Multiple Disabilities

Multiple Disabilities

 Group Members:

Cindy 

Melissa 

Brianne

I. Eligibility Criteria 

    A- Criteria for multiple disabilities designation:

       i. Presence of two or more lifelong disabilities (excluding being deaf-blind)

       ii. Disabilities disrupt the ability to function independently

       iii. At least one of the disabilities affects cognition significantly

       iv. It is hard to figure out which disability is negatively impacting school performance the most

       v. Eligibility is determined by the student’s case conference committee based on information gathered from:

                   1. Cognitive assessment

                   2. Current school performance

                   3. Social and developmental history (including communication skills)

                   4. Observation

                   5. Medical case history

                   6. Any additional information that helps to determine the student’s needs

    B- Critique

                       The requirements state that cognitive assessment is necessary to determine the student’s current academic performance. It is required that a norm-referenced test be administered however, if one cannot be administered the team is allowed to provide a criterion referenced assessment. This will allow the team to assess the child with a different test if they are unable to gather enough information using the norm-referenced test. Norm-referenced tests allow the SLP to compare the child to others (standardized assessment) while criterion-referenced identifies what an individual can and cannot do compared to a certain criterion. The team may not be able to compare the child to others and therefore the use of criterion-referenced tests may be more appropriate in certain cases. The team also has the option to use functional skills or adaptive behavior from various sources.  It is imperative that we get information about the child from all members of the multidisciplinary team in order to truly know the child’s skills/abilities to determine the child’s needs.  The guidelines also state that the team is required to observe the child in various settings (e.g. school, home, etc.). This will allow the team to observe how the multiple disabilities affects the student’s academic life as well as his/her daily activities outside of school. The guidelines state that in order to be eligible for services, the child’s disabilities must impact ability to function independently. The speech language pathologist and the other members of the multidisciplinary team can determine how the multiple disabilities are impacting the child through observation, assessment, and case history.  The multidisciplinary team also gathers information about the child’s social interaction skills and communication skills, which can impact all aspects of the child’s life. Overall, the requirements for eligibility will provide the team with a good understanding of the child’s skills and abilities as well as what the child needs in terms of services and support in an academic setting.

II- Eligibility Project – Case Study Example

    A. Description: The client that we chose is 12 year old diagnosed with moderate to severe disfluencies. Based on Indiana’s eligibility criteria for speech and language services in the schools, he is eligible to receive services because he presents with a speech impairment (fluency) that is affecting his everyday communication. This includes his ability to communicate with unfamiliar listeners, interact with school personnel and social interactions with peers. Also he meets the criteria because his disfluencies are non maturational in nature and not as a result of dialectal differences or because English is not his first language. After a fluency assessment was conducted (SSI-3), an attitude towards stuttering questionnaire was provided, and a social developmental history was gathered,  it was found that the client’s disfluencies ranged from moderate to severe and affected significantly his communication skills in school, social interactions with peers, and performance in school particularly with oral reading tasks, thus he is eligible to receive services at school. All the procedures, assessments and observations were conducted by a member of the multidisciplinary team (the school’s SLP) for a decision to be made.

     B. Critique of speech/language criteria used:

                       The eligibility requirements used to qualify this individual for services have both strengths and weaknesses.  In terms of strengths, the guidelines make sure to specify that dialectic differences and having a non-English first language are not grounds for service provision.  In Social Factors this Spring, we discussed how children speaking speaking non-standard English (e.g., African American English) are more at-risk for being misdiagnosed as having communication problems, so the inclusion of this criteria shows an awareness of this potential misstep and the necessity of its examination in the qualification process.  Additionally, the eligibility criteria also specify that at least one observation of the student’s speech must be made by a speech and language pathologist.  It is beneficial to us as practitioners to be explicitly mentioned as a vital part of the assessment team.  It ensures that someone with expertise in speech and language is able to interpret communication behaviors with a clinical understanding.  Lastly, a range of assessments are necessary for the diagnosis of any speech and language disorder. The breadth of assessment areas for fluency include both traditional fluency measures as well as supplemental measures including oral motor evaluations and an examination of social interaction skills.  This will benefit the development of the service plan as decision-makers will be working with a more complete understanding of the extent and impact of disfluency on the child.  The social ramifications for a speech disorder such as this must not be overlooked, and the requirements support this.  

                       Some clarification would improve these guidelines for the diagnosis of fluency issues.  The criteria state that speech and language disorders must be non-maturational in nature.  However, certain fluency disorders such as childhood stuttering have been shown to improve with age.  How does this impact eligibility?     Also, it is important to consider that the word “fluency” means something different to a speech pathologist versus a teacher.  The concept should be further described to ensure that eligibility in this area is not sought for reading issues but rather fluency disorders like stuttering.  The user-friendliness of this document could be improved by separating language impairment and speech impairment into two distinct categories.  Currently, the eligibility requirements for speech and language are written separately at some parts but are addressed as one classification in others, which may lead to misunderstandings of the requirements for someone who does not come from a background that differentiates language and speech.  Overall, however, we feel that the eligibility requirements pertaining to fluency attempt to provide members of the committee with a well rounded understanding of the case and the child’s potential to benefit from services.