Multiple and Severe Disabilities Assessment

Multiple and Severe Disabilities
For students with multiple and severe disabilities there are several tools that can be used for both educational and non educational purposes to aid in the students success.

Hearing Assessment

Diagnostic tools

Hearing aids are used by children in, as well as outside the classroom. Children may be given a hearing aid at any point in their life by a medical professional. In the classroom the E.A. can help ensure that the student is always comfortable using their hearing aid. They may have to become familiar with the child's hearing aid in case they may need assistance adjusting it.

Parents who have children that are hearing impaired, deaf in one or both ears, can go visit a specialist. The specialist may recommend that the child have electrodes implanted, in order that they may achieve better or some hearing.

Doctors may use an assessment test that uses beeps to measure the hearing level or loss in a person.
This test will not effect the Educational Assistant in the classroom.


Non Diagnostic tools


Infants are often assessed by testing the way an infant responds to sound. This type of assessment can include observation of behaviour, reflex audiometry, and play audiometry. This assessment is normally preformed with infants so it does not often effect the educational assistant.

Sign language is a tool used by people who may have hearing impairments. This tool may be particularly vital for the student to understand and communicate in the classroom. Educational Assistants working with students that have hearing impairments need to have a good relationship with their interpreter. As well as having a good understanding of sign language. Sign language can be a great asset to Educational Assistants working with hearing impaired students.



Visual Assessment

Diagnostic tools

Electrophysiological tests are assessment tools that doctors use to measure the optic pathways. The tests are searching for electrical activity in the pathways. When certain electrical activity is found this indicates that the person does not have good hearing capabilities.

Eye doctors use a visual acuity test to determine the persons visual level. The doctor will ask the person to read the charts that contain random letters and numbers, it is placed six meters away from the patient. they must read the chart with each eye individually, as well as with both eyes. After the test a score is obtained that is made up of two numbers. If the score is 6/6 it means that the person has good vision. If the score is 6/60 it means, they can only read something 6 meters away.

Doctors will use a functional test to assess a persons vision. This test assess the persons ability to track moving objects. A large visual field is used wear objects are moved around, they also track eye hand coordination, as well as the ability to use other faculties that require visual development.


Non Diagnostic tools

The braille alphabet is used by people who have visual impairments in order to help them read more successfully. This is a tool that can be used in the classroom. Educational Assistants should be very familiar with the braille system if they are working with students who have visual impairments.

A talking alarm watch can be used by people who have visual impairments. They might find it helpful to keep them on track. Students can use this to help them keep an orderly day.

The eye stick modern cane is a tool that has ultrasonic waves to measure the distance between the person and objects. The cane is not effected by rain, weather or climate problems and can measure them as well. It also delivers information about hazards to the person such as changes in the flow level. All the information is sent from the cane to a Bluetooth connection, and converted into a voice message.

Psychological -Educational Assessment
for Multiple and Severe Disabilities -Several tests are required for accurate results
-Assessment data is used to create an IEP as well as to offer the child placement
-Children with multiple and severe disabilities require the most natural setting possible for any kind of assessment
-Parent/guardian involvement is important in supporting the child and helping them to feel at ease
-Parents/guardians may also have important information for the assessment
-Children with multiple and severe disabilities can be so individual that not one testing method or tool can be used to gain an accurate assessment
-Tools and methods used in the assessment may very greatly according to the needs of the child.
-Some common methods or tools may not be used because of possible physical disabilities that may be present
-Unfortunately the assessments used can often show bias or inaccurate results, this may be because the standardised tests may not always be suited for the complex disabilities with severe or multiple disability cases
-Infant scales have proven to be good predictions for later development in children with multiple or severe disabilities
-The most common practise now is to use a functional approach (gathering skills relevant to the family and child using the child’s individual response mode in a natural setting)
Functional approach assessments include:
direct observation
informant interviews
adaptive behaviour scales
measures of paralinguistic communication
behaviour
alternate measures of communication
observational checklists
Parent interviews can be critical to an assessment (Winzer)

