analyzed.

The target behavior itself also has to be written down in a clear, unambiguous way, such that anyone involved with the case would be able to recognize it. This definition will be the basis of all future modifications so it's pretty important to be clear. Saying that Johnny throws tantrums in class isn't enough; outlining that Johnny turns over his desk and stomps on his books for several minutes when he is asked to solve a math problem is better.

Direct Observation is Crucial

The ABA conducting the assessment will also want to observe the behaviors directly, if at all possible. Their training may allow them to pick up on subtle factors in the ABCs that other observers might miss.

The observations will include information about:

External factors, including history of the behavior and any medications the patient may be on.

The context of the behavior-what the setting and activity is like.

The specific antecedents that cause the behavior.

The expression of the behavior itself, including minor but consistent details that may provide clues.

Consequences to the behavior, including reactions of others around the patient.

The frequency of the behavior may also be important.

The Hypothesis Leads to Likely Interventions

An experienced ABA uses the functional behavior assessment to reach behind the surface behaviors and understand what the subject is trying to accomplish through them. Is the patient seeking attention? Escape? Sensory stimulation? All the various possible motivations must be analyzed and examined to determine a plan of action that can alter the behavior. If a child yells in class frequently because they are trying to get attention, it requires a different approach than if they are yelling because they are angry.

When the functional consequences of the behaviors are understood adequately, the necessary interventions often become obvious. In Victoria's case, once it was established that her payoff was avoiding participating in the reading group, it was clear that extra steps had to be taken to ensure that she attended and to change the reinforcers for that behavior to encourage her participation rather than her avoidance.

The initial FBA is rarely the last one. The hypothesis constructed may not be the correct one. It has to be tested against the actual behaviors and further observations will need to be made. In complex or ongoing cases, it may require a series of interventions, each building on the last, to address problem behaviors. But by conducting each FBA systematically and scientifically, the ABA and other caregivers can always be sure they are making progress toward the ultimate goal.

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What is a Functional Behavior Assessment?

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Victoria was in the third grade when her teacher noticed a problem when it was time for the children to gather into reading groups. While the other kids would calmly go to their assigned places, Victoria would become agitated and start hitting her classmates.

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Extended School Year

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Have you heard of extended school year services, but aren't sure what they are or what qualifies a student with special needs for them? We've got answers for you.

If you have a child with an IEP and you're curious about extended school year services, here's the deal: You might be able to get Extended School Year services for your child, or you might not. The term extended school year services (ESY) is a part of the Individuals with Disabilities Education Act, specifically, Sec.300.106. This section was added to ensure that students who forget a great deal of what they learn over the long summer break are provided with continuing instruction. The legal definition of extended school year services states that the term refers to special education and related services that are provided to a child with a disability, beyond the normal school year of the public agency, in accordance with the child's IEP and at no cost to the parents of the child, and that meet the standards of SEA (state educational agency).

ESY services are not provided all summer long. Usually, such services are made available four to five weeks of the summer, meeting four to five hours per day; often, they're provided Monday through Thursday. The teacher may or may not be a child's normal school year teacher, but he or she is required to be qualified to teach special education and should understand the child's IEP program goals.

Qualifying for Extended School Year Services

As with many parts of IDEA, this particular section was added following a series of court cases in which the parents of a child with a disability claimed that their child would forget most of what he or she learned over the long summer break and take most of the next school year to re-acquire previously-learned skills. These cases were won by the parents and, as a result, this section was added to the law. However, not all students have a right to this service. Regulations state that, to qualify, a child with a disability must lose two-thirds of the skills they learned during the school year (usually based upon progress toward IEP goals), and take between six and nine weeks of the next school year to regain those skills. A number of students forget some of the skills they learn during the summer months; however, most do not lose as much as two thirds, regardless of disability.

There are problems with this part of the law, in that it was added in a revision/reauthorization of an existing legislation. Thus, public school districts do not receive funding to provide a full-blown summer program for all students with disabilities, and providing summer services is an added cost to these districts. Some states provide partial funding for these services, while other states provide only the funding for a normal school year. Therefore, local districts stay close to the "letter of the law." That means that each year, each individual IEP team must consider whether or not the child needs ESY services, and designate one of three instructions regarding ESY: yes, no or delayed decision. If the IEP is marked yes in this area, then these services will be provided based upon the recommendations of the IEP Team.

