Issue #21 – “How To” Series

In This Issue:

How To Put Together a Presentation Packet for the IEP Committee – An Example

&

How To Write an Assistive Technology Report

Introduction

If you are asked to be a Case Manager for putting together a packet to present to the committee for a student with a suspected disability, you will need to gather the following information. Normally you will make five packets; one for the psychologist, one for the parent, two for the chairperson of the committee and one for you (without the psychological or medical reports).

1. ____Initial Referral to the MDT from School Staff
2. ____ Parent Consent for evaluation
3. ____Social History Form
4. ____Medical Report Form
5. ____ Classroom Observation Form
6. ____ Psychological Report
7. ____Your Educational Report #4
8. ____Past teacher’s Reports
9. ____Standardized Achievement Test Scores
10. ____Attendance Records
11. ____Present teacher’s referral to the CST
12. ____Teacher’s Rating Scale Results

 

 

Initial Referral to the MDT from the School Staff-Blank

 

 

Parent Consent for Evaluation

State laws and/or district policies usually mandate that parent(s) must sign a consent form allowing the school to administer an evaluation on their child. As previously mentioned, the school usually obtains this form at the initial meeting with the parent to discuss the reasons for the referral or through the mail. Either way, this consent is required before any evaluation can take place. An example of such a form may look like the following:

 

PARENT CONSENT FOR EVALUATION

 

To the Parent/Guardian of Laura Johnson

School:  Meadow Lane                                                Grade: 5

 

We would like to inform you that your child______Laura

has been referred for individual testing because of the suspicion of a disability. Testing results will help us in determining your child’s educational needs and in planning the most appropriate program.  The evaluation procedures and/or tests may include the following:

• Intelligence: WISC-IV
• Communication/Language/Speech:
• Physical:
• Behavior/Emotional: Rorschach. TAT
• Academic: WIAT-III,
• Vocational:
• Other:

 

 

Before we can begin testing, it is necessary that the  School District Eligibility Committee have your written permission to evaluate your child. You have had the opportunity to discuss the need for this testing and the possibilities for special educational services with the school principal/designee. The evaluation(s) will be conducted by the multi-disciplinary team who will share the results of said evaluation with you at a building level meeting . Both this meeting  and a  Eligibility Committee meeting will be held within 30 school days of receipt of this notice .

 

I grant permission for the evaluation(s) mentioned above_________X__________

 

I do not grant permission for the evaluation(s) mentioned above_____________

 

Date___3/10/11_____Parent’s Signature: Mrs. Johnson

 

Date___3/11/11___________ Administrator/Designee____Dr. John Carner

Social and Developmental History Form

Date__________________________________

 

Name_____________________________________________________________Sex

 

School_________________________________________Grade__________DOB_________

 

Address__________________________________________________________________

 

Telephone_______________________________

 

Natural Parents __________ or  Child Resides with______________________(check one)

 

Father’s Name__________________________________Age___________Education_____________

 

Occupation_______________________________Business Phone____________________________

 

Mother’s Name_________________________________Age___________Education_____________

 

Occupation_______________________________Business Phone____________________________

 

Guardians or Other Individual’s

Names with Whom Child Resides___________________________Name______________________

 

Relationship_____________________________________Relationship_________________

 

Employment______________________________Employment________________________

 

Business Phone___________________________Business Phone___________________________

 

Siblings

 

Names                                Ages                                                                                 School

 

 

 

Others in Home: Name:                              Relationship                                   Age

 

 

 

 

 

Name:_______________________________________School__________________

Presenting Problem (as perceived by respondent)

 

 

 

Family History:

See Educational Report-December 2013

 

 

Developmental History-

Birth and Infancy Periods- Prenatal, birth, and postnatal facts. Include any unusual aspects in attainment of developmental milestones-  critical stages, traumatic experiences, falls or injuries, hospital stays, previous testing, medical conditions, medication, etc. Include any medical facts which might have an implication in the outcome of this case.

 

 

 

See Educational Report-December 2013

 

 

 

 

Social History– Include indications of child’ s conduct in  social skills, involvement in

groups or organizations, relationship to peers ,hobbies or interests etc.

 

See Educational Report-December 2013

 

 

School Adjustment: (Age and grade entrance to school, attendance, retention, change

of schools, previous psychological evaluations or prior reviews by CSE in another district.)

 

 

 

See Educational Report-December 2013

Behavioral Patterns–  i.e. eating, sleeping, relationship with adults

 

 

See Educational Report-December 2013

 

Individual filling out form_________________________Title__________________

 

 

 

Medical Form for the Eligibility Committee

 

To be completed by the Nurse-Teacher and included in the Eligibility Committee Packet.

