Applying the Results of Neuropsychological and Psychological Assessments

A Manual for Teachers and Specialists

Dawn E. Burau, Daniel K. Reinstein

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138238961
• eBook ISBN: 9781315296319
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

Neuropsychological and psychological evaluations in school settings are often rich in detail about a child's cognitive, academic and emotional functions, and come with specific recommendations to support the child's performance in school. However, there is often a gap between the assessment results and the implementation of the recommendations, since learning specialists and teachers frequently do not have the means to both interpret and implement the recommendations. This manual presents clear and specific guidelines for school counselors and teachers to decode and put into practice evaluation findings.

The book begins by describing various functional domains that are assessed in a neuropsychological evaluation, and then notes how to recognize behavior and learning styles impacted by difficulty in one of more of the domains. Furthermore, it outlines activities that could be used in the classroom or other environments to support a child's weaknesses, develop new skills, or appear to particular strengths. Finally, ready-to-use worksheets and activities are offered. This is an essential tool for school psychologists, special education teachers, and learning specialists and counselors.

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Implementing Evaluation Results in a School Setting

Introduction

Response to Intervention

Peeling Back the Layers

Developing a Therapeutic Relationship

Inclusion Possibilities

A Guide to Integrating Neuropsychological, Psychological Result and Relational Education

Introduction

It was getting to be too much. Leila had always been a difficult student, but by third grade her behaviors in the classroom were becoming intolerable to her teachers and peers in her small private school. She would talk non-stop, often interrupting anyone and everyone. When requested to do simple tasks within the classroom, she would often refuse with a simple, rude, “No.” At times, she would lie across the top of her desk with feet, hands, and head dangling over the edge, and when asked to sit properly would oh-so-slowly peel herself off the desk and crawl back into her chair, where she would chew on the ends of her hair. In small group assignments, she would argue with peers if they didn’t do things just right, or say hurtful things to her friends. She didn’t seem to understand how the things she said could be hurtful; it was “just simple truth. I didn’t mean to be mean.” It all culminated when, while on an outing, she yelled “shut up” at her teacher and kicked her on the shin. These behaviors just didn’t make sense because Leila was bright, very bright. She didn’t struggle at all academically (with the exception that her handwriting was sloppy).

Teachers and friends were actually pretty accepting of Leila. She wasn’t completely ostracized and the teachers felt Leila was likable. Leila could be kind, thoughtful, and funny. She had a way with words that was extremely clever. When she was engaged in a preferred activity, such as reading, she was extremely focused and self-reliant. Her drive for independence was admirable and she was a champion of the underdog. Despite her being so likable, the faculty were frustrated, having tried for years to really understand Leila’s behavior and attitude, and they were beginning to think that maybe she was just mean, spoiled, and selfish. Maybe a different school was a better place for Leila.

At this point, school staff recommended to Leila’s parents that she be assessed with a neuropsychological evaluation so they could better understand her needs. Leila was given a test battery that assessed her cognitive strengths and vulnerabilities as well as her emotional state and social perceptions as a means to better understand her behavior.

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With increasing regularity, school-aged children are being assessed and evaluated for various purposes. Screening occurs with the intent of identifying struggling students who may have a learning disability that could impact their ability to acquire academic skills. Assessment also occurs so that parents, clinicians, and teachers can better understand underlying factors associated with a child’s difficulties. While some of these assessments include principles of neuropsychological assessment and intervention planning, not all do. In addition, even fewer of these screening and assessment strategies integrate tests of emotional and behavioral functioning and development.

This leaves teachers, parents, and clinicians at a disadvantage. While initial screening procedures may be helpful in identifying struggling students, they may be limited in their ability to be useful in developing interventions. Educators, therapists, parents, and school staff are often well-intentioned but they are also often at a disadvantage, lacking the time and resources to not only screen and assess their students but to develop interventions that directly correlate to a child’s unique neuropsychological and emotional profile.

The intent of this manual is to provide a resource for clinicians, teachers, and specialists to make use of information garnered from comprehensive neuropsychological evaluations, which include psychological evaluations. Many people are involved in the process of evaluating students and then developing/implementing interventions. In this text, the term “specialist” refers to anyone involved in this process that is not a clinician or teacher. This includes but is not limited to: occupational therapists, speech therapists, outside consultants, reading and math remediation instructors, other school therapists and special education staff. The unfortunate and frequent gap between evaluation recommendations and implementation of interventions is largely due to the fact that specialists and teachers do not always have the time or means to both interpret and consistently apply these recommendations over the course of a school year. This manual will provide activities that are at the ready to address the various needs of students who present with learning disabilities and emotional or behavioral difficulties. In order to address the inherent overlap between academic, cognitive, social, and emotional development, tenets of attachment theory (Bowlby, 1988) and the ideas of Winnicott (1965) will be applied to the method of delivery and individualization of various interventions.

