LASA 1—Analysis of Historical, Legal, and Ethical Issues
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module_3_lecture_notes.docxModule 3
In this module, you will continue to explore specific high-incidence exceptionalities, including those related to behavior, emotions, communication, intellect, and autism spectrum disorders.
Complete the following readings early in the module:
· Human exceptionality: School, community, and family (10th ed.), read the following chapters:
· Emotional/behavioral disorders
· Intellectual and developmental disabilities
· Handel, A. (Producer), & Puchniak, T. (Director). (2001). Is love enough? [Documentary]. United States: Filmakers Library. Retrieved from http://flon.alexanderstreet.com.libproxy.edmc.edu/view/1641316/play/true/
· Ravindran, N., & Myers, B. J. (2012). Cultural influences on perceptions of health, illness, and disability: A review and focus on autism. Journal of Child & Family Studies, 21(2), 311–319. doi: 10.1007/s10826-011-9477-9. (EBSCO AN: 73325870) http://libproxy.edmc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=73325870&site=ehost-live
As our focus for this module is the specific dynamics between peer groups and the development of children, pay special attention to the assigned readings that deal with the topics listed below. You can even use the search feature in your digital textbook to help pinpoint specific text sections to review.
Keywords to search in your digital textbook and journal articles: strength-based assessment, behavior intervention plan, oppositional defiant disorder, conduct disorder, social maladjustment, adaptive behavior, chromosomal abnormalities, metabolic disorder expressive language, receptive language, Asperger syndrome or Asperger disorder, and stereotypic behavior.
Module 3 learning resources
Use Module 3 learning resources provided on the pages that follow to enhance your understanding of high-incidence disabilities. Take a moment to check out some of these featured learning resources:
· Exceptional Children: This self-assessment activity presents a scenario of Serafina, an exceptional child, and provides you the opportunity of identifying the exceptionalities presented and suggesting an intervention.
· Ethical Considerations: This self-assessment activity presents a scenario of Andrea, an exceptional child, and provides you the opportunity of identifying the ethical considerations that should be taken in this case.
Module Topics:
· High-Incidence Disabilities
· Emotional Disorders
· Behavioral Disorders
· Communication Disorders
· Intellectual Disorders
· Autism Spectrum Disorders
Learning outcomes:
· Describe and discuss the continuum of exceptional development, including identification of exceptionalities and individual strengths.
· Apply current, peer-reviewed research on environmental, biological, and cognitive influences on development to design systemic support and/or intervention plans for home, school, and transition for children with exceptionalities.
· Evaluate cultural, ethical, and legal considerations in identification and intervention and/or support of children with exceptionalities.
· Analyze historical and contemporary legal and political trends in treatment and education of children with exceptionalities.
Module 3 Overview
This module provides you with an understanding of other high-incidence exceptionalities, including those related to emotions, behaviors, communication, intellect, and autism spectrum disorders. You will learn about their prevalence, characteristics, known causes, evaluation, prognosis, and intervention using current research. As you learn about various exceptionalities, you will gain an understanding of how legal and ethical standards apply to evaluation and intervention.
In the assignments for this module, you will analyze the case of thirteen-year-old Anne Marie. You will discuss whether her problems are typical or atypical, and how you would go about gathering information to conduct a multifaceted assessment and design an intervention. You will also complete your first LASA in which you will analyze the historical, legal, and ethical issues in a documentary video, and prepare a report presenting arguments for and against parents with intellectual disabilities raising children.
Exceptional Children
The case of Serafina
Serafina is a fifth grade student. Serafina struggles socially due to a disability with which she has been diagnosed since she was four years old. Serafina absolutely loves animals and learns about them in exceptional detail.
She can name each animal’s genus and species, what it eats, its habitat, and its natural predators. As this tends to be her main focus, other girls have trouble relating to Serafina and tend to avoid her.
Serafina receives special education services to help with social skills, writing, and reading. She draws detailed, realistic pictures of animals and their habitats. If allowed, Serafina would spend her whole day researching animals on the Internet. She tends to gravitate more toward children who are younger than she is and enjoys doing jobs for teachers.
