PRESIDENT\'S COMMISSION ON SPECIAL EDUCATION

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ASSESSMENT AND IDENTIFICATION

TASK FORCE HEARING

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Courtroom of Borough Hall

Brooklyn, New York

Tuesday, April 16, 2002

8:10 a.m.

APPEARANCES:

CHAIRMAN JACK FLETCHER

COMMISSIONER ADELA ACOSTA

COMMISSIONER TERRY BRANDSTAD

COMMISSIONER ALAN COULTER

COMMISSIONER FLOYD FLAKE

COMMISSIONER NANCY GRASNICK

COMMISSIONER C. TODD JONES

COMMISSIONER BOB PASTERNACK

COMMISSIONER MICHAEL RIVAS

COMMISSIONER CHERIE TAKEMOTO

COMMISSIONER KATIE WRIGHT

P R O C E E D I N G S

DR. FLETCHER: We will begin with a

welcome from Brooklyn Borough President Marty

Markowitz.

MR. MARKOWITZ: Thank you very much.

I am sorry about the heat. Who would expect on

April 16th the weather we have been having the last

few days. We are at the mercy of the building

across the street, when they put it on, that\'s when

we get air conditioning. We will, hopefully, try

to make it as comfortable possible.

May I welcome you to Brooklyn, USA, the

heart of America. Good morning, Chairman Fletcher

and the members of the President\'s Commission on

Excellence in Special Education.

There is perhaps nothing more important

than ensuring that children with disabilities are

afforded every opportunity to receive a high

quality level education. Educating all students

including those with disabilities is the key goal

of New York City Public School System. In recent

years the system has undertaken important reforms

in the delivery system for its disabled students.

These reforms embrace the Individuals with

Disabilities Education Act which emphasizes that

students with disabilities shall be held to similar

standards as their nondisabled peers in the least

restrictive environment to suit each student

needs.

I applaud the Central Mission Study

comprised by the President\'s Commission on Special

Education programs with the goal of recommending

policies to improve special education services

throughout America. I am confident today\'s panel

of expert witnesses will provide useful testimony

and guidance to enhance current conversation on

ideas for reauthorization. I also believe their

insights will ultimately serve as a basis for the

Commission\'s final recommendation to President Bush

on ways to strengthen, even improve, special

education in the nation\'s public schools.

Thank you again for coming to Brooklyn

and for your tireless efforts in the important area

of public education policies. Thank you.

DR. FLETCHER: Thank you, Mr.

Markowitz. We very much appreciate the opportunity

to be with the citizens of New York in this

wonderful facility, air conditioning or no air

conditioning.

I am Jack Fletcher, I am the Chair of

the Assessment and Identification Task Force of the

President\'s Commission on Excellence in Special

Education, and I welcome you all to our meeting.

The focus of hearing today is the identification of

children with high incidence disabilities.

Before we get started, I want to

briefly describe to you the mission and activities

of the Commission. President Bush established this

Commission last October to collect information and

to study issues related to federal, state and local

special education programs. The Commission\'s

ultimate goal is to recommend policies to improve

the educational performance of students with

disabilities so that no child will be left behind.

The no child left behind message has become a

familiar and important one. It is the guiding

principle of the newly reauthorized Elementary and

Secondary Education Act that now comes into play

with the work of this Commission.

Why? Because children with

disabilities are at the greatest risk of being left

behind. The Commission\'s work is not designed to

replace the upcoming Congressional reauthorization

of the Individuals with Disabilities Education Act,

but rather, the report we produce and issue this

summer will not only provide vital input into the

reauthorization process, but also to the national

debate on how to best educate all children.

The Commission and this Task Force has

held hearings in Houston, in Denver, Des Moines,

Los Angeles and Coral Gables, Florida. We have

looked at issues such as parental involvement,

teaching quality, accountability, research and

funding and cost effectiveness. Our topic today is

a very important one. Effective identification of

children with high incidence disabilities is one of

the most complex issues in special education.

While some children are overidentified or

misidentified for special education services due to

racial, cultural or linguistic factors, other

students who need services are not identified.

In order for our public schools to

truly serve all students and ensure that no child

will be left behind, we have to develop better

methods of screening and identifying high children

with incidence of disabilities. African‑American

students, in particular, are more likely to be

overidentified with high incidence of disabilities,

for example, while African‑American students

represent 16 percent of public school enrollments,

they constitute 21 percent of the total enrollments

in special education. Some school systems have

recently taken important steps to improve

identification of students.

Here in New York City, the Board of

Education and the U.S. Department of Education

reached agreement in 1997 allowing the City\'s

school system to significantly reduce the number of

inappropriate and disproportionate referrals of

African‑Americans, Hispanics and English‑deficient

students student. The schools did this through the

increased use of remedial and pre‑referral

intervention programs. The U.S. Department of

Education Office of Civil Rights is awaiting

further data from the Board to confirm the success

of these programs.

Educators and parents need to be aware

and understand the range of factors that influence

identification. These factors include teachers

training, teachers referral practices, funding,

parents educational levels, household income, race,

class size, the categories of services as defined

by IDAE, crime rates in schools and urban, suburban

and rural environments. This an outcome‑oriented

Commission that is eager to hear from you. We need

your suggestions. Tell us about what works.

We will have a public comment period

this afternoon to ensure that you have a chance to

provide us with input. If you want to provide more

input, we are open to cards and letters and

e‑mails. Thank you for your interest in our work.

We will now begin today\'s hearing.

The first witness is Dr. Harold Levy,

the Chancellor of the New York City schools, who

will testify about the experience of the system in

1998 OCR Agreement for subsequent reduction in

over‑referrals of minority students in special

education. On May 17, 2000, the Board of

Education of the City of New York unanimously voted

to appoint Harold O. Levy as Chancellor. Mr. Levy,

a corporate attorney and a proud alumnus of the New

York City Public School System has served as an

Interim Chancellor since January 2000.

Mr. Levy has a long and distinguished

career. Prior to his appointment as Chancellor, he

served as Director of Local Compliance for Citi

Group, and he was also an appellate attorney at the

U.S. Department of Justice Civil Rights Division

and was affiliated with the New York law office of

Skadden Arps, et al. Mr. Levy has devoted much

time and energy to education, particularly the New

York City Public School System. In 1995, he was

asked by the Chancellor of the New York City

schools to serve as Chairman of the Commission on

School Maintenance and Facilities Reform. In March

1997, he was elected by the New York State

Legislature to serve as a member of the Board of

Regents. The Commission looks forward to Mr.

Levy\'s testimony.

Mr. Levy.

MR. LEVY: Thank you, Chairman

Fletcher.

Good morning, ladies and gentlemen. I

had the privilege of being with you, as some may

recall, in Houston, and enjoyed that very much. I

think I got to understand while I was there a sense

of what your business is and the seriousness of

your purpose. I, accordingly, have tailored my

remarks to make very specific recommendations so

that they may be considered as you write your

report.

I want to thank you for the opportunity

to discuss the important issue of special education

with you. As head of the largest school system in

the country, I hope that our experience will be

useful to the Commission and to the school

districts facing many of the same issues. New York

City, as you know, has budget of between 11 and 12

billion dollars. We have 1,100,000 children in the

system.

The next‑largest systems, Chicago and

Los Angeles, have 600,000 and 400,000, so the New

York City system is by leaps and bounds the

largest. What you will see is that the problems

that arise in any of these federal programs tend to

arise more pointedly here and tend to be more

visible. The Individuals with Disabilities Act,

the IDEA, has helped to provide a high quality

education for literally thousands of disabled

children in New York City and should be praised for

many of its accomplishments.

Let\'s me also say that I have a

personal interest in this for the reason that I had

a sister who was in the New York City School System

before the IDEA; indeed, before many of the special

ed improvements that have taken place. She died

before I was born of polio. And the less than

tender mercies of the New York City School System

were something that my family lived with as a scar

for many years, so this is an area that I feel a

personal ‑‑ a strong personal view on. I think the

IDEA has raised the level, the quality of education

for children who otherwise would not have had a

chance, and has done truly important work.

However, I am equally passionate about where it has

not served the educational interests of disabled

students well and where it needs to be reexamined.

The IDEA secured services for students

with disabilities where previously no such

guarantee existed. Having ensured the provision of

services, it refocused on the location of those

services in the least restrictive environment.

IDEA has been overwhelmingly successful; however,

there are some negative consequences that I think

should be addressed in the upcoming

reauthorization. I want to make clear that I

support the statute, that I think it is a strong

statute, and that what we are talking about today

are areas of improvement.

Let me begin. First, the criteria for

determining the existence of a disability are

inadequate within the current IDEA framework, and

in my judgment, contribute to misidentification and

overrepresentation. The reauthorization must

address more rigorous eligibility criteria.

IDEA has led to an ever increasing

percentage of students being classified as

disabled. The structure of IDEA provided powerful

incentives to schools to classify students as

disabled as a means of securing increased funding.

In their quest to access additional revenues,

school districts created overly broad criteria for

eligibility for special ed services. This resulted

in the segregation of many low performing students

in special education classes. Additionally, some

enterprising parents have taken advantage of minor

procedural flaws within the system in order to

secure special education services in private

schools.

There are a number of areas of

disability that are clear‑cut, often medically

diagnosed and the subject of clinical subjectivity.

For example, there is the far less clinical

judgment involved in determination of deafness,

blindness, orthopedic impairment, autism than in

such areas as learning disability and emotional

disturbance, LD and ED. It is no surprise that the

vast majority of students classified as disabled

are those are with relatively mild disabilities or,

indeed, the subject of subjective clinical

judgments and would, I believe, be better served by

intervention and prevention programs in general

education.

To address misidentification, we have

adopted the application of rigorous eligibility

criteria for classification as learning disabled

and emotionally disturbed. Two classifications

there were often broadly defined and resulted in

overrepresentation. Currently learning disabled

represents approximately 49.4 percent, and ED,

emotionally disturbed, represents 12.6 percent of

the entire special ed population.

While IDEA regulations state that the

term \"emotionally disturbed\" does not apply to

children who are socially maladjusted, there

appears to be a predisposition in the law to

classifying students who exhibit any social

maladjustment. While 85 or 86 percent of our

entire school population is minority, 89 percent of

students classified as emotionally disturbed are

minority. For example, we have students who have

exhibited behaviors that included destroying school

property, fighting, violence tendencies or

substance abuse who are increasingly being labeled

emotionally disturbed. In many cases, the

Committee on Special Education\'s determination that

the student is not emotionally disturbed is

overturned in the due process hearing.

In New York City, our programs that

serve severely emotionally disturbed students,

known as SIE VII and SIE VIII ‑‑ the SIE stands for

Specialized Instructional Environments ‑‑ provide

highly intensive management and supervision, crisis

intervention and guidance services. The number of

students attending these programs has increased by

24 percent in the last three years alone and now

stands at almost 8,000 students.

I welcome Reverend Flake. We need the

home team represented.

There is a thin line between social

maladjustment and emotional disturbance. With the

increase of students with acting‑out behaviors

being overidentified as emotionally disturbed, I

have made creating a safe and orderly school a top

priority. My own initiatives, combined with the

requirements of the state\'s Safe Schools Against

Violence in Education Act, so‑called SAVE Act,

adopted in June 2000, which I supported, provide a

framework that ensures that each school will have

an optimal place for teaching and learning.

Let me pause to say that the state\'s

SAVE Act allows teachers to remove children from

their classroom, although not suspend them. After

repeated removals, suspension is required. The

combination of having the SAVE Act and the

initiatives I have taken, which I will describe, is

an attempt to promote a safe and orderly

environment, but there is an inherent tension here

with the special ed requirements themselves.

I have redesigned and expanded our

second opportunity schools, the so‑called SOS

schools. We now have three Second Opportunity

Schools that serve middle school and high school

students whose violent and antisocial behavior

resulted in being suspended from their regular

school programs. SOS programs have been developed

in collaboration with community‑based organizations

such as one of the settlement houses such as The

Door, Wild Cat Academy, all very well respected

organizations within the New York City community‑

based organization community. They have unique

expertise and experience in serving socially

maladjusted students. Currently, 242 students are

in our SOS schools. We have the capacity to serve

300 students. We have also expanded our

alternative to suspension programs. These

initiatives are vital to address the growing need

in general education.

The 1997 IDEA amendments in the area of

discipline were clearly intended to provide schools

with greater ability to discipline students who

posed a danger to themselves and others. IDEA

still provides greater protections for classified

students than general education, thereby

contributing to the overidentification.

Let me observe, for example, a child

who, say, intentionally scratches a car, could be

viewed as either ‑‑ that action could be viewed as

either adolescent mischief or evidence of

psychological malady. The categorization which

comes at the time of the due process hearing or of

the CSE, take very different considerations into

account. CSE tends to rely on an overall judgment,

trying to take best interest of the child into

account. The due process hearings have a tendency

to categorize as special ed on the basis of almost

any testimony from someone with the appropriate

credentials. It is very hard ‑‑ let me say it a

different way, it is very hard for someone sitting

as a hearing officer to reject that testimony, and

very easy to accept it. Even when the

determination hinges more on the quality and the

nature of the witness, than it does perhaps on the

quality and the nature of the child\'s problem.

Second recommendation. IDEA should be

amended to allow funding of intervention and

prevention strategies to support students in

general education who are experiencing academic,

social or behavioral difficulties that place them

at risk of referral to special education.

Rather than any particular systemic

bias, I am convinced that overrepresentation is

primarily the result of a lack of intervention

services in the general education environment,

particularly in our poorer schools. During my

tenure as Chancellor, on of my highest priorities

has been to improve instructional and support

programs on a unified, whole school basis. Whole

school approaches create a single, seamless service

delivery system for all students, disabled and

nondisabled alike. They predicated upon the belief

that students are more alike than they are

different and that integrating resources results in

improved student outcomes for all. This strategy

puts an end to what I believe is an unhealthy and

unproductive competition for resources between

general education and special education, where

spending can be three times higher per pupil than

in general education.

Our recently adopted \"Continuum of

Special Education Services\" reflects the input of

teachers, parents and the advocacy community, and

fully embraces these principles. The new

Continuum encourages creativity and flexibility in

the development of instructional programs for

students with disabilities including those with

severe disabilities. It emphasizes intervention

and prevention and instructional strategies and

student supports rather than the labeling of

students. It breaks the definitions that are far

too limiting and prominently features the concept

of least restrictive environment.

We are witnessing gains as a result of

these reforms. Overall, initial referrals to

special education decreased by 27 percent in the

1996‑1997 and 2000‑2001 school years. Between

those two years, we had a 27 percent drop. In

addition, decertifications from special education

during the same time have increased by 43 percent.

Based at least in part upon the initiation of more

objective eligibility criteria, post‑evaluation

acceptance rates into special education have

decreased by 4 percent over the same time period.

Similarly, placements in less restrictive special

education settings have increased by 7 percent

systemwide.

As a consequence of the way IDEA has

been structured, we spent \$2 billion in support of

approximately 145,000 students who are labeled

special education, and only \$1 billion, literally

half the amount, for twice as many children,

296,000, general education high school students.

That\'s a factor of 4, twice the kids, half the

money. This imbalance was not created by choice,

but fostered by our compliance with IDEA. In

addition to being disproportionate, it strikes me

as fundamentally flawed to ignore the special needs

of our general education high school students who

need to be classified as disabled in order to

receive the benefit of the additional financial

support. At its very core, such a process

presupposes that the way to assist and provide

vital educational services to our student

population is after the fact rather than before it

in the form of intervention and prevention and

support services.

As part of Memorandum of Agreement with

the U.S. Department of Education Office of Civil

Rights to address mutual concerns regarding

overidentification, substantial efforts were made

to increase intervention/prevention programs in

general education. The results of those efforts

contributed to our systemwide reduction in

referrals to special ed. There is also powerful

research suggesting that a lack of instructional

and behavioral interventions is a contributing

factors to special education referrals. We are

constrained by the limitations imposed by IDEA.

The legislation must be amended to allow the

discretionary use of funding for whole school

approaches. I firmly believe that this will result

in a reduction of the overidentification.

Now, I want to say very clearly, I

strongly support full funding of IDEA. This is an

extremely important issue for school districts and

this school district in particular. We provide

services to students with severe disabilities that

have extraordinary needs, that often require very

costly services in order for these students fully

to participate in school. I will give you a few

examples that make the point. Currently, we have

six students with disabilities whose recommended

services exceed \$100,000 per year. This compares

with spending an average of approximately \$9,000 on

general education students, \$28,000 on students

classified students educated in the community

school districts, and \$43,000 on classified

students in our most specialized programs in

District 75, the special ed district. Most

recently, for example, just one example, we

modified the windows and lighting of a large

portion of a school building and equipped a vehicle

with state‑of‑the‑art ultraviolet eliminating

materials so that a single student with extreme

light sensitivity could attend an educational

program in a less restrictive environment. If we

are serious about innovative programming, then IDEA

has to provide additional funds. Presently, local

school districts absorb these extraordinary costs

without any additional reimbursement, and that is

unfair to all.

Third recommendation. IDEA must shift

from an emphasis on regulatory compliance to

greater accountability for program improvement and

student outcomes.

While IDEA funding is already limited,

I am deeply concerned that the current emphasis on

regulatory compliance rather than accountability

for student outcomes, diverts preci precious

financial and human resources away from meeting the

actual educational needs of disabled children.

IDEA procedural requirements are often redundant.

The IEP team membership provisions that require the

participation of teachers that are, quote, \"likely\"

to teach the student are counterproductive in large

urban systems. Too often teachers and other staff

are diverted from their primary task of

instruction. This is especially an acute problem

in large cities like New York where school

districts are challenged by a severe shortage of

special education teachers and other qualified

staff.

Even the most basic change in the

student\'s IEP, for instance, requires teachers and

other professionals to be pulled away from their

core duties and spend significant time on largely

administrative items. As a result, an inordinate

amount of special education funding is spent on

administrative compliance. This has resulted in a

reduction in the already limited amount of funding

available for improving instruction and

supplementary services to students. We must simply

existing IDEA procedural requirements and make the

special education process less unwieldy and

complicated. This will provide a greater benefit

to the local school districts and the students they

are committed to serving.

Fourth. IDEA language must be

clarified and strengthened to avoid abuse,

particularly abuse through litigation. I speak now

as somebody who is both a lawyer and someone very

much committed to education reform.

