Developmental Behavioral Pediatrics Evaluation Part 2

Honeybunches had his 2nd visit with the Developmental Behavioral Pediatrician down at the big hospital on July 14th.  Today (July 19th) I got the evaluation report in the mail.  I was impressed with how quickly it came and how thorough the report is. :)

Here are some of the highlights:

"Methods of Assessment:
Clinical Observation
Parent Report
Review of Medical Records
Review of School Records
Achenback System of Empirically Based Assessment (ASEBA)
Autism Diagnostic Observation Scale"

The report then goes into his history from birth through now including issues during his birth, health history, his developmental issues, previous diagnostic history, hospitalization history, medication history and all that fun stuff.

She went into detail about issues he has with his fine motor, sensory, gross motor, language and communication, cognitive, personal-social, self care, feeding/growth/nutrition, sleep, emotional-behavioral and relationships with adults and siblings in the family.

She clearly wrote under "Educational History" that "--is identified as a child with: Autism Spectrum Disorder".

I like how under "Current Developmental Status" she wrote:
"His mother has advocated strongly for good special educational services and he has made nice progress in recent years..." :) She also wrote in there how "He reports being bullied, but did not want to discuss it." I plan on going into that further with the school at his IEP meeting in September, requesting something be put into his IEP in regards to a bullying safety plan if that's something that exists or at least ways to protect him from bullying. I know as he gets older, that becomes more prominent.

Under "Behavioral Observations" she wrote how "-- answered my questions nicely at the beginning of the interview, but then became so focused on leaving in order to eat that he had difficulty answering questions. -- turned his body away from me while talking on several occasions and had poor eye contact. He seemed to understand that he has behavior problems but had little insight into how they affected others. The prosody of his speech was fairly flat limited affect.... He brightened when we talked about his interest in money and promptly showed me both his money and the signatures on his money.  -- indicated that he liked to do worksheets both at school and at home.  He also indicated that he loved riding his bike and scooter..."

Regarding the ADOS-2, Module 3 she wrote:
"The ADOS-2 is a semi-structured, standardizes assessment to evaluate language and communication skills, reciprocal social interaction, play, stereotyped behaviors and restricted interests. It includes a number of activities such as make believe play and cartoons. Module 3 is used for children and adolescents who use fluent speech to communicate..."
"-- used fluent speech to communicate. The child's speech patterns were fairy typical, but he used little variation in pitch or tone. -- directed vocalizations to me, but often did not look at me. He did not echo other's speech. -- used language that tended to be more formal than that of children at a similar developmental level with some occasional idiosyncratic utterances. -- occasionally offered information about his or her own thoughts and experiences, but was not able to share much information about his feelings. He had difficulty describing his emotional experience.  His conversational speech included some spontaneous elaboration of his own responses for the my benefit and provided some leads to follow, but this was less in amount than would be expected for his expressive language level and limited in flexibility. He took my leads in conversation if they were on a topic that was of interest to him. If I gave a conversational lead that was either not dramatic or not related to his interests, he would simply say "Yep" and change the topic. -- used some spontaneous use of descriptive gestures in the demonstration task and the description of a cartoon. However, he had a very difficult time integrating eye contact, verbalization and gesture..."

Reciprocal Social Interaction:
"--- was pleasant to work with throughout the assessment. But, midway through the assessment he noticed a tiny spider web and spider in the corner of the room. He stared at it throughout the rest of the assessment, and then discussed insects at a much higher rate. He was difficult to engage in a play scenario with super heroes.  He wanted to use the tools to remove the leg of one of the heroes and focused on this throughout the play scenario... -- showed poorly modulated eye contact to initiate, terminate and regulate social interaction..."

She went into his speech-communication issues that she noticed in detail.

He told her that "Friends are people you met and did not seem to have insight into give and take relationships... He expressed that he wanted to be a banker or a cop and live in a bank when he grows up."

