Monday, August 10, 2009

A subjective conversation about the issue of grade retention

My occupational therapy practice is sometimes as much about parents as it is about children - and in fact the two are so intertwined that making the distinction is irrelevant. We get questions all the time about parenting decisions - and as these are directly related to both parenting and childhood occupations we try to help. Summertime is famous for conversations about retention.

I have read all the studies - but won't list them here because they may not apply. Still, the studies state that there is sometimes temporary/immediate benefit to grade retention but that those benefits disappear in subsequent years.

The problem with the studies is that they are done on such a large and heterogeneous group that it is difficult to say exactly who these results apply to. Parents and teachers and administrators get lost in the issue because they inject all kinds of ancillary concerns including
  • what will it mean if he is the physically largest child in the class?
  • is it true that the extra year will allow him to be more 'developmentally mature?'
  • our district does/does not have a retention policy so we don't do it that way
  • at the cost of $xxxxx.xx to educate a child who has a disability each year, we can't afford retention!
Clearly this is an example where large population research needs to be honed down and we need to look at practices on individual district levels. It would be more accurate for a district to conduct internal studies using consistent curriculum and early intervention/remediation/special education practices. That would allow for a valid basis of comparison between retained and non-retained students.

Parents ask me about retention all the time - and I usually shrug my shoulders. There does not seem to be evidence that can universally apply to all children. In general, I fall back to the basic idea that 'developmental readiness' may or may not be a valid concept because there is no way to measure such a construct. Is it possible that 'developmental readiness' is a smokescreen term to hide our lack of attention to specific individual or curriculum based factors?

That leaves us to curriculum or educational methodology (which includes remediation and special education). It certainly makes no sense to retain if we are going to deliver the same curriculum a second year! Rather, a best-practice approach should include intensive case-study to determine the individual factors that contribute to lack of progress and then educational planning based on those individual factors. I believe that this is the best approach to take until we see district-based outcome studies.

I am not sure how soon we will see this - because although we have Individualized Education Plans it is also true that we create curriculum and hope that all the children will fit inside our creations. Curriculum is efficient - but perhaps is a poor way to consider best-practice when administering special education. Is it enough for us to develop special-case curriculum and try to fit as many pegs as possible into the holes we drill? This ultimately boils back down to an issue of resource allocation. Just how far are we willing to go to deliver truly individualized education - and what can we actually afford?

Perhaps it is wrong for us to call it individualized? Would we be willing to admit that it is not?

I sometimes think that if we answered this question that we could begin to have a real conversation about the value of retention.

Thursday, August 06, 2009

tree frogs and coming to grips with a diagnosis of autism

I saw Jason today whose family has not yet acknowledged his autism. They will soon, as society will not allow them to continue explaining away his stereotypical behaviors for much longer. For now, from the perspective of his family, "he loves to jump and wave his hands!" and "he just doesn't like to talk much." and "he loves rocking in that rocking chair!"

It is all fine; it is not my job to cram some doctor's provisional diagnosis down the family's throats. I don't even pretend to know how difficult it must be for parents to come to this kind of acceptance - but I frequently see how long it takes to get there so I can imagine that it is not an easy path to walk along.

Anyway, I was intrigued today while I was listening to his grandmother make many assumptions about Jason's behavior. Jason walked near the refrigerator and the grandmother interpreted this as him wanting a bottle because she believes that he is emotionally regressing since the baby brother was born. It was a complex set of assumptions tied to the simple act of walking through the kitchen.

When he walked out of the kitchen the grandmother perceived that he was mad because he didn't get what he wanted. It is possible that she was correct but there is no reason to believe that her interpretation was correct. It was all created perception, and there was no external reality to support the perception. Again, it was all fine - but the complexity of her interpretation based on limited facts was intriguing.

As I drove home I realized that this was very similar to an article that I read about tree frogs. The author hypothesized that they urinated before they jumped because they were "afraid" of large predators (as if frogs pee their pants when they are scared??). The more appropriate explanation is that the frogs urinate because they lose a significant amount of weight and frogs that urinate before they jump are able to jump farther, thereby giving themselves a significant survival advantage.

The author was guilty of the same anthropomorphism as Jason's grandmother. As humans we have a tendency to interpret all kinds of behavior as cognitively purposeful when indeed it may not be. I am in no way suggesting that Jason is cognitively equivalent to a tree frog; rather, I would just point it out that the grandmother's interpretations of his behavior fall into the same category of fuzzy logic as the author that attributes the emotion of 'fear' to a frog.

Perhaps in the absence of data it is easy for us to 'fill in' information that is consistent with our own cultural beliefs or world view. This is an adaptive mechanism for people who need to make sense out of their experiences. There is no externally valid 'sense' to a child having autism, so this kind of emotional 'closure' most likely serves as an important short term survival function.

Tuesday, August 04, 2009

Reforming funding for school-based special education - at the point of a gun

Nearly three years ago I offered to work for NYS for free to help tackle the problems of Medicaid fraud for special education services (see http://abctherapeutics.blogspot.com/2006/06/new-york-states-medicaid-problem-in.html). The system needs reform badly - and although I never expected to be asked to serve I was actually quite sincere in my concern and desire to effect some improvement in the system.

As I predicted back then, there would eventually come a day of reckoning to pay for the fraud and abuse - and it seems that we are at that day. In today's Albany Times Union, reporter James M. Odato informs us that the New York State Education Department is withholding Medicaid payments to school districts in accordance with a settlement agreement that has NY State paying out hundreds of millions of dollars back to the federal government.

Also as predicted, this leaves school districts in quite a pickle - because they are still mandated to provide these services by law - and now the burden for payment may fall to local districts - which equates to higher taxes for all.

I have always viewed opportunities and threats the same - both require action. I think that this particular situation provides an opportunity for districts to begin looking at their models of service provision and see how to provide services more efficiently. That includes setting appropriate entrance and exit criteria for related services, adopting evidence-based or RTI-type models for educational intervention, and improving team building to ensure that services are reinforced in a transdisciplinary way throughout the curriculum. All of these strategies would help improve the efficiency and also the quality of special education services.

Professionals also have new opportunities to improve focus on school-home carryover. Parent involvement is critical for positive educational outcomes and may be the largest underutilized resource in the special education equation.

Because I am inherently cynical I understand fully how someone might think that I am speaking code for decreasing related services and abdicating responsibility to parents - but I am not. I am talking about an open dialogue about educational best practices and establishing responsible and defensible criteria points for intervention. We have had too many years of poor oversight, lack of accountability, and variable interpretation of special education regulations.

Reform is hard but reform can be good when it is done correctly. Reform should not be driven by some perceived benefit of political expediency or in satisfaction of legal settlements. Our special education system and its funding mechanism is broken and now we have a real chance to improve.

Will we make the most of this opportunity?