In the province on Ontario all diagnoses made regarding psychiatric health during assessments must be made by a person certified by The College of Psychologists. All diagnostic assessments must be conducted by, or supervised by, a registered Psychologist. “The Registered Health Professions Act (RHPA), formally recognises Psychologists as one of the Health Care Providing Professionals who may lawfully diagnose in the Province of Ontario. This same Act makes it illegal for anyone to diagnose or deliver Psychological Services who is not certified by The College of Psychologists of Ontario.” (Simcoe Muskoka Catholic District School Board) Diagnostic assessments can also often be conducted by a person who is familiar with the student so that the student feels the most comfortable. The performance of the student on the assessment may be affected by the presence of an unfamiliar person. Diagnostic psychiatric assessments must always be at least over seen by a psychologist, but may be conducted by another person. Often it can be very difficult for any student to have a psychological assessment through school recommendation, in result of, the long waiting list in many regions of Ontario. Therefore, the timing of this assessment for students with multiple and severe disabilities will depend on the particular students needs, when a psychiatric test is deemed useful, as well as when the student makes it through the waiting list.            
Assessments are conducted in the most natural settings possible for the student as to not disturb their normal routine or to interfere with their performance on the assessment. Educational related assessments can be done in the students regular classroom or learning environment. The student’s regular environment can vary greatly depending on the students needs and placement.      The Role of the Educational Assistant regarding Psychological Assessments
Educational Assistants may be expected to assist in the primary assessment if needed. They may also be asked to monitor the student progress throughout the school day, keeping accurate records of the student’s progress and behaviour. E.A.’s may be asked to implement or preform regular activities with the student in order to increase the student’s progress. The Educational Assistant should also be responsible for understanding the student’s needs, and how to respond appropriately. They might also be asked to use a range of assessment tools, however the range of tools used during the psychiatric assessment of a student with severe or multiple disabilities is so vast the E.A. should be prepared to familiarise themselves with each student and the tools used on an individual basis.     

This article about a little boy named Ben, it covers a mother’s journey through the diagnoses and assessment of her son.   http://bloom-parentingkidswithdisabilities.blogspot.ca/2012/08/more-than-words-part-2.html

References

Simcoe Muskoka Catholic District School Board: Special education plan 2005-2006http://www.smcdsb.on.ca/UserFiles/Servers/Server_6/File/Archived/Parents%20and%20Students/Special%20Education/Spec%20Ed%20Plan%2005-06.pdf

 

Neurological Disorder Assessments

Assessment of Neurological Disorders is not easily measured. Assessors usually incorporate a number of measures, use different test procedures and allow various adaptations to tests and responses. Depending on the particular disorder children may require assessment in many different areas such as:

Diagnostic Tools:

Neuropsychology:
The study of how the functions of your brain and nervous system affect the way you think and behave.

Neuropsychologist:

Specialist in understanding and treating problems that occur following damage to the brain.
• Neuropsychologists usually work in a private practice or in an institutional setting such as hospitals or clinics.

 

Neurological assessment:
 A tool for evaluating how much a child’s performance may be influenced by unusual functions of the brain and nervous system. It helps school psychologists systematically measure a child’s skills and determine the best learning environment for the child.

A complete neuropsychological assessment requires gathering and analyzing information about the child’s development physically, socially and psychologically as well as the child’s education. This information comes from a variety of sources:

•  Parents observations
• Formal observation, for example, watching the child copy designs, pronounce words or figure out an arithmetic problem.
• Some standardized assessment measures with established validity and reliability already exist- for example, asking a child to generate rules from examples or to state socially accepted behaviours for given situations

The two most common tests used to assess neuropsychological disorders are:

 

• The Halstead-Reitan Neuropsychological Test Battery (which includes the revised Wechsler Intelligence Scale for Children)
• The Luria-Nebraska Neuropsychological Battery.
• The earlier a child sees a neuropsychologist the better, and further diagnosis can be examined.

 
MOTOR ASSESSMENTS:

Physician or Occupational Therapist

Motor assessments are initially performed in specialised clinics or hospitals, and should be done as soon as possible as to determine possible treatment and on going therapy. Periodic on-going assessments can be done at schools or at home.