Conclusion:
"The ADOS-2 can be considered a reasonable estimate of --'s behaviors and skills in social communication.  On the ADOS-2, --'s scores were consistent with the diagnosis of Autism Spectrum Disorder...
ADOS Classification and Concern Level: Autism Spectrum Disorder, Moderate."

Then she went into why he meets the criteria, what criteria he met, etc which I previously wrote about in a recent post entitled Dev. Beh. Pedi eval part 1.

She gave recommendations for the school including:
"He requires a very individualized instruction and a functionally informed positive behavioral support plan in the classroom and home environments. I believe he would benefit from a highly structured curriculum like SRA connecting math concepts and reading mastery. If -- states he does not want to attend a crowded assembly or a similar situation, his request should be accommodated. It is much better that he asks for this in advance rather than having an aggressive episode. The behavior analyst should make sure that frequent preference assessments are conducted so that effective reinforcers can be used in his behavioral plan.  -- often asks perseverative questions.  If he asks a question once, answer it. If he asks the same question again within a relatively short period of time, have him write the answer down. Then you can respond to future repetitive questions by pointing to the written answer. He may benefit from the use of a Time Timer at home and school. --may benefit from teachers systematically creating schedule changes and rewarding him for tolerating these changes..."

She recommended "Color coding his schedule to indicate whether an item is a definitely scheduled item or if something is just a possibility. -- has improved over the years and although his aggression has decreased, it is more complicated when he is aggressive now due to his strength and size... "

"-- needs to work on skills that will lead to independence in his living environment, community and in a vocational setting.  The Assessment of Functional Living Skills is an assessment skills tracking system encouraged on the guide for the development of skills that will help individuals with disabilities be as independent as possible. The AFLS could be used to guide a portion of --'s school educational program." (She then went into many more details about the AFLS.)

Again, I am impressed with this evaluation report and the previous intake report she sent! Now, time to write a letter to send to the school requesting this AFLS evaluation be part of his three-year IEP eval and also write some new accommodations I want added to his IEP based on this report... 

Another School Year Over... Progress Updates

Today was the last day of school for Honeybunches.  That means it's also report card and progress report time again.  It's confirmed in writing that his placement next year with be with Mr. M again. :)

Some highlights from his Progress Reports:

Honeybunches has:
(Counseling goal report) "Greatly improved his ability to verbalize his feeling associated with frustration, anxiety and stress.  He continues to struggle with using these strategies, however overall has made significant gains this year.... -- Continues to work on identifying and verbalizing his feelings.  He continues to struggle with the comprehension of his feelings, which in turn hindered successful peer interactions.  Continued work in this area would be beneficial... -- Continues to struggle in the larger group setting and often removes himself from the classroom's social skills lesson.  Continued work in this area for -- to remain in class and participate would be beneficial..."

(Behavioral) "During group lesson, -- may protest at times and want to do his independent work right away, but he will stay and participate in the classroom/group activity 100% of the time due in a large part to his desire to earn stars." (Sensory activities are a big part of his behavioral goals, but he refuses to do his sensory activities most of the time although he takes other breaks which are scheduled throughout his day...)

(Sensory Motor) "-- continues to participate in weekly therapy sessions in a small group setting. He is pleasant and cooperative. He will offer assistance when needed, suggest particular activities and state when he needs help.  It has been a pleasure working with -- again this school year and observing his significant progress in all areas of his sensory motor development."

(Occupational Therapy) "-- Has acheived his benchmarks and has improved his readability of hand written text through the use of a spacer. He is now working on correcting a few letter forms that further impact readability. When he works to monitor written output, speed of copying can vary. -- is always happy, polite and cooperative... The team should consider decreasing services if his progress continues next marking period..."

(Speech and Language) "I have enjoyed working with -- this year.  He continues to put forth good effort during language sessions on most days.  -- continues to benefit from multiple choice tasks when providing synonyms or antonyms for words and when identifying the main idea for short paragraph level material.  His ability to define multiple meaning words by using them in sentences has increased from 20%-100% for familiar words...."