Typically, the students who receive ESY services are those with more severe disabilities, and are often served in self-contained programs; students with less pronounced disabilities are least likely to be selected as needing these services. As stated, each IEP team should carefully consider a student's needs and make a data-based decision. Parents should ask about ESY services during the annual IEP meeting if they believe their child needs them.

Getting Extended School Year Services for Your Child

With summer upon us, this is your last chance to gain ESY services for this year. Start by attempting to contact your child's special education teacher or the case manager of your IEP team. If they are still working, they will let you know what steps to take. If they have gone home for the summer, then you should call your district special education office and talk with the administrator in charge.

Remember that the key to qualifying for ESY services is having forgotten, or being unable to utilize roughly two-thirds of what was learned in a school year. Then, a student must take more than six to nine weeks to recover those lost skills. If your student forgets that much and takes that long to recover, he or she will benefit from ESY services.
Reference Cases
Alamo Heights Independent School District v. State Board of Education

Education for the Handicapped Law Report 554:315 (5thCir. 1986)

Armstrong v. Kline. Education for the Handicapped Law Report 551:195 (E.D. Pa. 1979)

Baltimore (MD) City Public Schools (1986). Office of Civil Rights Letter of Finding

Education for the Handicapped Law Review 352:185

Battle v. Commonwealth. Education for the Handicapped Law Report 551:647 (3rd Cir. 1980)

Bucks County Public Schools v. Commonwealth of Pennsylvania. Education for the Handicapped Law Report 559:153 (Commonwealth Ct.
of Pa. 1987)

Davila, R.R. (1990, Nov.). Office of Special Education and Rehabilitative Services Policy

Letter 17. Education for the Handicapped Law Review 419 Georgia Association for Retarded Citizens v. McDaniel. Education for the
Handicapped Law Report 555:251 (11th Cir. 1983)

Holmes v. Sobol, Education of the Handicapped Law Report 559:463 (W.D. NY. 1988)

Mesa (AZ) Public Schools (1989). Office of Civil Rights Letter of Finding. 16 Education for the Handicapped Law Review 316\
Reusch v. Fountain, 21 Individuals with Disabilities Education Law Report 1107 (D. Md. 1994)

Schrag, J.A. (1989, Aug.). Office of Special Education Programs Policy Letter. Education for the Handicapped Law Review 213:255

Stacey G. v. Pasadena Independent School District. Education for the Handicapped Law

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What Are Extended School Year Services and Who Qualifies?

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Have you heard of extended school year services, but aren't sure what they are or what qualifies a student with special needs for them? We've got answers for you. If you have a child with an IEP and you're curious about extended school year services, here's the deal: You might be able to get Extended School Year services for your child, or you might not.

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Academically or Intellectually Gifted

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Vision Impaired

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Visual Impairment (VI): Blind & Partly Sighted

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Students who are visually impaired include: students who are blind, have no vision or little potential for using vision; students who have low vision; students who have a visual impairment after best correction that adversely affects their educational performance; or students who have been diagnosed with a progressive condition that will most likely result in a visual impairment or no vision after best correction.

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Traumatic Brain Injury

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Links updated, July 2015
In This Publication:
______________________

Susan's Story

Susan was 7 years old when she was hit by a car while riding her bike. She broke her arm and leg. She also hit her head very hard. The doctors say she sustained a traumatic brain injury. When she came home from the hospital, she needed lots of help, but now she looks fine.

In fact, that's part of the problem, especially at school. Her friends and teachers think her brain has healed because her broken bones have. But there are changes in Susan that are hard to understand. It takes Susan longer to do things. She has trouble remembering things. She can't always find the words she wants to use. Reading is hard for her now. It's going to take time before people really understand the changes they see in her.

What is Traumatic Brain Injury?

A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. (The exact definition of TBI, according to special education law, is given below.) This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:

thinking and reasoning,

understanding words,

remembering things,

paying attention,

solving problems,

thinking abstractly,

talking,

behaving,

walking and other physical activities,

seeing and/or hearing, and

learning.

The term TBI is not used for a person who is born with a brain injury. It also is not used for brain injuries that happen during birth.