The motor system evaluation is divided into the following:

 

• Body positioning
• Involuntary movements
• Muscle tone
• Muscle strength
• Mobility
• Considers physical status
• Functional aspects (how the child moves)

COMMUNICATION ASSESSMENTS:

Speech and language problems are generally assessed by a team of specialist such as:

• Psychologist
• Speech/language pathologist
• Physician
• Educator
• Neurologist

An in-depth assessment by a speech/language pathologist includes an assessment of the child’s:

• Hearing ability and hearing history
• History of speech-language development
• Oral-motor functioning and feeding history
• Expressive and receptive language performance (syntax, semantics, pragmatics, phonology)
• Social development
• Quality/resonance of voice (breath support, nasality of voice)
• Fluency ( rate and flow of speech)

It is recommended that the in-depth assessment include both standardized tests and alternative assessment approaches.

• Standardized tests are important because of the objectivity and structure they offer to the assessment process, even though standardized test scores alone are insufficient to make a diagnosis.

• Alternative approaches, such as an analysis of samples of the child's speech and language, are important because many dimensions of communication are not easily measured using standardized tests (such as pragmatics, discourse, voice, fluency, oral-motor, and feeding).

These types of tests are performed in specialised clinics.

 

VISION ASSESSMENT:

Optometrist- Eye clinic

• Conventional testing:  Standard vision test. If the student is non-verbal or does not recognize a standard alphabet chart, the optometrist will test the child's ability to follow or track and object.
• Child is able to use picture cards and select correct picture.

Ophthalmologist: Eye surgery clinic

  When a child does not respond to conventional testing diagnosticians use Electro diagnostic procedures.

• Electro diagnostic procedures assess the electrical activity of the optic pathway and occipital cortex of the brain.
• The presence of electrical activity indicates that an active pathway exists.

HEARING ASSESSMENT: 

Audiologist- Hearing centre

• Pure tone audiometry: Sweep test to determine the child’s threshold of hearing. (the level of which the child first detects a sound).
• Speech audiometry: Used to assess the child’s ability to detect and understand speech.

With neurological disorders it is difficult to distinguish if a child is not responding to a sound because they cannot hear it or because they are inattentive. Audio logical assessment is divided in to two groups:  Electrophysiological and behavioural:

•  Electrophysiological procedures include electroencephalography (EEG) – measures responses to auditory stimuli by measuring the brainwaves.
• Acoustic impedance audiometry: assesses conductive hearing losses by measuring the movement of the eardrum and middle ear muscles and bones in response to auditory stimulation.

Behaviour testing includes observation of behaviour,

• reflex audiometry – A startle movement as a result of a loud sound.
• play audiometry- Used in children over two, using a game in which the child performs an activity in response to the sound.
  

CEREBRAL PALSY: 

• motor assessment/vision/hearing assessment.
• observation of movements and not meeting developmental stages 

 Educational Assistant (EA) Red Flags:

Physical changes:

• More/less muscle spasms.
• Often students with CP experience seizure. Some symptoms include: change in alertness, may look like the student is day dreaming, shaking, body stiffness etc. If a seizure lasts more than 5 minutes, or is repetitive (one after the other) seek medical help.
• During a seizure, make sure the affected limbs are safe, but do not restrain. Dangling feet/arms could get hurt.
• Watch for the student struggling with fine/ gross motor skills (grasping, eating, holding) and intervene before frustration sets in.
• Choking: Some individuals with CP may have problems swallowing, if this is the case always observe the individuals carefully while they are eating.
• Blisters/redness under braces: Braces may be to tight or irritating the skin.

Emotional changes:

•  Frustration/anger: The student may become frustrated if they cannot perform a task or play with their peers.
• Social issues: Students may become out casted by peers/ bullied, or withdraw themselves.
• Depression
• Anxiety
• Behaviour disorders

Non-Diagnostic Tools: 

•  Extensive EA observation and documentation, especially in the area of movement (decrease/increase), and emotional changes.
• The EA should to be able to recognize when the student is having a seizure. Seizures look different from individual to individual. For a student with Athetoid CP, it may be more difficult to recognize the signs. EAs must be aware of typical seizure signs, loss of consciousness, staring into space, non responsive, jerking movements in contrast to the usual involuntary movements of the student. Through extensive observation/documentation, any unusual movements which resemble a seizure should be taken seriously.
•  Output of urine if a catheter is present.
•  Any decrease in appetite.
• Watch for learned helplessness: encourage as much independence, allow the student to reach their full potential.