(Reading) He is 60% accurate in the skill of "Given a written passage, written directions and a verbal prompt, -- will be able to identifying important details in writing". His goal was 80%. He can determine the meaning of words with 50% accuracy.  Goal for that skill was 60%. He had a goal to read 80 wpm with no more than 3 errors on 4 out of 5 trials.  He did not meet that goal, but did make progress (Which is what I look at the most) going from 55 wpm in November to 61 wpm in June on the DIBELS assessment.  The teacher did note that his "Ability to read fluently varies a lot from day to day and this assessment was done first thing in the morning when it is usually done in the afternoon..." The teacher also commented how he's "Put forth great effort on the Read Naturally Program.  At his request we were able to obtain some 5th grade materials... as he'd gone through most of the 4th grade..."

(Math) He is meeting most of his goals regarding place values, addition with three digits and regrouping, written subtraction with three digits (However the teacher wrote how he needs to be reminded to regroup before he gets going) as well as multiplication and division. He is not meeting his division goal as he's only 40% accurate on #s 100-200 although he's 90% accurate with the smaller numbers. The teacher says that multiplication is a strong skill for him.

(Written Language) "He is doing very well with writing paragraphs, but needs 1:1 help expanding his writing to 2-3 paragraphs.  -- will rewrite his sentences, but will need to get verbal prompts to be able to do this."

His report card does not go by A, B, C, D or F like most children's do.  His goes by
1: Developing grade level skills.  Not yet able to produce required grade level work.
2: Progressing toward grade level.  Producing required grade level work with direction and assistance.
3: Meeting grade level skill.  Producing quality work.
4: Exceeding grade level skills.  Producing highest quality work consistently.

In English Language Arts he got mostly 2's. He did get 3s this trimester in "Understands and utilizes new vocabulary" as well as "Reads with accuracy, fluency and expression". He got 1 in "Edits work" and "Writes an organized piece with purpose, clarity and details" but got a 4 for "Effort".

The narrative for this trimester says "--works very hard in reading.  He did a lot of Scholastic Reading Counts books and Read Naturally stories this trimester and has been improving significantly from his cold to hot reads."

Spelling he got 2 in "Learns spelling words for weekly tests" as well as "Applies correct spelling" but got another 4 for "Effort". :) That narrative says how "We don't do weekly spelling words as we try to focus more on reading and writing.  However, with the Word of the Day we do focus on proper spelling as well as with his written work."

In Math he got mostly 2s again, but got 4 in "Effort", 1 in "Communicates mathematics thinking using correct vocabulary, orally and in writing" and 3 in "Computes accurately". That narrative says " -- loves doing math and always wants to get to his worksheets.  We have been working with him to focus more on accuracy and less on speed."


Social Studies he got 2 in "Demonstrates understanding of concepts...", 2 in "Interprets and constructs data from maps, charts and tables", 1 in "Communicating understanding..."but again a 4 for "Effort".

Science his teacher says "Participates in Science lessons, although they are not his favorite.  He enjoyed our concluding field trip to the Aquarium..." ht moved up from 1 to 2 in "Communicates scientific thinking...", got a 4 for "Effort" and 2s in understanding, making skillful predictions, and draws appropriate conclusions.

In Work Habits he got a 4 for his overall grade; 2s in handwriting and communicates effectively in oral presentations and class discussions, presents neat and careful work; 4s in follows rules, uses time efficiently, accurately completes and returns homework on time, interacts and works cooperatively with peers and adults and follows oral and/or written directions; 3s in organizes work space and uses appropriate study skills. The teacher wrote "Has strong work habits and is one of the hardest workers I have ever had the pleasure to teach.  He has made some progress in making his work neater and more legible. He is very polite and interacts well with peers and adults alike.  He will have Mr. M next year as his teacher...."

Art and Music gave him a simple 3 while in Physical Education he got a 4.  They are not broken down like the other subjects are.

