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Last year, I was involved in a multidisciplinary team (MDT) meeting to determine eligibility for one of the clients on my caseload.
I’ve written about this child’s background and history before, but I’ll summarize it here. The child in question is now 6 years old and in first grade. He was born at approximately 36 weeks gestation and tested positive for a variety of drugs and alcohol at birth. He was removed immediately from his birth mother’s custody. He spent a month in the NICU detoxing from the drugs in his system and then went home with his adoptive parents. His adoptive family is a wonderful blend of cultures and backgrounds.
He was followed by early intervention services until the age of 3. I wish I could blame the rest of the story on the pandemic, but I can’t. In my community, the local school district “loses” track of a lot of kids with special needs when they age out of early intervention. My client was one of those, although he did turn 3 during the height of the pandemic. His parents placed him in a variety of daycare and private preschool settings until he was about to turn 5 and enter kindergarten.
I began working with this client when he was 4 years old. I strongly encouraged the family to contact the local school district’s Child Find program to have their son evaluated for an IEP prior to kindergarten entry. They were able to get an appointment for an evaluation for special education for him in May before school started in August. At the time, my client was receiving home-based occupational and physical therapy in addition to home-based speech-language therapy.
When the parents reported back that Child Find had found my client to not be eligible for an IEP, the OT and I were floored. I asked the parents to see the report from Child Find. Despite the fact that my client had performed below the 7th percentile in two different areas evaluated, the Child Find team decided to take no action. Per the parents, the Child Find team told them during the evaluation that they did not often see children like their son in their offices. The Child Find team told the family they were used to working with children with severe disabilities.
Let me remind you this was in Spring 2022.
This client began kindergarten in a magnet school program. I tried my best to persuade his mom to enroll him at his neighborhood elementary school. She met with the principal and assigned teacher from the magnet school prior to the start of the year in Fall 2022. They assured her they could work with her son.
They couldn’t.
The MDT initially refused my client’s mother’s written request for a special education evaluation that she made on the first day of school in August 2022. They did at least wait the 15 calendar days they are allotted under federal law, but they refused her request despite my client’s escalating behavior in the classroom. Exactly one week later, an incident occurred involving my client that could no longer be ignored. Because there was no IEP in place to deal with his escalating behavior, my client was suspended for one day. He was suspended for a Thursday. The parents met with the principal, teacher, and school psychologist on that Friday and again requested an evaluation for special education. Per their report, they disclosed their son’s medical and developmental histories to the women in the room and that all of the women made their own notes. This time, because the teacher had concerns at this point, the request for a special education evaluation was granted.
“Karen-ism” at its Finest: MDT Meeting Edition, Fall 2022
The initial MDT meeting was held in late Fall 2022. The special education evaluation was conducted by the school psychologist (a direct district employee), the contracted speech-language pathologist, and a special education teacher. These individuals attended the meeting as well as the classroom teacher and a facilitator (administrator) from the district who served as the LEA representative. A nurse had contacted my client’s mother to ask about his current health status, but did not ask questions about his medical or developmental histories. The nurse did not attend the meeting, but did contribute to the MDT report. All of the school employees present were white/mainstream culture.
I attend a lot of IEP-related meetings with the families on my caseload. I do this on my own time. While I’m happy to do what I can to support the families I work with, I really should not have to attend this many IEP meetings. It’s the district and the behavior of their employees (both direct and contract) that make the families so wary and anxious of going to these meetings without support. I would feel the same way if I was in their shoes.
This MDT meeting began the way they all do. The evaluators went over their report. In this case, it was just one report compiled by the school psychologist. The issues started immediately. There was no mention of this child’s birth or developmental history in the background section. They did at least mention that he lived at home with his adoptive parents – a substantial improvement over the Child Find report where that information was not included until the last paragraph of the document. I asked why the information about the child’s developmental history was not included in the report. The psychologist reported she was not aware of his background despite having been present at the meeting following the child’s one-day suspension. His parents quickly reviewed his developmental history for the MDT and I asked that the report be amended to include that information. The team grudgingly agreed to make the amendment to the report.
By the end of the report introduction, it became immediately clear that the MDT was making a case to find the child eligible for special education under the category of autism.
The testing they administered included some stock early preschool- and school-age language testing and a behavioral checklist completed by the parents and the classroom teacher that covered a variety of behavioral issues. The speech-language testing revealed the presence of a moderate-severe language disorder, exactly what I had diagnosed. The data from behavioral checklists from the family and the classroom teacher was wildly different, a fact which was glossed over by the school psychologist. The GARS, CARS, and/or ADOS-2 were not administered by the MDT as part of determining an educational diagnosis of autism. When I asked why none of these protocols were given when the MDT was considering eligibility under the category of autism, the psychologist replied that no one on the team was certified to administer them.
As luck would have it, I am certified in administration of the ADOS-2. I’m quite familiar with it and the questions that are asked of examinees across the different modules. I know what behaviors protocols like the ADOS-2 look for in determining whether or not someone has autism. I also know what severe developmental language disorder looks like. I also have experience with clients who have been prenatally exposed to drugs and alcohol. There are behaviors that overlap across these disorder types. Differential diagnosis can be challenging. And, it is possible to have two or even all three disorders.
The MDT team finished reporting their findings and stated that, as a team, they were in agreement that my client be found eligible for an IEP under the category of autism. My client was 5 years old at the time. It would have been possible and appropriate for the team to consider eligibility under the category of developmental delay and reconvene in Spring 2023 after considering the client’s medical and developmental histories. I suggested the team consider the possibility of doing so.