Information on different types of seizures:
Different Types of Seizures Video
Seizure First Aid: You Can Do It!
Noah's Absent Seizure

SPINA BIFIDA: 

 Physician/Obstetrician- Ultrasound lab

• Spina Bifida is detected by ultrasound, usually by the fourth week of gestation.
• Spina Bifida Occulta is diagnosed using an x-ray after birth (most people with SB Occulta do not know they have it).
•  Spina Bifida Meningocele can be corrected by draining the fluid in the sac.
• Spina Bifida Myelomeningocele (the severest type) can also cause hydrocephalus (water on the brain). A shunt can be surgically inserted to drain the fluid.

Educational Assistant (EA) Red Flags

Behaviour/emotional changes:

Social problems- withdrawing from peers/bullied
• Psychological issues/ emotional issues- depression
• Unusual irritability

Physical changes:

• Seizures- a seizure that lasts more than 5 minutes and occurs one after the other without regaining consciousness is considered a medical emergency.
• Decrease in movement
• Headaches
• Vomiting
• Lethargy
• Infection in the area of the shunt (if present)- swelling, redness
• Self injurious behaviour- Lack of skin sensation may cause S.I.B
• Redness or blisters under braces.
• Fever- infection

Non-Diagnostic Tools:

• EA observation/documentation
•  As well as all of the above, the EA should be aware of learned helplessness, students with SB tend to become dependent on parents, teachers and EA's. Allow the student to be as independent as possible. This way it does not allow for any unnecessary regression, and helps the student reach their own full potential.
• Output of urine (if catheter is needed)- Individuals using a catheter are prone to urinary tract infections. Low output of urine and fever could mean a U.T.I.

FETAL ALCOHOL SPECTRUM DISORDER:

• FASD is usually diagnosed by a Doctor or diagnostician.
•  An early diagnosis is essential to allow access to interventions and resources that may mitigate the development of subsequent “secondary disabilities” (e.g., unemployment, mental health problems, trouble with the law, inappropriate sexual behaviour, disrupted school experience) among affected people.

Diagnosis of FASD is based on four primary criteria:

• Growth deficiencies that stunt prenatal and/or postnatal growth.
• Permanent brain damage resulting in neurological abnormalities, delay in development, intellectual impairments and learning or behavioural disabilities.
•  Facial anomalies, including short eye opening and thin upper lip.
•  Maternal use of alcohol.

Diagnosticians use a 4-digit code to rate FAS in the above areas in terms of the level of impairment, beginning with 1-no evidence of impairment and going to 4-definite/severe evidence of impairment. The four digit code can result in 256 possible combinations in each category, defined by severity and impact on the student.

Educational Assistant (EA) Red Flags:

Since a child with FASD has an array of characteristics it is important for the EA to document any related behaviour in order to be able to monitor any significant changes, and be able to recognize a red flag situation. Some possible red flags to watch out for are:

Behaviour/Emotional changes: More/less

• Aggressive.
• Withdrawn.
•  More temper tantrums.
•  Non-compliance etc.
• Peer/social issues- Students with FASD are at a higher risk (about 50%) for committing sex related offenses. A red flag would be a student with FASD harassing a member of the opposite sex or making unwanted advances.
• Poor attendance- Students with FASD are at a higher risk for abusing drugs/alcohol, which may lead to a decrease in attendance.
• Signs of depression/mental health problems.

Physical changes:

• Weight loss- poor nutrition at home/depression.
• Signs of physical abuse- bruises, cuts etc.
• Unusual lack of focus/swaying- under the influence of drugs/alcohol.
• Seizures.

Non-diagnostic Tools:

The most important non-diagnostic tool for continuing to assess a student with FASD is extensive observation, documentation/communication. The EA should always record any behavioural related occurrences in an ABC chart (antecedent, behaviour, consequence chart).  Record any emotional or physical changes within the student, and review it with the Special Education team. Communication between everyone involved is the most important non-diagnostic tool. 