While the intended purpose of IDEA was

to support students with disabilities and assist

them in securing high quality educational services,

and it has done so marvelously, the statute has

also given birth to a cottage industry of attorneys

specializing in this part of the law and has led to

a rapid escalation of law suits against school

districts, especially in the area of the Carter

case tuition reimbursement requests.

Now, I know that you have heard this

before and I know that this is familiar turf, but I

think it is important for us to go through at least

our experience so you that you see how it plays

against some of the smaller districts that I know

you have heard from.

In New York State, as well as

nationwide, litigation of issues through due

process proceedings has increasingly focused on the

procedural aspects of IEP development and minor

technical errors. Procedure is subject to

significant levels of scrutiny, that is gentle way

to phrase it. I have seen some of the hard‑fought

litigation cases take place in these hearing rooms,

and it is a series of pleadings and analytical

descriptions that it becomes hermeneutic, they are

doing careful readings of scripture and text.

That\'s not what it is about, in my judgment, to

help children.

In Carter tuition reimbursement cases,

failure to comply with even minor or nonmandated

procedural details has been leading to decision for

full tuition reimbursement. This is not Miranda,

this is not, you know, we throw the case out if you

make a procedural error. Yet, that has become

entirely too frequently what the hearing officers

do. Clearly, these outcomes were not contemplated

by IDEA.

I will give an example. Parents have

unilaterally abused placed students with substance

abuse problems in highly segregated, residential

settings as far as away Oregon and Maine and have

then requested the New York City school system to

fund the cost of the programs and attendant

transportation under the Carter decision. In such

cases, the students classification is at question.

The system\'s position may be that the student is

demonstrating social or behavioral maladjustment

but not classifiable under the IDEA, and not in

need of so restrictive an environment so far from

home. Yet, a minor technical error in such matters

has resulted in full funding for such a

questionable placement. Funding of such

restrictive settings is the rule, despite least

restrictive environment provisions of the IDEA.

This hallmark of the legislation is generally

disregarded in light of the fait accompli nature of

the parents\' unilateral choice. This result if

often because of a minor, technical error not

resulting in substantial deprivation of a free

appropriate public education. I am not opposed to

a free appropriate public education. I am opposed

to abuse of the system.

In another case, tuition reimbursement

was awarded do to the fact that the student\'s

teacher participated by telephone so she would not

have to leave school and stop teaching. Due to the

fact that the teacher did not have the evaluation

of the student available at the moment when the

call was put through, even though she was

testifying about classroom performance only, full

tuition reimbursement was awarded rather than

remanding the case back to the CSE to convene a new

meeting.

Last year alone, we had 1,240 requests

for Carter tuition reimbursement. Perhaps most

troubling is that 50 percent of the cases, fully 50

percent of the cases, were pursued by parents whose

children have never attended nor plan to enroll in

public school, but see the opportunity for their

child\'s private education to be paid for at public

expense. Carter reimbursement for one year in this

system was over \$13 million. This does not include

substantial personnel and administrative costs.

The Carter issue has created a serious and

increasing financial burden on the school system,

diverting resources from the classroom, and unless

dealt with, will grow.

I am willing to be held accountable if

we are unable to meet the needs of any student with

a disability. This decision, however, must center

on the substance of the child\'s needs and our

capacity to address them, and not on compliance

with procedural technicalities.

Chairman Fletcher, on behalf of the New

York City Public Schools, I want to thank you again

for inviting me to testify and for considering the

record and the needs of our system. I am convinced

that amending the IDEA to be a more flexible,

better funded and less regulatory statute will

assist us in our mission of creating a single,

seamless service delivery system for all students.

I would also like to introduce several

members of my staff who are here whose work and

persistence, and shall I say nagging me to get it

right, has been a great help. Fran Goldstein,

Linda Wernikoff, in particular, have really led the

fight for special ed reform inside the system, and

in my judgment, there are no more true advocates on

behalf of the children.

I would be happy to take any questions,

but I forewarn you, I am going to lean heavily on

them to answer.

DR. FLETCHER: Thank you, Chancellor

Levy, for your testimony. We are going to open for

questions by the Commission, and in order to ensure

that each Commissioner has a chance to ask

questions we are going to start with Commissioner

Acosta and give each person about five minutes to

ask questions. We won\'t let you ask questions for

more than five minutes and if you don\'t have

questions, we will go to the next person.

Ms. Acosta.

COMMISSIONER ACOSTA: Good morning.

Thank you for your testimony, and I am a native New

Yorker, so I am happy to be back home. Little did

I know that when I went to school there I would be

sitting in Borough Hall with such an illustrious

group of fellow New Yorkers. So I thank you for

your testimony.

I just have a couple of questions,

Chancellor, about the SAVE Act. Could you clarify

for me, it sounds to me that all schools should

have an overall schoolwide discipline plan, but is

this something extraordinary?

MR. LEVY: All schools do have a

safety plan, a discipline plan. The State

Legislature this past year, at the urging of the

teachers union, the UFT, and with my support,

passed a law that permits each individual teacher

to remove any child who is disruptive in the

classroom from the classroom for essentially up to

three days. And there is various procedural

safeguards built in, but what it boils down to is

that any teacher can remove a child from his or her

classroom for up to three days. It is not to say

that they can suspend the child, it is not to say

that they can expel the child, but they can remove

the child from the classroom.

So if a child is disruptive, it gives

that teacher a legal authority to say \"You are out

of here.\" I think of it as the kid gets a time

out.

COMMISSIONER ACOSTA: Because it is

legal, is there a time restraint for special

education kids? Is there a certain amount of days

that a special education child can be removed from

the classroom.

MR. LEVY: Is there a different

standard?

I am told that there is not.

COMMISSIONER ACOSTA: There is not.

So if I am a special ed kid in the school and I am

disruptive, I can be taken out of my learning

environment?

MR. LEVY: Fran, why don\'t you answer?

MS. GOLDSTEIN: It is not that we send

them out of the building. We provide them with an

alternative setting within that building with

instructional supports and guidance supports.

MR. LEVY: One of the things I did

early on, indeed, before this statute was enacted,

was I saw having a safe and orderly environment as

being a high priority in the school system and I

concluded that on the basis of the public agenda

polls, on the basis of a poll that we did of all

parents, 10 percent of our parents, it is very

clear that a safe and orderly environment is high

on their priority.

So what I did was I created an

in‑school suspension center. I proposed it to

Mayor Giuliani to fund in every school. In fact,

we funded it so that there is at least one in every

district, and in some districts there is one in

multiple schools. And the idea is that it be a

small environment, that there be teaching that goes

on and there could be all kinds of support

mechanisms for children sent in.

Indeed, in some ways, the way I was

thinking about is children often call out for

attention by acting out, and this would get them a

teacher who is supportive, more attention because

it would be a much smaller classroom setting, and

the idea was that we would get the work assignments

from the regular class sent in, so that two‑to‑one,

four‑to‑one, five‑to‑one setting could work to

benefit the kid and then send them back. That\'s

the model. We haven\'t able fund it near the level

that it should be.

When the SAVE legislation was enacted,

these two came to fit together, so that a teacher

who would say \"I am removing you from my class,\"

would wind up sending the child to that kind of

environment. Now, that\'s a best case.

What has also happened, I regret to

report, is that a teacher would take somebody out

and that that child would simply go to another

teacher\'s class. And that\'s something I have tried

to halt, because that doesn\'t serve the other

teacher, it doesn\'t serve the child, it doesn\'t

serve the first teacher. It gets rid of the kid,

but that\'s not what I want. My theory on this has

been quite simply denying a child an education

should never be used as a form of discipline.

And it is easy to say, I mean, in this

system we don\'t expel kids. As you well know,

there are plenty of systems in the country that do

expel kids. The only time we say enough is when a

child reaches a certain age and acts at, then we

say, \"Okay, that\'s it,\" but that\'s the only point,

when they reach 18 or whatever the age is.

COMMISSIONER ACOSTA: Are there any

special trainings that teachers receive, like staff

development, so that there is ‑‑ you mentioned

earlier that there are socially maladjusted

students who are not emotionally disturbed or don\'t

qualify under IDEA. And I am backing that up with

my question about are there still cases ‑‑ or where

are the cases in New York City school systems where

racially and linguistic minority students are

overidentified and who does the overidentification

‑‑ who does the identification, rather?

MR. LEVY: Do you want to describe the

evaluation process?

DR. FLETCHER: Please introduce

yourself.

MS. GOLDSTEIN: I am Francine

Goldstein, I am the Chief Executive for School

Programs and Support Services for the New York City

School System.

We have a very complex evaluation

system. When a child is referred, the referral

goes to the school principal, either by a parent or

by a teacher. Then there is a committee of

clinicians who are composed of a psychologist, a

social worker and an education evaluator. There is

a social intake with the parent, the child\'s

history is taken, and then there is a battery of

tests if they deem that this child needs to go

through the battery of tests.

For a child who is not English

speaking, in many cases, they receive the battery

of tests in their native language. Then there is a

determination made on the eligibility. What we

have done in the last several years and with the

agreement with OCR was to strengthen the criteria,

because what we have found was, as the Chancellor

described, that it was very easy for students to be

classified as learning disabled and emotionally

disturbed. And we spent a long time with groups of

real professionals and universities going over what

the criteria should be for a learning disabled

child and an emotionally disturbed child.

In the past, we found that the

clinicians wouldn\'t ask \"Is the child in need of

special referral?\" But the answer was \"Where do we

put the child?\" It was a place, it wasn\'t a

service. And that\'s what we have spent the last

several years doing, making sure that they received

training with Mel Levine from Chapel Hill, Don

Daschler, Marilyn Friends from the University of

Kansas. We use our universities and hospitals in

New York. We use NYU Child Study Center to train

teachers on how to work with children who may have

some sort of behavior problem but not necessarily

need to be in need of special education.

COMMISSIONER ACOSTA: Thank you so

much.

DR. FLETCHER: Ms. Goldstein, the

Commission would like to leave the record open and

ask for a copy of your criteria for identifying

children with learning disabilities.

MS. GOLDSTEIN: We will be happy to

provide you with that.

DR. FLETCHER: In fact, any high

incidence disabilities. We would be very

interested to see that.

COMMISSIONER ACOSTA: We will be

happy to provide you with any information.

DR. FLETCHER: Thank you.

Commissioner Coulter?

COMMISSIONER COULTER: Chancellor

Levy, first of all, I want to thank you very much

for your testimony. It is heartening, I think, to

see the chief executive officer of the largest

school system so concerned about children with

disabilities and the need of effective education.

Let me just ask you two questions in

two separate areas. You spoke, I think, eloquently

to the concept of a whole school in a single system

meeting the needs of all children in a seamless

system. I think one of the key factors in ensuring

that you have a seamless system is regular

classroom teachers, general education teachers,

implementing interventions for children who have

instructional needs. Especially, I think, in your

description, these are children that in more

traditional systems would go through a referral

process, be evaluated and be identified as needing

special education.

In that conception, the key variable,

at least as we have heard testimony, is the regular

classroom teacher knowing what to do, having

sufficient support in order to do it, and some

accountability, I think, at the administrative

level, that that teacher will follow through

affirmatively and assiduously and make certain that

it gets done. As, Chancellor, what are your

administrative provisions within the school system

to make certain that folks do the right thing?

MR. LEVY: You ask a very important

question. One that I think goes to the heart of

the matter.

A seamless web whole school approach

only works if the participants are held to a high

standard and there is a methodology to make sure

that that is happening. I am going to talk about

three things and then I will let Fran embellish.

One, the quality of special ed, the

amount of placement and the professional

development for the teachers, the general ed

teachers, is part of the evaluation of every one of

superintendents and is a core part. When we go

through the analysis that we do for each district,

and I have conversations one‑to‑one with the

superintendent, what I look at is a set of data

that includes school‑by‑school, grade‑by‑grade, how

the special ed kids are doing. It identifies the

number of certifications, the number of

decertifications, and instructionally by

performance how the children are doing. So we can

spot with some degree of precision, you know, \"In

the third grade in P.S. 189 it looks like the ELL

kids are doing better, it looks like the general ed

kids are being worked on, but your special ed kids

are falling off a cliff in math. What are you

doing about it?\"

And the conversation can be as robust

as that. So the core preventive, if you will, is

taking the data and analyzing it very carefully.

My experience in coming to this position is that

school systems are great generators of data and

lousy users of it. And what I\'ve tried to do is

use this wealth of information that we have.

Indeed, just this week it all went up a on website.

So you can actually, and I invite you to do it, sit

there and do the manipulations yourself, the

question you asked earlier, how many and where, you

can identify it school‑by‑school where the

concentrations are. So it gives me a great tool.

So one answer is, we evaluate the superintendents

and we keep it in part of their performance

profile.

Two is we put it on a website so that

the parents and the advocacy community can use it

and respond and pressure us to get it right.

And three is we have extensive

training. Not nearly enough. We have 80,000

teachers in this system, of whom 13,000 are not

certified to teach. I won\'t even go into the

question on how many are certified to teach in the

subject matter that they are teaching.

So the broad answer is, we have

managerial ways, reporting ways to check it, and we

have programs to provide professional development

at the systemwide level, at the districtwide level

and at the schoolwide level. And we have teams in

place in each school that are supposed to be doing

this. I use the word \"supposed to be\" because I

have walked into too many SBSTs where there is

nothing going on, school based teams. But that\'s

the work, that\'s the job.

DR. FLETCHER: Thank you very much.

MS. GOLDSTEIN: I just want to add two

other things. That we have pupil personnel teams

that are not for special ed youngsters, and that is

to really answer the general ed question. We have

teams in every school and we have done a lot of

training with them to ensure that if there is a

child in need of services, that child receives the

service or a group talks about what kind of

services are available for the child and family.

And the other thing is that we provide,

really, the dollars to the schools in general ed so

that they can have the preventive services, because

without the dollars, you cannot do this.

COMMISSIONER COULTER: Thank you.

MR. LEVY: Thank you, Commissioner.

DR. FLETCHER: I\'m sorry, we forgot to

announce that we have an interpreter for the deaf

in the front. Would you please identify yourself

for the people who need these services.

(Interpreter complies.)

DR. FLETCHER: Thank you very much.

Commissioner Rivas.

COMMISSIONER RIVAS: I want to thank

Chancellor Levy for his testimony. I have one

quick question.

Back to your secondary opportunity

school, the percentage of minorities, I guess, that

are referred to that, are they pretty much in

proportion with your general school population?

MR. LEVY: No. I think that there are

more minorities in there.

COMMISSIONER RIVAS: Do they get, I

guess, reevaluated and are able to get reintegrated

into the regular school system or is that a

permanent designation?

MR. LEVY: It is not a permanent

designation. There is a discrete period of time, a

minimum of a year, some have actually gone six

months, and there is a maximum period as well. A

year is the most.

New York City has a mixed history on

this, and let me just say, there used to be

something called the 600 schools, which some of us

who went through the New York City Public School

System remember. 600 schools were schools for

children who had acted violently, had acted out.

To those of us who weren\'t in them, we thought of

them as reform schools. And they were disbanded,

they were pretty miserable places. And the 600

designation was so many of our schools have numbers

and this would 625, 628, and so on.

That needed to be shut down and was

done years ago. I was very conscious of that when

we set this up because I did not want this to be a

holding pen, you know, a prison, a baby prison. I

wanted this to be an educational institution that

had people in it who were skilled in dealing with

children who present these kind of problems. And I

think we have accomplished that because we have

hooked up with community based organizations, who

in means instances, know how to do this better than

the traditional school approach.

COMMISSIONER RIVAS: Thank you very

much.

DR. FLETCHER: Commissioner Flake.

REVEREND FLAKE: Thank you very much.

I welcome you, Mr. Chancellor, and I

thank you for the time you have spent out of this

setting trying to help us with some of these

issues.

In our discussion the other day, item

number 4, we talked about the classification

language must be clarified and strengthened to

afford use of legislation, particularly as it

relates to the common problem, and you indicate

that your are spending astronomical sums in many

instances trying to solve individual cases, many of

those cases the needs not being able to be met

within the district, but those are actually dollars

going out somewhere else.

You are not specific here in terms of

recommendations. Do you have more specificity for

how you would suggest this problem gets resolved?

AUDIENCE: Excuse me, we have no idea

what you just said. Not one word.

MR. FLAKE: Really, I\'m sorry.

DR. FLETCHER: You asked for

clarification. I think you need to lean more

towards the mike.

MR. FLAKE: Okay. Essentially what I

asked for was clarification of point number 4. I\'m

sorry, as a preacher, I should know better.

MR. LEVY: I never thought I would

live to see the day where anyone would ask Reverend

Floyd Flake to raise his voice.

MR. FLAKE: Please forgive me.

MR. LEVY: I have made some specific

recommendations in here, but I guess the telling

point here is technical violations and technical

procedural improprieties should not give rise, and

certainly not in the first instance, to orders of

provision of services. I think this is, I mean, I

can take my hat off as Chancellor and start

lawyering a bill, but I would simply say this

quintessentially a process issue and it is a

question of providing standards to the hearing

officers to exercise discretion and giving them

more precise criteria. I think that might be a way

to do it.

But I would happy to try to provide

further guidance and talk with counsel on this. I

actually invited somebody who was a member of the

American Arbitration Association Board and one of

the real deans of the arbitration hearing world to

take a look at these Carter cases for me on a pro

bono basis. And he came back with a very

interesting observation. He said you are losing

these cases because there is inadequate attention

to procedural detail on the part of board lawyers.

And I said is it incompetence, do we

just need more bodies here? And he said no, these

are being very sharply litigated on the other side,

and what you need to do is litigate it as sharply

as that. That\'s one answer, simply what we could

do as a way to prevent this from happening is

lawyer it up and down the CSE path to make sure

that the fact pattern fits what has to be done.

And that may be, if we don\'t change this, my

judgment, that is what is going to happen all

across the country, you are just going to have

school boards retaining outside counsel and telling

them every CSE determination, every one that has

the potential for being expensive, we are going to

lawyer in a heavy way. That, in my judgment, would

be a terrible waste of our special ed money.

Another way to run that, in my view, is

to establish different criteria and have a rule of

in effect no material injury, so as to lift the

procedural barrier and put it on a different level.

But I would be happy to go back and try and come up

with some language level changes.

DR. FLETCHER: Thank you very much.

The Chair yields to the Assistant

Secretary who has a question.

MR. LEVY: If I might make to Reverend

Flake just one other thought on that.