How is TBI Defined?

The definition of TBI below comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities.

IDEA's Definition of "Traumatic Brain Injury"
Our nation's special education law, the Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as...
"...an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma." [34 Code of Federal Regulations §300.8(c)(12)]

How Common is Traumatic Brain Injury?

Approximately 1.7 million people receive traumatic brain injuries every year. ( 1) Of children 0-19 years old, TBI results in 631,146 trips to the emergency room annually, 35,994 hospitalizations, and nearly 6,169 deaths. ( 2)

What Are the Signs of Traumatic Brain Injury?

The signs of brain injury can be very different depending on where the brain is injured and how severely. Children with TBI may have one or more difficulties, including:

Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.

Difficulties with thinking: Because the brain has been injured, it is common that the person's ability to use the brain changes. For example, children with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.

Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.

A child with TBI may not have all of the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it's hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education.

It's also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student's difficulty comes from the earlier injury.

Is There Help Available?

Yes, there's a lot of help available, beginning with the free evaluation of the child. The nation's special education law, IDEA, requires that all children suspected of having a disability be evaluated without cost to their parents to determine if they do have a disability and, because of the disability, need special services under IDEA. Those special services are:

Early intervention | A system of services to support infants and toddlers with disabilities (before their 3rd birthday) and their families.

Special education and related services | Services available through the public school system for school-aged children, including preschoolers (ages 3-21).

To access early intervention: To identify the EI program in your neighborhood, ask your child's pediatrician for a referral. You can also call the local hospital's maternity ward or pediatric ward, and ask for the contact information of the local early intervention program. There, you can have your child evaluated free of charge and, if found eligible, your child can begin receiving early intervention services.

To access special education and related services: We recommend that you get in touch with your local public school system. Calling the elementary school in your neighborhood is an excellent place to start. The school should be able to tell you the next steps to having your child evaluated free of charge. If found eligible, he or she can begin receiving services specially designed to address your child's needs.

In the fall of 2011, nearly 26,000 school-aged children (ages 3-21) received special education and related services in our public schools under the category of "traumatic brain injury." ( 3)

What About School?

Although TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or an intellectual disability. As a result, they don't receive the type of educational help and support they really need.

When children with TBI return to school, their educational and emotional needs are often very different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child's family, friends, and teachers also recall what the child was like before the injury. These other people in the child's life may have trouble changing or adjusting their expectations of the child.

Therefore, it is extremely important to plan carefully for the child's return to school. Parents will want to find out ahead of time about special education services at the school. This information is usually available from the school's principal or special education teacher. The school will need to evaluate the child thoroughly. This evaluation will let the school and parents know what the student's educational needs are. The school and parents will then develop an Individualized Education Program (IEP) that addresses those educational needs.

It's important to remember that the IEP is a flexible plan. It can be changed as the parents, the school, and the student learn more about what the student needs at school.

Tips for Parents

Learn about TBI. The more you know, the more you can help yourself and your child. The resources and organizations listed below will connect you with a great deal of information about TBI.

Work with the medical team to understand your child's injury and treatment plan. Don't be shy about asking questions. Tell them what you know or think. Make suggestions.

Keep track of your child's treatment. A 3-ring binder or a box can help you store this history. As your child recovers, you may meet with many doctors, nurses, and others. Write down what they say. Put any paperwork they give you in the notebook or throw it in the box. You can't remember all this! Also, if you need to share any of this paperwork with someone else, make a copy. Don't give away your original!

Talk to other parents whose children have TBI. There are parent groups all over the U.S. Parents can share practical advice and emotional support. To locate parent groups near you, including your Parent Training and Information Center, have a look at our short brief, Parent Groups.

If your child was in school before the injury, plan for his or her return to school. Get in touch with the school. Ask the principal about special education services. Have the medical team share information with the school.

When your child returns to school, ask the school to test your child as soon as possible to identify his or her special education needs. Meet with the school and help develop a plan for your child called an Individualized Education Program (IEP).

Keep in touch with your child's teacher. Tell the teacher about how your child is doing at home. Ask how your child is doing in school.

Tips for Teachers

Find out as much as you can about the child's injury and his or her present needs. Find out more about TBI through the resources and organizations listed below. These can help you identify specific techniques and strategies to support the student educationally.

