Saturday, June 11, 2011

Why Should I use a Neuropsychologist?

Someone I have worked with recently shared that they were not sure why they should use a Neuropsychologist rather than someone else to diagnose their three year old child in an IEE.  This had seemed obvious to me as someone who had a background in Clinical Psychology, but others don't necessarily understand the different classifications within the world of clinical psychology and why one title may be preferred over others in different situations.

A neuropsychologist is the elite in the world of educational testing.  They have the most education, the most training,, and the most experience.  All Neurop0sychologists will have a Bachelor's degree (either B.A. or B.S.).  Many have a Masters degree (either M.A. or M.S.).  They will have a doctoral degree (either Ph.D. or PsyD.), and they will have additional education in Neuropsychology.   In addition they must have completed all training as a psychologist, and completed additional training in neuropsychology.  After completing all of the above training and education, they also must past state tests that prove competency.  A neuropsychologist is more than able to diagnose anyone with learning problems and in some ways may be 'overkill' for a younger or more disabled student, but their degree of fitness as an expert is pretty unimpeachable.  The "neuro" part means they have studied the brain in more depth and they are able to administer tests that allow them to make more detailed assumptions about the brain.

A clinical psychologist is also someone that would make an excellent expert, although they have not spent the additional time studying neuropsychology.  For many children this would be adequate, but districts are less likely to admit to the expertness of the Clinical psychologist than the Neuropsychologist.  Keep in mind though, that districts rarely use Clinical psychologists to test the children in the district, so their "experts" in most cases are not as educated or trained as vigorously as most Clinical psychologists.  Testing is the specialty of the Clinical psychologist, although their testing strength may not be in educational testing.  Most often they test for psychological disorders.  They will have had to complete state testing to ensure competency.

A school psychologist must have a Master's Degree and pass a state competency test.  They are allowed only to practice in schools and their education focuses almost exclusively on learning to administer and evaluate educational tests.  They have no continuing education requirements.

An LCSW or Licensed Clinical Social Worker is trained and licensed to be a counselor or therapist.  This person would have an M.S.W. (Master's of Social Work).  They must also complete hours of training and pass a state competency test.  They have some training in administering and evaluating tests, but they have not specialized in educational testing and would not be considered an expert for the purposes of educational testing.

An MFT or Marriage and Family Therapist is very similar to an LCSW, except that their specialty is in relationships and they would receive either an M.A. or and M.S. in Clinical Psychology.  They would also not have the necessary requirements to be considered an expert in educational testing.
A Psychiatrist is a medical doctor who specializes in administering medications for psychiatric conditions.  Many children in special education may see a psychiatrist for medication management but they would not be considered experts in educational testing.  They might be an excellent witness for some aspects of a case involving special education, but they would not be a expert in the area of testing.

There are many other jobs within the area of psychology, including psychiatric nurses, psychiatric techs, behavior specialists, BCBA's, and on and on.  For educational testing however there is one group of specialists that is the top "expert" in the field and that is the Neuropsychologist.  When confronting educational issues/testing it is best to use the Neuropsychologist if possible, if you cannot get a Neuropsychologist then a Clinical Psychologist would be appropriate if they specialize in educational testing.  Although school districts will tell you that the school psychologist is an expert, using one as your "expert" is not in your child's best interest.  And, it is important that you never use someone whose credentials are not adequate in educational testing as your expert as any reports or testimony by the inadequately trained person can not be taken seriously.

Choosing the Right School

Our school district has a policy that disallows what they call "school shopping".  Their opinion is that each of their school sites that offers certain programs all offer THE SAME program.  Of course we all know that this isn't true - otherwise why would parents prefer one school site over another?  This isn't to say that one is necessarily better than another (although that may be the case), but could it be that one site is better or more appropriate for a specific child?  I believe so.  I believe it is disingenuous for the district to state that they are all THE SAME and therefore transfers are not necessary.