 

Date:4/13                          Student’s Name : Laura Johnson              Grade: 5

 

Address :                                                                                                       State                                   Zip

 

Date of last medical  examination_______January 2012

 

Name and address of physician______Dr. Warren Binrton

 

 

Medical findings (attach copy if pertinent)________none_______________________

____________________________________________________________________

 

Last vision exam____11-10______________Results______20/20_______________________

 

Last hearing exam_____11-10____________Results_____no problem________________________

 

Speech_______NA_______________________________________________________

 

Additional Information which might have implications in

determining the outcome of this case: none

 

Nurse’s Signature: Mrs. Florence Nathansen

 

 

 

Classroom Behavior Checklist

 

Student Name: Laura Johnson

Teacher Mrs. Richman

Class Observation in: Science Class-Mr. Nettles

Time of observation 1:30pm

Length of Observation: 30 minutes

Observer: Special Education Teacher (you)

 

Please list positive behaviors or behavior strengths that the student displays:

 

 

	Almost Never	Occasionally	Frequently
Hyperactive:
Out of seat………………………………………………………….	x
Constant movement in desk………………………………………..	x
Can’t remain in line to and from classes……………………………	x
Constant verbal behavior…………………………………………..	x
Has nervous muscle twitches, eye-blinking, nail-biting, etc. ……..	x
Withdrawn
Listless, tired……………………………………………………….		x
Seems generally unhappy………………………………………….		x
Stares blankly into space……………………………………………			x
Rarely asks for assistance even when work is too difficult………..			x
Does not attempt work…………………………………………….			x
Apprehensive about committing self to a response………………..			x
Weeps or cries without provocation……………………………….	x
Avoids calling attention to self…………………………………….		x
	Almost Never	Occasionally	Frequently
Poor Attention/Concentration
Does not follow oral lessons……………………………………….	x
Does not follow lessons on board or visual materials……………..			x
Rarely completes any assignments…………………………………			x
Daydreams…………………………………………………………			x
Demands individual explanation of assignments………………….	x
Easily distracted from task by ordinary classroom stimuli (minor movement, noises)…………………………………………………			x
Aggressive
Attacks other children by hitting, shoving, etc…………………….	x
Verbally attacks and provokes other children……………………..	x
Steals……………………………………………………………….	x
Explosive or angry when things do not go own way………………	x
Argues with the teacher over behavior…………………………….	x
Destructive of others’ belongings and schoolwork………………..	x
Strikes back with angry behavior to teasing……………………….	x
Disruptive
Demands attention of any sort from teacher and peers…………….	x
Doesn’t follow class or school rules (quiet, on time, etc)………….	x
Interrupts lessons by antics (verbal or physical)……………………	x
Tells bizarre stories………………………………………………..	x
Does not conform to limits on own without control from others….	x
	x
Uncooperative
Blames other for own mistakes…………………………………….	x
Will not follow routine…………………………………………….	x
Works only when threatened with punishment……………………	x
Defiant of teacher’s requests……………………………………….	x
Argues with peers over minor situations…………………………..	x
Must have last word in arguments…………………………………	x

 

 

	Almost Never	Occasionally	Frequently
Manipulative
Wants excessive visits to nurse…………………………………….			x
Wants excessive visits to the bathroom……………………………	x
Works only when given individual help……………………………		x
Blames mistakes on anything but self (size of book, your directions, etc. )…………………………………………………….	x
Constantly puts self down or criticizes own work…………………		x
Tries to keep you off task by talking about other things, etc………	x
Approaches new tasks, situation with “I can’t do it”………………			x
Inappropriate Social Behavior
Comments that no one likes him/her……………………………….		x
Has no friends at school……………………………………………		x
Does not like to go out for recesses………………………………..		x
Does not initiate play or talk with peers……………………………		x
Is avoided by peers at school………………………………………		x
Personal appearance is lacking in cleanliness, order………………	x
Does not function in group or class discussions……………………	x
Ridicules peers, torments younger or smaller students…………….	x
Exhibits inappropriate behaviors in room (nose-picking, masturbation, etc.)………………………………………………….	x

 

 

Comments:

Psychological Summary

Privileged and Confidential Information

 

Name: Laura Johnson                                     School-Meadow Lane

Address: 31 Apple Tree Rd                              Date of Birth-12/9/2002

Mineola, N.Y.                                      Date of Referral: March 1, 2012

Phone: 742-1097                                               Date of Testing: March 3, 2013

Parent’s names: John/Patricia                      Date of Report: March 5, 2013

Teacher’s Name: Mrs. Richman                   Chronological Age: 10-3

Referred by: teacher

Grade:5

 

Reason for Referral

 

Laura was referred for evaluation because she exhibits short attention span, confusion over directions, reticent behavior, poor handwriting and low academic achievement.