I am very pleased with the progress he's made this year.  He's been sitting hear timing himself doing "Read Naturally" that came home with him for over an hour.  He did it for quite a while this afternoon too. Three weeks until tutoring begins, which is our town's elementary school version of ESY.

Developmental Behavioral Pedi 2014 Part 1

Today Honeybunches had the appointment with the Developmental Behavioral Pediatrician down at the big hospital we've been on the waiting list for since October. This was the intake appointment.  Then they'll do two more appointments: One for the ADOS and another to go over results/reports.

Today's was very beneficial. She told me that many parents have been having a hard time with the school districts regarding the new DSM-5 and whether or not children still have Autism (Although they are technically just supposed to be given the new Autism Spectrum Disorder diagnosis).

She observed him, asked him some questions, me some questions, had him fill out a questionnaire and went over some paperwork previously sent in.  She said even from our appointment today, just going over certain questions and mostly through observing/talking with him she can tell he meets ALL the new criteria for Autism Spectrum Disorder. 

"Diagnostic Criteria for 299.00 Autism Spectrum Disorder

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. She said he met this one clearly.
   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. She said he met this one too.
   3. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. She said although he's developing some new friendships, he still meets this category too.

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):She said he clearly meets all four, although to be diagnosed he only needed to meet two...
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
   4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior. She did not go over his severity in detail as of yet...

3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
5. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be beloiw that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder."

She said although she could have confidently diagnosed him today, some school districts have been giving parents issues if they don't have a ADOS report to go along with the new DSM-5 diagnosis.  She said there is a new ADOS to go along with the new DSM. She said that doing the ADOS (Although not necessary) will help prevent any school questions in the future. So we go back in exactly four weeks for the ADOS appointment, then we'll have a follow up appointment just to go over the results. She clearly seen him persevering about wanting to eat lunch lol.  I told her how he smells everything.  She said while many children with different diagnoses have sensory issues in different ways, it's the smelling everything is Autism related.  I found that interesting. She also found it interesting how his intense interest area is money.  I mentioned to her how he can go to the store and bank 5+ times per day to change his money.  For example he can have a $10, go change it for two $5s. Come back and go change it for 5 $2s.  Then ten $1s... Etc. He knows the serial numbers, secretary and treasurers.  I told her his other favorite area of intense interest is trains.  She began asking him a couple questions about his favorite train.  He said Netfork Southern lol. 

She mentioned that she can see an underlying anxiety disorder.  I mentioned how he was previously diagnosed by a Developmental Behavioral Pedi at Tufts with Generalized Anxiety Disorder, but a more recent eval by a child psychiatrist at the hospital she is affiliated with said it was part of his Autism and Bipolar.  She said that while what was previously diagnosed as ADHD was part of it (She did not see the hyperness that goes along with that diagnosis), the anxiety disorder she believes is separate.  She said she'd want to be careful about labeling him as ADHD because then doctor's would be likely to try stimulants, which are often a disaster for "Children like him".  I then mentioned how his first med was Ritalin at age three which was a disaster. She gave me a questionnaire regarding anxiety to fill out for our next appointment.  She suggests getting him a Cognitive Eval (Which they also do in her office) when he is between 15-16 to help get adult services into place.  She said that at that age I will be "Concerned about his cognition and memory". ;) That's the age when differences with IQ become more prominent.

Another thing the doc mentioned was that she does not understand why they gave him the diagnosis of PDD-NOS instead of Classic Autism to begin with.  From observing him, she said it's very appearant. He previously scored "Severely Autistic" on the CARS rating scale back in 2009. I mentioned to her that the doc who diagnosed him said that the only reason she did not give him that diagnosis was because he could speak (Although he has Receptive-Expressive Language delays) and he also made limited eye contact (Which he did not do with this doctor today). I can see her evaluation being very helpful with Honeybunches three year IEP eval coming up in September.