When our oldest was returning to district after having gotten all he could from the county program for kids with severe emotional difficulties he wanted to attend a particular high school that was not our neighborhood high school.  It wasn't that our neighborhood high school was so bad, but he had made some enemies before going into the county program and he was nervous about how he would be welcomed back. The last time he had seen a group of about 6-8 boys was when they were chasing him and threatening to do him harm.  The district agreed that he would be transferred to the other school site as part of his IEP.   

My oldest daughter has had some difficulty in our neighborhood elementary school, mostly teasing and great difficulty making any friends.  She is quite a cute girl, she is sweet and a good friend once she is your friend, but she is also painfully shy, has a great deal of anxiety, and if she is not diagnosable as depressed, she is very close.  Her most recent psychological evaluation suggested that she is clinically depressed, but the district prefers to ignore that since she is not taking a specifically antidepressant medication - just a medication that is used for depression and anxiety.  I have actually avoided making a big deal out of the depression with the school because from everything we have seen and discussed with various professionals her depression is primarily driven by her anxiety - so working on the anxiety helps to diminish the depression so we have chosen to work on the cause of the depression rather than focusing on what seems to be a diagnosis of outcome rather than a primary diagnosis.   She has also been diagnosed with Partial Fetal Alcohol Syndrome - which tells us that she is a follower and that she is likely to follow anyone who accepts her down whatever rabbit hole they might lead her.  All kids are like this to a certain degree, but kids with pFAS are especially vulnerable to this.  

We had this particular child transferred in Jr High as the school in our area was in "Program Improvement" meaning they were not doing well at teaching the children that attended there.  We had allowed her to attend a "Program Improvement" school prior to this and had seen her skills slip - especially her oral language skills.  She went from a child who spoke mostly appropriately to a child who wouldn't use proper tenses and would use double negatives with regularity.  We had seen her propensity for following the crowd already.  

The school that she transferred to has been a wonderful opportunity for her.  Her language didn't really improve, but then it didn't get worse either.  She did however find a small group of caring and compassionate friends who although they don't invite her often or include her in all of their activities, are open to having her come along at times and treat her with caring and respect.  This group is among the popular kids which then helps her to be treated kindly by other kids at the school.  If someone is mean to her, the "cool kids" stand up for her, and so teasing and humiliation have been at a minimum.  I don't think there are many kids who get through Jr. High completely unscathed so this was really a great situation for her.

Now, as it is time to move on to High School, the IEP "team" refuses to send her to the High School that her current Jr. High feeds into.  They say she must return to her "home school".  This decision of course does not take into account her Generalized Anxiety Disorder, her Partial Fetal Alcohol Syndrome, or her Clinical Depression that is included in her most recent Neuropsychogical Evaluation even though I have not made a big deal out it with the district.  Their excuse is that the law states that when possible a child should be educated at the school of residence.  We all know that the law they are referring to was intended to PROTECT our children, and is in this case being used to imprison this child in a situation where she will once again be placed with the children who have previously humiliated and teased this child.  She will also have no group of friends who will stick up for her so she will hang out with whoever will tolerate her quirkiness, and she will once again be vulnerable to all manner of abuse since she will do whatever it takes to "have friends".  Wouldn't we all be willing to go outside of our comfort zone if otherwise we were left with no one to have lunch with or talk about our favorite shows or tars or whatever with?  Being lonely is a great motivator - most of us will do whatever it takes to avoid isolation.

Was the IEP process meant to force children to attend  the local school even when their psychological diagnoses would recommend against it?  Was it meant to allow a district to avoid taking responsibility for a child's well being?  Was it meant to set up a pretense that all schools are equal for all children?  I believe that emotional diagnoses are supposed to be considered as a part of the IEP process as well as educational diagnoses.  I also believe that if all of the schools programs were actually the same then parents wouldn't prefer one setting over others.

The way I am choosing to deal with this issue is to file for a 504 hearing.  It is similar to Due Process under IDEA but a 504 dispute is based on issues of disability and discrimination.  The beauty of this particular type of hearing is that the district cannot rely on the SELPA (a mega-district here in CA) to do all of the work for them and they may be more likely to carefully consider the case than rush to a hearing since the onus is on them.  I will write more as we get further into this and learn how the district chooses to respond.