Q1. What exceptionalities and individual strengths does Serafina have?
Serafina is a child with Autism Spectrum disorder, characterized by challenges with social skills, restricted area of interest, and challenges in befriending children her own age. Although her area of interest is restricted, Serafina has an obvious love of science and enjoys doing jobs for teachers and being around younger children. Serafina’s memory for details about various animals is impressive, and it seems that she is a gifted artist.
Q2. What interventions would be appropriate for Serafina?
All of Serafina’s strengths can be utilized to work with her. She could be asked to present information about certain animals to children in kindergarten or first grade, and she could use her art skills to design posters for teachers or school clubs. Utilizing her artistic abilities might help her communicate with other students as she designs poster, t-shirts, or other items for the school.
Emotional Disorders
Consider the following example of Sam, a twelve-year old boy.
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Sam has always faced difficulty controlling his temper at home and school, and his teachers are concerned about him. He has a very difficult time accepting criticism and frequently lashes out at peers and teachers. Although he has one close friend, Sam finds it difficult to maintain relationships. He seems angry, although he often cannot explain why. Sam is often remorseful of his behavior but is not sure how to control it. |
Sam’s description shows how complex childhood emotional disorders can be. Sam’s symptoms are not typical of what we picture adult depression to be, but his difficulty with relationships, irritability, and lashing out without knowing why could be indicative of depression. Sometimes, such behaviors can lead to the child being viewed as one who does not know how to behave, but if properly evaluated and treated, children like Sam will not continue to suffer.
Emotional and behavioral disorders in children include, but are not limited to, depression, anxiety, schizophrenia, eating disorders, oppositional defiant disorder (ODD), and conduct disorder (CD). Additionally, children often receive comorbid, or co-occurring, diagnoses.
Assessment typically includes referring to a detailed developmental and medical history, observation over several days, in several locations, and at different times of the day. Assessment also includes evaluation of cognitive functioning and achievement; interviews of parents, teachers, and other professionals working with the child; and behavior checklists completed by parents and teachers. Assessment batteries vary by clinician and presenting problems, but as you can see from this list (which is not exhaustive), they are typically multifaceted and collaborative.
Until the 1970s, childhood depression was not recognized by American psychiatry as a clinical diagnosis, despite the heated debate in the 1960s. Since the 1950s, depression related to medical problems had begun being noted in children. Today, we know that children can indeed suffer from depressive disorders, anxiety, and even bipolar disorder. However, their symptoms might differ slightly from adults. For example, in children, depression often manifests as irritability, sleep disturbance, and behavioral problems (Cytryn, 2003).
In federal law, the Individuals with Disabilities Education Act (IDEA) category that subsumes emotional disorders such as depression and anxiety is emotional disturbance (ED). Eating disorders and psychotic disorders also fall under this category. IDEA does not have a separate category for behavioral disorders.
Although children with behavioral disorders can and do receive special-education services, one caveat in the law complicates this. This caveat states that children who are socially maladjusted cannot qualify under ED unless they also have an ED.
This condition can be very confusing. Some interpret it to mean that children diagnosed with ODD or CD should be excluded. Others assume that those with ED do not make conscious decisions about their actions or understand consequences, while those with social maladjustment do. Olympia et al. (2004) argue that the issue is much more complex and that careful assessment should be conducted to determine the impact of a child’s symptoms on his or her education.
Food for Thought
Think about the ethical dilemma involved in deciding whether a child should be excluded from special education due to social maladjustment.
Cytryn, L. (2003). Recognition of childhood depression: Personal reminiscences. Journal of Affective Disorders, 77(1), 1–9.
Olympia, D., Farley, M., Christiansen, E., Pettersson, H., Jenson, W., & Clark, E. (2004). Social maladjustment and students with behavioral and emotional disorders: Revisiting basic assumptions and assessment issues. Psychology in the Schools, 41(8), 835–847.
