In my last post I discussed remediation. For a variety of reasons rehabilitation often is not done. The main reason is because educational testing does not take the next step necessary to answer “why?” (is this child performing or not performing in this way). As a result, rehabilitation is never even identified. The result is the services provided more closely resemble tutoring. However, this is an expensive mistake which I am going to explain here.
Academic concerns is what drives a student assessment. Since the school system is only obligated to provide the support necessary to help a child succeed in obtaining a government mandated education, this is understandable. As a result of this perspective most of the testing focuses on academics and not necessarily on the underlying cause. A sad example of this is the child who is not doing well with literature-based subjects and is found to have a language impairment. Here the assessment process stops. If there is one thing that I would love to see change it would be this, speech and language services should only be provided after a complete audiological evaluation was done. There are many reasons a student may struggle with “verbal” subjects. During my time working in NYC DOE, IEP’s would often cross my desk of children who only upon the three-year review had their hidden hearing loss diagnosed. There is no way to know how many hidden hearing losses were never identified. We do know that three years of time effort and funding were wasted on therapy that could not be heard properly. Additionally, we know that therapy is often not as effective as we would expect. One particularly sad case in my private practice, was that of a high school boy who had been receiving services for 10 years! His speech was hard to understand, and he could not read well or keep up in class. When mom showed me his initial evaluation from when he was 4 years old, I noticed that the speech pathologist had recommended a hearing test. When I questioned mom she replied baffled, “he had in school”. When I explained to her that this was only a screening, whose purpose is to identify children who are not having trouble (yet), she was very upset that no one had told her this sooner. When someone is already struggling the underlying areas must be thoroughly assessed, not merely screened. This was a young man with a mild disability but a significant handicap. All his years of therapy were more than a waste because he was intelligent enough to understand that there should have been more improvement for the effort he put in and now he was frustrated for being so “stupid” that he couldn’t “get it” (his words). Too often when we opt for teaching isolated skills we are choosing the splintered skills approach. Much of remediation is approached like this as well.
Supposing a child is not walking. A physical therapist is brought in to teach him to walk. Here too, the education system (early Intervention or school) is not designed to differentially diagnose:
Is there a visual issue inhibiting the walking?
Is there a vestibular issue inhibiting the walking?
Is there a motor issue inhibiting the walking?
It can be anyone of these, a combination or another reason all together. You can see how important the answer to these questions are in providing rehabilitation to the fundamental issue, so the child is not stuck in a perpetual loop of services. When the fundamental issue is not addressed services may be needed for every skill along the way such as: toilet training, bike riding, jumping rope, baseball, basketball, etc. Some of these skills may be deemed unnecessary to succeed in school and are not addressed, but then our child will have a social issue compounding his gross motor issue when he cannot join his peers for play during recess.
We have previously discussed a reading related example in the post, “The Academic Distractor…”
We have also discussed why a good differential diagnosis is key and how the whole task analysis© is helpful in differentiating. Now you know why differential diagnosis that leads to rehabilitation is so important, if you want an independent student, rather than one who limps through the education system with tutoring/support and is then stripped of this support as soon as s/he graduates.
Flesh out what might be the underlying problem for one of your students/children by utilizing the whole task analysis and the show stoppers.