The importance of assessing emotional factors is increasingly recognized. Various studies have demonstrated that social-emotional competencies are important skills that support early school success and growth of academic competency in early grades (Denham et al., 2012; Jennings & DiPrete, 2010; Romano et al., 2010). The emotional state of an individual impacts their ability to regulate behaviors related to learning, classroom readiness, and deployment of attention (Bierman et al., 2008; McClelland et al., 2007). For example, children who have difficulties regulating negative emotions may not have the coping strategies to focus on learning activities, whereas those who can maintain a positive emotional state might be able to stay on task and remain engaged in academic activities (Graziano et al., 2007; Miller et al., 2006; Shields et al., 2001; Trentacosta & Izard, 2007). This is related to the child’s emotional awareness and ability to identify their feelings and feelings of others.

This intrapersonal and interpersonal ability allows the child to interpret emotions in a classroom setting and comprehend the actions of others. Without these skills, the child may feel confused and overwhelmed. It has been demonstrated that this relationship between emotional/social awareness is connected to preschoolers’ academic readiness (Garner & Waajid, 2008; Leerkes et al., 2008; Shields et al., 2001). These social-emotional skills are correlated to later school successes such as developing reading skills and overall academic achievement, as well as later social-emotional health (Denham et al., 2014). It can be argued that assessments of school-aged children should not only include their cognitive skills but also their social-emotional abilities, as assessed by psychological evaluations (Reinstein & Burau, 2014).

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Over the last 15 years, the need for the integration of psychological and neuropsychological assessments has been argued by a number of authors (Semrud-Clickman et al., 1997; Smith, 2007; Tramontana & Hooper, 1997; Miller, 2010; Reinstein & Burau, 2014). Without an appreciation of the complex interplay between neurological, cognitive, behavioral, social, and emotional factors, treatment teams cannot develop interventions that address the whole child, creating a space in which the child feels safe and secure and can ultimately succeed (Reinstein & Burau, 2014). This reinforces the concept that utilizing neuropsychological assessments in a school setting cannot be viewed as a luxury but rather as essential to accurate diagnosis and treatment planning (Cleary & Scott, 2011). That said, many schools are at a disadvantage in the way in which children are evaluated, due to increasingly limited resources.

A variety of assessments are often used to determine a student’s eligibility for special education services. Among the battery of tests, often neuropsychological evaluations provide important information/diagnoses for a student. However, it can be difficult to formally integrate information and recommendations into the legal documents that provide students with what they need. Recommendations for services such as individual remediation, special tutoring, the presence of an aide, or access to a resource room can be made in a neuropsychological evaluation and followed by schools, but how are the discrete cognitive and emotional functions reflected in legal documents?

In an attempt to narrow the gap between available resources, time, and implementation of interventions, this manual is intended to be a reference, providing teachers, clinicians, and parents with activities that can align with the results of integrated neuropsychological and psychological evaluations. In order to utilize this manual, it will be necessary to have a solid understanding of neuropsychological constructs, language, and evaluation results. The activities discussed throughout this manual are intended to be delivered through a relational perspective.

Before we continue to learn about Leila, it is important to understand the history and current process through which children are evaluated and the subsequent trends in intervention in a public school setting.

Response to Intervention

In 2004, the Individuals with Disabilities Education Improvement Act (IDEIA) became the nation’s special education law. This law requires states to provide free appropriate public education (FAPE) in a least-restrictive environment (LRE) for all children regardless of the type of disability they may experience. This includes children with learning disabilities, as well as those with a severe, pervasive, and/or chronic emotional/affective condition that impacts their ability to perform everyday tasks (Sulkowski et al., 2011). Prior to the IDEIA, the law required the use of a “discrepancy model” for identifying struggling students (Hoover et al., 2008). This method often relied on a student’s inability to perform at grade level despite the expectation they were capable of doing so. With the legal reform of 2004, educators and researchers began to develop new means for screening, assessing, and developing interventions for struggling students. This reform also established the requirement for the development of an Individualized Education Program (IEP) for individuals who qualify for special education services. This legal document outlines the type of educational program the student will have access to, and various accommodations, and determines clear annual goals with benchmarks. The intent of the document is to ensure that the student will have the best possible access to state curriculum or the federal guidelines, the Common Core State Standards (CCSS). Issues related to the development of IEPs and CCSS will be addressed in Chapter 9.

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Response to Intervention (RTI) has become the most well-known systematic approach for attempting to provide FAPE for students with special needs. A 2011 survey was conducted by GlobalScholar in which, among nearly 1,400 school- and district-level workers, 68% indicated they have either partial or full districtwide implementation of the RTI model, particularly at the elementary grade level (Shah, 2011). Such studies display the heavy prevalence of this model within the public school system.