Emotional Disturbance: U.S, Department of Education (2012). IDEA sec 300.8 Child with a disability. Retrieved from: http://idea.ed.gov/explore/view/p/%2Croot%2Cregs%2C300%2CA%2C300%252E8%2Cc%2C4%2C
Treatment of Emotional and Behavioral Disorders
Similar to ADHD, emotional and behavioral disorders (EBD) require a multifaceted approach and are carefully evaluated. The treatment of EBD can include one or more of the following:
Academics
As noted previously, academics are important because many children with EBD exhibit learning difficulties. If academic interventions are not included in the treatment, progress might be limited.
Medicine
Depending on the type of emotional or behavioral problem, medication might be considered. These include stimulants, antidepressants, anxiolytics, or antipsychotics. Physicians need to work with parents to carefully weigh the risks of potential side effects, which can include weight gain, fatigue, and sleep problems.
Behavioral Support
Positive behavioral support (PBS) is a popular treatment option and is included in IDEA. This method builds on principles in psychology and introduces positive classroom and school-wide interventions that replace punitive interventions.
This method prevents problem behaviors by creating consistent, explicit expectations and consequences (positive and negative) in a culturally sensitive manner. Interventions are practical and aimed at keeping children in the classroom. For example, if a problem behavior includes talking out in class, an acceptable alternative is introduced. This intervention is based on developmental and behavioral theory, and involves ongoing data collection to assess its effectiveness and alter the intervention as necessary (Sugai et al., 2000).
Sugai, G., Horner, R. H., Dunlap, G., Hieneman, M., Lewis, T. J., Nelson, M., . . . & Ruef, M. (2000). Applying positive behavior support and functional behavior assessment in schools. Journal of Positive Behavior Interventions, 2(3), 131–143.
Communication Disorders
When you learn about a child receiving speech therapy, stuttering is the first thing that comes to mind. However, there is much more to communication than fluency in a language.
Pragmatics (social language), receptive language (comprehension of language), expressive language (how one gets the message), and articulation (sounds) are all part of communication. Just as learning, emotional, and behavioral disorders are frequently comorbid, communication disorders often coexist with other exceptionalities.
A fourteen-year longitudinal study compared children with language or speech impairment to nonimpaired children. The study followed a cohort of children from the age of five years to nineteen years. When they were evaluated at the age of nineteen, it was found that children with early language impairment were more likely to be diagnosed with an anxiety disorder, specifically social phobia. Additionally, there was a higher rate of antisocial personality disorder (Beitchman et al., 2001).
It is sometimes difficult to determine when intervention is warranted and when difficulties are typical of development. Considering the possibility of these difficulties turning into lasting or additional problems, erring on the side of early intervention may be the best practice.
Beitchman, J. H., Wilson, B., Johnson, C. J., Atkinson, L., Young, A., Adlaf, E., . . . & Douglas, A. (2001). Fourteen-year follow up of speech/language impaired and control children: Psychiatric outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 40(1), 75–82.
Speech Therapy: Visit ASHA Web site at http://www.asha.org/
Intellectual Disabilities
Terminology regarding people with intellectual impairments has evolved over the years. For example, the term mental retardation has now been replaced with intellectual disability. This reflects societal changes in what is deemed acceptable terminology. In order to receive a diagnosis of intellectual disability, one not only has to exhibit significantly below average cognitive ability, but also function well below average on adaptive skills.
Typically, cognitive ability is determined by a formal intelligence test. Adaptive behavior is often determined by interviews, observations, and behavioral checklists conducted with teachers and parents to determine the extent to which one can manage self-care and navigation of the community.
An intellectual disability must be present before the age of eighteen to be diagnosed as a disability. Therefore, if an individual experiences a significant decline in mental functioning due to a terminal illness or injury, he or she will not be diagnosed with intellectual disability.
Notice that the expression “extent to which one is able” has been used purposefully. It is important to not only determine deficits but also to focus the assessment needs on a child’s strengths to build upon them.