Honeybunches Spring 2014 Report Card and Progress

Report cards and progress reports came today. :) Overall, I am happy with his progress.  That's something that not everyone would understand as you can see from these:

Although he got mostly "2"s, I am proud.  It means he is making progress. He moved up to "3"s in a few areas.  That's what I focus on. I am glad that his teacher only gave him 1s on "Writes an organized piece with purpose, clarity and details" because that should help us keep him in OT for another year.  At his last yearly review, they were talking about possibly cancelling him from OT services when they do his three-year eval this upcoming October. I was going to fight that anyways, but now I have more ammunition! Some things on his report card with "1"s are because of his diagnoses.  For example, I believe that "Comprehends inferential meaning (Implied, not stated), "Applies problem solving skills" and "Communicates mathematics/scientific thinking/social studies using correct vocabulary..."might always be areas he struggles with. Him having issues with communicating will help me keep him in speech 2x week. As you can see, he put in a lot of effort as he got "Exceeding grade level skills" in every area!!! He is trying and making progress.  I love reading the teacher comments, such as how he increased his reading fluency by 16 words since the beginning of the year. As long as he is progressing, I am happy.  He might not ever make honor roll, but as long as he is trying his best, this Momma will be supporting him and proud of him.  Maybe I am even more proud than those Momma's whose children do get all A's, because I know how much harder it is for him.  I feel like creating a sticker that says "My child progressed this year" or "My child got 4s for effort".  Hmmm, maybe I can get Shut Up About Your Perfect Kid to make a badge for me lol...

His progress reports also came home.  Here are some comments from them....

Counseling:
"--- has improved his ability to verbalize his feelings associated with frustration, anxiety and stress.  He continues to struggle with consistently using these strategies, however overall has made significant gains this year... He continues to work on identifying and appropriately verbalizing his feelings. He continues to struggle with comprehension of his feelings, which in turn hindered successful peer interactions. Continued work in this area would be beneficial... --- continues to struggle in the larger group setting and often removes himself from the classroom's social skills lesson.  Continued work in this area for --- to remain in the class and participate would be beneficial."

Behavior:
Mostly this one talks about his goals, most of which are sensory related and how he "Engages in sensory activities 25% of the time" instead of 8:10. There is another sensory related goal also, which states how he chooses to take breaks which get him up and moving instead. On a good note, there is a goal that states in 8:10 trials when he is in a classroom setting, with verbal directions and verbal prompt he will participate positively in group activities in 8:10 trials.  He is currently doing this 100%, although he might protest at times and want to do his work independently, but will stay and participate in the classroom group activities 100% of the time.  (Remember, his class is only him and two other boys with the teacher and two class aides so it's still a small group setting.)

Sensory Motor (PT):
He achieved two of his objectives, but continues to work on another in regards to trunk/upper body strength. (If only his forceful hugs counted lol...)

Visual Motor (OT):
He met three of his objectives out of five. They are still working on getting him to write within the assigned spaces and his copying skills. He increased his printing speed, is using both hands for typing tasks and can produce, edit, save, print a draft.

In Speech and Language, he is still progressing towards all 4 of his goals.

Reading: He is working towards his goals of being able to identify important details in writing with 80% accuracy (At 60%); using context cues to identify the meaning of a words with 60% (At 50%); "Given a written passage at a 4th grade reading level, written directions and verbal directions, along with a verbal prompt, he will read 80 wpm with no more than 3-4 errors on 4:5 trials" (He can read 71 wpm with 0 errors which was significantly improved from his September assessment of 55 wpm AND they got him 5th grade Read Naturally work from the other school at HIS request). I am proud that he advocated for himself in getting it! :) :) :)

Math: He's meeting all his objectives!

Written Language: This explains how he needs 1:1 help expanding his writing to 2-3 paragraphs and needs verbal prompts on other areas, but is progressing.

Yup, this report makes a Momma proud as he is progressing!!!

Baby steps are the most important.  As Miley Cyrus says "It doesn't matter how fast we get there... It's the climb..."