 

Background History

 

see educational report

 

Tests and Procedures Administered

Bender Gestalt Visual Motor Test

Wechsler Intelligence Scale for Children-IV

Figure Drawing

Sentence Completion Test

Thematic Apperception Test

Review of records

Parent intake

 

 

Test Results

Wechsler Intelligence Scale for Children III

 

Information-12                                                             Picture Completion-13

Similarities-13                                                                              Picture Arrangement-6

Arithmetic-6                                                                                 Object Assembly-5

Vocabulary-12                                                                              Block Design-5

Comprehension-13                                                                      Symbol Search-5

Digit Span-13

 

Verbal Comprehension 119

Perceptual Reasoning-85

Working Memory-105

Processing Speed-80

Full Scale IQ-105

 

Interpretation of WISC–IV Results

Laura was administered fifteen subtests of the Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) from which her composite scores are derived. The Full Scale IQ (FSIQ) is derived from a combination of ten subtest scores and is considered the most representative estimate of global intellectual functioning. Laura’s general cognitive ability is within the Average range of intellectual functioning, as measured by the FSIQ. Her overall thinking and reasoning abilities exceed those of approximately 50% of children her age (FSIQ = 100; 95% confidence interval = 95 – 105). Her ability to think with words is comparable to her ability to reason without the use of words. Both Laura’s verbal and nonverbal reasoning abilities also are in the Average range.

Laura’s verbal reasoning abilities as measured by the Verbal Comprehension Index are in the above average range and above those of approximately 85% of her peers (VCI = 119; 95% confidence interval = 115 – 123). The Verbal Comprehension Index is designed to measure verbal reasoning and concept formation. Laura’s performance on the subtests that contribute to the VCI are all in the above average range except arithmetic, suggesting that her abilities in this domain are well developed.

Laura’s nonverbal reasoning abilities as measured by the Perceptual Reasoning Index are in the Low Average range and above those of approximately 18% of her peers (PRI = 85; 95% confidence interval = 82 – 88). The Perceptual Reasoning Index is designed to measure nonverbal concept formation, visual perception and organization, simultaneous processing, visual-motor coordination, learning, and the ability to separate figure and ground in visual stimuli. Laura’s performances on the subtests that contribute to the PRI are somewhat low, suggesting that her abilities in this domain are less equally developed.

Laura’s working memory abilities as measured by the Working Memory Index are in the Average range but above those of only 55% of her peers (WMI = 105; 95% confidence interval =100 – 108). Laura’s abilities to sustain attention, concentrate, and exert mental control are relative to her verbal comprehension ability with the exception of arithmetic. Mental control is the ability to attend to and hold information in short-term memory while performing some operation or manipulation with it. Laura’s difficulty when asked to solve mental computation problems may be evidence of weak math skills. The academic difficulties noticed by Mrs. Campbell may be related to this weakness in math skills. This pattern is more common among children who are experiencing academic difficulties in the classroom than among those who are not.

Laura performed significantly lower on the Arithmetic subtest (Scaled Score = 6) than on the Letter-Number Sequencing subtest (Scaled Score = 12). Both of these tasks require attention, concentration, and mental control, but the Arithmetic subtest also requires specific abilities in numerical operations and mathematics reasoning which she may be lacking.

Laura’s speed of processing abilities as measured by the Processing Speed Index are in the low average range and above those of approximately 16% of her peers (PSI = 80; 95% confidence interval =77 – 83). Processing visual material quickly is an ability that Laura performs poorly as compared to her verbal reasoning ability. Processing speed is an indication of the rapidity with which Laura can mentally process simple or routine information without making errors. Performance on this task may be influenced by visual discrimination and visual-motor coordination. Because learning often involves a combination of routine information processing (such as reading) and complex information processing (such as reasoning), a relative weakness in the speed of processing routine information may make the task of comprehending novel information more time-consuming and difficult for Laura. Thus, this relative weakness in simple visual scanning and tracking may leave her less time and mental energy for the complex task of understanding new material. The problems noticed by Mrs. Campbell may be related to this weakness in processing speed. The pattern of processing speed abilities lower than verbal comprehension ability is more common among students who are experiencing academic difficulties than among those who are not.

Projective tests indicate a very overwhelmed, depressed and confused little girl who has experience a great deal of academic frustration resulting in her present academic and emotional state. Further testing indicates a girl with good resources but limited self-esteem. At the present time she views the world as expecting too much from her and is afraid of letting people, especially her parents, down. Laura perceives herself as not worthy of friends and as a result tends to shy away from social situations for fear of rejection.

While Laura exhibits anxiety and some depression, it should not be considered pervasive. Her present emotional state seems to be secondary to her academic problems. She is a very capable girl who under the right circumstances can be very successful. However, if her present situation continues her confidence will continue to deteriorate and it is feared that school avoidance might arise.

 

Conclusions and Recommendations

Laura is a 3rd grade girl presently functioning in the average range of intellectual ability. However, many indications i.e. scatter point to greater potential perhaps within the above average range. A Johnson history of academic failure and pressure possibly stemming from severe learning problems has resulted in secondary emotional characteristic symptoms. As a result the following recommendations are suggested:

 

1-A full educational battery should be administered to determine the extent, if any, of her academic difficulties historically observed by her teachers.

2-If such deficits exist, then a review by the CSE for a child with a suspected disability should be arranged.