Intellectual Disability: Visit AAIDD Web site at http://www.aaidd.org/
There are many causes of intellectual disabilities, including genetic disorders, injury, infection, prematurity, metabolic problems, and teratogens (such as parental drug use). Academic, functional, and familial interventions are critical for maximizing every child’s full potential.
Consider the following example:
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Connor was diagnosed with hydrocephaly (water in the brain) and Down syndrome at birth. He received early childhood intervention (ECI) services. He was also referred to his local public school for an evaluation just before he turned three so he could be evaluated for public preschool for children with disabilities (PPCD). The assessment team consisted of a school psychologist, physical therapist, occupational therapist, and speech-language therapist. As the multidisciplinary team members began evaluating Connor, they were surprised that he did not seem able to perform basic tasks, such as drinking from a cup without spilling or turning on a faucet to wash his hands. The team interviewed Connor’s mother and learned that since she did not feel he was capable of learning basic skills, she did not teach him. She knew he would spill a cup and so she would not let him use one without a lid. Although a speech-language therapist and occupational therapist visited their home for sessions, she chose not to carry out their suggestions beyond the sessions. It was apparent that Connor’s mother loved him; she just seemed hopeless about his future. |
As Connor begins PPCD, it is imperative that the family participates in his therapeutic process. Teaching the family how to work with Connor and help him function as independently as appropriate will reinforce the lessons he is learning at school, while helping him work toward a promising future.
The ARC is an organization that was begun with the commitment to deinstitutionalize people with intellectual disabilities an draise them to their full potential. It advocates education and work opportunities for people with intellectual disabilities. The Arc (2012). http://www.thearc.org/page.aspx?pid=2530
Pervasive Developmental Disabilities
Much has been done to raise awareness about pervasive developmental disabilities (PDDs) in recent years. Previously, the DSM separated disabilities on this spectrum into the following:
· Autistic disorder
· Asperger syndrome (or Asperger disorder)
· Rett’s disorder
· Childhood disintegrative disorder
· Pervasive developmental disorder, not otherwise specified (PDD-NOS)
However, with the most recent edition of the DSM, these disorders are now grouped into one disorder called Autism Spectrum Disorder (ASD). For a child to be diagnosed with ASD there must be a significant and pervasive impairment in the areas of reciprocal social interaction and communication or stereotyped behavior. Stereotyped behavior might include the following:
· Unusual interest in something others would not find interesting, such as vacuum cleaner models or garbage truck routes
· Repetitive movements, such as lining up toys but not actually playing with them imaginatively, or flicking one’s fingers in front of his or her eyes
Symptoms can range from relatively mild disruptions, such as unusual voice quality and difficulty engaging in give-and-take conversations, to rocking, self-harm, and lack of speech.
Rett’s Disorder
In children with Rett’s disorder, development appears to start normally. However, between five and forty-eight months, there is a loss of motor skills and decreased head growth. Children often engage in stereotyped hand wringing and most often have severe intellectual disabilities, as well.
Childhood Disintegrative Disorder
In childhood disintegrative disorder, development progresses normally for the first two years, after which the child starts losing acquired skills in any two of the following areas of development: communication, social skills, adaptive behavior, play, or motor skills. Often, children who have been toilet-trained regress in that skill. There also tends to be significant intellectual impairment.
Autism: The Autism Speaks Web site provides information on autism and sources for advocacy and family support. Visit the website at: Autism Speaks (2012). http://www.autismspeaks.org/
Autism Spectrum Disorders (ASD)
Professionals working with children who have an ASD frequently say, “When you have seen one child with autism, you have seen one child with autism.” This is because even when two people have the same diagnosis, they are still very different individuals.
As you may have learned in a previous course on child development, babies are interactive and social very early. Early signs of ASD often include limited eye contact and lack of joint attention. Joint attention occurs when a person looks at an object and then back at the child, after which, the child follows the person’s gaze to share in looking at that object. Additionally, children with ASD have difficulty with the theory of mind. Simply put, this means that the child has a hard time taking someone else’s perspective.
About twenty-five percent of children with autistic disorder experience seizures and approximately seventy-five percent have an intellectual disability (Volkmar & Pauls, 2003).