Give the student more time to finish schoolwork and tests.

Give directions one step at a time. For tasks with many steps, it helps to give the student written directions.

Show the student how to perform new tasks. Give examples to go with new ideas and concepts.

Have consistent routines. This helps the student know what to expect. If the routine is going to change, let the student know ahead of time.

Check to make sure that the student has actually learned the new skill. Give the student lots of opportunities to practice the new skill.

Show the student how to use an assignment book and a daily schedule. This helps the student get organized.

Realize that the student may get tired quickly. Let the student rest as needed. Reduce distractions.

Keep in touch with the student's parents. Share information about how the student is doing at home and at school.

Be flexible about expectations. Be patient. Maximize the student's chances for success.

Resources of More Information

American Academy of Family Physicians. (2010). Traumatic brain injury. Online at: http://familydoctor.org/familydoctor/en/diseases-conditions/traumatic-brain-injury.html

CDC | Centers for Disease Control and Prevention. (2010). Traumatic brain injury. Online at: www.cdc.gov/TraumaticBrainInjury/

Center on Brain Injury Research and Training. (n.d.). Traumatic brain injury: An overview (interactive learning module). Online at: http://www.cbirt.org/resources/interactive-learning-modules/

National Institute of Neurological Disorders and Stroke. (2014, July). NINDS traumatic brain injury information page. Online at: http://www.ninds.nih.gov/disorders/tbi/tbi.htm
Organizations Brain Injury Association of America
Main website: http://www.biausa.org/

Find your state BIA affiliate: http://www.biausa.org/state-affiliates.htm

National Brain Injury Information Center: 1.800.444.6443 (brain injury information only)

National Resource Center for Traumatic Brain Injury (NRCTBI)
http://www.tbinrc.com/

TBI Educators
http://cbirt.org/resources/educators/

Brainline
Information available in English and Spanish.
info@BrainLine.org
http://www.brainline.org/

Center on Brain Injury Research and Training
http://cbirt.org/

Family Caregiver Alliance
Information in English, Spanish, Chinese, Korean, and Vietnamese.
https://caregiver.org/

TBI Recovery Center
http://www.tbirecoverycenter.org/

References

1 | National Center for Injury Prevention and Control. (2012). Traumatic brain injury. Available online at the Centers for Disease Prevention and Control (CDC) website: http://www.cdc.gov/TraumaticBrainInjury/index.html

2 | CDC. (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations and deaths, 2002-2006. Available online at: http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf

3 | Data Accountability Center. (2012). Data tables for OSEP state reported data. No longer available online.

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Links updated, July 2015 In This Publication: ______________________ Susan was 7 years old when she was hit by a car while riding her bike. She broke her arm and leg. She also hit her head very hard. The doctors say she sustained a traumatic brain injury.

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Other Health Impaired

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Definition

Other health impairment exists as an umbrella term encompassing hundreds of types of impairments that may result in a chronic condition limiting the individual's ability to effectively access the educational environment. This category is determined by limitations in the three areas of strength, vitality, and alertness, and these students may be cognitively intact. Three leading classifications under other health impairment include epilepsy, asthma, and diabetes.

However, it is the subcategory of attention-deficit/hyperactivity disorder (AD/HD) that will probably impact your classroom most frequently. According to the DSM-IV, AD/HD is defined as a "persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and severe than is typically observed in individuals at a comparable level of development." (p. 85)

Because of the wide parameters of the other health impairment category, the bulk of this section will be devoted to those students with AD/HD, as they are the highest incidence condition in this category. They are also the students most likely to be impacted negatively by their condition; students with epilepsy, asthma and other conditions in the other health impairment category may have little or no adverse impact on educational performance when their conditions are properly medicated.

Prevalence

The U.S. Department of Education reports 5,971,945 students receiving special education services in the 2003-2004 school year. Of that number, 7.6% or 452,045 students, received special education services based on a classification of other heath impairments.

Because IDEA does not specifically define or count incidence of AD/HD, the exact prevalence of the condition is difficult to determine. However, it is estimated that from 2 to 9% of all children are identified as having the condition.