In the criminal setting, when cases go

up on appeal and courts of appeal are reluctant to

overturn, although there has been a violation,

there is the harmless error notion, there is no

reversal because although there was error, it was

harmless error, would not have impacted the result.

MR. FLAKE: But that can\'t be remedied

by legislation then?

MR. LEVY: Oh, yes.

MR. FLAKE: It can?

MR. LEVY: That absolutely could be

put here as a standard.

The offsetting consideration is we want

to make sure that the child who has a genuine need,

gets it addressed. And then you also want to make

sure that where it\'s, you know, this case of the

telephone, we didn\'t want to take the teacher out

of the classroom, we wanted the teacher to

participate at the hearing. We thought we were

doing something which was called for by hearings

and arbitration and flexibility, and we said,

\"Fine, we will get the teacher on the phone.\"

The teacher didn\'t have the file in

front of her, and on that bases, the child gets

remanded to a different form of remediation. I

just think that is not what the statute had in

mind.

DR. FLETCHER: Dr. Pasternack.

DR. PASTERNACK: There are a number of

questions, but in the interest of time, I will try

to ask just a couple. I was intrigued with many of

the things that you testified about. I would like

to take you back to the issue of socially

maladjusted versus emotionally disturbed young

people.

It is has been reported to us that you

are spending a large amount of money on assessing

kids for eligibility for possible placement in

special education. I wonder if you could comment

whether if we eliminated IQ testing, whether that

would allow your school psychologists to help you

in making more accurate determinations and

differentiations between emotionally disturbed and

socially maladjusted youngsters and whether, in

fact, that might be a remedy for the problems that

you articulated so eloquently earlier.

DR. FLETCHER: Please identify

yourself for the record.

MS. WERNIKOFF: My name is Linda

Wernikoff, I am the Deputy Superintendent of

Special Ed Initiatives in New York City public

schools.

Yes, I think if you would eliminate

mandatory IQ testing it would certainly be a way of

having our school psychologists spend their time

doing intervention and prevention. One of the

major things that we have done in New York City is

increase the flexible way that school psychologists

spend their time, so that in addition to serving on

Committees of Special Ed, they have been an

integral part of our intervention and prevention,

conducting functional behavior assessments, doing

behavior intervention plans, not only for students

who are referred to Committees on Special Ed, but

youngsters who are in general ed who are having

difficulties, so we would say yes.

DR. PASTERNACK: Thank you.

Chancellor, I wonder if you could talk

to one of the issues that we are primarily

interested in today, as you know, is the

disproportionate identification of African‑American

youngsters in the category of mental retardation

that was so well documented in the recently

released NRC report. I wonder if you could talk to

us about why you think that may be occurring in the

New York City schools.

MR. LEVY: I tried to address that in

the testimony. I think if we had greater

opportunity to have a more seamless prevention

model, we would reduce that. That\'s a partial

answer, that\'s not a total answer.

I come back to the issue of distinction

between emotionally disturbed and socially

maladjusted. It is too easy to label and to

categorize. The same child who in another context

would be said he scratched the paint because he was

under stress, this is an emotional concern and he

is having terrible problems with his family, in

another context with other kinds of assistance,

with other kinds of advocates, winds up being

labeled as ill, as sick, as having a psychological

impairment.

Lawyers are in the business of

categorizing, you know, is it a tort or is it a

contract? Is it a criminal matter or is it an

administrative matter? We do that all the time.

That\'s part of the lawyer\'s training. And, you

know, the lit‑crit people understand this notion

with greater subtlety then even the lawyers do, in

my judgment, because what they are doing they are

going about their training and imposing it on the

world. They are going to graph it and chart it and

everybody\'s got their place and every action has

their category.

I think what is going on here, at least

in part, is a function of taking the same behavior

and categorizing it differently, in part in virtue

of who the advocates for the child are and in part

in virtue of what the socioeconomics of the child

are. And we do a disservice. I think on the

whole, the categorization of emotionally injured is

a stigma, and we sort of expect adolescent mischief

but it is different if the child is ill.

Well, the way I think of it

simplistically is, is the kid ill or is the kid

bad? That decision should not turn on the child\'s

skin color or the wealth of family, but rather

ought to turn on some other criteria more

objectively imposed. So I would answer your

question, at least in part, by saying, the system

comes down on different kids in different ways.

And that\'s what we need to resist.

DR. PASTERNACK: I know I don\'t have

much time left, so another question I would like

for you to quickly address, if you could, is in the

difference between your highest achieving schools

and your lowest achieving schools, as it effects

students with disabilities, what is the biggest

difference?

MR. LEVY: A very big question.

I would say, if I had to answer it as

bluntly as that, I would say let me give you two

answers.

One, quality of teachers. The amount

of professional development, the selectivity, the

assignment makes a big difference. And the level

of interest and concern and attention paid by

school leadership, meaning the principal and people

on the school leadership team, the people who are

the administration of the school. If they take

their eye off the ball, things go in the wrong

direction.

DR. PASTERNACK: So instructional

leadership, quality of personnel are two issues

that account for the differences between the

highest achieving and the lowest achieving schools?

MR. LEVY: Yes.

DR. PASTERNACK: Thank you.

I would like to just quickly introduce

our newest colleague at the U.S. Department of

Education of the Assistant Secretary for the Office

of Civil Rights, who is here in the audience with

us today, the Honorable Jerry Reynolds. And I

appreciate him being here and wanted the Commission

to recognize him.

MR. LEVY: As a former member of the

Civil Rights Division of the Department of Justice,

welcome.

Commissioner Takemoto.

COMMISSIONER TAKEMOTO: Welcome. I am

the Executive Director of Virginia\'s Parent

Training Information Center, and I am always

fascinated when I hear administrators and others

complaining about the high cost of litigation from

parents, because from the parents I speak to, they

feel like they are outgunned, procedurally,

legally, by school systems and their attorneys.

And it seems to me, in my observations, that

families who have the access to attorneys get the

services, while families in the lower socioeconomic

brackets, which in our country is represented

largely by minorities, are not getting the services

that they need.

So my question is ‑‑ I agree,

procedures should not be the determining factor for

children receiving an appropriate education, and

sometimes it is the devil that you know is better

than the devil will that you don\'t know, but I

would like to know from you, would you rather that

we looked at something like meaningful educational

benefit as a criteria for whether or not a child

would have a higher level of services, because I

have yet to meet a parent who walks in and says,

\"My kid is doing well in school, therefore, I am

going to go sue the system to get more.\"

So would you be willing to trade some

of the procedural losses and gains for a system

that said a child will make meaningful, educational

progress, and forget about whether or not they got

they are evaluation in 60 days?

MR. LEVY: I would only be willing to

do that if you could assure me sufficient funds to

do it for all the kids. The issue ‑‑ one person\'s

technical, procedural impediment is another

person\'s safeguard of their rights. I accept that.

But also recognize that Carter cases are coming

along and, candidly, middle class parents and upper

class parents are using that to pay for a level of

services that we can\'t provide to anybody in the

system. Everyone is entitled to a first class

education, and I say to you, that a significant

number of people are not getting it. And it is not

necessarily the ones who can afford lawyers.

I take your point entirely, that there

are people who need lawyers and need procedural

safeguards. And I am not suggesting in the

slightest that we ought to eviscerate IDEA. I am

saying that there are problems that need to be

tinkered with here. If, as a matter of litigation,

if as a matter of, you know, here\'s the procedural

standard and with an order that ends with the line

\"so ordered,\" I could assure quality of education

for each of my 1,100,000 children, I assure you, I

would sign that order today.

The problem is administratively putting

it into place, and therein lies the issue. How do

I say this? I used to be on the Board of Regents.

On the Board of Regents, we could pass standards

and high level aspirations and regulations. I am

cursed to actually implement the damn things I

voted for.

COMMISSIONER TAKEMOTO: And as this

task force considers some of the early intervention

initiatives that are going to keep kids out, my

concern is are schools going to be able to produce

to not only keep the kids who should not be in

special education out, but make sure that the kids

that are in special education get benefit?

I believe that\'s a civil right and it

seems to me that folks are already signing letters

of assurance that all their students are getting

appropriate education anyway. So I am wondering if

a higher standard of meaningful educational benefit

would be more difficult to deal with than worrying

about whether or not procedures have been passed

and whether or not that would be more meaningful.

MR. LEVY: The exercise for me is not

to distinguish as between general ed and special ed

as to who gets good education. I hold them

accountable to provide the education at a certain

level and a certain standard, and that applies to

both general ed and special ed.

DR. FLETCHER: Commissioner Grasnick.

COMMISSIONER GRASNICK: Thank you,

Chancellor Levy, for your excellent testimony

today.

If you or members of your staff would

identify some key areas of research that would

assist in more precision in the identification of

students with special needs?

MR. LEVY: We will be pleased to

provide that.

COMMISSIONER GRASNICK: Thank you.

The second question I have is, I think

as I have heard your testimony and others, that the

IEP process is often very much an input system and

not results oriented. And I applaud the diminished

number of students you have identified as special

needs, but I am interested on the other end, as you

track the students and their performance and the

development of the IEP, do you have a benchmarking

system that once students are identified will allow

you to track their continuous progress to the point

of exiting the identification?

MR. LEVY: Do you mean is there a

systemwide program that monitors them as they go?

COMMISSIONER GRASNICK: Based on a

results oriented system?

MR. LEVY: There is no separate one

for special ed. We have a systemwide sort of

monitoring and tracking, as you would in any

system, but, no, there is not a special one for

special education.

COMMISSIONER GRASNICK: So I guess the

question I am really asking is, when you develop

the IEP, are there benchmarks or progress that are

anticipated and reflected as part of that process.

MR. LEVY: Sure, absolutely. And

there are periodic meetings and every child is

evaluated in a regularized way.

Do you want to add to that?

MS. GOLDSTEIN: Yes, there are goals

and objectives on the IEP, and teachers meet with

parents and meet among themselves and review the

IEP and the goals and all of that. And there are

re‑evals and triennials as in any other system.

But we also do standardized testing

with our youngsters, and if the child is not within

the standardized testing, then they have

adjustments made to their testing or modifications.

COMMISSIONER GRASNICK: And if the

students, either individually or collectively, are

not performing well, are there specific

interventions?

MS. GOLDSTEIN: Candidly, our special

ed youngsters don\'t perform as well on tests as our

general ed youngsters. And that\'s why we just

revamped the whole continuum and all of our special

ed programs, because one of the concerns that we

had was that once they were placed in special ed,

they were not performing as well as they should be

as well.

COMMISSIONER GRASNICK: My final

question, if I haven\'t exceeded my time, it is my

impression that many students are identified

because of, in a sense, default from what we

haven\'t done in regular education.

Could you just speak for a moment to

very early intervention services, when we look at

accountability for regular education and what that

would mean in terms of identification.

MR. LEVY: There is no question, the

earlier the identification, the better. And what

we need to do is train our people so that the

evaluation can take place at an early enough level

and done in a professional way so that we have

early intervention or the opportunity to really do

something to bring the kid back into general ed.

The increase in the number of decerts,

in my judgment, is an indication that they system

is working. And that\'s something that hadn\'t

occurred for many years, the recognition that

children could move back in.

The other observation I would make,

something that a number of you took interest in

Houston. We test our special ed kids. They are

part of our testing regime, and have always been.

And the state has what is called the RCTs, which

apply to some kids, but pretty much, everyone gets

tested. And that\'s part of the New York City

tradition.

How do you address this? Early

intervention, quality intervention, make sure the

general ed teachers recognize the warning signs

when they occur and don\'t wait for something

severe. I track this stuff on a monthly basis, and

it worth making a point. I get a report which

shows me by district, how many kid go from general

ed to least restrictive, to SIE VII. How many

referrals, how many decerts, where there are

upticks. And I talk to the superintendents about

this on a monthly basis.

One of Fran\'s functions is to track and

monitor who is doing what? So if I see, for

instance, a large number of children going from

general ed immediately into SIE VII with no stops

in between, that\'s a red flag to me. That tells me

someone is taking their eye off the ball, because

that should not happen. It is rare, rare, rare,

that a child would suddenly manifest, without any

warning, these kind of problems.

The other thing that I monitor with

some care is how we are doing on our cases. I ask

our general counsel from time to time to show me

the hearing officer decisions, so that I get a

quality control notion of how we are doing. You

know, the decisions are sort of a sampling, a

skewed sampling but an important sampling of which

are the squeaky wheels, what are the things we are

doing wrong. And when there are criticisms, we try

and respond to that.

The criticisms that I worry about, what

I was trying to say before is, I think sometimes

the decisions are over the top.

COMMISSIONER GRASNICK: Thank you.

DR. FLETCHER: Thank you.

Commissioner Wright, the last shall be first.

COMMISSIONER WRIGHT: Good morning.

As the last one, because you can see that I am a

\"W\" and if the Chair is going in alphabetical

order, then I am always last, and that can be good

or bad. It is bad that I have to make sure that I

listen to everything to make sure that I am not

asking questions that have already been asked.

And so I guess, I am batting clean up,

is that right, Mr. Chair?

DR. FLETCHER: That\'s correct.

COMMISSIONER WRIGHT: To my knowledge,

I think that just about everything has been asked

and answered, but I am curious to know, maybe you

have answered this, what are your services for and

how do you identify your severely developmentally

disabled? I mean, like your TMH kids, trainable

mentally retarded and ‑‑

MR. LEVY: I\'m sorry, we are having

trouble hearing you.

COMMISSIONER WRIGHT: Severely

mentally retarded, your severely developmentally

disabled. I would like to know what do you do

about that?

MS. GOLDSTEIN: We have a separate

district for the severely disabled youngsters, but

a lot of those youngsters are referred, not only by

our evaluators, but obviously through medical kinds

of reports. Our autistic youngsters, many of the

mentally retarded youngsters, are referred by

physicians and come in with severe medical

diagnoses, in addition to some of the psychological

and other kinds of things that we do.

COMMISSIONER WRIGHT: Are these

children, I know that there is not too much to

include them, but what does New York City ‑‑ where

do you serve these children? Do you pay tuition

for them to be served by other agencies?

MS. GOLDSTEIN: No. They are served

in a New York City public school. We call it our

District 75, which is our severely disabled, but we

service ‑‑ we have severely impaired both

physically and mentally challenged youngsters in

our schools, we have autistic youngsters in our

schools, and they are served in public schools.

Some of them may be in their own buildings, but

they are within our public school system.

COMMISSIONER WRIGHT: So you do not

have to buy service for them from other agencies?

MS. GOLDSTEIN: No, not at all.

We may use some hospitals just as a

support for us, but we don\'t necessarily use them

as the full support.

COMMISSIONER WRIGHT: My last question

is: Do you refer children, and I am sure you do,

when you work with other agencies, such as mental

health agencies and like that, do you refer

children to mental health?

MR. LEVY: Yes.

Let me say on District 75, I have

visited a number of these schools, and I must say

that I did not go there with great relish, because

for me personally, it is a very difficult,

emotional thing to go to those schools. I can\'t

tell you how impressed I am by the quality of

instruction and the quality of care in the special

ed district.

There are schools all throughout the

city and the gentleness and the concern and the

quality of the care given is really quite

extraordinary. Those are people who do amazing

things for children with terrible deformities and

handicaps and do them very well.

COMMISSIONER WRIGHT: Excuse me, I

couldn\'t hear what you were saying because of that

siren, could you repeat what you said?

MR. LEVY: I say I visited a fair

number of the District 75 schools, and I want to

tell you and assure you, that the quality of the

services that I have seen is very high, and that

the care and care‑giving of the people who work in

that district is quite extraordinary.

It is not just clean buildings, it is

not just adequate supplies. It is a degree of

concern and compassion for the children that is

very impressive and makes you proud of what public

government can be about.

COMMISSIONER WRIGHT: I certainly

appreciate your input today and your testimony.

Thank you so much. It is good to see you again,

Chancellor.

MR. LEVY: Good to see you again.

DR. FLETCHER: If we could clarify, it

sounds like you are describing a school

environment that is predominantly self‑contained

for children with severe disabilities.

MR. LEVY: Yes.

DR. FLETCHER: What do you do about

LRE, least restrictive environment, for these

children?

MS. GOLDSTEIN: We have moved a lot of

general ed children into the buildings for space

issues. And where we can, many of these youngsters

are on respirators and need very specific kind of

buildings. And that\'s why originally those

programs were in their own building. As we are

moving more, and we have a five‑year plan with the

state to move more of those youngsters into LR

settings. We have been moving general ed or other

kinds of special ed programs into those buildings.

Or where there are accessible buildings, we are

moving them into the community school districts or

high school settings.

We have a lot of inclusion programs for

those youngsters. We have over 8,000 of our

District 75 youngsters in inclusion programs.

DR. FLETCHER: Thank you very much for

your testimony.

Did you want to add something to that?

MR. LEVY: I neglected to mention that

the vice president of our school board is here, if

I might introduce, Dr. Rena Pellizzari.

DR. FLETCHER: Welcome.

MR. LEVY: Thank you very much.

DR. FLETCHER: We will move on to the

next panel. We have a panel of three distinguished

presenters. This panel is on categorization and

will address issues involving referrals, categories

in special education programs. I am going to go

ahead and introduce all three speakers who will

talk in turn.

The first speaker will be Dr. Frank

Gresham from the University of California‑

Riverside, he does research and professional

activity in areas that involve social skills

assessments and training children in applied

behavior analysis.

The second speaker will be Dr. James

Ysseldyke, who is a Professor of Educational

Psychology at the University of Minnesota. Dr.

Ysseldyke has many years of experience in

education, has worked as a secondary teacher,

special education teacher, school psychologist and

university professor and researcher. His research

and writing have focused on issues in assessing and

making instructional decisions about students with

disabilities.

The third speaker will be Dr. Gwendolyn

Cartledge, who is a Professor of Special Education

at the School of Physical Activity and Educational

Services at the Ohio State University. Dr.

Cartledge has been a faculty member at Ohio State

since 1986. Prior to that, she was on the faculty

of Cleveland State University from 1975 to 1986 and

has been a teacher and a supervisor in several

different school systems.

We will begin with Dr. Gresham, if you

are ready.

DR. GRESHAM: Thank you, Chairman

Fletcher. I would like to say I appreciate the

opportunity to testify before the Commission today

on issues related the validity of IDEA categories,

the effect of categories on the incidence and types

of referrals and the impact of categories on the

existence of early intervention services.