RTI was developed to provide a framework for providing all students with evidence-based instruction as well as ongoing measurements of their performance (Parisi et al., 2014). This framework has three intentions: (1) making instruction decisions in all classrooms; (2) determining eligibility for special education services; and (3) providing a system for identifying learning disabilities without relying on a discrepancy model (Hoover et al., 2008). To do so, entire student populations are screened/assessed three times a year, using assessments that are brief and easy to administer. If a student is identified as struggling, intervention can be made on a three-tier system that provides various levels of intervention. The student is then reassessed, as all the students are, after having access to the appropriate tiered level of support to determine the effectiveness of the intervention. If the intervention has proven ineffective, the student can then receive services from a more intensive tier (Parisi et al., 2014). For example, Tier 1 allows for changes and additional support within the general education classroom. Tier 2 allows for more intensive and individualized interventions, such as pull-out reading groups or tutoring, if the student continues to demonstrate significant difficulty. Tier 3 allows for students to have access to more highly specialized instruction and individualized interventions, such as a participation in a substantially separate classroom within a public school.

This systematic approach can be useful and moves away from the discrepancy model, but the extent of its efficacy is still being determined. For example, additional research is needed to document the usefulness of RTI in the later elementary, middle, and high school years (Otaiba et al., 2014). More so, while there is a preponderance of research regarding reading disabilities and RTI (especially at elementary grades), there are fewer studies related to disabilities of mathematics and emotional/behavioral difficulties. Under current laws and use of RTI, students with anxiety generally must fail to respond to evidence-based interventions before qualifying with an Emotional Disturbance allowing them access to higher-tiered intervention. At times, these students are assessed outside of the school setting to establish the presence of an anxiety disorder, but because the assessment does not directly indicate how the emotional difficulty affects the child’s educational performance, there is no impact on the provision of services at school (Sulkowski et al., 2011). Furthermore, different schools utilize different assessment strategies and techniques. This can be a strength of RTI, avoiding a one-size-fits-all mentality, but how are assessments chosen and how is the data utilized? School psychologists and school neuropsychologists have indicated that the brief screening/assessment strategy may be too brief, unable to capture important nuances of a child’s learning profile that could impact decisions regarding intervention strategies (Cleary & Scott, 2011). It is the lack of integration across grades, disabilities, service providers, and depth of assessment within and outside of school settings that create gaps that students can slip through, damaging their ability to access curriculum, develop a sense of self, and foster social relationships.

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Furthermore, is RTI able to effectively guide intervention? While this model strives to assess the effectiveness of intervention, does it provide enough information to inform individualization of curriculum delivery? Or indicate the emotional needs of a child? Mascolo et al. (2014) propose a system springing from RTI that allows for the careful selection of intervention and treatment planning that includes a system for tailoring interventions to the unique strengths and vulnerabilities of a child. This system is based in the Cattell-Horn-Carroll (CHC) theory of intelligence. This approach carefully integrates various cognitive domains, but it does not integrate a child’s emotional or behavioral profile into the process of tailoring interventions. As referenced above, Sulkowski et al. (2011) have described how RTI can be applied in school to address anxiety. However, this is not common practice. In fact, they note the disconnect between outside evaluations and implementation of interventions:

It is important to note that psychologists who practice in clinical and community settings often produce psychological evaluations establishing the presence of anxiety disorders in youth. However, since this assessment may fail to establish how a disorder affects the child’s educational performance or may lack important components that are mandated under IDEIA for special education eligibility (e.g., behavioral observations, teacher interviews), these evaluations may not impact the provision of services at school. For example, a school using RTI will require data establishing two criteria (e.g., functioning below peer-referenced norms and lack of adequate response to intervention) for eligibility. In cases where an outside evaluation supports the presence of a disorder that may impact a child’s educational performance, pupil appraisal/IEP team members may decide to add the missing evaluation components to qualify a student to receive special education services under IDEIA. However, no mandate exists requiring these individuals to accept or follow diagnostic or treatment recommendations proposed by outside professionals, especially if there is an absence of corroborating data from different environments (e.g., home, school, community).

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This situation exists for the many complex emotional conditions with which children are currently struggling. More often, emotional issues that...

Table of contents

• Cover Page
• Applying the Results of Neuropsychological and Psychological Assessments
• Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• Preface
• Acknowledgments
• 1 Implementing Evaluation Results in a School Setting
• 2 Cognitive Interventions
• 3 Executive Functioning Interventions
• 4 Memory Interventions
• 5 Visual Motor Functioning Interventions
• 6 Social/Emotional Functioning Interventions
• 7 Facilitating Academic Instruction
• 8 Development of the IEP
• 9 Working with the Family
• References
• Index