Characteristics

IDEA lists a number of different chronic health problems as possible reasons for the other health impairment label, including asthma, attention deficit disorder, attention deficit hyperactivity disorder, diabetes, epilepsy, cardiac conditions, hemophilia, leukemia, rheumatic fever, sickle cell anemia, and nephritis. It would be impossible to list all of the possible characteristics under such a large disability category. The primary issue in other health impairments, whatever the condition, the resulting symptoms could adversely impact the student's educational performance. If a child has diabetes, but it is controlled through medication and does not impact learning, special education services are not appropriate for that child.

Students with AD/HD are categorized according to their characteristics into three distinct subtypes: predominantly inattentive AD/HD, predominately hyperactive-impulsive AD/HD and combined type AD/HD.

Students with the predominately inattentive type of AD/HD will exhibit six or more of the following characteristics:

Does not pay attention to detail and often makes mistakes across a number of activities

Has difficulty maintaining attention during activities

Does not complete schoolwork or other assigned activities

Has difficulty with organization of activities

Avoids activities that require mental effort or concentration

Loses materials necessary to complete assignments

Easily distracted

Forgetful in many activities

Students with the predominantly hyperactive-impulsive type of AD/HD will exhibit six or more of the following characteristics:

Fidgets or squirms in seat

Gets up or leaves seat frequently during class

Runs about or climbs when inappropriate, and is generally restless

Difficulty in engaging in play activities quietly

Talks excessively

Blurts out answers

Has difficulty waiting for their turn

Interrupts others

Students with the combined type of AD/HD will have some features of both the inattentive type and the hyperactive-impulsive type of AD/HD. This is the largest population of students carrying the AD/HD label.

Impact on Learning

Students with AD/HD, no matter what subtype, can have deficits in three areas that may impact their educational performance. These three areas are executive functioning, intellectual functioning, and social/emotional functioning.

Executive functioning is the ability to process information, make decisions, and solve problems. Students with AD/HD display deficits in a number of executive functions, including working memory, internalization of speech, self-regulation, and reconstitution. These students often have an inability to learn from the experiences of the past and can repeatedly make the same mistakes. This problem with memory is often impacted by issues with self-regulation, as these students also have difficulty understanding the effect that their behavior can have on others. In addition, students with AD/HD have trouble internalizing their thoughts and can blurt out inappropriate comments. Reconstitution is the skill of analyzing thoughts and behaviors. It is this deficit in executive functioning that can be the most frustrating to these students: they may know exactly what is expected of them, but are unable to act accordingly.

The average level of intellectual functioning of students with AD/HD is a matter of controversy, but what is certain is that these students frequently have problems with academic achievement. Ten to forty percent of these students are also diagnosed with a learning disability of some type, and 30% have a reading disability. However, these students also can display a high degree of creativity and can display intense levels of focused concentration on a task of interest.

Students with AD/HD often exhibit a number of emotional issues as well, and as many as 25% of these students have some type of anxiety disorder. These emotional issues can lead to conflict with parents, teachers and peers; low self-esteem; difficulty making social connections; and higher rates of alcohol and substance abuse.

Teaching Strategies

Without the appropriate supports, students with AD/HD may experience long-term difficulties in academic, social, and emotional functioning. However, there are a number of strategies that can be taught to these students to enable them to have more control over their own educational outcomes:

Allow extra time for these students to shift from one activity or environment to the next.

Teach these students specific techniques for organizing their thoughts and materials. Organize the classroom accordingly, and keep all materials in permanent locations for easy access.

Allow extra time for finishing assignments or for testing.

For more complex activities, simplify steps to make them more manageable.

Seat the student close to the teacher and away from any peers that might be distracting.

Post a daily and weekly schedule that clearly delineates each activity. These schedules can then be used as prompts to direct the student back on task.

Keep these schedules as consistent as possible, and keep unstructured time at a minimum.

In a more global sense, teaching these students to create their own goals and objectives can help them learn to manage their lives across any number of environments and activities. This process includes the following steps:

Clearly define your goal.

Develop objectives to achieve this goal.

Define the actions necessary to achieve the desired outcome.

Teaching this process gives control back to the individual, allowing for greater motivation and self-awareness.