3- Family counseling should be discussed with the Johnson’s priMelissa care physician. This counseling will not only provide the Johnsons with tools in handling Laura but also offer Jan the opportunity to vent her frustration. She will also be able to learn coping strategies to prevent her frustration and anxiety from overwhelming her.

Respectfully submitted

Dr. Brian Wilson

 

Past Teacher Reports

Mineola Public Schools

Report Card Comments

 

Name of Student: Laura Johnson

Grade: Kindergarten

Teacher: Mrs. Linus

Comment: Laura is a very sweet little girl. At first, she seemed to have some anxiety about being in school. She talked about wanting to go home but after a few weeks this behavior subsided. Laura seemed to get Laura with the other children. However, she seemed to be somewhat slower than her peers in cutting, coloring, writing and other fine and gross motor areas.

When we started getting into reading sounds and so on she seemed to be more involved. On math tasks she seemed to have a short attention span and seemed confused.

Laura seemed to need things repeated when it came to directions. I was concerned so I had her hearing tested by the school nurse and that seemed to be fine. Jennifer’s desk was always filled with papers even though I asked her several times to clean it. She always seemed to misplace things especially her math work.

Laura strengths were in reading, sound recognition, and verbal participation.

I Socially Laura got along well with the other children in the class. While not a very active participant, she was well liked by the other children who reached out to her a great deal.

I looked back on her Kindergarten screening results again and noticed several high risk issues which I felt needed special attention. I think she made some progress and hope that she continues this progress next year.

 

Name of Student: Laura Johnson

Grade: First

Teacher :Ms. Padula

Comments: Laura had a somewhat inconsistent year. She seemed to like reading and participated in that activity. She was in the top reading group and seemed to enjoy the status. However, Laura seemed to avoid written work and math work. She told me that she just forgot to do her assignments. I spoke with Mrs. Johnson and she said she would work with Jennifer.

Laura did not seem to be part of any particular group although the other children never mistreated her. On the playground she would sometimes wander off by herself.

I thought about referring her but I thought that her issues were based in maturity and considering how bright she is she would grow out of them. I suggest that Mrs. Johnson work with Laura over the summer in the areas of writing and spelling which should help a great deal next year.

The phys d teacher has noted that he sees Laura as a child with coordination issues but feels that it is developmental and she should mature with age.

 

Name of Student: Laura Johnson

Grade: Second

Teacher: Mrs. Bellows-

Comments: Laura struggled this year except in reading. She seemed to begin having social and academic problems as the year progressed. I was going to refer her for testing but it was late in the year. I spoke with Mrs. Johnson who said she had been working with Laura but would increase it. I told her that she needed a great deal of math help. I hope Laura matures and grows out of her resistance to school. She is a likable child with a great deal of potential.

Laura seemed to shine in reading which is her favorite area. She was far ahead of the other children so I had her read top the kindergarten children which she loved. I also had her work in the library with Mrs. Carson who enjoyed her company very much.

In class Laura seemed to daydream and wander off and I had to bring her back to the reality of the situation rather often.

Mrs. Johnson was very cooperative and we had several meetings this year to discuss Jennifer’s issues. I did not get the opportunity to meet Mr. Johnson.

On the playground  Laura seems to be a loner. While the other children try to get her involved she seems to prefer being by herself.

 

Name of Student: Laura Johnson

Grade: Third

Teacher: Mrs. Kapson-

Comments: Laura seemed to have a difficult year this year. Her attendance was a very serious problem and she seemed overwhelmed by the work. I spoke to Mrs. Johnson several times about her attendance and she indicated that Laura was sick in the mornings so she kept her home. Laura is a stubborn girl who refused to do her work in school. She was oppositional and defiant in a passive way. She needs to learn how to follow rules and finish her assignments even if she doesn’t like the task. I feel that her work style interfered with the other children by setting a poor example.

While an avid reader, her skills in writing and spelling held her back from handing in work. She seemed bright and contributed to class discussions. She was tolerated by her peers but had very few real friends.

I had several conferences with Mrs. Johnson although I never had the opportunity to meet with Jennifer’s father. Laura often did not finish work in class and had to frequently take it home to finish.

While a very articulate girl with an excellent vocabulary, she did not seem to interact with her peers even in small groups. She did however participate regularly in reading discussions and social studies.

 

Name of Student: Laura Johnson

Grade 4

Teacher: Mrs. Garcia

 

Laura has had a very inconsistent year. I was very concerned about her lateness’s and absence patterns and spoke at length with the mother. She indicated that she would work on it. Her reading is exceptional as is her language and vocabulary. She had definite problems in math, spelling, and writing. She expressed her ideas very nicely but could not seem to place her ideas coherently on paper. Socially Laura had definite problems and seemed to be isolated despite attempts by others to engage her. She was not mean to other children, just withdrawn. She frequently became lost in her readings during recess and free time.