Let me state at the outset, and I think

it is important point to make, that what I have to

say is restricted entirely to so‑called high

incidence disabilities, which include specific

learning disabilities, mild mental retardation and

emotional disturbance. Controversy over issues of

early identification and validity of categories is

virtually nonexistent for low incidence

disabilities such as deaf, blind, orthopedically

handicapped or students with chronic illnesses who

might otherwise be served as other health impaired.

Many of these low incidence

disabilities are identified before school entry,

sometimes at birth, but the validity of the

assessment procedures used to identify these

students are well‑established and not controversial

and there is often a direct link between assessment

procedures and intervention strategies.

Unfortunately, the same cannot be said about high

incidence disabilities. I might also add that I

have two young children with low incidence

disabilities, one that was diagnosed at age three

with childhood cancer. He is now five years

post‑chemo and doing fine. And one is two years

old, was borne profoundly deaf and has just

recently had cochlear implant surgery.

The process by which public schools

identify students with high incidence disabilities

often appears to be confusing, logically

inconsistent and unfair. Research indicates that

students with high incidence disabilities are often

misidentified by public schools. Misidentification

can occur in three ways.

One, students can be misidentified

within one of the 13 special education categories.

This form of misidentification is the most common,

where students who would other otherwise meet

established criteria for mental retardation are

misclassified as learning disabled. Over the past

25 years, there has been a 283 percent increase in

the prevalence of learning disabilities and a

corresponding 60 percent decrease in the prevalence

of mental retardation. These prevalence rates, at

least in part, might be explained by the form of

misclassification.

The second type or form of

misidentification occurs when students who do not

meet eligibility criteria for any category are

assigned a disability label, thereby creating what

is known as a false positive identification.

Again, the enormous increase in the prevalence of

learning disabilities over the past 25 years might

be explained in part by this form of

misidentification. To be sure, there are children

with slower rates of learning who are not disabled,

and many misidentified non‑disabled students may

result from poor instruction or extenuating family

circumstances rather than a disabling condition.

Misidentification of nondisabled students may

inhibit future achievement and access to

appropriate education within a general education

environment.

The third type of misidentification

occurs by error or omission when students who would

otherwise meet eligibility criteria for disability

are misidentified as not having a disability

resulting in a false negative identification.

These students are never referred for assessment,

are never exposed to a quality pre‑referral

intervention and, thus, will never receive special

education and related services to which they are

entitled or would be entitled.

It is tempting to interpret the above

findings as a reflection or the failure on the part

of school personnel to comply with state special

education codes governing eligibility

determination; however, classification has three

purposes, advocacy, services and scientific study.

So‑called error rates in school identification of

students with high incidence disabilities can be

estimated by validation of cases of schools for

purposes of service delivery against criteria

specified in state education codes that are

relevant for scientific study.

Joe, would put up the first overhead

for me, please.

What this table represents, these data

show the convergence ‑‑ these data, I might add,

were based on a sample of 150 carefully selected

kids as part of a research grant from the Office of

Special Education Programs on identification of

high incidence disabilities. What this table

reflects is children who we identified in the

project as having a specific special learning

disability based on California\'s state education

code, which fundamentally uses an IQ achievement

discrepancy of approximately 22 points between

ability, IQ and achievement.

And what the school identified what the

contrast is, the relationship between who we

identified meeting state eligibility criteria and

also who schools identified as learning disabled,

assuming they used the same criteria, what you will

see here are there were a total of 61 cases that

were identified by schools at least as learning

disabled. And the agreement between the project

identified and school identified cases of learning

disabilities is somewhat underwhelming. In fact,

we would have done slightly better by simply

flipping a coin. So we had about a 47 and a half

percent convergence.

I might also add that of the 61 school

identified learning disability cases, 30 percent of

those cases had IQs of less than 75, and obviously

exhibited no discrepancy between ability and

achievement.

Jim, if you would throw the next one up

there, please.

What this particular overhead shows is

that if you look at the overhead, you see a

comparison of four groups. And, remember, false

positives are students who are not meeting

eligibility criteria who were classified by schools

as LD, and false negatives are students who would

meet eligibility criteria but who were not

identified by schools as LD. I am going cut to the

chase here in terms of this slide and I want to

point out that these data suggest that an absolute

level of low achievement, and not low achievement

relative to aptitude is the defining characteristic

of who schools call learning disabled.

So you might also put the other one up,

Jim.

What we\'ve got here in this particular

overhead, given the same data, these are again the

113 cases on whom schools had reached decisions

regarding eligibility and how they stacked up

relative to our project diagnostic criteria, and so

what you see running through here is a lot of

comorbidity between kids who are identified as LD

but also identified as ADHD, also identified as

emotionally disturbed and so on.

What I want to point out, Jim, if you

will slide up the bottom of that slide, you will

see that of the 19 cases in this case of whom

schools call learning disabled, these kids would

probably, given current diagnostic criteria at

least in California, would probably be suspected of

having mild mental retardation, although the State

of California is about average in terms of

prevalence rate of learning disabilities, but they

are among the lowest in the prevalence rate of

mental retardation. Something on the order of one

half of one percent of the school population.

Do you have another one up there?

Okay, you can leave that up there.

I have argued in the past and have

written a comprehensive paper for the Learning

Disability Summit that was held last in Washington

D.C. last August, which, by the way, was Dr.

Pasternack\'s first day on the job as Assistant

Secretary of Special Education, that the field

should adopt a responsive to intervention approach,

to not only learning disabilities but also other

high incidence disabilities as well. To summarize

this position, I would maintain the following:

One, that a child\'s inadequate

responsiveness to an empirically validated

intervention can and should be taken as evidence

for ‑‑ and should be used to establish eligibility

for special education and related services.

Two, the strength, intensity and

duration of intervention should increase only after

the child has failed to show an adequate response

to intervention.

Three, assessment procedures used to

measure responsiveness to intervention must have

treatment validity.

And, four, the assessment of treatment

integrity are what some people might call treatment

fidelity, should be a central feature of the entire

process of adopting a responsiveness to

intervention model for children with high

incidence disabilities.

What you see this depicted here in this

particular slide is a modification or adaptation of

the special education eligibility model used in

Heartland Education Agency in Iowa. And what this

model is is a multiple gating procedure, as you can

see four levels, where the intensity of the

intervention increases only after a child ‑‑ it has

been demonstrated that a child is unresponsive to

intervention. This particular overhead was written

for my paper for the Learning Disability Summit,

and it specifically relates to learning

disabilities, more specifically to reading

disabilities. However, it is can be modified and

adapted for other disability groups as well,

particularly, emotional disturbance, for example.

I have made some recommendations to

the Commission in the document that I submitted to

them, and I will simply go through these very

quickly. The current approach to defining learning

disabilities based on IQ achievement discrepancy

should be summarily abandoned because it is

fundamentally flawed, invalid and prevents early

identification intervention efforts.

School study teams should give more

weight to teacher judgments in the special

education eligibility process. Particularly at the

referral and placement steps. Assessment

procedures that contribute information to informed

instructional decisions should become primary

instruments of special education eligibility

determination. Current assessment practices

utilizing static assessment procedures that

contribute nothing to a structural decision‑making

should also be abandoned.

Measures used to determine eligibility

and monitor academic progress should have

established treatment validity, a point I made

earlier, in that they should monitor academic

growth, can distinguish between ineffective

instruction and unacceptable individual learning

and are suitable for making instructional decisions

and are sensitive to detecting intervention facts.

A child\'s inadequate responsiveness to

intervention can be taken for evidence of high

incidence disabilities, I have already mentioned,

and a responsiveness to intervention models should

be conceptualized as a multigated procedure with

the strength of interventions. And I define

strength by either the frequency, intensity and/or

duration of interventions as matched to the level

of unresponsiveness to interventions.

DR. FLETCHER: Thank you very much,

Dr. Gresham.

Dr. Ysseldyke.

DR. YSSELDYKE: Dr. Wright, you

alluded to the challenge you face. Going through

school with a name like Ysseldyke, I\'ve always gone

last and I\'ve had to go fast, so that is what I am

going to do today, is move very quickly through

this. My friends refer to me as a passionate

professor, and I am passionate about improving

educational results for all students, especially

students at the margin, so, Reverend Flake, today I

get to preach about my favorite chapter and verse,

so if I seem a little overly passionate, I am.

I don\'t get an opportunity to do this

very often. And I believe you folks don\'t either.

So I think you have a unique, historical

opportunity, and that is, you have an opportunity

to make some significant changes in what is going

on out there in practice. I think you have the

opportunity to legitimize the bootlegging of good

assessment practices. As I travel around the

country, my diagnostic personnel tell me that they

engage in far too much time assessing children,

making predictions about their lives, and far too

little time making a difference in their lives, and

they tell me that is because the federal government

makes them do that. I believe they are lying, but

you have to help them understand that they can

actually do some of these things.

You have an opportunity to free

diagnostic personnel of the guilt that they feel

when they do good things. And I would simply call

your attention to the fact that I believe, I think

there is substantial research to support my

contention that there is absolutely no shortage of

knowledge about what to do instructionally with

kids with disabilities. As you say, we can\'t ever

get there because we are spending out time engaging

in what Seymour Sarrison from Yale University

called an incredible search for pathology.

I have made some recommendations, I

will only highlight a couple of these and then I

will take an approach based on logic rather than

research. I want to stress three major

recommendations that serve as the theme of what I

have to say. I was asked to talk about whether

the diagnostic categories ‑‑ whether the special ed

categories are valid.

I think we just ought to stop the

debate about whether categories are valid, real,

relevant to instruction and beneficial to children.

We know the answer to that question, and the answer

is that, for the most part, with some exceptions

that I will mention, they are not. You have an

opportunity as a Commission to call a halt to

categorical special ed eligibility determination

practices that require a search for pathology; that

is, static, test based documentation within

students deficits, deviance and disabilities. And

you have an opportunity, as a Commission, to

require a shift in focus in special education to

one of competence enhancement, where we work very

hard together to use evidence based instructional

practices to move all students from where they are

to where we want them to be.

That\'s going to require allowing

diagnostic personnel to spend considerable time

documenting evidence of having applied effective

instructional strategies before engaging in kind of

a psychometric robot activity of looking for

deviance. And it is going to require a push for

the use of diagnostic paradigms in which

assessments and classifications lead to treatments

with known or predictable outcomes.

I would like respectfully to suggest

that the question that we consider is not whether

the IDEA categories are valid, but whether we still

want them to be the organizing constructs that

drive our response to the needs of students with

disabilities. We have been doing that for at least

80 years, since Orin, in his textbook, laid out all

of those terribly named categories. The names have

changed over time, but we have still been engaging

in an activity of trying to find the kids. And I

would submit to you that we can continue to do

that, we can do it with considerable, incredible

sophistication. We can fractionate subtype, define

and redefine, but in my opinion, this will not be

in the best interest of children.

The answer to the question of whether

the categories are valid is a no, but. In

Minnesota we say, \"Yeah, but,\" this is a no, but.

You have to differentiate some of the kids out of

there. Frank did a good job of that, mentioning

kids who are blind, deaf, kids with other health

impairments, kids with traumatic brain injuries,

severe mental retardation. But the other

categories have only had meaning in social context

and we change the categories in order to fit the

needs of the day.

We knew this in 1975 when Cromwell,

Blashfield and Strauss in their classic chapter on

classification in Howe\'s book on Classification of

Children pointed out that diagnostic constructs are

specialized types of scientific constructs that

have four pieces. A, historical, etiological

information, and, B, assessable student

characteristics. Their usefulness, that is the

assessable student characteristics, historical

information, only has meaning when we know what

treatments to apply in order to get predictable

outcomes. So the only legitimate diagnostic

paradigms are those that include C and D

information, that is, where what we do

diagnostically leads to treatments with known

outcomes.

I would submit to you, that for the

most part in special education, we are missing

that. Cromwell, Blashfield and Strauss also

pointed out to us that in order for categories to

make sense they need to have four characteristics.

They need to be reliable, reproducible, their needs

to be universality. All members of the category

have to have at least one thing in common, all

beagles have at least one thing in common. There

also has to be at least one specific, that is, one

characteristic that differentiates members of the

category from nonmembers of the category.

Frank, I am going to be ready for the

overheads here in just a second, we will go fast.

These are all data. I want to show

you, we took 50 students identified by schools as

learning disabled and then we took 26

operationalizations of the definition of learning

disabilities, and we categorized each of those

school identified LD kids according to each of the

different definitions. Every time you see a color

rectangle, that is an LD kid called LD by the

schools who meets the criteria for being called LD

according to the definition.

Frank, next slide, please. Then we

took 50 low achieving kids, these are kids who were

consistently performing below the 25th percentile

on achievement tests, applied the same definitions.

Every time you see a color rectangle, this is a

situation in which a low achieving youngster meets

the criteria for being LD.

Next slide, Frank. For all individual

measures, we computed just plain old frequency

distributions. Looking at the extent to which the

scores earned by students were learning disabled

disabilities differed from the scores earned by

students with low achievement. We got an average

of 90 percent overlap between the two groups on all

psychometric measures.

I brought these slides along, they are

old but I want to make it very clear what I\'ve said

in the past and I am saying today. I have argued

that there is no psychometrically reliable and

valid way to differentiate members from nonmembers

of the category learning disabilities. This does

not mean, and I have not said that there is no such

thing as LD. But, please, free us from the

straight jacket of IDEA diagnostics and allow us to

focus, instead, on responding to the needs of kids.

And, by the way, I want to tell you

that there is very competing explanations for the

findings which I have shared. I will be real quick

in a couple of summary comments. I spent last

weekend with two‑year old grandson so I watched too

many \"Bob the Builder\" videotapes, and I heard over

and over again that old phrase \"Can we do it?\"

\"Yes, we can.\"

If federal law includes mandated

categories of disabilities, we will fractionate

kids with incredible sophistication. We will come

up with types and subtypes and subtypes of

subtypes. And I would submit to you, that I would

hope that you would free us of having to engage in

that kind of activity. Please do not give

professionals the opportunity to engage in

expensive, elaborate, diagnostic sorting practices

that have no demonstrated instructional validity.

I would push you to the kind of problem

solving modeling that Frank Gresham has mentioned.

There are so many instances in which practitioners

‑‑ I am more familiar with school psychologists ‑‑

have demonstrated really good ways to find the

right kids to serve and to improve instructional

outcomes for all kids without having to engage in

all of the elaborate sorting practices. They are

also among the practitioners who feel the most

guilty about what they do. So you have a wonderful

opportunity to free them of that.

90 percent of the kids who are referred

by teachers are tested. 73 percent of the kids who

are tested are declared eligible for special ed.

Now, either that\'s a little high or we could just

the whole paradigm, put them all in special ed and

then try to figure out where we made our mistakes.

I thank you for the opportunity to make

these comments and I look forward to a chance to

respond to your questions. Thank you.

DR. FLETCHER: Thank you very much.

Dr. Cartledge is next.

DR. CARTLEDGE: Good morning. I want

to thank you for inviting me to present my

comments. I just want to say that Frank and Jim

come from a slightly different background than I do

as a school psychologist, and I would love to say

that over the years, I have followed their work,

but actually it is probably the reverse, that I am

older than they are.

But at any rate, I am coming from a

perspective as a teacher, as opposed to a school

psychologist, and focusing on assessment. I also

have identified much more testimony than I can

read, so it will just go into the record I hope. I

am going to skip around and I apologize for having

to skip around here.

Also as preliminary statement here, I

have been asked to really focus on the

overidentification of minority children. It has

already been pointed out that there is an

overrepresentation of minority children,

particularly African‑American children as well as

Native American children or American Indians. This

data, even though we can say things like

African‑American children make up 16 percent of the

school population and something like 20 percent of

all new children identified in special education,

something like 34 percent of all the children

identified with mental retardation, 26 percent of

all the children identified in programs for

seriously emotionally disturbed. That data needs

to be desegregated in terms of regions and areas.

For example, we know that some states,

and one piece of data that I received was that in

the State of Virginia, nearly half of their

children in programs for mild mental retardation

are African‑American. So it varies from state to

stay, even though we say things like

Asian‑Americans are under represented, if we would

look at the State of Hawaii, that is not exactly

the case, that native Hawaiians are overrepresented

in special education. So many of us are left to

ponder exactly why this is the case. And I don\'t

have any hard and fast answers, but I do have a

couple of areas that I would like to focus on.

I also want to point out that gender is

a major issue. Although impoverished and

culturally and linguistically diverse children as a

group have long been educationally marginalized,

the subgroup must vulnerable for this distinction

is culturally and linguistically diverse males.

Males, in general, tend to be disproportionately

identified for special education. Particularly, in

the categories of behavior disorders and mild

mental retardation, and placed in programs for

serious emotional disturbances at a rate that is

three and a half times that for females.

When male status and cultural

linguistic diversity are combined, special

education status and other undesired outcomes are

even more predictive. Black males, compared to

while males, regardless of socioeconomic level are

much more likely to be suspended at a younger age,

receive lengthier suspensions, be tracked in low

ability classes, be retained in their grade levels,

placed in special education classes, programmed

into punishment facilities such as juvenile court,

rather than treatment, and given more pathological

labels than be warranted.

Socially conscious authorities

increasingly assert that U.S. schools are failing

their students and disproportionately fail students

of color. A pronounced example of a school\'s

failure and its disciplinary measures ‑‑

DR. FLETCHER: Use the mike, please.

DR. CARTLEDGE: Is that better?

DR. FLETCHER: Much better.

DR. CARTLEDGE: The over emphasis on

punishment and coercive practices can be

ineffective, leading to negative modeling as well

as causing students to devalue school, the

schooling process and school personnel.

Suspensions and punitive practices

start very early in the child\'s schooling. In my

recent work in the schools, I have noted

kindergarten children, first grade and second grade

students suspended and suspended regularly. Often

it is the same child experiencing repeated

suspensions and it is not uncommon for the

youngster to have little or no understanding of the

reason for these actions.

For example, at least two youngsters

that I have been working with recently were

suspended because they found a knife on their way

to school, had the knife in their pockets and

weren\'t doing anything wrong with the knife, except

that when it was determined that these youngsters

had the knifes, they were suspended for something

like six weeks of school. Each of these youngsters

received something like two hours a week of

tutoring during this time of suspension. And what

makes these ‑‑ and then when the youngster comes

back to school, he is further and further behind.