Assistive Technology:

There are no specific technological devices that are recommended for students with AD/HD, but there are a number of tools that can be helpful in strengthening and supporting the organizational abilities of these individuals. Low tech devices such as notebooks and dividers can be utilized to record and organize assigned homework and classroom tasks. For older students, personal digital assistants, dictating machines, and a variety of computer programs can perform the same task.

For most students in the other health impairment category, it is the needs of the individual that drive the designation of appropriate assistive technology. For the most part, the majority of these students can access and benefit from the same technological supports that are used with their normally developing peers.

Important Information

The following two publications from the U.S. Department of Education address important issues related to the instruction of children with ADHD:

Organizations

A.D.D. Warehouse

ADD Warehouse has built the world's largest collection of ADHD-related books, videos, training programs, games, professional texts and assessment products. They are a leading resource for the understanding and treatment of all developmental disorders, including ADHD and related problems.

300 Northwest 70th Avenue, Suite 102
Plantation, FL 33317

Web: www.addwarehouse.org

Adults, adolescents, and children with Attention-Deficit/Hyperactivity Disorder (CHADD)

CHADD provides education, advocacy and support to individuals with ADHD. They publish a variety of printed materials to keep members and professionals current on research advances, medications, and treatments affecting individuals with ADHD.

8181 Professional Place, Suite 150
Landover, MD 20785

Web: chadd.org

American Diabetes Association

The American Diabetes Association funds research to prevent, cure, and manage diabetes and delivers services at the community level.

1707 North Beauregard Street Alexandria, VA 22311

Web: www.diabetes.org

Asthma and Allergy Foundation of America (AAFA)

The Asthma and Allergy foundation of America works to develop and implement public policies to improve the quality of life for people with asthma and allergies.

Web: aafa.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Council for Exceptional Children

The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving educational outcomes for individuals with exceptionalities, students with disabilities, and/or the gifted. CEC advocates for appropriate governmental policies, sets professional standards, provides continual professional development, advocates for newly and historically underserved individuals with exceptionalities, and helps professionals obtain conditions and resources necessary for effective professional practice.

1110 North Glebe Road, Suite 300
Arlington, VA 22201-5704

Email: service@cec.sped.org
Web: www.cec.sped.org

Epilepsy Foundation-National Office

The Epilepsy Foundation of America® is the national voluntary agency solely dedicated to the welfare of the more than 3 million people with epilepsy in the U.S. and their families. The organization works to ensure that people with seizures are able to participate in all life experiences; to improve how people with epilepsy are perceived, accepted and valued in society; and to promote research for a cure.

4351 Garden City Drive, Suite 500
Landover, MD 20785-7223

Web: epilepsyfoundation.org

Epilepsy Foundation of Southeast Texas

2630 Fountain View, Suite 210
Houston, TX 77057

8802 Harry Hines Boulevard
Dallas, TX 75235

Email: dstahlhut@efset.org
Web: www.efset.org

Epilepsy Foundation, Central and South Texas

10615 Perrin Beitel, Suite 602
San Antonio, TX 78217

Email: staff@efcst.org

Learning Disabilities Association of America (LDA)

LDA is the largest non-profit volunteer organization advocating for individuals with learning disabilities and has over 200 state and local affiliates in 42 states and Puerto Rico. The membership, composed of individuals with learning disabilities, family members and concerned professionals, advocates for the almost three million students of school age with learning disabilities and for adults affected with learning disabilities. LDA's mission is to create opportunities for success for all individuals affected by learning disabilities and to reduce the incidence of learning disabilities in future generations.

4156 Library Road
Pittsburgh, PA 15234-1349

E-mail: info@ldaamerica.org
Web: www.ldaamerica.org

National Association of Protection and Advocacy Systems, Inc

The National Disability Rights Network (NDRN) is the nonprofit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP) for individuals with disabilities. Collectively, the P&A/CAP network is the largest provider of legally based advocacy services to people with disabilities in the United States. Through training and technical assistance, legal support, and legislative advocacy, the National Disability Rights Network works to create a society in which people with disabilities are afforded equality of opportunity and are able to fully participate by exercising choice and self-etermination.