My suggestion was immediately dismissed by the school-based members of the team. It was at this point that the contracted speech-language pathologist spoke up. She said the MDT was only prepared to grant an IEP with eligibility under the category of autism. She said and I quote, “It’s autism or nothing.” She was backed up in a more polite way by the school psychologist. The family was told the only way forward was to accept eligibility under the category of autism. The facilitator spoke up and told the family that the eligibility category did not really matter, that the district did not base placement decisions on the child’s eligibility category.
Maybe the eligibility category did not matter to these Karens, but it definitely did to the family.
I was there, but even I cannot imagine what it must have felt like to be the parents in this situation. Can you imagine being told that your child could only have access to special education if you agreed they had autism? And this, after being told twice by the same district that they did not share your concerns about your child’s development?
See why I get asked to go to a lot of IEP meetings?
At this point, I asked the facilitator to explain the independent education evaluation (IEE) process to the parents if the MDT was not willing to consider finding the child eligible under the category of developmental delay and reconvening in the spring before he turned 6 years old. I stated that because the team had not considered the client’s medical and developmental histories in their determination of eligibility and that the family disagreed with the eligibility category for the IEP, I wanted the parents to know their rights in this situation.
The facilitator explained the process. The mom immediately said she wanted to pursue an IEE.
The actual initial IEP meeting was scheduled for a week later. In the interest of full disclosure, the IEP document developed at the second meeting was a solid plan that addressed the child’s needs in the school environment.
However, I continue to be shocked by the behavior of some of both contracted and direct employees of the local school district. I continue to be shocked and appalled at the way they behave in front of their direct administrators. I continue to be appalled at the way some of these Kens and Karens talk to families. I can only think that, at some point, the shoe will be on the other foot and they will have to experience someone treating them or their family the same way. Maybe then they will change their behavior.
The IEE, Fall 2023
Following the MDT meeting, my client’s mom formally requested an IEE from the school district. I helped her write the request, making sure to indicate that the MDT had not considered the child’s medical and developmental histories in their determination of eligibility. The way they chose to amend the original report (by adding only a paragraph and stating the changes were only made at my request) added to the family’s case. The district’s director of psychological services immediately granted the request and agreed that the family had the right to pursue an IEE at the district’s expense within one calendar year.
I’m reasonably sure the district is well aware of the shortage of practitioners in our area. The evaluators have waiting lists of 2-3 years. Yes, years. But, this mom was determined. She kept calling and was able to schedule an IEE with the leading developmental psychologist in the area. The IEE took place this week.
Clearly, I don’t have a copy of the report yet. But, per the family, autism spectrum disorder was immediately ruled out. The developmental psychologist wants to conduct some additional testing to more definitively determine whether the child presents with fetal alcohol syndrome disorder (FASD) and/or ADHD. But, not autism. The developmental psychologist who conducted the IEE administered the ADOS-2, the gold standard protocol in terms of diagnosing autism spectrum disorder.
We’ll have to have another IEP meeting when the results are received by the school district. Because the developmental psychologist’s findings will result in a change in eligibility category and that requires the IEP team’s consent.
I had to dispel an interesting rumor for the family this past week. I’m not sure where this rumor originated, but I will see what I can find out. The family had been told by someone else that if the results of the IEE indicated their son did not have autism or ASD, the family would have to pay for the IEE and/or their medical insurance would be billed for the evaluation.
In this case, that is not true. The mom had gone through the proper channels and had her request for the IEE approved by the director of psychological services (in writing) that her son was entitled to the IEE because the school-based MDT did not consider his medical and developmental histories in their evaluation of him. As a result, along with the written letter stating the district granted the family’s request for an IEE, a voucher was sent to pay the independent evaluator up to $2000 for the evaluation if it was completed within one year.
The whole point of an IEE is to have an independent, highly qualified examiner evaluate the child and provide a written report of their findings. It does not matter if the results conflict with either the school district’s or the family’s opinions. As long as the family follows the school district’s policies and procedures for the IEE, the evaluation must be conducted at public expense.
The only situations in which a family must pay out of pocket for an IEE is when 1) the family and the school district have already arrived at the due process hearing point or 2) if the family’s request for the IEE has been declined by the district (with written indication of the reasons for the denial). Neither of those situations applied in this family’s case.
How the Local District Could Have Avoided the Entire Situation
The local school district easily could have saved itself the $2000 cost of the IEE. How? At the time of the initial MDT evaluation and meeting, my client was 5 years old. Working on the presumption that the MDT really did not know about his medical and developmental histories, the MDT could have decided to find him eligible for an IEP under developmental delay, agree to review the new information, conduct additional assessments and evaluations as warranted, and reconvene in the spring semester to review the MDT’s findings. It is absolutely permissible to find a child eligible for an IEP under the category of developmental delay until they turn 6 years old.
At the very least, the MDT members could have considered how their words, their tone, and their behavior would affect the family. This child and the family already had been failed twice by the same district’s evaluation policies: first, by the recommendation that the child not be eligible for an IEP at kindergarten entry despite meeting the criteria of performance below the 7th percentile in two areas evaluated; and second, by the refusal of the school-based MDT to conduct an evaluation before the behavioral incident that required intervention. Can you imagine what it must have felt like for this family who had already been told twice there were no concerns about their son to then be told, “it’s autism or nothing” to be able to access much needed services for their child?
I am not sure why the local district allows its employees and contractors to treat families this way. Keep in mind that both the contracted SLP and the contracted “Ken” special education teacher work for the same district. Both of these incidents have happened with families of differing socioeconomic statuses and have happened within the last 12 months. I’m also not sure why the local district adopts such an adversarial position toward families in general.
Then again, the district has expected its teachers to work without a contract since the beginning of the year. So, maybe the attitude adjustment needs to begin at the highest levels of administration.
Outside The Box 