This starts a trajectory of more and

more discipline problems, and very soon the

youngster is referred for special education. Now

what makes this very problematic for me and

egregious in my mind, is that, one, the youngsters

fall further and further behind academically. But

even more important, the youngsters receive no

instruction about what they did wrong or how to

correct their behaviors in the future. So my

background, in terms of teaching social skills, I

really strongly recommend that we focus on, one,

prevention, and, two, teaching children more

adaptive ways to behave.

Last week the State of Ohio released

its disciplinary data. And this data for the first

time was reported according to race and gender.

Consistent with national data, African‑American

students were disciplined more often than whites

and other groups, with a few exceptions where they

were exceeded by Hispanics and native American

youngsters.

Particularly noteworthy was the

observation that in one district, Shaker Heights,

to be specific, all the minorities, including

Asian‑Americans, had higher rates than whites, and

the rate for blacks was 12 times that for whites.

Now, in the other districts, the rates for black

children tended to be something like two or three

times that for whites. The interesting thing is it

was noted that as the white membership of the

school district increased, the chances of a black

student being subjected to disciplinary actions,

correspondingly increased.

This observation parallels the research

findings on special education referrals for

minority students discussed later on in this paper.

Essentially what that says is that we not only have

disproportionate referrals with minority

youngsters, particularly African‑American and

American Indian youngsters, but what the literature

tells us is that for all minority youngsters, as

the school system becomes increasingly white, the

likelihood of that youngster being referred for

special education goes up accordingly. Now, I am

at a loss as to how to explain that data except to

say that the disciplinary data closely parallels

the data for referrals to special education. And

the other thing that we know, there are two factors

that determine whether or not a youngster is

referred for special education. One happens to be

a reading problem, the other happens to be a

behavior problem.

Low expectations is the other factor

that I feel contributes to special education

referrals, disproportionate referrals for minority

children. Another way in which schools contribute

to the disproportionality of CLD students is

through low expectations. Consider the case of the

psychological I received recently for a youngster

who I refer to as D. He was assessed for an SED

program or a program for emotionally disturbed.

His cognitive scores put him at or

about 34 percent of his peer group. His academic

assessment in reading and math put him at 13

percent and 19 percent of his peer group

respectively. Interestingly, the examiner

concluded that his attained achievement scores

appear commensurate with his overall level of

cognitive ability and frequent disruptive behavior.

As he neared the end of first grade, he was already

severely behind his age mates in the basic skills

of reading and moderately behind in math. A

profile of disruptive or aggressive behaviors,

coupled with first grade academic failure is highly

predictive of behavior disorders and overall school

failures. Assessments that suggest that D is

making expected progress, would undoubtedly lead

educators to continue with current teaching

strategies and to maintain relatively low

expectations for school success. Low expectations

is one of the factors that severely plague CLD

children, especially African‑American males.

This is one reason why I concur with

some of the other testimony that we really need to

eliminate IQ testing for this purpose. I am going

to skip over here and talk about instructional

issues.

Too often these children are poor,

entering the schooling process with approximately

one‑half the language and academic readiness of

their more affluent peers. Impoverished CLD

children are unlikely to receive early learning

experiences needed for success in school. Their

unreadiness sets the occasion for a trajectory of

increasingly greater failure. After a period of

sufficient failure, the schools initiate a process

of labeling and special education placement.

The special education label suggests

some disorder within the child and the need for

more resources. Too often, however, especially for

CLD children, special education is a place to put

students when they do not perform. instead of

being sources for habilitation, special education

for black and many minority students is often

marked by low‑level instruction, restrictive

placements and limited opportunities to return to

the mainstream. The curriculum in many of these

classes, especially in programs for children with

behavior disorders, is one of control so that the

classes essentially become holding stations until

students eventually drop out or are pushed out of

school.

Children with behavior disorders have

the poorest outcomes of all the children in our

schools. The importance of a challenging

curriculum and effective teaching and robust

learning cannot be overemphasized for these

students. One of my more encouraging recent

experiences has been observations of urban African‑

American males identified with behavior problems

fully intergrated into general education classes

where scripted, high‑paced, dynamic lessons were

being conducted by teachers trained in direct

instruction. These lessons, characterized by high

rates of oral and written student responses are so

tightly structured that students are constantly

engaged in academic responding with limited

opportunities to act otherwise. These conditions

reduce the opportunities for students to disrupt

and undermine the learning of fellow classmates.

In the general classrooms where we

observed, the typical uniformed observer could not

easily pick out the labeled student. And I will

move through this quickly to point out that in this

school, because of overcrowding, this is a school

that a lot of parents wanted their children into,

because of overcrowding, the administration was

deciding to remove the children with behavior

disorders and put them back into special classes.

But because these youngsters were doing so well in

their general ed classes with the special

curriculum, the teachers refused to let them be

returned to their special classes so that they took

in additional children as opposed to returning them

to special ed. And this finding, this occurrence

is very consistent with some national data, some

national findings that suggest that good

instruction and good direct instruction can be

highly effective in preventing the overreferral of

minority children.

Teacher issues ‑ I am going to just

point out that teacher skill is an extremely

important factor relative to overrepresentation.

Preservice teachers appear to be no more prepared

for student diversity than their predecessors.

Children in diverse classrooms are more likely to

be taught by inexperienced teachers until after a

survival period when the teachers are given a more

rewarding classroom.

The quality and quantity of instruction

provided students from diverse backgrounds often

are inferior to instruction offered to more

affluent peers. These students need to be taught

more, not less. Their instruction needs to be

explicit and it needs to be active, giving students

many opportunities to respond.

My recommendations: Disproportionality

is a complicated issue compounded by many factors,

not the least of which are poverty and racial bias.

And by the way, I just want to point out that one

of the most recent reports that come out, suggested

that one of the main reasons for overrepresentation

for minority children happened to be poverty.

Well, poverty is one factor, but many authorities

in this area fail to address the fact that when we

move into more affluent districts, these children

are even more likely to be identified, so you can\'t

just say that poverty is the only factor. There

also happens to be an issue of culture in the way

that we perceive these children.

Overrepresentation is a critical

concern if we wait for children to fail and then

place them in programs that are least likely to

foster their academic and cognitive growth. The

point of focus needs to be on prevention. How do

we provide the preschool and general education

instruction that leads to school success and

greatly reduces the number of CLD children,

particularly African‑American, who need specialized

services and placement.

The first recommendation is early

intervention and education. For children at the

greatest risk, early intervention needs to

parallel, if not exceed, those services that are

currently available to families of infants with low

incidence disorders such as sensory disabilities

and Downs Syndrome. CLD children born into

families with specific markers associated with

school failure, for example, extreme poverty,

premature parenting, parent criminality, family

disorganization and so forth, need to be targeted

for early intervention. These interventions should

include family support and education, health

services, sustained high quality care and cognitive

stimulation.

Preschool children from this population

need access to high quality preschool programs.

Recent scientific reports showing lasting effects

of quality early childhood child care into

adulthood is instructive. These authors, Campbell

and her colleagues at the University of North

Carolina and Chapel Hill, found high‑quality early

childhood child care to have a lasting effect on

cognitive and academic development even into high

school. And it was interesting that her findings

showed that children who were in these programs,

not only achieved better, but were less likely to

be referred for special indication, were less

likely to access the criminal justice system, were

more likely to finish high school, and more likely

to go into college.

Emphasis needs to be placed not only on

remediation for those at risks for school failure,

but also on stimulating the cognitive abilities for

youngsters who show promise of giftedness. And

this is the other side of the coin. These

youngsters are least likely to be identified for

advanced programs and gifted programs, partly

because we are waiting for them to succeed and we

are waiting for them to succeed when they often are

in less than adequate school programs.

The second recommendation is general

education personnel preparation. I really think

that this is largely a general ed, not a special ed

problem, and that it needs to be addressed from

that perspective. Children are labeled and placed

in special education programs only after an

expanded period of failure in general education

classrooms. For many children, improvements in

school performance can be brought about through

increased teacher support and effective instruction

behavior management practices. Preservice and

in‑service training for general ed teachers needs

to be designed to equip personnel at least with the

following competencies. One happens to be cultural

competence. I will skip over that and move on to

the next one which is effective instruction.

I am moving quickly, because right now

I have a model school\'s project going in the

Columbia City schools that I am really quite

excited about and what we are doing is to help

teachers develop good instructional skills. Skills

along the lines of what I was talking about earlier

where children are having success. And we are

having success too. One of the things that we are

doing, though, in addition to providing

after‑school professional development seminars

which are voluntary and you don\'t always get

teachers to participate, I have my highly trained

graduate students, Ph.D. level graduate students,

working in the classrooms with the teachers,

serving as what I call coaches.

And what we have done is we have helped

teachers to identify, design, implement

instructional strategies to work with all of the

children in the classroom. And we have been

collecting data, I didn\'t bring my slides, but

essentially what the data shows is that when these

teaching practices are in effect, not only are

children responding more correctly academically but

the level of disruptive behavior goes down

dramatically. And we have seen a reduction in

disruptive behavior for all of the youngsters in

the classes where we are working. So that leads to

the second ‑‑

DR. FLETCHER: Dr. Cartledge, we need

you to wrap up, please.

DR. CARTLEDGE: Stop now?

DR. FLETCHER: No, you can wrap up. I

just wanted to alert you.

DR. CARTLEDGE: I just wanted to say

that teachers need to acquire skills in behavior

management and we need to create schools that

address all of these issues, and I just ‑‑ I am not

going to talk about that.

I just want to mention families of

culturally and linguistically diverse learners.

Families have been an important driving force

behind much of the special education legislation

and programming. And we all recognize and respect

the role that they play. However, most of these

families have been white middle class families. We

need to aggressively pursue the involvement of CLD

families and schools need to be trained to make

outreach to families.

Thank you.

DR. FLETCHER: We appreciate your

testimony, Dr. Cartledge.

The Commission members do not have

written copies of your testimony, so we will keep

the record open and ask you that provide that for

us.

DR. CARTLEDGE: I sent two copies to

Troy.

DR. FLETCHER: We will chastise him

later, but I want to officially leave the record

open so that we can receive it.

We have some time for questions, but I

will ask the Commission members to limit themselves

to their most important questions starting with Dr.

Wright.

COMMISSIONER WRIGHT: I get to bat

lead off this time, right, Mr. Chair?

DR. FLETCHER: That\'s correct.

COMMISSIONER WRIGHT: Dr. Cartledge,

if you could just elaborate just a little bit more

on family support. Your presentation, it appears

to me to be very strong in family support, and I am

very interested in family support. Could you talk

a little bit more about the family support.

DR. CARTLEDGE: First of all, there

are some people that do a much better job of this

than I do, and one of the most recent issues of

\"Exceptional Children,\" there was an article by

Park, Turnbull and Turnbull, where they talk about

poverty in general and they talk about the kinds of

services that we need to provide families of poor

children. Most of us are sort of oblivious to the

kinds of stressors that present themselves to

impoverished families and how that interferes with

children\'s learning.

And the supports that they need deal

with both physical as well as emotional as well as

cognitive and intellectual needs. Many of these

impoverished families don\'t know the kinds of

things that they need to do to stimulate the

children\'s emotional as well as intellectual well‑

being, so I think there is a real need to address

that issue if we are serious about prevention.

COMMISSIONER WRIGHT: Thank you.

DR. FLETCHER: Thank you very much. I

will refer Commission members to the research of

Dr. Susan Weander, which provides systematic parent

education programs for high poverty families,

exactly what you mentioned and what Dr. Cartledge

just described.

Dr. Grasnick.

COMMISSIONER GRASNICK: I would direct

this to any of the panel members. Thank you for

your presentation.

What do you see as the role of a

well‑functioning language system as it relates to

the identification of children with special needs,

particularly learning disabled, and does it beg for

much more intervention in terms of developing the

language system early on for children, particularly

those with circumstances of poverty or who are from

families who are speakers of other languages?

DR. YSSELDYKE: I will just make one

comment, and that is, I guess, to refer the

Commission where I would look, and that\'s to the

Hart and Grissley book on \"Meaningful Differences,\"

which points to the significant discrepancy in

language background of children in poverty and

children who are not in poverty and highlights for

us in very clear, empirically documented ways the

tremendous need for early intervention in language.

DR. FLETCHER: Does anybody want to

add?

DR. CARTLEDGE: I would point out that

the children come to school, impoverished children

come to school with one‑half the language of the

middle class.

But I also want to point out that a lot

of our problems with culturally and linguistically

different children is the way we assess them. We

fail to assess them in their native language, we

fail to understand cultural differences.

DR. FLETCHER: Commissioner Takemoto?

COMMISSIONER TAKEMOTO: This is an

issue that is near and dear to my heart in many

way, but I will try to limit my important questions

to probably my most important question about this

issue.

Someone that I heard recently said that

far too many minority and language diverse

children, particularly males, are consigned to a

system of hopelessness and failure when they get

eligible and enter special education services.

That touches me deeply because a part of me knows

that with all this research‑based intervention and

recommended practices and from what we know about

special education, special education works and it

has worked for millions of kids who had no hope and

were in that failure of hopelessness cycle before.

Yet, I know far too many of those students,

particularly minority students, who are still in

that hopelessness failure system.

We have heard a lot about early

intervention here. Tell me more about special

education and how we could look at things like

meaningful educational benefit within that, and

whether we know enough so that all students,

including minority students, will make gains and

will not be left behind?

DR. FLETCHER: I think Dr. Gresham

could address that because it is essentially in his

testimony on page 13, talking about the research

evidence on response to intervention.

COMMISSIONER TAKEMOTO: For students

who end up in the special ed.

DR. GRESHAM: I\'m sorry, I didn\'t

understand.

COMMISSIONER TAKEMOTO: We have heard

a lot of evidence about response to intervention as

a means of keeping kids out of special education.

But in the area of, for those students who I am

also very concerned about, including my own child

and children of parents that call me, once you

cross over that line called special education, what

do we have in terms of evidence‑based instructional

practices that they will make meaningful education

benefit?

Are we at a point where we can hold

schools accountable for that meaningful educational

benefit?

DR. GRESHAM: I think Dr. Cartledge

probably addressed part of that, as I heard her in

her testimony.

COMMISSIONER TAKEMOTO: The focus of

the testimony was on early intervention, but I do

know that many families of students who are

minority families, as you know, Dr. Gresham, are

calling because they want their kids in special

education because they know special education can

work, and far too many minority families are now

calling me saying because of this

overrepresentation issue, we don\'t have access to

special education?

What on the special education side do

we have to offer families that is so wonderful that

children will make meaningful progress, or is

special education still a place of hopelessness and

failure that people are saying it is?

DR. GRESHAM: I think at least with

high incidence disabilities, in my reading of

research on that question, somebody wrote an

article one time, it escapes me who wrote it, maybe

Jim knows, \"What is Special About Special

Education?\" The answer to that question is

nothing. Meaning that special education is

sometimes just a place where you receive

instruction under entitlement but in terms of

instructional strategies, good teaching is good

teaching, effective instruction is effective

instruction.

So I think there is a lot of research

on effective teaching literature, to show that you

can get a measurable education benefit out of good

instruction.

Dr. Cartledge, I think mentioned direct

instruction being a good example.

DR. YSSELDYKE: Can I mention one

thing?

It is really critical that we recognize

if you want to improve instructional outcomes for

kids, you have to know where you are going. We

have done a good job recently of specifying

standards, goals and objectives. You have to know

how to get there. There is a well‑confirmed ed

knowledge base on how to teach kids and it is not

restricted to kids with disabilities.

Most importantly, you have to know

whether you are getting there, and we have a long

history in this country of excluding students with

disabilities from our assessment and accountability

systems. That\'s changed recently. In our work at

the National Center in Educational Outcomes, we

have seen significant increases in participation in

kids with disabilities in state and district

assessment systems, and that\'s meant good things

for kids with disabilities.

We see standards in their IEPs. We

see kids making progress towards standards, and we

see some school systems for the first time in

history, assuming that they have responsibility for

improving outcomes for those kids because they

count. So I would also encourage the Commission to

just reinforce, strengthen that part of our law

right now which says that you must account for the

performance and progress of all students, for

indeed, we count who we count.

COMMISSIONER TAKEMOTO: Thank you very

much.

DR. FLETCHER: The Chair will ask

three quick questions, very fast, starting with Dr.

Gresham since he is standing up there.

Dr. Gresham, we have heard testimony

that essentially the data is not adequate to

implement response to the instruction models and

that, therefore, they should not be implemented at

this point in time until we do more research. Is

that the opinion that you were expressing on page

13 of your testimony?

DR. GRESHAM: I think there are places

where that particular model has been very

successful. I point out, in the overhead I pointed

out to you Heartland AEA‑11 model had been using

that particular approach to eligibility

determination for about the past eight or nine

years with a dramatic amount of success in terms of

eligibility entitlement decisions. Not only

monitoring academic progress, but also entitling

children to special education.

So I think we\'ve got a working model at

least in one state. Now that state may not be

representative. That argument certainly can be

made, but there are other districts I think that

are also using a similar approach, a

problem‑solving model like that.

DR. FLETCHER: Thank you.

Just real quickly, Dr. Ysseldyke. Dr.

Cartledge and Dr. Gresham both recommend

elimination of IQ tests. You didn\'t say anything

about whether you thought IQ tests were valid or

not for the identification of children. I was

wondering what your recommendation was.

DR. YSSELDYKE: I would third the

recommendation, or I guess it is fourth this

morning, that we eliminate the required use. I

point out the required use because school

psychologists think that they have to do this stuff

in every case, so WISC, RAST and Bender kids over

and over again and write reports.

And anything that you can do to help

alleviate that thinking, that that\'s what we have

to do, would be appreciated. And knowing a

youngster\'s IQ tells us nothing about how to teach

the youngster. You learn how to teach students by

teaching students and gathering data on the extent

for which what you do moves them toward the goals

and outcomes that you hold for them. Not by

knowing whether they are a 38, a 78 or a 138.

DR. FLETCHER: Thank you.

Dr. Cartledge, you testified about the

value of direct instruction instructional

approaches. Just a point of clarification, direct

instruction means lots of different things to

different people. And I was wondering if you meant

programs specifically called direction instruction

programs or if you are really talking about the

importance of explicit instruction?

DR. CARTLEDGE: Both.

DR. FLETCHER: So you would

essentially advocate or see value in the use of

what is traditionally called direct instruction

programs for children with disabilities, who are

also, for example, poverty or minority status.