Laura is a sweet girl with a big heart. She took care of all the animals this year and was very responsible. However, I am concerned about her work and considered referring her but felt she might grow out of it. I spoke with her mother and gave her suggestions on helping her at home. I also tried to help her in school but the techniques I used did not seem to work. I think she will grow out of it since she is such a bright girl. I judge her reading to be above average, spelling and writing below average and math below average.

 

 

Achievement Test Scores/SAI Scores

 

Mineola Public Schools

Student: Laura Johnson

School: Grand Avenue

Grade: 1

Stanford Group Achievement Test

	Reading. Comp	Vocabulary	Math Procedures	Math Problem Solving	Total Reading	Total Math
RS	32	24	10	12	56	31
NP	87	85	15	14	86	15
LP	82	78	10	11	80	11
GE	4.2	4.1	K	K	4.2	K
S	8	8	2	2	8	2
SS	125	125	75	72	125	74
Range	Superior	Superior	Below Average	Below Average	Superior	BA
AE	9.1	9.2	4.0	4.0	9.2	4.1

 

Student: Laura Johnson

School: Grand Avenue

Grade: 3

Stanford Group Achievement Test

	Reading Comp	Vocabulary	Math Procedures	Math Problem Solving	Total Reading	Total Math
RS	33	26	11	13	59	35
NP	87	86	13	15	86	14
LP	78	77	9	9	79	10
GE	5.8	5.9	1.2	1.5	5.8	1.6
S	8	8	2	2	8	2
SS	124	126	76	73	125	73
Range	Superior	Superior	Below Average	Below Average	Superior	Below Average
AE	10.1	10.2	4.8	4.7	10.2	4.8

Student: Laura Johnson

School: Meadow Lane

Grade: 5

Stanford Group Achievement Test

	Reading Comprehension	Vocabulary	Math Procedures	Math Problem Solving	Total Reading	Total Math
RS	36	39	10	13	75	35
NP	88	88	12	14	86	13
LP	78	77	10	9	79	10
GE	7.1	7.2	2.8	2.9	7.2	2.8
S	8	8	2	2	8	2
SS	126	125	72	74	125	74
Range	Superior	Superior	Below Average	Below Average	Superior	Below Average
AE	13.0	12.9	5.7	5.9	13.1	5.7

Otis-Lennon School Ability Test -Laura Johnson-

Grade 3

 

	Total	Verbal	Non Verbal
Raw Score/# Presented	45/72	24/80	21/47
SAI	105	119	96
National PR/Stanine	60/6	79/7	38/4

Note: SAI-School Abilities Index

Otis-Lennon School Ability Test- Laura Johnson-

Grade 5

	Total	Verbal	Non Verbal
Raw Score/# Presented	48/66	28/74	18/45
SAI	104	115	93
National PR/Stanine	55/5	77/7	34/3

 

Mineola Public Schools

 

Attendance Records

 

Student Name: Laura Johnson

 

Kindergarten (2005-2006)

 

Days present: 176

Days absent: 4

Specific days absent: February 7, 8, 9, 10

First Grade:(2006-2007)

 

Days present: 170

Days absent:      10

Specific days absent: January 4, 5 February 6, 7, 8, March 5, 6, June 5, 6, 7

 

Second Grade (2007-2008)

 

Days present: 168

Days absent:   12

Specific days absent: October 8, 22, November 5, 12, 19, January 14, February 4, 25, April 1, 2, 3, 4

 

Third Grade (2008-2009)

 

Days Present: 155

Days Absent: 26

Specific days absent: Oct. 6, 17, 20, 27 Nov. 3, 10, 17, 24 Dec. 12, 19, January 9, 16, 30 Feb. 5, 23, March 9, 20, 23, April 10, 17, 24, May 8, 15, 22, June 8, 15

 

Fourth Grade (2009-2010)

 

Days Present: 158

Days Absent: 15

Specific days absent: Sept 7, 14, 21, Oct. 9, 16, 23, Nov. 16, Dec. 14, Jan. 4, 11, 25, Feb. 12, March 17, 18, 19

 

Fifth Grade (2010-2011)

 

Days Present: 108

Days Absent: 3

Specific days absent: Sept. 6, 20, 27

 

 

INITIAL STUDENT REFERRAL FORM TO CHILD STUDY TEAM

 

STUDENT REFERRAL FORM

 

IDENTIFYING DATA

 

Name: Laura Johnson                                   School: Meadow Lane

Address: 31 Apple Tree Rd                          Date of Birth-12/9/2002

Mineola, N.Y.                                      Date of Referral: January 2013

Phone: 742-1097

Parent’s Names: John/Patricia

Siblings: Janice-17 and Melissa-13

Teacher’s Name: Mrs. Richman

Referred by: teacher

Grade: 5

 

REASON FOR REFERRAL-Laura C.A.: 10.1

 

Why are you referring this student to the Child Study Team?

