Comments from the NEUROLOGIST,
A 13-year-old boy "Ralph" and his parents came to see me because Ralph is calling his mom names at home, refusing to help with chores around the house, and is disrespectful of the teachers at school.
He has an IEP. He has been diagnosed with ADHD and is on methylphenidate in the AM, at a reasonable dose for his weight, but this doesn’t seem to be doing the trick. He is not finishing homework, or finishing it and forgetting to hand it in, or it is done in a sloppy manner. He said he felt “life stinks” with school and friends. When his history teacher said this work will not be accepted if it comes in so sloppy, he waited until he thought the teacher was far enough away and then made a gesture that is not acceptable in school. The teacher sent him to the principal. This is the second time that this has happened.
Mom is upset because she got a call from the principal that if he made that gesture again toward a teacher, he would be suspended. His parents wanted to know if there is anything else a neurologist can do?
The answer is yes.
We would change to a longer lasting stimulant, one of the newer stimulants that have a longer span. We would also often use a second medication that treats depression or anxiety if this fit the description of the student’s life and if he tested positive on written tests for depression and anxiety. I also would talk over the need for a referral to a psychologist to make sure depression is not getting increasingly out of control.
Comments from the ATTORNEY,
The most important issue is changing Ralph’s behavior. Mom has to write to the school, tell them what the problem is, and ask that the IEP team (which includes the parents) meet so that Ralph’s IEP can be modified. The IEP and the school in implementing it have to be able to deal with Ralph’s behavior problems. If a child’s behavior “impedes the child’s learning or the learning of other children” the IEP team must “consider the use of positive behavioral interventions and supports, and other strategies, to address that behavior.”
Don’t forget not only is it necessary to develop a Positive Intervention Plan, but the school must follow this plan.
In order to develop appropriate strategies and a plan it is first necessary to know as best as possible what is causing the behavior problems. This is where a “functional behavioral assessment” comes in. The purpose of this assessment is to determine the cause, or “function” of the behavior: Why is Ralph behaving the way he is? Is it to get attention? Determining the cause(s) of the behavior is essential to developing an appropriate behavioral intervention plan. There are different ways or combinations of ways to perform this assessment; but that can wait for another day.
Other related issues, which will be discussed in a future blog post, include:
If this does happen again and the child is to be suspended or expelled from the school (s)he is first entitled to a “Manifestation” hearing. Was the behavior a manifestation of, or caused by, the disability? If the behavior is a manifestation of the child’s disability, the consequences for the behavior will very likely be different than if it is not.
