Forensic Corner; About Education
Lee H. Haller, M.D.
0n May 11, 1999, the Department of Education (DOE)
promulgated 275 new regulatory interpretations for the
1997 amendments to the Individuals with Disability Act
(IDEA). This issue's column allows me the opportunity
to: a) let you know about these additions and changes,
b) show where they fit within the context of your practice,
and c) discuss how you can help children obtain these
services.
The complete child and adolescent psychiatrist is able
not only to do assessments and make recommendations
for medication and therapy, but also is adept at recognizing
when environmental changes are warranted. One example
of this type of intervention is the recommendation for
alterations in school programming. However, until the
passage of the Education for All Handicapped Children
Act (EAHCA), there were no specific laws that mandated
that children with handicaps had to receive special
considerations. The scope of EAHCA was broadened by
the subsequent passage of the Rehabilitation Act (of
which section 504 has been particularly relevant for
ADHD children), the IDEA, with amendments, and now this
new set of regulations. All of them describe and define
the rights that children with mental and physical handicaps
have in order to receive specialized educational services.
Although the services are potentially available, the
child will not necessarily receive them because only
children who carry certain diagnoses may receive services,
and school systems are not in the business of diagnosing
handicaps. Therefore, it is incumbent upon us as diagnosticians
and therapists to recognize when special educational
programming is warranted, to make that recommendation
to the parents, and then to follow up by notifying them
that the school system is obligated, by law, to make
educational accommodations for the handicapped.
The EAHCA and IDEA are federal statutes, which mandate
that handicapped children be given accommodations that
allow them to receive an appropriate education. The
laws do not mandate that children receive an optimal
education, but they do mandate that a child must receive
a free, appropriate, and minimally adequate one.
Although the laws have mandated the provision of services,
they have not covered all situations. To receive these
supportive services, a child must first be designated
as having a handicapping condition. This finding must
comport with educational regulations, which may not
necessarily be the same as carrying a DSM diagnosis.
As with many laws and regulations, ambiguities exist
which require clarification. Sometimes, resolution has
been achieved through litigation. Other times, the appropriate
government agency (in this case the Department of Education)
will issue regulations that clarify areas that are vague,
such as has recently occurred.
The new regulations have eliminated some of the gaps
that existed. For example, Attention Deficit Disorder
had not been covered as a handicapping condition, specifically.
Although services had sometimes been available under
Section 504 of the Rehabilitation Act, the new IDEA
regulations now specifically list ADD and ADHD. This
clarification of the regulations should help those children.
Children with autism have been covered under the IDEA,
but only if their symptoms were evident before age three.
The new regulations expand this to cover those children
whose diagnosis of autism is only made after the age
of three. Before children can receive special educational
services, the parent, as legal guardian, must give consent.
Previously, children living with foster parents could
be denied services because foster parents were not specifically
authorized to act on behalf of the child. The new regulations
allow foster parents this authority.
In regard to school suspensions, the prior status had
been that a child could be suspended for 10 days or
less without such suspension constituting a "change
of placement," which would therefore trigger the need
for a revised education plan. The new regulations dictate
that if the child is going to be removed for more than
10 days in one school year, then an individual education
placement (lEP) team must either review existing behavioral
plans and/or develop such a plan. The objective is to
prevent future problems as well as to address causes
for the disruptive behavior. Additionally, the new regulations
re-emphasize that children may not be suspended (for
more than 10 days) or expelled for behavior that is
a manifestation of their disability.
School systems may balk at providing an intensity of
service that is sufficient. You can assist patients
by making the parents aware that once services are recommended
for the child, they should be available through the
local public school system. Give the parents an idea
of how to approach the school to ask for special services.
Make them aware that the use of an educational advocate
or even an attorney may be necessary in order to achieve
their goal. When you give this information along with
your other recommendations, you are increasing the likelihood
that your patient will benefit from your input.
Dr. Haller is in the private practice of forensic psychiatry
in Potomac, Maryland
AACAP
News/September-October1999 |