 

Laura is a student who has attended this school since kindergarten. I had one of her sisters in class a few years ago and was very impressed by her sister’s progress and ability. However I have serious concerns about Laura’s ability to cope with the requirements of 5^th grade. I have had several meetings with Mrs. Johnson about her performance issues and mentioned that I would be searching out other help from the Child Study Team. She was very cooperative and anxious about the results of our investigation. She felt that Laura has been struggling for many years and would like to get to the bottom of the problem.  In math she is below level and frequently omits key steps when performing mathematical operations. I am not sure if she understands what she is doing. Laura also does not know her basic math facts and seems unable to memorize them but seems to do better when I give her the math tables. When she does do her math she has poorly controlled handwriting and confused arrangement of numerals and signs on the page. Laura’s handwriting is poor and often illegible. As a result this affects her class work and essays on tests. Laura’s spelling is also a major problem in that she often adds unrelated letters, reverses syllables, omits letters and has trouble with spacing and letter formation.

 

Laura is an excellent reader and is in the top reading group. She participates in this area but not too many others. She seems to enjoy working on a one to one basis with other students and is helpful for lower readers when it comes to reading assignments However, Laura is also very disorganized and has serious difficulties being neat, structured, and organized in school. As a result her work is often messy. While a very caring child Laura has serious difficulties with time management and the organization of time needed for the completion of tasks in school.  Laura also has trouble copying from a book to her paper, copying from the board to her notebook, and is very awkward frequently bumping into things around the room. Laura seems to shine on a one-to-one basis or small group involvement. She also seems to falter in the afternoon and seems to have less energy for complicated tasks. This is not as evident in the morning.

 

According to my observations, academic skills also seem poor in computational math, written spelling, art and physical activities. Her reading seems on grade level but no formal tests have been given. I often see her squinting but she does not wear glasses. I sometimes become frustrated because of Laura’s “stubbornness” in finishing her class work.

 

Socially, Laura is not very popular. While the other children accept her they rarely seek her out. She is also not very socially assertive and as a result spends a great deal of the day by herself. While she eats lunch with some girls she never seems to interact. On the playground she wanders off by herself and seems self-absorbed. However, when I pair her up with another student she is more engaged and sociable.

 

I notice that she likes to find a quiet area in the room in which to work and prefers listening to lectures rather than writing notes. She seems to get lost when it comes to long assignment in class and has definite issues with managing long term assignments.

 

I have tried working with her individually and at times she seems to respond but does not seem as if she can be consistent. She gives up easily and I feel that there is more there than I am able to see. Her desire to want to go to the nurse because she is not feeling well is a concern of mine but seems to be getting less frequent.

 

I have spoken to the parents and have expressed my concerns. They have been very angry but cooperative and are also looking for answers. They feel that this has been going on too long and the school is remiss in defining Laura’s real issues.

 

Has the parent been notified of this referral? yes _X__no___

 

 

Teacher Rating Scale

 

 

Name: Laura Johnson                          Teacher: Mrs. Richman                       Grade: 5

Student Behavior Rating Scale

Please rate the following behaviors according to the following scale:

Rating

1- The behavior does not apply to this child and is never observed

2- The behavior is rarely exhibited

3- The behavior occurs some of the time

4- The behavior occurs most of the time

5- The behavior always occurs

 

__4__Anxious                                                                            __3__Tires easily

__1_Disruptive                                                                           __1_Defies authority

__1__Fights frequently                                                            __3__Fears criticism

__2__Unhappy                                                                          __1__Critical to others

__4_Withdrawn                                                                         __1__Controlling

__4__Moody                                                                               __5__Painfully shy

__4__Distractible                                                                     __5__Slow starter

__2__Impulsive                                                                         __5__Inconsistent

__4_Does not complete work                                                 __1__Hyperactive

__4_Short Attention Span                                                      __3__Hypoactive

__4__Daydreams                                                                      __4__Fearful of new situations

__1_Argumentative                                                                   __5__Procrastinates

__5__Disorganized                                                                   __5__Rarely takes chances

__4__Easily Confused                                               __1__Overreactive

__5__Poor speller                                                                      __4__Problems with writing

__1__Poor reader                                                                      __4__Problems with math

__1_Limited reading comprehension                                   __1__Poor vocabulary usage

__1__Faulty articulation                                                         __1_Poor expressive language ability

__3_Poor grammar                                                                   __1__Inadequate word attack skills

__1__Problems judging time                                                  __4__Poor balance and coordination

__4_Poor fine motor skills                                                      __5__Poor gross motor skills

__5__Slow in completing tasks                                             __4_Tracing and drawing difficulties

__1__Poor logical reasoning and thinking                         __1Difficulty with abstract concepts

__4__Poor number concepts                                                 __3_Problems with auditory memory

tasks.

