The Nexus Between the DSM amp IDEA Social Maladjustment v Emotional Disturbance Mary Schwartz Impartial Hearing Officer Illinois 1 DO THEY GO TOGETHER DSMIV IDEA 2 DIFFERENT PURPOSES ID: 336853
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2010 Special Education Hearing Officers and Mediator Training (San Diego)
The Nexus Between the DSM & IDEA: Social Maladjustment v. Emotional DisturbanceMary Schwartz, Impartial Hearing Officer, Illinois
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DO THEY GO TOGETHER?
DSM-IV
IDEA
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DIFFERENT PURPOSES …
IDEA
Determine eligibility for special education and related services
Develop educational program to meet unique needs of individual student
DSM-IV
Official nomenclature for professionals
Differential diagnosis based on medical model
Treatment planning
Third party reimbursement
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DIFFERENT CRITERIA …
IDEA
ELIGIBILITY
Child must have at least one of disabilities defined in regulations
Disability must adversely affect child’s educational performance
Because of above, child needs special education and related services
DSM-IV AXES
AXIS I:
Clinical Disorder
AXIS II:
Personality Disorders and Mental Retardation
AXIS III:
General medical conditions
AXIS IV:
Psychosocial and environmental problems
AXIS V:
Global Assessment of Functioning (GAF)
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16 DSM-IV DIAGNOSTIC CATEGORIES
Those most likely to appear in due process complaints/hearings
Disorders usually first diagnosed in infancy, childhood or adolescence
Mood Disorders
Impulse Control Disorders
Anxiety Disorders
Schizophrenia and Other Psychotic Disorders
Personality DisordersSubstance Abuse DisordersSomatoform DisordersEating Disorders
Sleep Disorders
Adjustment Disorders
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DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE
Intellectual and Cognitive Impairments
Mental Retardation
Learning Disorders
Motor Function Impairments
Motor Skills Disorder
Tic DisordersStereotypic Movement Disorder
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DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE
Disruptive or Self-Injurious Behavior Disorders
Attention Deficit DisordersConduct Disorder
Oppositional Defiant Disorder
Feeding and Eating Disorders of Early Childhood
Elimination Disorders
Separation Anxiety DisorderReactive Attachment Disorder of Infancy or Early ChildhoodInformation Exchange Disorders
Pervasive Developmental DisordersCommunication DisordersSelective Mutism7Slide8
MOOD DISORDERS
Predominant Feature: Disturbance in mood
Mood episodes are building blocks for diagnoses of mood disordersDivided into:
Major Depressive Disorder
Dysthymic Disorder
Bipolar Disorders
Cyclothymic Disorder
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IMPULSE CONTROL DISORDERS
Conduct Disorder
Oppositional Defiant Disorder (ODD)
Intermittent Explosive Disorder (IED)
Pyromania, Trichotillomania
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ANXIETY DISORDERS
Panic Disorders
Phobias
Post Traumatic Stress Disorder (PTSD)
Generalized Anxiety Disorder
Substance-Induced Anxiety Disorder
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SCHIZOPHRENIA & PSYCHOTIC DISORDERS Schizophrenia
Psychotic Disorder NOS
Brief Psychotic Disorder
PERSONALITY
DISORDERS
Narcissistic Personality Disorder
Borderline Personality Disorder
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SUBSTANCE ABUSE DISORDERS
Substances include alcohol, illegal drugs, medications
CategoriesSubstance Dependence
Substance Abuse
Substance Intoxication
Substance Withdrawal
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SOMATOFORM, EATING & SLEEPING DISORDERS
Somatization Disorder
Body Dysmorphic Disorder
Anorexia Nervosa & Bulimia Nervosa
Breathing Related Sleep Disorder
Sleep Walking Disorder
ADJUSTMENT DISORDERS
Emotional or behavioral symptoms in response to identifiable stressor (symptoms are not bereavement)
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DSM-IV IS RELEVANT……
Symptoms per above diagnoses provide information that may be relevant to determination of emotional disorder
Expert testimony may reference and discuss DSM-IV symptomatology
BUT NOT SUFFICIENT
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THREE PART ANALYSIS REQUIRED
One or more of the characteristics listed
Over long period of time and to marked degree, and
Adversely affects educational performance
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E.D. CHARACTERISTICS
Inability to learn that cannot be explained by intellectual, sensory, or health factorsInability to build or maintain satisfactory interpersonal relationships with peers and teachersInappropriate types of behaviors or feelings under normal circumstances
General pervasive mood of unhappiness or depression
Tendency to develop physical symptoms or fears associated with personal
or school problems
Includes schizophrenia
Does not apply to social maladjustment unless it is determined that
chihad emotional disorder per above.16Slide17
SOCIAL MALADJUSTMENT
“Teenagers, for instance, can be a wild and unruly bunch. Adolescence is, almost by definition, a time of social maladjustment for many people.”
Springer v. Fairfax County School, 134 F.3d 659,664 (4
th
Cir. 1998).
Characterized by:
IntentionalityLittle remorseLack of empathyFailure to take responsibility for behavior
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ADVERSE IMPACT
Parameters of educational performance
Quantity of impact If adverse impact, must still determine that student needs special education and related services
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FURTHER CONSIDERATIONS …
Does it matter when emotional disorder is raised – at case study evaluation stage or at MDR?
If a parent is pro se, do we approach questioning of experts differently when DSM-IV diagnosis is raised in testimony?
If we hold a degree and/or certification as clinician, can we use that expertise (and opinions formed thereupon) as part of our decision?
If decision is for district, what about commenting in decision on difficulties faced by family due to student’s emotional problems?
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