DR. CARTLEDGE: Right, yes.

I closely observe these programs and I

have seen real good outcomes, although teachers ‑‑

many teachers don\'t like them because they are so

structured and scripted, but what I am concerned

about is that a lot of teachers don\'t get good

training in providing explicit instruction unless

they do go through a program of this sort.

What we are doing right now, we are not

using, DI. We are using variations of that. But

what we are trying to do is to get teachers to

present instruction where it is very explicit and

requires students to respond continuously. But

what we are having to do is to have coaches go in

there and work with the teachers to make sure that

they are able to do it.

I know I am sort of long‑winded ‑‑

DR. FLETCHER: We really do need to

move on. You have answered my question very

nicely. Thank you.

Reverend Flake.

REVEREND FLAKE: Thank you very much,

Mr. Chairman.

This is for anyone. The question of

discrepancies, even when there is culpability as it

relates to socioeconomics as related to economics,

not just poverty, would that suggest there are some

preclusions about the socilogical imperatives that

teachers may perceive based on the background of

the child before they are even assessed, and then

the assessment confirms for them what they were

thinking in the first place, as opposed to a purer

analysis that says that maybe some of these kids

are just behavioral problems that are at certain

growth levels that can be adjusted within a

traditional classroom structure?

DR. YSSELDYKE: I will just give you a

quick response because it is something that I

didn\'t say in the testimony.

We spent a lot of time studying the

process of referral. And the answer to your

question is incredibly complex. What we know for

sure is that teachers refer kids who bother them.

Different kinds of teachers are bothered by

different kinds of kids. So when a youngster walks

into a teacher\'s classroom uttering a long string

of four letter words, the teacher in one case

refers him immediately for assessment for behavior

disorders. The other teacher says, \"Thank you,

thank you for sending me Alan. The last three

didn\'t talk. This one at least talks, we will

change the words that he used.\"

So the response to your question has to

be taken in social context, and I think that\'s

reflected really nicely in Dr. Cartledge\'s data on

different school districts in Cleveland and the

kinds of kids you get. I would submit to you that

one the difference ‑‑ the racial difference occurs

in a place like Shaker Heights is that those kids

differ from the other kids that folks are used to

teaching in their classes, and they probably

demonstrate some behaviors that bother folks.

DR. GRESHAM: I just want to reinforce

what Jim said, and also if you look at the bottom

of page 4 of my prepared testimony, it talks about

referral. Basically, referral decisions are not

based on standardized test results, so that is the

second stage where the real determination takes

place, referral definitely takes place using local

norms based on teachers local norms, and that can

be relative. It is relative to kids in that

classroom, kids in that district.

Also, as Dr. Ysseldyke pointed out,

teachers tend to refer kids that bother them, kids

that demonstrate what we call externalizing

behaviors.

REVEREND FLAKE: Just one question in

general to think about, would I be correct in

assuming that in many instances there is already a

predetermined lower expectation that these kids

will ultimately be able to perform or come out of

the special ed class?

DR. GRESHAM: I think that may be true

in some cases. I don\'t know how prevalent that is,

that belief.

REVEREND FLAKE: So that has not been

analyzed?

DR. FLETCHER: It was discussed in the

RC report.

REVEREND FLAKE: All right, thank you.

DR. FLETCHER: Commissioner Rivas.

COMMISSIONER RIVAS: I would like to

thank you each of your for your excellent

testimony. You have given us much information and

many recommendations.

I guess my question for you is, due to

the time frame that we have to compile a report

that we have to present to the Commission as a

whole, and this being one of many tasks forces, I

would like for you to give me what your top

recommendation for the improvement of the

assessment and identification part of IDEA.

DR. GRESHAM: The committee?

COMMISSIONER RIVAS: Each one of you,

because we got many recommendations.

DR. GRESHAM: What I would recommend

for my part is number one on my recommendation

list, which is the current approach to defining

learning disabilities based on IQ achievement

discrepancy should be abandoned. That\'s number one

for me.

Number two would be we should adopt a

responsiveness intervention model instead.

DR. YSSELDYKE: You can in short time

have immediate impact. Look at Lucas and Louisiana

and Mississippi, where it was mandated that folks

provide evidence that they had actually taught kids

and had data on the extent to which those students

were profiting from alternative instructional

procedures before they were allowed to put kids

into an assessment.

Your two approaches that may work is to

recommend that we provide special ed services to

the bottom 20 or 22 or 23 percent of the school age

population based on documented performance and

progress and achievement. My good colleagues,

Maynard Reynolds and Margaret Wong, who is now

deceased, demonstrated you will get the same kids

as you get with all the categorical stuff.

But I think it is requiring that people

provide evidence that they have actually employed,

evidence based practices, and that the kid is not

profiting from that kind of instruction. So the

multiple gating procedures that Gresham talks

about, that Hill Walker talks about, that lots of

the folks talk about, dual discrepancy kinds of

approaches. I would strongly recommend that you go

that way and, yes, please, get rid of the

discrepancy.

DR. FLETCHER: Thank you.

Commissioner Coulter ‑‑ oh, I\'m sorry.

DR. CARTLEDGE: I don\'t have a simple

remedy here. I would essentially say that one of

the things that we need to do is to provide

specialized intervention within general ed

classrooms.

When youngsters are identified as

having a problem, instead of sending that youngster

on to special education or providing intervention,

I would suggest that we provide specialized

intervention within those settings. And then if

the youngster is not responsive, then perhaps

placed in special education. But I don\'t think

most general ed teachers know how, on their own, to

implement the recommendations that are provided by

the special ed teams. Many of them make a good

effort, but they don\'t have that expertise and we

are not providing the training for them.

DR. FLETCHER: Thank you.

Dr. Gresham, do you want to add to

that? You don\'t have to.

DR. GRESHAM: No.

DR. FLETCHER: Okay, Dr. Coulter.

COMMISSIONER COULTER: Once again,

like the other Commissioners, I want to thank you

very much for your remarks.

We have heard testimony in previous

hearings with regard to the lack of scientific

basis for the use of the IQ discrepancy model, and

I have been troubled by at least several national

organizations that have appeared to be taking the

position that, despite the fact that there is no

science to support this model and despite we

obviously have, at best, mediocre results for

children with disabilities, including drop out

rates that are 50 percent or greater in some

instances, that they continue to push for the

status quo. And I can accept a fear of change, so

to speak, but I guess Dr. Ysseldyke, if I heard

your testimony correctly, you said that there are

number of places in the United States today that

are operating under alternative systems for

identification and that those people, it sounded

like you said it was like trying to operate this as

almost ‑‑ I think the word you used was a bootleg

place process.

Could you speak to the capacity of the

country today. If we took away that rule, could

people rise to the challenge and do something that

is scientifically valid rather than simply

repeating what they have been doing in the past,

that I think all three of you have testified does

not make sense?

DR. YSSELDYKE: Okay, I did it again.

I would refer you to the work in Heartland AEA,

people like Jeff Crimes, Dan Rashley, Dave Tilley

and Randy Allison have good evidence on the

effectiveness of noncategorical approaches and they

have a text on that I can give you the reference

to. Joe Kovalevsky, Dave Prosy and their

colleagues in Chicago schools have been operating

with a problem‑solving model based on the Iowa

approach. Minneapolis Public Schools, my

colleagues Doug Marst and Andrea Kantor, people

like that have had a waiver on having to classify

kids for a period of time.

And I guess rather than just to refer

to more places, I would refer you to several

publications of the National Association of School

Psychologists where they document those best

practices, and to the new Volume IV of \"Best

Practices in School Psych,\" that lay that out. And

my read on the school psych profession is that they

have been calling for this for a very, very long

time and haven\'t been able to get a receptive ear.

So those are at least some of the

locations, Alan, just off the top of my head.

DR. FLETCHER: Thank you.

Commissioner Acosta.

COMMISSIONER ACOSTA: Once again, the

last shall be first and the first shall be last,

Dr. Wright.

I thank you for your excellent

testimony, and as many of my fellow Commissioners

have already asked the questions, so let me ask

quickly, when I was in school in New York City,

reading was used as a category for identification

of special education.

Should reading be used as a category?

Is it still being used? What with can we do about

it? And that is for Frank or Jim. And, Jim, with

all due respect to Bob the Builder, \"juntos

podemos\" first.

DR. GRESHAM: I would just refer you

back to, this was Chairman Fletcher\'s idea, we had

a follow‑up meeting, I think, wasn\'t it back in

November for the LD Summit, and what we did in that

case would be, as know the current law, IDEA,

defines seven categories at least in learning

disabilities, seven subcategories of specific

learning disabilities. I think we did a poor man\'s

factor analysis ‑‑ or poor woman\'s factor analysis

‑‑ they reduced that to about three or four, if

memory serves.

Is that not correct?

DR. FLETCHER: We tried, but we

weren\'t able to get consensus on that.

DR. GRESHAM: Right. The point is the

overwhelming majority of children who are placed in

learning disability programs are for reading. And

we know much more about reading than we do any

other academic area in terms of remediation. A lot

of that being due to the research that has been

funded over the years from NRCHD. We know less

about remediation now in some of the other

categories, so I don\'t know whether a separate

category of reading is justified because a kid

could probably read okay but also have some

specific math issues.

Unless you have another one.

DR. YSSELDYKE: I just wouldn\'t

categorize them. I would take his reading problems

and provide him with effective instruction and

there is knowledge base on how to do that. If you

have to figure out who to serve and it is a

resource question, decide how many dollars you\'ve

got and serve the bottom X percent of the

population based on their performance in reading, I

think we will address a lot of that through what is

left of the REA and of the Reading First

initiatives.

COMMISSIONER ACOSTA: Thank you.

Just one last statement to Gwen. I

come from a community where, unfortunately, I agree

with you, that we have to raise expectations of

teachers, but how about families who have low

expectations as well as teachers, both minority and

non‑minority teachers, and that is where the rubber

meets the road for me, a lot of my minority

teachers have low expectations of minority

children. And how do we do that within the

context, because one of the other issues that we

are facing as a Commission, is making

recommendations for teacher preparation?

DR. CARTLEDGE: That\'s a very good

question, and I would agree with you totally, and I

have dealt with it all in terms of my applied work.

And, forgive me, Reverend Flake, but I

don\'t think that preaching is going to do the job

here.

REVEREND FLAKE: I agree with you.

DR. CARTLEDGE: I think that the best

thing that we can do is to go into the schools and

show that the children can do it. And we do have

schools where children are doing it. And I think

that the proof of the pudding in this case is in

the eating. When teachers begin to see that

children achieve, then they will begin to believe.

When parents begin to see that their children

achieve, they will begin to believe.

COMMISSIONER ACOSTA: Thank you.

DR. PASTERNACK: The testimony that

you have provided this morning is supportive of the

President\'s charge to this Commission, that it is

tame for us to focus on how we achieve excellence

in special education. And I thank you all very

much for coming before the Commission.

I have many questions, but in the

interest of time, I will start with the same

question for all three of you, and that is, why, in

your opinion or based on the data that you are

aware of, is the drop out rate for students with

disabilities twice the drop out rate for their

nondisabled peers?

DR. CARTLEDGE: Well, I think it is

just for all of the reasons that we have mentioned.

That is, first of all, we are dealing with, to a

large extent, especially in the high incidence area

with the exception of LD, we are dealing to a large

extent with impoverished children. We are dealing

with youngsters who may not have much hope anyway.

We are dealing with youngsters that schools see not

only as different, but difficult. Many times these

youngsters are pushed out of school.

And the data that came out in Ohio, one

of our school systems south of Columbus has decided

to stop suspending youngsters for truancy and

things of that sort, and this at the high school

level, and the reason is what they found is that

the youngsters were dropping out of school. It was

counter‑productive. So with the measures that we

use in school very often to address the youngster\'s

problems are very often ineffective and they drop

out.

DR. GRESHAM: I would just add to that,

besides the cultural and family issues that might

help explain that, I think a very behavioral

explanation of that, when you are confronted with a

situation where you know you are going to fail, and

you can predict that you are always going to fail

in that situation, there is no really hope.

Somebody mentioned the word \"hopelessness\" before.

It is an easy choice to drop out of school.

And I think there is a very good reason

why kids do, simply because they know they can\'t be

successful, because they never received adequate

instruction, apart from some family background

issues that might contribute to that.

DR. YSSELDYKE: I would agree. I

think it is an issue of instructional match. As we

look at what goes on in schools, the area we find

and observe in classrooms, the one thing we find

most often with kids is that instruction is

inappropriately matched to the level of skill

development of the learner, and then the

expectations are out of whack.

I guarantee you that if you tell me

that I can\'t get out of a situation until I get a

score of 80 in gold, I am going to drop out

immediately. If instead, you employ a concept of

personal best, and say, \"Jim, what is the best you

have ever done?\" And I say \"Maybe 110,\" and you

set realistic goals and then provide me with

feedback that tells me that I am moving towards

those and that I am a successful person, then I am

going to do what Frank suggests.

I think kids drop out because they feel

they have no chance of being successful. You tell

me I got to shoot a decent score in golf, I am out

of here. I don\'t want to hang around. And there

are really good programs, I have to tout some of

ours at the University of Minnesota, a program

called Check and Connect. My colleagues Sandy

Christiansen and Caramel Lair, where they have also

developed some procedures to make sure that kids

actually attend school. The kids who drop out are

the kids who learn over time that it is a better

deal not to be there than to be there. So if we

get folks checking on them and connecting with them

and making sure that they are there experiencing

success, we can make some changes in that.

DR. PASTERNACK: Did we hear testimony

today that you all believe that we have

instructional strategies to be able to achieve

excellent results for students with disabilities?

That is just a quick \"yes\" or \"no.\"

DR. YSSELDYKE: Absolutely. There is

a well‑confirmed knowledge based on effective

instruction.

DR. PASTERNACK: Then why don\'t we

have more effective results for students with

disabilities in this country?

DR. YSSELDYKE: Because of a lot of

contextual considerations. We put teachers ‑‑

one, teachers sometimes know about things like

retroactive and proactive inhibition and they don\'t

know what to do on a daily basis with kids, so we

haven\'t got as much good training as we ought to

have on implementation of empirically demonstrated

strategies and tactics so that teachers know

precisely what to do on a daily basis with kids.

Secondly, we create, in many instances,

overwhelming circumstances in which we expect folks

to be successful with kids, including kids with

disabilities.

DR. PASTERNACK: I know we are out of

time, but I have to ask one more quick question,

and that is the issue of pathologizing kids and the

critical need to identify kids earlier.

Is there a noncategorical way to

identify kids earlier so that we can being to

intervene in the lives of those kids earlier

without having to continue the flawed model that

you have all talked about eloquently this morning

with labeling kids?

DR. YSSELDYKE: I am just going to

refer you to the work of Charlie Greenwood, Julie

Carter, Scott McCollum, Mary McEvoy and the folks

at Oregon, Ruth Kaminsky, Roland Good, on

monitoring the progress toward instructional, all

kinds of very young children, they can predict very

early which kids are going to experience

difficulty, and they\'ve got well‑designed

interventions for those kids.

DR. PASTERNACK: And since the Chair

has left the room for the moment, can we ask, Dr.

Ysseldyke, that you provide the Commission with

those sites so that we will be able to go ahead and

access that literature.

DR. YSSELDYKE: All right, and it is

the OSEP funded Early Outcomes Institute, which is

a combination of those three universities, so we

will get you that.

DR. PASTERNACK: Thank you very much.

COMMISSIONER WRIGHT: Who is

presiding?

DR. PASTERNACK: It is Commissioner

Pasternack.

COMMISSIONER WRIGHT: I have one other

thing that I wish to say. I wish to say that in

preparation for this, I went back to my Ysseldyke

tapes, so I got prepared for this.

And I want to say this to you, that

your testimony today is consistent with your work

in your textbooks that we use and so I didn\'t have

to ask you a lot questions because I am familiar

with your work and we use your work in our college

textbooks. Thank you.

COMMISSIONER JONES: One short

administrative announcement, and this is also for

the benefit of the public as well. We have a

luncheon speaker that we have added, which wasn\'t

on the schedule. So over lunchtime, we will be

continuing with that, although obviously, you are

free to leave at any time, the observers.

For the Commission members, we are

bringing in lunch, and everyone, I believe except

Commissioner Grasnick has been made aware of this,

everyone needs to get their order together now and

give the money to me or to Linda, so we can

actually feed you here at lunch.

The Commission is going to take a

ten‑minute recess.

AUDIENCE: Who is the luncheon

speaker?

DR. PASTERNACK: The speaker at lunch

is Dr. Dorothy Kerner Lipsky, who is the Director

of the Center for School Restructuring and

Inclusion at the City University of New York in the

great City of New York.

COMMISSIONER JONES: The Commission

stands in recess.

(Recess.)

DR. FLETCHER: We are going to get

started now if people would take their seats.

Our next witness is Dr. Howard Abikoff.

Dr. Abikoff is a Professor of Child and Adolescent

Psychiatry at New York University School of

Medicine. He is also a Director of the Institute

for Attention Deficit Hyperactivity and Related

Disorders at the New York University Child Study

Center.

As you might imagine, Dr. Abikoff is

going to talk about issues that pertain to the

identification of children with Attention Deficit

Disorder.

Dr. Abikoff.

DR. ABIKOFF: Thank you, Commissioner.

I want to thank the Commission for inviting me to

meet with you all today and to provide some

testimony, and I look forward to an interesting

question and answer period.

As you can see from the title of my

slide, I am going to be presenting an overview

today of ADHD, including a description of

diagnostic procedures and treatment approaches, and

I would also like to present some policy

recommendations regarding ways to facilitate the

identification, management and education of these

youngsters in school settings. Before I begin,

however, I would just like to provide the

Commission with a copy of an International

Consensus Statement on ADHD that was prepared in

January of this year, and it was signed by an

international consortium of scientists around the

world. And this statement can serve as a reference

regarding the status of the scientific findings

concerning ADHD, the validity of the disorder, and

the impact it has on those individuals diagnosed

with the disorder. So I have this here, I will be

happy to give it to you at any time.

DR. FLETCHER: Thank you, Dr. Abikoff,

we will enter that into the record.

DR. ABIKOFF: With that said, why

don\'t we take a quick historical trip and see how

this disorder has been conceptualized historically.

And I have up here a historical time line.