Cause
We do not yet know exactly what causes ASD, but we do know that there is likely a genetic component. Although great fears have been raised about vaccinations causing ASD, many studies have debunked that theory, and the original study asserting evidence of this link has since been retracted and found to be fraudulent. In February 2010, the original study was retracted from the journal that had published it (The Editors of the Lancet, 2010).
We do know that there is a combination of factors contributing to the different manifestations of ASD. So far, although treatment can help children make significant progress, there is no definite cure.
Treatment
As with exceptionalities discussed previously, interventions are multifaceted and include behavioral and academic interventions, and in some cases, medication. Because of a propensity toward structure and relative strengths in nonverbal ability, children with ASD tend to benefit from schedules and routines that are in written or pictorial form.
The Editors of The Lancet. (2010). Retraction—Illeal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 375(9713), 445.
Volkmar, F. R., & Pauls, D. (2003). Autism. Lancet, 362(9390), 1133–1141.
Overrepresentation
It is important to discuss overrepresentation, or disproportionality, as you learn about high-incidence exceptionalities.
Theoretically, there should be similar proportions of racial groups categorized in the IDEA eligibility categories that encompass high-incidence exceptionalities. Sullivan and Artiles (2011) analyzed this issue and stated that disproportionality has persisted in legal and social science literature for at least sixty years.
The study found that African American children are more likely to be identified in the categories of mental retardation (intellectual disabilities) and emotional disturbance than white children. Native Americans are overrepresented in the category of learning disabilities. Conversely, Hispanic and Asian American or Pacific Islander children tend to be underrepresented in all categories of high-incidence exceptionalities (Sullivan & Artiles, 2011).
The Larry P. v. Riles (1979) decision resulted in a moratorium on intelligence testing of African American children in California because of culturally biased standardization. Test biases resulted in disproportionate numbers of African American children being identified as having mental retardation. In the late 1980s, this order was reversed as African American parents felt that the assessment would help specify required services and it was discriminatory to ban the testing for one group. The best practice for any child is to use a multifaceted assessment, rather than relying on one tool.
Sullivan and Artiles (2011) point out that disproportionality is a complex issue that needs to be analyzed by more than simply comparing local numbers to state or national numbers. Some factors that might contribute to disproportionality include the number of minorities in the school, teacher ethnicity, and school size.
The issue of disproportionality in identification of minority students for special-education services reminds us of the important considerations of cultural and linguistic diversity in evaluation and identification of children with exceptionalities.
Larry P. v. Riles, 495 F.Supp. 926, 987 (N.D.Cal.1979).
Sullivan, A. L., & Artiles, A. J. (2011). Theorizing racial inequity in special education: Applying structural inequity theory to disproportionality. Urban Education, 46(6), 1526–1552.
Ethical Considerations
Professionals often must weigh ethical obligations when determining the best course of action to help a child.
Andrea’s case
Terrance is a school psychologist. He is asked to conduct an evaluation to determine whether Andrea, a first grader, meets criteria for special education services.
Andrea is constantly in trouble. She takes things from other children without asking, talks back to the teacher, and requires more supervision than the other children require. However, Andrea is performing academically as expected for first grade and has a few friends with whom she plays at recess.
Andrea’s teacher has told Terrance that he must recommend that Andrea qualify for special education so that she can implement a behavior intervention plan to send Andrea to a resource classroom for at least some portion of the day. Terrance is torn. His evaluation indicates that Andrea has an unstable home life, but no evidence of a true disability. However, he has seen Andrea’s obstinate behavior first-hand and understands the teachers frustration
Q1. What ethical considerations should be taken in Andrea’s case?
Terrance is torn because he does not feel in his professional opinion that Andrea has a disability requiring special education services, but he does understand that she needs assistance. One aspect of Terrance’s professional code of conduct includes avoiding harm to clients, which could occur if he were to identify Andrea with a disability contrary to his assessment results. Additionally, legal requirements must be met, including an identified disability and a documented need for individualized instruction.