 

TRAUMATIC BRAIN INJURY:
 Doctors and medical imaging technicians

• Using MRI and CT technologies to assess brain damage after a head injury.
• Usually done immediately after any trauma to the head.
• Performed in the hospital.
  

Educational Assistant (EA) Red Flags:

  Emotional/ Behavioural Impairments: 

• depression
• mood changes
• temper
• irritability 

Physical Impairments:

•  fatigue 
• headaches
• sensitivity to light and sound
• sensitivity to sound/noise

Impact on Environment:

• social isolation 
• withdrawal in interests 
• poor decision making
• sense of helplessness

Non-Diagnostic tools:
Some students with TBI experience problems with attention, concentration, retention, and memory difficulties when it comes to learning. The EA should observe and document any unusual changes to the students characteristics or physical well being, as any changes, even small ones could have underlying signs or signals that could lead to more serious complications.
 

Sources: Winzer Textbook
Use of Cognitive and Communication Strategies to Enhance Care Transitions for Persons with ABI

English Language Learners-Assessment

The Process
1. The school board assign staff to assess the English proficiency of the English Language Learners.
2. An interview will be held to assess the oral communication skills, which includes speaking and listening.
3. There will then be a an assessment of reading comprehension
4. There will then be a math skills assessment.

The Initial Assessment
 There are two different ways of conducting the initial assessment:  1) Provide newcomers with an orientation session regarding schools in Ontario. 2) In other boards, the assessment is undergone at the school level, and it can be taken over a period of days.

The initial assessment provides insight to the students linguistic, academic, and other strengths, interests and needs. This also includes any special educational needs they might have or need.  

*The assessment results need to be recorded*

The initial Interview
It gives a good opportunity for dialogue between the family, student and the school. This is a time where  all the parties in the meeting can exchange necessary information and ask important questions. 

• The interview should be conducted in the family's home language.
• Should have the support of an interpreter so that accurate information is being interpreted and understood. 
• ALWAYS include the parents in the initial interview. 
• Whenever possible, direct questions to the student-this allows for an informal assessment in the students ability to have a conversation in his or her own language as well as English. 

• It is INAPPROPRIATE to ask the student to interpret at the interview. 

When implementing the initial assessment , the assessor will need to take a

number of factors into account:

• time available

• time of year

• student’s age

• prior exposure to English (e.g., in another school system)

• length of time here

An initial assessment serves to identify:

• a student’s eligibility for ESL services

• the student’s current level of English proficiency  

*English language proficiency includes

both receptive English (listening,

reading) and expressive English

(speaking and writing)*

• the extent and range of English services needed, including a recommendation for: the type of support

 appropriate for the student who may need the help  in order for them to succeed.

Initial Assessment of Mathematics

• It is good to begin with math, because ELLs sometimes find it easier to show competence with numbers and symbols than they do with words.
• Make sure the assessment tool is free of cultural biases
• Begin with counting
• Give student manipulatives and geometric shapes 
• Be conscious of how age and fatigue can affect a students performance. 

Different types of assessment testing

Assessments of Reading, Writing and Mathematics,
Primary Division (Grades 1–3) and Junior Division (Grades 4–6)

EQAO

• should be done for students in grade 3 and 6
• assessment in reading, writing and mathematics
• Grade 9 provincial assessment in mathematics 

Classroom Assessment
Often times, assessment tools require students to read material aloud that is unfamiliar to them. ELL's sometimes have a hard time with comprehension of what they are reading because they are concentrating on the pronunciation of the words. Experts say that there is no way to know for a fact if ELLs tested low in English because of lack of content knowledge, or other factors that interfered with the testing.  

ELLs should receive support until they have the level of proficiency needed to learn in English without any added support.

ELLs with Special Education Needs

• School boards develop a protocol in identifying English Language learners who may need some special educational needs. 
• Although many countries have the same, or almost the same identification systems in place to determine any developmental delays as Ontario, many do not. 
• Ongoing consultations with parents and teachers need to be established as supports for learning. 
• ELLs with exceptionalities need to be identified as soon as possible, so that placement and programming can be arranged.
• Need to have an IEP written up.

References

http://www.eqao.com/
http://www.ssat.org/test/test-levels-elementary