I think it is important to recognize

that ADHD is what is considered to be a neuro

behavioral syndrome, and it has undergone

definitional changes over the years, especially as

our knowledge of this condition has increased. The

key issue, however, is that the core symptoms of

this disorder always have been defined on the basis

of behavioral characteristics. As you see, as we

move to the left of the slide, the early

conceptualizations, MBD, if you will, both minimal

brain damage, and then slightly later, minimal

brain dysfunction, they were very vague and over

inclusive. And they refer basically to a cluster

of symptoms, including learning disabilities,

hyperkinesis, impulsivity and short attention span.

In 1937, Dr. Bradley in Connecticut

reported some positive effects of amphetamines when

he was treating youngsters with behavior disorders,

and he found that it reduced their disruptive

behaviors and facilitated academic performance.

However, beginning in 1960 and then going on into

the late \'60s, there was a special dissatisfaction

with the term MBD. And, in fact, it led to coining

of the term \"hyperactive child syndrome,\" which in

1968 was changed to the \"hyperkinetic reaction of

childhood,\" which stressed motoric symptoms.

However, modern classifications, and those include

the diagnostic and statistical DSM‑III, 3R, and the

more recent 4, have described the signs and

symptoms of the disorder without implying any

specific etiology, as did MDD, even though it was

nonspecific. And that\'s important and we will get

to that more in a moment.

So the current emphasis of ADHD

emphasizes really three main behavioral areas ‑

inattention, impulsivity and hyperactivity. And I

will be talking about that in more length shortly.

How prevalent is this disorder? There has been

concern that maybe it is only a U.S. phenomena,

and, in fact, that is not the case at all. What we

see from studies from around the world, is that the

prevalence is fairly consistent across diverse

geographic racial and socioeconomic populations.

And basically the differences in prevalence rates

that we see here are, more than anything, largely a

function of the diagnostic criteria that are used.

For example, the ICD‑9, the

international classification of diseases, and now

it has been updated to ICD‑10. Those criteria for

attention deficit disorder are much more

restrictive than the DSM criteria. The result is

that you get lower prevalence rates in countries

where the ICD criteria are used. As an aside, it

is interesting to note that if you have clinicians,

for example, in Britain, who use the ICD criteria,

if you have them diagnose youngsters using DSM

criteria, you end up with the same rates that are

found here in the states.

The earlier DSN criteria has a narrow

focus and they were largely based on hyperactivity

and the current criteria, especially DSM‑IV,

include again, as I said, hyperactive, impulsive

and inattentive subtypes. And those have resulted

in higher rates of diagnosis.

Now, what do we know about the etiology

of this disorder? Well, we are fairly certain that

it is caused by a complex interplay of factors.

For example, there are biological factors that can

predispose an individual for ADHD, including

post‑traumatic or infectious encephalopathy, lead

poisoning and fetal alcohol syndrome. There are

environmental factors such as abuse, sexual or

physical, or neglect, female adversity and

situational stress. And there is also evidence,

increasing evidence now from neuro science and from

neuro imaging research of abnormalities in brain

function and anatomy, including abnormalities in

frontal networks, in frontal striatal dysfunction

and dysregulation in neurotransmitter systems in

the broken, especially the dopamine systems.

What have the neuro imaging studies, in

fact, shown us, and here is a summary slide. The

recent studies have basically pointed out that

there are different brain structures in ADHD

youngsters, which are smaller than individuals

without ADHD. And, in fact, those differences are

about 10 percent. And these include such areas as

the basal ganglia and the two areas in there known

as the cordate and the globus pallidus, that are

very rich in dopamine receptors, again, the

neurotransmitter system that is assumed to be

critical for functioning related to ADHD.

There are also smaller areas in the

cerebellum in ADHD youngsters, particularly an area

known as the cerebella vermis. Frontal lobes,

which are very much involved in executive function,

have also been shown to be smaller in ADHD

youngsters than in controls. And again the frontal

lobes are also very rich in these dopamine

receptors.

And, again, these differences of

approximately a 10 percent decrease in size

compared to individuals without ADHD are strong

evidence for a biological basis for the disorder

and the fact that the biological group differences

exist. However, it is important to note that the

findings from these neuro imaging studies are based

on group mean differences and that there can be

overlap in the findings in children with ADHD and

without ADHD. In essence, if you rely on neuro

imaging alone, you will end up with a lot of false

positives and a lot of false negatives. So I think

what is important to know right now, although this

is a terribly important research tool, and it is

providing us with many, many leads, neuro imaging

is not a valid diagnostic tool for individual

patients.

What about genetic findings? There has

been strong evidence that has been collected over

the past few decades that elucidate a genetic

component to ADHD, and these include twin studies,

family studies, especially of siblings and

relatives, as well as adoption studies. And what

do we know about the heritability of ADHD. Well,

what I have tried to depict here on this slide is

the heritability for different disorders, and I

have listed panic disorder, for example, ADHD and

schizophrenia and height. And what we know is that

the high heritability of ADHD has been borne out in

numerous studies and that genetic factors are

implicated in measures of attentiveness and

activity as well as in the diagnosis of ADHD.

And as you can see on the slide, the

studies confirm a genetic basis for ADHD with a

heritability of about .75. What this means is

about 75 percent of the variants in the phenotype

for ADHD can be attributed to genetic rather than

to environmental factors. If a disorder was

completely attributable to genes, the heritability

would be 1.0. And it if were caused by the

environment, the heritability would be zero. And,

again, what I have shown for reference is the

heritability of panic disorder, schizophrenia and

height.

So what do we know in terms of the

summary of our findings for a genetic basis of the

disorder? Well, it comes from, number one, twin

studies, where we know that there is a 92 percent

concordance in monozygotic twins for the disorder.

And, in fact, even in full siblings, there is a 50

percent concordance rate. Family studies show that

first degree relatives of ADHD children have a

higher risk for the disorder than do relatives of

controls. We also have information of adoption

studies that\'s very informative. And they indicate

that the adoptive relatives of children with ADHD

are less likely to have the disorder than are

biological relatives of these children.

And then finally, new work that is

going on in molecular genetics also points to the

relationship that genes have in this disorder. And

we know that ADHD, for example, has been associated

with mutations in the human thyroid receptor‑beta

gene. Although this was something that really hit

the press several years ago, we now know that this

condition is very rare and can only account for a

few cases of ADHD; however, there is more work to

suggest that two specific genes, the dopamine

transporter gene and what is known as the D4

receptor gene may be playing a role in the

heritability of the disorder.

With that as a very quick summary of

some of the scientific evidence to validate the

presence of this disorder, I want to turn now to

how this disorder impairs functioning in

individuals who have ADHD.

As you can see on the slide, it impacts

all aspects of patients\' lives and results in

impairments of peer, family and adult

relationships, in school functioning, in

functioning at work, in leisure activities and in

self‑esteem. These are children and individuals

who have many, many failure experiences. And as a

result, many of them feel quite badly about

themselves, eventually become dysphoric and even

depressed as a result of the consequences of the

disorder.

These are youngsters who have very

deficient social skills, they have few friends.

Many of them are neglected by other children, or if

they are aggressive, in fact, they are more often

than not rejected. Their academic functioning is

severely compromised even if they don\'t have

learning disabilities. I am sure we will be

talking about that more today. And we see this

compromised functioning in terms of lower grades,

they are held back much more than typical children,

and fewer of them go on to college.

We also know that as they get older,

because this is really now a disorder which we know

to be chronic, many of them in terms of their job

performance leave jobs more often and change jobs

or they get fired. And in addition, they also

suffer from more marital conflicts than do adults

without ADHD.

Now, what are the core symptom areas of

this disorder? It is characterized by symptoms in

two core areas as I have listed, inattention and

impulsivity hyperactivity. And I am going to

review each of these in turn shortly, but we need

to keep in mind that these aspects of functioning

are developmental in course and they change their

presentation with age. And it is very important in

addressing symptoms that a clinician must consider

normal age‑related development of the ability to

pay attention, to inhibit, and to control

restlessness and control impulsive behavior.

There are subtypes of the disorder, and

I have listed the three of them here, and we will

go into them in a little bit more detail, but I

think what is important to keep in mind that with

the new DSM‑IV, we now have three different

subtypes of the disorder, the most common of which

is the one on the bottom which is the combined type

in which children meet criteria that I will

describe in a minute for both the inattentive type

and the hyperactive impulsive type. The next most

common is, in fact, the inattentive type of the

disorder. And the least common is the hyperactive

impulsive type. And we are more often likely to

see that in younger children and not as children

move on into elementary school grades.

So what does the inattentive type look

like? What I have done is I have listed directly

from the DSM the symptoms that, in fact, are

evaluated in order to determine whether or not, at

least in part, a youngster may, in fact, have a

predominantly inattentive type of the disorder.

And, again, what is important to note is that a

youngster must consistently show at least six of

the symptoms that are listed there. And the other

thing to keep in mind, and we will see it in a

slide that is coming up, although all of this needs

to be met, it is not sufficient by itself. There

are other criteria that need to be met in order for

the diagnosis to be made. Again, I will get to

that in just a moment.

What are the symptoms of impulsivity

and hyperactivity? Here, too, what I have done is

I have listed the symptoms that make up these two

constellations, and that is six or more of the

following of any of them have to be manifested

often, and as we will see, in more than one

setting. And as you can see, the impulsive

behaviors would include blurting out answers before

a question is finished, a child who had difficulty

awaiting turn in any situations. It could be while

waiting on line, playing games with other children

and the like. These are youngsters who, because of

their impulsivity, tend to interrupt others or

intrude on others. It is just very, very difficult

for these children to wait.

In terms of their hyperactivity, it

demonstrates in both minor motor movement and in

more gross motor movement, so the children may

fidget a lot in their seat, and you will see that

in terms of a lot of movements and squirminess in

the seat, a lot of playing with materials at their

desk with their hands. These are children who in

situations in which it is expected that they stay

seated, they find it extremely difficult to do so.

And that would be not only in the classroom, but it

might be at a movie theater, it might be at a

church or synagogue, it might be at a restaurant,

et cetera.

And what they also show is

inappropriate running and climbing, a restlessness.

And this is excessive, over and above what you

might expect in a situation in which this should be

moderated. They have difficulty in engaging in

leisure activities quietly. A good description of

these kids is that they always appear to be on the

go. And the other is, although it is not the best

term, what we sometimes here is, \"My goodness,

these children have motor mouth.\" They are

constantly talking. And as you might imagine, in a

classroom setting, that can be very, very difficult

for both the other children and the teacher as

well. With that as a background in terms of what

these symptoms look like, we need to recognize that

there is considerable variation in symptoms.

Number one, the symptoms must appear in

more than one setting. It is not just enough that

the symptoms I have just described occur at home or

at school. They must occur in at least two

settings. Although when that happens, it may occur

more in one than in the other. The other thing we

need to keep in mind about this disorder is that

there is extreme variability, even day to day, and

sometimes within the day. Some of that is setting

specific, but, in fact, the variability in symptoms

is one of the hallmark characteristics of the

disorder.

And the other thing is that we need to

know, in fact, there are times when these children

in certain kinds of novel, stimulating settings

especially, may appear to be able to maintain

sustained attention for long periods of time. We

hear from parents often, who will say \"My child

will play in front of that computer game for three

hours and not leave. How can he do that?\"

Well, in fact, we have what is called

interest‑based performance, and what sometimes

happens is that we see that there is both

variability in functioning and this kind of ability

to sustain attention in some settings for at last

some period of time, it leads to the false

impression among some that these children are

either lazy, uncooperative or willful, especially

when typical boring tasks are asked of them. And

that is not the case at all. Everything else that

I have described before are behaviors that these

youngsters are absolutely unable to control.

Now, what are the other criteria that

need to be considered in order for the diagnosis to

be met, in addition to the symptoms that I

indicated? And these are not transient symptoms

and, therefore, they must persist for at least six

months. The other thing is that they are more

frequent and severe than is typical of the

individual\'s level of development.

The other thing is that this is

something that had to have started before the

children began school, prior to age seven. In

fact, we often see this historically in children as

young as three, and parents will report for some

children that they were the most active infant they

had ever seen, that they were crawling very early,

coming out of the crib early, and, in fact, needed

less sleep than other children.

The other thing that is critical is

that these symptoms must impair the youngsters

functioning in two or more settings. And

impairment is a critical criterion here. We are

not just talking about children who engage in some

of these behaviors more often than other children,

they are not just at the end of the normal

distribution. They are that, but in addition,

these symptoms must interfere with their

functioning. And that differentiates them from

youngsters who may be especially active or may at

times be inattentive, but nevertheless, they are

able to function well in situations when sustained

attention or ability to sit is required of them.

That\'s not case with these children.

And I have listed the other two

criteria there. It must cause significant

impairment in social, academic or occupational

functioning if they are older. And the symptoms

cannot be better accounted for by another mental

disorder. I will talk about that again in a

moment.

Again, it is important to keep in mind,

hyperactivity is not required for the diagnosis of

ADHD. And, briefly, there are, in fact, two other

ADHD diagnoses listed in the DSM, and I have put

them up here. Some individuals can be classified

as ADHD in partial remission, and that is, it was

diagnosed in the past but the criteria are no

longer met, even though clinically significant

symptoms remain. And then, finally, you have ADHD

not otherwise specified or NOS. And that is where

we have individuals with prominent symptoms of

inattention or hyperactivity impulsivity, but they

do not meet full criteria for ADHD. And those are

individuals classified as NOS.

Now, how does this disorder present

over time? What is the course of the disorder?

And what I have tried to show here on this time

line is that we know it is chronic, and, in fact,

based on a whole host of follow‑up studies that

have now been done, anywhere from 50 to 70 percent

of individuals diagnosed with ADHD in childhood can

be expected to have significant problems associated

with this disorder, certainly into early adulthood

and probably beyond as well. Nevertheless, there

are some, in fact, for whom the disorder does

dissipate over time, but even for those for whom it

continues, the nature of the symptoms change over

time, and what we see is that hyperactivity, in

fact, to some extent decreases. At least the overt

motor restlessness. You still get reports from

these individuals of a kind of an internal

restlessness or agitation, but they don\'t show as

much overt motor activity. And to some extent,

there is some reduction in impulsivity as well.

What tends to maintain over time is

inattention and all of the symptoms associated with

it, especially those related to executive function

deficits, including organizational, time management

and planning deficits. So that\'s what we tend to

see over time. But, obviously, we are most

concerned here at this meeting about the children

with ADHD who are especially in elementary school.

And that\'s where we know most about the disorder

and where most of our work, our studies and our

evaluations have taken place.

What do these kids look like? I have

tried to list up here for you how a youngster might

present in a school setting and how he appears

relative to his other peers. I am hoping that most

of you can read that list here, so that I don\'t

have to take you through each of them in turn.

What I think is critical is when you have a

youngster who presents with this kind of picture,

what we know is that this will adversely effect

their academic performance, it causes increasing

difficulty in peer relationships. And that is a

very strong risk factor for the development of

later psycho pathology. Children who have poor

peer relationships and get on poorly with other

youngsters their age, if that continues, are at

significant risk for the development of other

psycho pathology as they get older, including

conduct problems, higher risk for substance abuse

and the like.

I think the key, as we will talk about

later today, is that without intervention,

especially because as I indicated, for most of

these individuals, this does not disappear with age

without intervention, this kind of a picture and

the failures that are associated with this may lead

to poor self‑esteem and depression and can

compromise their functioning in many, many ways as

they move through adolescence and adulthood.

In fact, with that said, what about

adolescence? What do these children look like?

Number one, as I indicated, mother restlessness

decreases and there is instead a kind of inner

restlessness which is sometimes reported. We know

that because of their impulsivity which continues

to some extent, adolescents are going to be much

more involved in rule‑breaking if they are ADHD

then if they are not. They get into a lot of

conflict with authority figures. They get involved

in a lot of risky behaviors, so what we see are a

lot of car accidents. These kids end up having

more speeding tickets, and if you review Motor

Vehicle Bureau records, you will see a significant

difference in both accidents and speeding tickets

for youngsters with ADHD then for those without.

Their poor peer relationships continue

through adolescents and they also show a lot of

emotional lability. And as I have indicated as

well here, their vocational outcome is quite

problematic. And these youngsters are also ‑‑

youngsters with ADHD, which I think is very

important to keep in mind of its public health

consequences, not only are they at high risk for

drug and alcohol abuse, but also for delinquency

and antisocial behavior. Not only do they not meet

their potential, but they result in great cost to

society in terms of having to treat them, and in

some cases, having to incarcerate them.

Now, what\'s important to keep in mind

about this disorder, it is terribly important, that

it frequently does not occur by itself. Rather, in

fact, it tends to co‑occur, or the term we use is

to be comorbid with other diagnoses. And what we

know is that in general about two‑thirds of

children with a diagnosis of ADHD, are also likely

to have another comorbid condition. In fact, many

of them will have three.

The other issue, of course, is that

these other conditions will not be recognized

without appropriate evaluation and are frequently

missed. About half of the children can be expected

to meet criteria for two other disorders which make

up what is called the disruptive behavior disorders

of childhood. And those are known as both

oppositional defiant disorder or ODD and conduct

disorder. And both of those are more common in

boys than in girls.

A number of children with ADHD also

have mood disturbance. Many of them clinically

significant. Those rates vary widely, and it

depends on the criteria that we use to make the

diagnosis, so based on different studies, we may

see rates as low as nine percent or rates as high

as 38 percent for depressive disorders. And in

these cases, the rates are similar for boys and

girls.

Many of these children are also

especially anxious, with full‑blown anxiety

disorders, whether it is a generalized anxiety

disorder, separation anxiety disorder or the like.

And in general, about 25 percent of them or so tend

to meet criteria for these disorders. And, again,

based on criteria for making a diagnosis, it ranges

anywhere from 8 to 30 percent and the rates in boys

and girls tend to be similar.

With regards to the prevalence of

learning disorders, be it reading, spelling or

arithmetic, here it very much is going to depend on

the classification procedures that are used to make

that definition we heard an awful lot about today

by out other distinguished speakers. So, in fact,

if a very liberal criteria is used, we may get

anywhere from 40 to 60 percent of youngsters with

ADHD also meeting criteria for a learning disorder.