New School Safety Plan

I received Honeybunches updated Behavior/Safety Plan today from school.  It says:

"(Honeybunches) spends his day in the ILC which is designed to provide intensive behavioral and social supports along with specialized academic support.  A high staff to student ratio provides the opportunity for a great deal of proactive social support for each child.  This is a very structured setting with a predictable schedule and clearly established routines. 

There are a number of systems set up to promote pro-socieal behavior.  Students earn stars every 15 minutes for speaking appropriately, cooperating with adults, being on task, respecting adults and maintaining self=control.  A certain percentage of stars by 11:15 each morning and by 2:30 each afternoon allow them to earn breaks.  The breaks are also contingent upon safe behavior and completion of academics.  Earning stars determines the number of points for the monthy "Treatsure Box" and also counts towards a level system which allows students to earn increasing privileges as they move up through the system.  In addition, they earn stickers on a car for especially good academic efforts, positive social interactions and exercising self=-control in difficult circumstances.  Cooperative efforts are encouraged through a compliment chain and an addition classroom reward system.  

Supports outside the Classroom: The school counselor works with (Honeybunches) both individually as well as in a class wide group that focuses on social knowledge and skills.  He also has a supportive relationship with his previous teacher, principal, the district psychologist and the district BCBA behaviorist.  

Sensory: The teacher will consult with the Occupational Therapist to determine sensory breaks for (Honeybunches).  They will generally be offered after times that are typically challenging for him: unstructured times, recess, physical activities, or school-wide events. As the afternoon is generally a time when it is more challenging to sustain academic efforts breaks may be offered more frequently. These are typically short breaks of 3-5 minutes that allow him to calm down but are not so long that they will interfere significantly with academic time.  Most of the time he prefers to do his academics.  Often moving to a quiet space may be all (Honeybunches) needs to reduce sensory overload. 

Self-Regulation: The ability to be aware of their emotional state and to have skills to help themselves return to a calmer place is crucial to all students.  For the majority of the students in the ILC this has been an area of difficulty.  A 5-point scale with a 1 being his calmest and a 5 being the most agitated has been developed with (Honeybunches).  It indicates what it looks like and feels like at each level as well as what (Honeybunches) can do to return to a calmer place if he is becoming upset.  Over time it is hoped that (Honeybunches) will internalize these concepts and be more able to regulate himself.  

Target Behaviors: These behaviors are documented each day.  Currently disruptive behavior and delay in starting his academic assignments are our two priorities.  At this point unsafe behaviors such as aggression and leaving staff supervision are no longer a significant concern.

Safety: ILC staff are trained in TCIS - Therapeutic Crisis Intervention for Schools.  This model incorporates a variety of de-escalation techniques, therapeutic behavioral approaches and physical restraint (If necessary) to assure student safety.  The ILC has an adjacent time out room that is easily accessed from the classroom.  This space is available to the students assigned to the ILC anytime throughout the day - either self or staff directed.  There is no consequence to the student if used appropriately to "Take a break" and allow for improved self-regulation.  

If (Honeybunches') behavior escalates and becomes unsafe or aggressive, he will be escorted to the time out area if he does not respond immediately to a verbal prompt.  Once there he will be released and allowed to calm down unless he becomes unsafe at which point he would be restrained.  All restraints will be logged to include information related to the reason for the restrain,, time it began, time it ended and the student's behavior during the restraint.  (Honeybunches) will be released from the restraint when he is able to keep his body calm and refrain from threatening statements for one minute.  He must remain quiet and safe for a minimum of five minutes in the time out area before he is allowed to return to a prior activity.  As soon as possible following the completion of a time out he will be provided with the opportunity to have a Life Space Interview to process what led to the crisis, how the behavior was unsuccessful in getting him what he wanted and an alternative strategy for getting his needs met.  

(Honeybunches) will be closely monitored and supervised throughout the day both in the classroom and during unstructured activities (i.e. lunch, recess) by the ILC staff.  This implies both visual and physical proximity to ensure his safety.  Walkie-Talkie handsets will be used for effective and efficient communication during recess.  