900 Second Street, NE, Suite 211
Washington, DC 20002

Web: www.napas.org

National Attention Deficit Disorder Association (ADDA)

The mission of ADDA is to provide information, resources and networking to adults with AD/HD and to the professionals who work with them. In doing so, ADDA generates hope, awareness, empowerment and connections worldwide in the field of AD/HD. Bringing together scientific perspectives and the human experience, the information and resources provided to individuals and families affected by AD/HD and professionals in the field focuses on diagnoses, treatments, strategies and techniques for helping adults with AD/HD lead better lives.

P.O. Box 543
Pottstown, PA 19464

Web: www.add.org

National Center for Learning Disabilities

The National Center for Learning Disabilities (NCLD) has developed this comprehensive site to help: parents make informed decisions affecting their children who have a learning disability or who may be at risk for learning disabilities; educators gain access to authoritative information about research-based instruction, assessment and support services; child care providers and early childhood teachers understand early literacy skill development, recognize warning signs and respond to young children's needs; and advocates promote educational rights and opportunities for all individuals with learning disabilities.

381 Park Avenue South, Suite 1401
New York, NY 10016

Web: www.ld.org

References

American Psychiatric Association (2000). (DSM-IV-TR) Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC: American Psychiatric Press, Inc.

Hunt, N., and Marshall, K. (2006). Exceptional children and youth. Boston, MA: Houghton Mifflin Company.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives. Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

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Information on health impairments and the impact it may have on learning.

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Behavioral & Emotional Disability

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Intellectual Disability

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Specific Learning Disability

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Specific Learning Disabilities - Project IDEAL

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Specific learning disabilities can be defined by a disorder in one or more of the basic psychological processes involved in understanding or using language.

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Autism Spectrum Disorder

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Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. According to the Centers for Disease Control, autism affects an estimated 1 in 36 children in the United States today.

We know that there is not one autism but many subtypes, most influenced by a combination of genetic and environmental factors. Because autism is a spectrum disorder, each person with autism has a distinct set of strengths and challenges. The ways in which people with autism learn, think and problem-solve can range from highly skilled to severely challenged. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently.

Several factors may influence the development of autism, and it is often accompanied by sensory sensitivities and medical issues such as gastrointestinal (GI) disorders, seizures or sleep disorders, as well as mental health challenges such as anxiety, depression and attention issues.

Signs of autism usually appear by age 2 or 3. Some associated development delays can appear even earlier, and often, it can be diagnosed as early as 18 months. Research shows that early intervention leads to positive outcomes later in life for people with autism.

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What is autism spectrum disorder (asd)? Click here to read the definition, learn about different types of autism and how to help autistic kids.

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Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder

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National Institute of Mental Health (NIMH)

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Overview

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.

Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

Signs and Symptoms

Risk Factors

Treatment and Therapies

Join a Study

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Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms: Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

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Developmental Delay

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The term "developmental delay" is typically used in school systems as a general term to describe a young child who is exhibiting significant delays in one or more areas. An early childhood assessment looks at these specific areas:

Physical development - fine motor skills, gross motor skills

Cognitive development - intellectual abilities

Communication development - speech and language

Social or emotional development - social skills, emotional control

Adaptive development - self care skills

Young children develop at varying rates. The goal of special education is for a developmentally delayed child to receive early intervention services and eventually catch up to his or her peers. When a child reaches a specific age determined by the school system (usually somewhere between age five and nine,) a child must be reevaluated to determine progress. Hopefully a student will no longer need special education services. Often a more descriptive disability is identified at this time (i.e. learning disability, intellectual disability, etc.)

If you have concerns about your child's development, share these concerns with your pediatrician who can recommend a screening with your school system if necessary. (See SPED referrals for more information)

Child with a disability for children aged three through nine (or any subset of that age range, including ages three through five), who is experiencing developmental delays as defined by the State and as measured by appropriate diagnostic instruments and procedures in one or more of the following areas: Physical development, cognitive development, communication development, social or emotional development, or adaptive development; and who, by reason thereof, needs special education and related services.

A Parent's Guide to Developmental Delays : Recognizing and Coping with Missed Milestones in Speech, Movement, Learning, and Other Areas By: Laurie Fivozinsky LeComer

The Child With Special Needs: Encouraging Intellectual and Emotional Growth By: Stanley I. Greenspan, Serena Wieder, Robin Simons

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The term "developmental delay" is typically used in school systems as a general term to describe a young child who is exhibiting significant delays in one or more areas.