 

 

Draft IEP

Section 1- Background Information

 

School District/Agency:

 

Name and Address:

 

Individualized Education Program

 

Date of CSE/CPSE Meeting:                      Purpose of Meeting: Initial

 

Student Name:

 

Date of Birth:                                                                                              Age:

 

Street:

 

City:                                                                                                               Zip:

Telephone:                                       County of Residence:

 

Male_ _ Female __ Student ID#:  3467H                        Current Grade:

Dominant Language of Student:                             Interpreter Needed: Yes___ No ___

 

Racial/Ethnic Group of Student:

 

(Optional information)

American Indian or Alaskan Native_____

Black (not of Hispanic origin)_____

White (not of Hispanic origin)_____

Asian or Pacific Islander_____

Hispanic_____

 

Date of Initiation of Services:                                                  Projected Date of Review:

 

Date of Eligibility:                                                                       Date for Reevaluation:

 

Medical Alerts:

 

Mother’s Name/Guardian’s Name:

 

 

Street Address:

 

City:                                                                                       Zip:

 

Telephone:                                                                           County of Residence:

 

Dominant Language of Parent/Guardian             :                    Interpreter Needed: Yes__ No__

 

Father’s Name/Guardian’s Name:

 

Street Address:

 

City:                                                                                                Zip: same

 

Telephone:                                                                                    County of Residence:

 

Dominant Language of Parent/Guardian:                          Interpreter Needed: Yes__ No___

 

 

 

 

 

Section 2- Present Levels of Performance

 

1-Academic/Educational Achievement and Learning Characteristics: Address current levels of knowledge and development in subject and skill areas, including activities of daily living, level of intellectual functioning, adaptive behavior, expected rate of progress in acquiring skills and information and learning style

 

1-Present Levels: Academic development (List name of test and most recent individualized

achievement test scores)

 

See educational report dated March 2013

 

 

2-Present Levels:             Cognitive ability (List name of test and most recent IQ test results)

 

 

See psychological report dated March 2013

 

 

3-Present Levels:              Language ability (List name of test and most recent test scores)

 

NA

 

4-Present Levels:             Learning style (List learning style factors determined by the assessment)

 

5-Social Development: Describe the quality of the student’s relationships with peers and adults, feel­ings about self, social adjustment to school and community environment and behaviors that may impede learning.

 

See educational report dated March 2013

 

 

6-Physical Development: Describe the student’s motor and sensory development, health, vitality and physical skills or limitations that pertain to the learning process.

 

See Medical Report

 

7-Management Needs: Describe the nature and degree to which environmental modifications and restrictions are required to address student’s ability to be maintained in a classroom setting.

 

See  psychological report

 

 

Section 3-Measurable Annual Goals and Short Term Instructional Objectives

 

Annual (Long Term) Goal:

Short Term Objective:

 

Behavioral Objectives:

1-

2-

 

Annual (Long Term) Goal:

Short Term Objective:

Behavioral Objectives:

1-

2-

Annual (Long Term) Goal:

Short Term Objective:

Behavioral Objectives:

1-

2-

Section 4- Special Education Programs and Related Services/Program Modifications

 

A. Special Education                                    Initiation Date                 Frequency          Duration

Programs/Related Services

 

1-

 

2-

 

3-

 

 

B. Extended School Year Services (ESY)   Yes_____ No____

 

If yes provide specific rationale:

 

 

C. Supplementary Aids &                            Initiation Date                 Frequency          Duration

Modifications or Supports

For the Student

 

1-

 

2-

 

3-

 

 

 

D. Describe any assistive technology devices or services needed:

 

 

 

 

E. Describe the program modifications or supports for school personnel that will be provided on behalf of the student to address the annual goals and participation in general education curriculum and activities.

 

NA

 

.

 

 

Section 5-Participation in General Education Classes, Nonacademic and Extracurricular Activities

 

Explain the extent of participation in general education programs and extracurricular and other non-academic activities including physical education or adaptive (adapted) physical education and occupational education (if appropriate). Explain the extent, if any, to which the student will not participate with non-disabled students in the regular class and in other activities.

 

Section 6- Summary of Selected Recommendations

 

 

Recommended Placement

 

Extended School Year (ESL) Services? Yes___ No__

 

Recommended Placement

 

Transportation Needs:

Section 7- Reporting Progress to Parents

State manner and frequency in which progress will be reported: Parents/guardians or student over 18 will be informed of the student’s progress toward meeting the academic goals and objectives with the same frequency as non-disabled students using the following criteria:

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Name:   Billy Smith                                                      Teacher: Mrs. Stewart

Address: 42 Bryant Ave                                              Phone: 456-9876

 

Date of Birth: 1/5/99                                                  Referred by: MDT

Grade:  9th                                                                     Date of Evaluation: March 2014

School: Harwood Middle School                             Date of Report: April 2014

Parent’s Names: Bill/Martha                                    CA at time of Evaluation: 14-3

 

PURPOSE OF EVALUATION

The School District has requested an Assistive Technology Evaluation for John. This evaluation will focus on the use of technology to remediate, enhance and/or Provide John with options for improving his note taking skills.