Home/School Communication: A "Daily Communication Sheet" is sent home to provide (Honeybunches) family with a short narrative of his day along with information on his status on the Level System, Time Outs (If any), Restraints (If any) and Homework.  There is a place for adult's signature as well as a place for comments and questions.  Serious incidents will also be communicated to his family through a phone call."

Revised Acceptable IEP

To know what is going on with this post please read about his IEP Annual Review Meeting and his IEP I received last week after that meeting which resulted in a Dispute Resolution Reconvene Meeting. Anyways, today I got his new IEP.  This one is much more acceptable. It's even better than the previous one! 

They gave him back his "Longer School Year" stating Honeybunches "Is to receive tutoring for four days a week, two hours a day for four weeks. It is essential that ---'s tutor is someone he is familiar and comfortable with." That is even better than before, because it stipulates who is to do the tutoring. They also added in his Assigned Seat under transportation and gave him a "Transportation Support Plan" that says "If members of the team identify an increase in the number of refusals to board the general education bus or an increase in the number of behavioral incidents that occur related to transportation service and/or if there is an observed change in ---'s attitude toward riding the general education bus, the following steps will be taken to provide additional levels of transportation support:

A monitor will be added to the general education bus to support (Honeybunches).

If further support is required, special education transportation will be provided, and the team will evaluate the need for a monitor using available data."

That's so much better and more clear than it even was before. They also put home use for the Ipad back into the IEP, moved the Ipad to PLEP A and PLEP B as an "Assistive Technology Device" which the OT agreed it was and put it under "Student Strengths" like I requested. 

Turns out going to Due Process was not necessary, at least this time! I feel like the school must hate me now, but I try to look at things as what will matter in five to ten years. Will it matter I made them hate me? Will I remember that part of things? I doubt it. What will matter is that I did everything I could to get Honeybunches the help he needed in school. Honestly, it does bother my heart a bit though. I've been that way my whole life... wanting everyone to be happy. Anyways, I got all I wanted for Honeybunches in the IEP... and then some! I guess that means I did a good job advocating for him, even if the school thinks I am a #&*!$ (Fill in the symbols with whatever word you want lol...)

IEP meeting round #2: Dispute Resolution

When I got the IEP in the mail, I noticed the IEP chairperson made several changes:

• Took "Longer School Year" out of the IEP moving "Tutoring" to "Additional Information".
• Changed the wording regarding his Ipad, took out home-use. 
• Some dates were wrong. 
• Changed wording in the transportation area and took things out so basically he had him on regular transportation with no supports. 

First I sent an email to the IEP Chairperson trying to work things out in a nice way.  He was not willing to negotiate at all and justified every single change he made.  After that, I emailed the SPED Director and Superintendent telling them I was partially rejecting his IEP and looking forward to Due Process lol.  I did partially reject his IEP (Brought it to the office, had the secretary initial/date/stamp it received and mailed a copy to the DOE/DESE Bureau of Special Education Appeals).  I wrote the IEP chairperson and SpEd Director a nice 5 page letter stating the regulations, why he needed what I requested, what regulation it went along with, etc. The school district requesting a meeting. So that's how we ended up at today...

I walked in with my big rolley cooler type bag on wheels. It has 3 big binders (2'' with info regarding this mess, 3'' with his most recent IEPs/Evals + other recent materials and the third 3'' with his old IEPs and other old info), Wright's Law, The Complete IEP Guide, a copy of the state regs, my notebook and other info I might have needed.  The secretary joked asking if I was moving in.  Things went very well.  I requested his old teacher Mrs. Understanding and the new SpEd Director's presence.  Also there were OT, PT, Principal, School Psych, School Counselor, his current teacher and the IEP chairperson. I walked in, opened the bag, sat the Wright's Law book on the table, opened one binder to the Mass Regulations and sat where I knew the SpEd Director and IEP Chair could be close by to see it lol.