 

BACKGROUND HISTORY

John is a 14 year old student who is in a ninth grade inclusion program at the local HighSchool. He is classified as Learning Disabled with Attention Deficit Disorder. John haspreviously attended the Nassau Country Day School. His academic levels ofperformance have been described as average for Reading and Math and well below average for Writing.

 

PRESENT COMPUTER AVAILABILITY

John reported that he currently has six computers at home, five being Macintosh and one being a PC with Windows XP. John informed us the he uses the computer at home for downloading music from the internet and emailing friends on AOL. In school there are Gateway PC’s available for use in the computer lab and one also in his Guided Studies class.

 

EVALUATION OBSERVATIONS

John was evaluated in a closed room office situation for approximately one hour. He understood the purpose of our meeting and was very cooperative and willing to participate in all of the tasks asked of him. Several of his teachers were available to provide input with respect to his academic goals and objectives as well as their individual class writing requirements. During this functional assessment, informal measures were used to evaluate academic skills and his ability to use various assistive technology devices. The following is a summary of his performance:

Handwriting Skills: John who is right hand dominant and prefers printing to cursive writing, filled in a simple form which displayed sizing, spacing and spelling error was asked to perform several handwriting samples of near, far point and auditory copying was asked to copy a paragraph taken directly from his Earth Science textbook while on his desk, from the board, and as if it were being dictated in a class note taking situation.

His far point copying sample displayed missing words 6 out of a text of 50. It appeared he would look up at the board and from memory, writes the words down thus making frequent gross spelling errors and word reversals. The individual timed results are attached; however, all of the samples were replete with sizing, spacing and spelling errors.

Keyboarding Skills John was given a Macintosh PowerBook G3 laptop computer to type selections with. John was then asked to type the original paragraph which took slightly longer than his near and far point copying samples.

He is a two handed typist whose keyboarding skills are in the “hunt and peck” method and although he is quick, he is not particularly accurate. John has revealed that he has not had formal keyboarding training and has just picked it up as he has used the computer. John was able to maneuver the desktop with minimal assistance and displayed basic text editing skills related to word processing such as deleting, inserting, moving and copying letters, words and phrases, spell check, saving and printing his work.

Write:OutLoud is an easy-to-use talking word processor that also has a talking spell checker. It greatly benefits students who need to listen as they write as well as for students who need to review their writing auditorially for reinforcement and proofing. John found typing letters, words or sentences with the speech function of this program on too distracting.  John was instructed that this function can be shut off and used only upon completion of an entire document being typed so that it is read back all at once didexpress an interest in the audible spell check feature as well as having an entire document read back.

 

John was then asked to use an AlphaSmart 3000. This device is a portable word processor that students can take class notes with and later on transfer their notes to any word processing application on a Macintosh or PC computer. Johns was again able to navigate the keyboard and understand the concepts of using spell checker, creating individual files, one for English, one for Science etc., and then eventually transferring this information to his home or resource room computer.

Academic and Cognitive Skills: John’s current levels of functioning have been described as average academically with the exception of writing and in line with characteristic ADD identifiable behaviors. John showed us his notebooks and Ms. Benson, his Guided Studies teacher, described how she uses color coding and outlines to assist John in overcoming his organizational problems as well as clarifies his class work and homework assignments on a daily basis.

 

OCCUPATIONAL THERAPY OBSERVATIONS

John demonstrated poor organizational skills and tends to rush through his handwriting of class notes, etc. at time using his own abbreviation system. During the evaluation process, “breaks” were given as John demonstrated difficulty focusing on the task at hand following an approximate 10 minute block of time. It was, however, easy to refocus him and bring him back to task. At this time he does not receive Occupational Therapy services.

 

SUMMARY

John is a student who has a classification of Learning Disabled and Attention Deficit Disorder and whose learning differences present obstacles to accessing his academic environment and achieving his academic goals. John requires the support he currently receives each day to reach these goals and objectives on a daily basis.

Compensatory Strategies:

 

• Simple outlines or templates provided by the teacher wherever possible.
• Encourage the use of organizational guides such as notebooks, appointment books and structured study guides to reinforce his current organizational skills.
• Provide more time for all written tasks.
• Allow the use of a tape recorder for individualized homework or class work assignments when appropriate.
• Use of a calculator will assist in mathematical and computational problems.

 

Recommended Technology

A keyboarding program such as Mavis Beacon Teaches Typing is a structured typing tutorial program that would improve John’s keyboarding skills and is currently used at his school.

A portable word processor such as the AlphaSmart 3000 would allow John to type notes and keep them organized in electronic folders while eventually beingable to be uploaded to a full-sized word processing program on either a Macintoshor PC computer. A list of these devices is attached with appropriate contact numbers. All are available on a loaner basis from each company for your individual assessment.

Write:Outloud could prove to be a useful tool for John in his writing as it would provide spelling and auditory reinforcement for him.

Follow up and reassessment should be part of an ongoing technology plan, if technology is determined to be a viable option for John by those able to assess and monitor his progress.

 

Jane Berman

Assistive Technology Specialist

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