They agreed to put the Longer School Year back in his IEP specifying the 2 hours per day, 4 days a week for 4 weeks he's been getting for the past few Summers.  He said he learned something.  He came from the high school as a SpEd teacher where at that school they had a complete Summer school program.  There that's what they consider ESY/Longer-School-Year.  There tutoring is not, when in the elementary school it is.  Although we agreed upon that, I don't see it in the meeting notes....
 
At the end of the meeting I asked if what we agreed upon was actually going to make it in the IEP.  I also asked Mrs. SpEd Director lady if she ever proof-reads IEPs.  She said randomly.  I asked her if she could read (Honeybunches)'s before it goes out.  She said she would.  School psych and Mrs. Principal described the "Historical patterns of events regarding transportation." (OT) discussed the Ipad's benefits of being an "Assistive Technology Device" and agreed it was such. She brought up the question if we write it with a time stipulated such as for the duration of his involvement with special education... what if something better comes out in a couple years? I agreed to leave that part out based on her point that technology is improving and their agreement to place it in the other areas.   School psych made the point that it should also go under PLEP A and PLEP B which everyone agreed upon. 

As for transportation: School psych lady and I went over his history. (Basically in a nut-shell for Kindergarten he was on the van, but was aggressive with the bus driver and other students some of whom were medically fragile so I drove him the rest of that year and got reimbursed from the school district; In grades 1-4 he had a 1:1 on the regular bus.) School psych pointed out how he has difficulty with any transitions and gave examples.  They are making changes regarding what IEP Chairperson called his "Transportation Support Plan" which will state "Criteria for enacting the transportation support plan:
- Increased number of refusals, increased number of behavioral incidents
-Change in (Honeybunches)'s attitude towards riding the bus. 
The plan will state:
Step 1: Addition of a monitor to the general education bus.
Step 2: Include special transportation and evaluate the need for a monitor"

They also agreed to write in the IEP his assigned seat behind the bus driver by himself, although I don't see that in the meeting notes. They clarified "Proximity to teacher" which will be changed to "Seat within 15 feet of teacher" or "Seat within 15 feet of instruction".  I let Sped teacher determine the exact number of feet.

I was pleased with how the meeting turned out.  I got the important stuff. (Or shall I say, at least it seems that way now, but I'll see when the IEP comes if what we agreed upon today actually makes it's way into this IEP.) We did agree to leave out an accommodation that the IEP chair and teacher took out that stated "Counting in real life situations to be implemented throughout his day", because he's way past that now with his math skills.  Basically I threw that in there to have something to negotiate with so it looks like I was cooperating.

I told them it was important for things to be clarified and the reason I nitpicked through the IEP (Which I would have anyways) was because since my father died last year, my mother's been having a hard time affording to keep the house.  I don't know if we'll have to move in the next year or so.  I told them that's why it's important things be written in a certain way so if we were to move and he went to a different school district things would be clear.  IEP chairperson said that gave him a different perspective.  He talks a lot about this school district. Sometimes things in life happen and children move or get school choiced out of here (Which is something I've always debated regarding when Honeybunches gets to middle school).

All in All this meeting went well.  I was determined it would.  I feel accomplished!  My advocating skills and knowledge of the federal laws plus state regulations needed to be polished off anyways lol.  I guess I am thankful that I was given this challenge in life so I had the opportunity to do that.  Now I sit and wait for the IEP to come in the mail probably sometime next week.  Then I'll see if what we agreed upon makes it's way into this one.  At the last meeting we signed off on the meeting notes.  Certain things were in those notes that IEP chairperson decided to change in the IEP.  Hopefully now that they know I am knowledgeable regarding the laws/regulations and not scared of Due Process they will be more cooperative. 

I am also the SEPAC (Special Education Parent's Advisory Council) Chairperson.  The DESE (Department of Elementary and Secondary Education) is coming in a few weeks to review certain programs including the special education system here.  They want to interview me as I represent the SEPAC group.  Hmmm maybe that worked to my advantage as well?