If more conservative criteria is used, the rate

drops to between 20 to 30 percent. Regardless, we

tend to find that this is more common in boys than

in girls. So we know that it\'s occurring with

other disorders, but the issue of making a

differential diagnosis when a youngster presents

with suspected ADHD becomes critical in helping us

to understand what is going on in a particular

youngster. And I have listed here some issues that

need to be kept in mind. I\'ve indicated that we

know that there are common comorbid disorders that

do occur with ADHD, but it also can be complicated

by a large number of conditions that can mimic

ADHD.

What we know, for example, is that

there are environmental factors that may be

contributing to ADHD symptoms. For example,

physical, emotional or sexual abuse and severe

family discord can produce symptoms of inattention,

impulsivity and hyperactivity that will mimic the

disorder, but, in fact, are not indication if one

does an appropriate clinical evaluation of an

actual Attention Deficit Hyperactivity Disorder.

I\'ve listed across on the right side a

number of disorders, some of which co‑exist, some

of which can mimic and present with symptoms that

look like ADHD. And it is critical in our clinic

evaluations that we attempt to determine whether or

not any of these conditions exist in order to rule

out other explanations for the problems a child

presents with.

Now with that said, how do we make the

diagnosis? I have listed here different

techniques. And the reason I have done so is

because what\'s critical to keep in mind is

currently there is no single marker that can be

used to make the diagnosis. There is no biological

test, there is no laboratory test for which one

could say if the child is positive on this, we know

this youngster has ADHD. So instead, what

clinicians do is to use a combination of techniques

and measures to assess ADHD symptoms, impairment,

and also to assist in the differential diagnosis.

As I have indicated there, these include interview

and history. There are standardized assessment

measures, including rating scales and neuro

psychological tests, as well as ruling out, through

neurological and physical testing, alternative

explanations for the symptoms the child might

present with.

Now, in terms of practice guidelines,

what I would like to bring to the Commission\'s

attention is, in fact, recently in 2000, the

American Academy of Pediatrics published some very

useful clinical practice guidelines both for

diagnosis and for the evaluation of a child with

ADHD. And those appears in Pediatrics itself in

2000 Volume 105. And I have also listed for those

who are interested, the website where one could

actually download in those practice guidelines in

their entirety. That is a quite useful document.

Now, what is done in the interview?

Well, I have listed up here the kinds of

information that it is important to obtain in order

to get a better understanding of the youngster\'s

functioning. And it is critical to work with the

parents and the child. In fact, what we know about

clinical interviewing with children is that for

youngsters under the age of 9, the reliability and,

therefore, the validity of the information that

they offer is quite suspect and oftentimes of

little, if any, clinical utility. It is even more

difficult for children with ADHD because they tend

to be youngsters who find it difficult to report

accurately about their own behavior. The term that

is sometimes used is an \"illusory correlation,\" and

what we mean by that is that these children will

often tend to describe themselves as doing just

fine, when, in fact, parents and teachers and the

like say just the opposite. You might have a

youngster who is crawling around on your desk, and

if you ask him if he has any trouble sitting in his

seat, he will say \"No, not at all,\" while you are

trying to pull him down off the desk. These

children tend not to self‑reflect and are not

introspective, so it hard for them to provide you

with detailed historical and current information

that is accurate about their functioning. So

instead, we rely, especially if the children are

young, we rely especially on information that is

obtained from parents, as well as from teachers.

And much of that information must be historical.

We need to get a developmental history. We must

get an unfolding the parents of the youngster\'s

functioning from early‑on to the present day. And

as we collect that information, we are also trying

to find out whether or not there might be

alternative explanations for why child is having

the difficulties that he or she is presenting with.

Certainly, we are also trying to get medical

information to rule out the possibility of other

explanations, including lead poisoning, for

example.

It is also very useful to get family

psychiatric history. That can provide useful hints

as well. As I indicated, the disorder is highly

heritable, and we will find in many of these

families, one member, be it another sibling or a

dad, may also have ADHD as well as other disorders

that tend to occur more frequently in family

members of someone who has ADHD than in family

members of children without ADHD. So a

comprehensive clinical evaluation is critical.

And there are a number of different

interview schedules that available. And I have

listed some up them up there. Two very common ones

are the diagnostic interview schedule for children,

DISC, and another one called the DICA. These are

available in written and electronic forms, they

cover all the childhood diagnoses. Now what is

good and bad about it is it requires little input

from the interviewer and can be administered by

trained nonprofessionals. However, the problem

there is that you will sometimes end up with false

positives because the bottom line is that to make

an accurate diagnosis, although you collect

information about the symptoms, you must be able to

probe, to do follow‑up questions, to understand the

information that you are obtaining from the

informant to make certain that they both understand

the nature of the question and that the response

they are giving is truly characteristic of the

problems specific to ADHD, and not due to another

complication.

DR. FLETCHER: Dr. Abikoff, you have

four more minutes.

DR. ABIKOFF: Okay, in that case, some

quick points.

Rating scales, they are easy to use.

They provide important information about how

deviant the youngster is compared to other kids,

but they cannot be used to make a diagnosis. I

can\'t repeat that enough. Scores on a rating

scale, whether it is the Conners rating scale or

the Accembac, will not be used to make the

diagnosis. And I have listed those there.

Neuropsychological tests similarly,

although they may point out strengths and

weaknesses which can help in terms of treatment

planning, will also not be diagnostic. Another

thing, if the child is put on medication and

improves, that means he must be ADHD. Not so.

That does not validate a diagnosis of ADHD, because

we know from studies done with normal volunteers,

they will show similar benefits to at least acute

dosing with stimulants that mirror what we see in

ADHD kids.

How do we manage it? There are a

variety of techniques for trying how to plan how to

intervene with a youngster based on the needs

profile that they present with. Perhaps in the

question and answer, we can talk about stimulant

medication. There are a whole host of medications

that are now out there. Especially some newer ones

that work throughout the whole school day and don\'t

require a second dose during the day. It is the

first line established treatment for ADHD. This

has been the most studied treatment of anything in

all of child psychiatry. We know what it does, and

I have listed it there, and hopefully you can read

all of that. But it is not a cure for the

disorder. About 80 to 90 percent of children will

show at least moderate benefit if they are tried on

one or two stimulants. Where problems remain in

terms of pro social skills deficits, some children

have side effects, parent management techniques

continue, problems with organizational and time

management skills which are terribly important for

these children, do not improve with medication, and

they need to be addressed in other ways.

There are psychosocial approaches that

are available in treating these youngsters. What

is key to keep in mind, for many of these

approaches as much time is spent working with the

adults who live and help manage these children,

meaning the parents and the teachers, as the work

gets done with the children. And, hopefully, we

will be able to go into that in some detail. I

have listed up here the kinds of work that can be

done with families. There is some work that can be

done with children. If you do social skills

training, it must be done in groups. One‑to‑one in

your office is going to get you nowhere with these

children. And to the extent that you can work with

them and have the teachers and parents aware of

what it is you are focusing on so that they can

reinforce it and prompt it at home and at school,

you will end up looking much better.

I have indicated here the kinds of

interventions that can be done in the classroom,

including the use of classroom rules, typical

contingency management techniques, the use of daily

report cards, very useful. You target certain

behaviors and set goals for the children in the

classroom. The teacher monitors it, at the end of

the day they indicate on the card the degree to

which those goals were met. That report card is

brought home to mom. Mom looks at it, and based on

how well the child did, the child is given various

rewards and reinforcements at home. It places

minimal demands on the teacher and is quite

effective.

Other suggestions for the teacher are

listed here. Kids lose their books all the time.

Have an extra set of books at home. Kids can\'t

find their homework assignment or they don\'t know

what it is that needs to be done. Let the kids

make certain that when they leave the classroom,

that homework assignment sheet is filled out and

signed by the teacher. Put the kid in the front of

the room so that the teacher can give frequent

prompts and also reword the kid with praise. Do

not give lengthy, serial instructions, they won\'t

keep it in mind. Make sure that you are consistent

in the way in which certain instructions are given

each day to the children.

Quickly, policy recommendations. We

have heard this from some of our other speakers

today. It is critical that there be more work done

to teach educators, both regular and special

educators about this disorder. How do we do it?

It needs to start early on in training back in

college. We need to make changes in the college

curriculum, and in addition, there needs to be

on‑going in‑service training programs.

There must be from day one, when they

are in college, a familiarity with behavioral

strategies and their use and usefulness in

classroom settings. They need to know what ADHD

look like and what it isn\'t. Many of the teachers

are just not familiar enough with how this disorder

presents in the classroom, and we must debunk

misconceptions about the disorder.

Another important thing, we must make

better use of our school psychologists. They are

doing too much testing as opposed to not enough

intervention work with teachers and not enough

assessment of this disorder as it appears in school

settings. Last thing, we have heard about early

identification and intervention, we can talk about

that more. It goes without saying, it is critical.

The communication between school

personnel and treating clinicians who are not in

the schools, it is an absolutely essential

component of our work with the schools as we work

with children with ADHD whether the treatment is

medication, behavioral treatment or both, and I can

talk to you about results from a study I have been

involved in that point to the terrible importance

of that second point here.

Organizational and time management

skills. The schools need to develop specific

curriculum to teach the kids, all of them, how to

do better with these skills. It is assumed that

children learn it on their own, they don\'t. Some

kids do pick it up on their own. This is

especially problematic for children with ADHD.

There needs to be specific curricula taught to

teachers and then implemented in the classrooms.

And then my last point is that the

parents need to be very much involved in the total

IEP process. I think I went over four minutes, but

I think I got it in.

DR. FLETCHER: Thank you very much for

your testimony and all the wonderful information

that you have provided to the Commission. I am

going to start the questioning and then I will move

to my left to each of the Commissioners. I think

you have probably have time for one or two

questions per Commissioner.

One of the big issues that our panel is

supposed to address are identification practices

for all children. The one concern that has been

expressed is the significant increase in the number

of children identified under the \"other health

impairment\" category, which many attribute to the

specific eligibility set forth for children with

ADHD in the last reauthorization.

Can you make any comments about why

there might be such a tremendous increase in the

number of children identified as ADHD and placed in

special education?

DR. ABIKOFF: That\'s, obviously, a

critical issue. And I think a lot of it has to do

with the misidentification of children because of

the inappropriate use of criteria for making that

diagnosis, and that can occur in several ways.

The rating scales that I alluded to

briefly before, the Conners rating scale is

probably the most widely used of all. A lot of

professionals, not only educators, but especially

educators, take it to be, for lack of a better

term, a quick and dirty way of making a diagnosis

of ADHD. You can\'t do that. You can have children

who are going to be elevated on those scales and it

not because they have a clinical diagnosis of ADHD.

They could be active, they could be inattentive,

but the point is, how impairing is it, at what age

did it occur, and what are the other possible

explanations for those behaviors occurring.

Without an appropriate clinical

evaluation, one is unable to decide whether or not

information based just from those criteria are

sufficient. So I think part of it has to do with

the way in which the diagnosis itself is made. We

also know there are halo effects that color the

assessments that are made of youngsters who

present, for example, with conduct problems. You

have a negative halo effect and what it does is it

tends to color the way in which those adults will

also report on the children\'s other aspects of

functioning, even though those other aspects of

functioning may not be impaired.

We have done some studies to show that

if you show teachers videotapes of children who are

showing oppositional behavior in the classroom, but

those children are not hyperactive and inattentive

and we have controlled the rates, and we asked the

teachers to rate those children in terms of their

hyperactivity and inattention, they are rated as

high, very high. Even though, in fact, it is not a

function of what the child is doing, it is, in

fact, a function of a negative halo effect that is

impacting the teachers\' perceptions and judgments

about that individual.

So I think as a quick, I don\'t know if

it is a complete answer, but as a quick answer, I

think that in an attempt to get more children

special education services, more children than

should be are being inappropriately identified as

ADHD, when I am fairly certain that for many of

them that diagnosis is not appropriate.

DR. FLETCHER: That\'s very helpful. So

what you are really saying is that if a school

system wanted to do something about the

identification of children with ADHD, they should

institute more rigorous evaluations. And I

presume, for example, that these evaluations are

very much within the purview of appropriately

trained school psychologists?

DR. ABIKOFF: I think so,

Commissioner. That\'s a very important issue. I

think that if they haven\'t gotten that training,

there is no reason why in master\'s and Ph.D. level

school psychology programs that could not be a

focus of their training. And there is no reason

why if they were, in fact, fully equipped through

their training to do so, that they could help, if

not, in fact, make that diagnostic decision in

school.

My concern is that many of my school

psychology colleagues have, in fact, not received

appropriate training in those diagnostic procedures

and the schools don\'t rely on them. So I think

that is an issue that is worthy of attention.

DR. FLETCHER: But, in fact, many

schools refer out for what I call independent

medical evaluations specifically for ADHD, and I

think it is fair to say those evaluations are not

much better either.

DR. ABIKOFF: There is no doubt that

many of my colleagues in medical settings, be they

pediatricians, pediatric neurologists, child

psychiatrists, and my boss will kick me for that,

may, in fact, not do as good a job as they should,

especially because there are issues of comorbid

diagnoses as well that must be paid attention to,

and folks who are in pediatric practice without

extensive mental health training and background,

may, in fact, frequently miss other comorbid

disorders that are impacting on a youngster\'s life

and, therefore, the treatment plan and

recommendations that are made may not be the best

one for the youngster.

DR. FLETCHER: Thank you. One other

quick question.

I am wondering if you would comment on

what it is that makes a child with Attention

Deficit Disorder disabled. As you know,

eligibility for special education is a two‑prong

determination, you have to have a disorder, but

there also has to be a demonstration of educational

need. And what I am going really getting at is

whether it is Attention Deficit Disorder per se

that makes most children disabled, or is it really

the comorbidities that contribute to the disability

itself.

DR. ABIKOFF: It can be both, and I

will try to be quick about that.

You can have a youngster with ADHD

alone, without a comorbid learning disorder, whose

educational functioning is terribly compromised.

And what you can see, for example, is in fact, you

can have a youngster of 140, I have worked with

many of them who were brought to me because of

difficulties in terms of academic functioning.

These are children who because of, number one,

misbehavior in the classroom, interrupt the

classroom functioning. But more so than that,

these are children who because of executive

function deficits may not be able to get their work

in, even though they did it. They may want to do

their work when they get home, but they can\'t find

it because they can\'t find their homework

assignment book. These are children who will rush

through their work so that if you have them go back

and force them to check, they are likely to correct

errors that they made that instead were careless,

so instead what we find is on achievement testing,

especially in a group setting, these kids will do

much worse than they would in a one‑to‑one. They

will rush through their work, they will make

careless errors, they will skip entire pages and

not even be aware that they have done so.

So for a variety of reasons you can end

up with compromised academic functioning, even for

children who do not have concomitant learning

disorder. In children for whom both are present,

as you might imagine, then you have serious skills

deficits in addition to everything I have just

mentioned and the academic functioning is even

further compromised.

DR. FLETCHER: Would it be correct to

say, though, that a lot of the recommendations that

you would make for a child who only had Attention

Deficit Disorder would be what we would call

curriculum modifications and that they could be

done either through special education or through

the 504 process?

DR. ABIKOFF: Yes, absolutely so.

That is absolutely critical.

And to the extent that through 504 you

might be able, for example, even at the end of the

day to have an aide who comes in and checks the

child\'s bookbag and makes certain that everything

in that bookbag that the child is taking home is

supposed to be in there and should go home that

day, including a homework sheet, the books that are

needed and the like. That\'s just a small example

of that.

You can have other situations in which

right in the classroom the aide is there to help

prompt the child to engage in behaviors and master

on their own, although that will take some doing.

DR. FLETCHER: Thank you.

Reverend Flake.

REVEREND FLAKE: Just a quick comment

and question. I am thankful that my children are

adults now because this impulsivity and

hyperactivity seemed to be a major part of their

lives, so I am glad I got this report after they

have moved on to college.

The only question i have, and I think

all of want to know your opinion on the

continuation of IQ test as a primary assessment

tool versus all of the other things you have

listed, and where would you put the IQ in this

process?

DR. ABIKOFF: I would agree with what

my colleagues spoke about in the previous

presentation. I am not quite sure it helps us very

much, and in fact, one of the things that we know

about children with ADHD is because of their

impulsivity and their inattention, they will

frequently on IQ tests, score much lower than their

actual intellectual functioning would suggest.

For example, if a child is on stimulant medication

and doing well, and you give him the same test or a

variant of the test, their score can go up anywhere

from 7 to 10 points and sometimes more.

The medication didn\'t make them

smarter. All that happened was their ability to

focus appropriately and to consider and reflect on

their responses results in a better estimation of

their functioning, and in fact, the disorder, part

and parcel, results in some lower scores than you

would get. So I have my concerns about how useful

that is for some placement issues and the like.

DR. FLETCHER: Commissioner Rivas?

COMMISSIONER RIVAS: I just want to

thank you for your testimony. I don\'t really have

any questions right now. I know we are limited on

time. I will pass it to Commissioner Coulter.

COMMISSIONER COULTER: I think we all

want to express our thanks to you for your

testimony and the fact that you tried to cover a

lot of ground in a relatively small period of time.

I am concerned that some of the

interventions that you have described, for

instance, you gave a very good example about the

need to systematically teach children how to manage

time, how to organize materials, et cetera. I get

the impression that when you are recommending that,

you are really recommending that for any child who

would evidence a problem in that area, right?

DR. ABIKOFF: That\'s correct.

COMMISSIONER COULTER: I don\'t think

that is specific to any particular diagnosis.

DR. ABIKOFF: That\'s correct.

COMMISSIONER COULTER: So if, in fact,

you have a problem oriented approach to looking at

problems of children as they exhibit themselves in

classrooms, if that\'s present, where is the value

in the specific diagnosis of ADHD?

DR. ABIKOFF: Although I gave that as

one indication of a way in which one could

intervene in a classroom, and you are correct, I

think there we, along a dimension from kids who are

very good in terms of their executive function

organizational skills, to kids who are very poor,

and there may be some children who are poor who are

not ADHD, the difference, though, I think, number

one, is even the severity of it is going to be

greater in ADHD children than those who are not.

You cannot imagine the kinds of

problems that arise in the lives of these kids

because of these difficulties. But that is just

one aspect of their dysfunction, if you will. It

is everything else that results in that diagnosis.

They are impaired in almost every aspect of their

functioning that is important for a child. And I

have emphasized not only the problems they have at

home with siblings and with parents, their peer

relations are so severely compromised that many of

these children have no friends or they end up

gravitating to kids who will accept them who are

like them, and more often than not that means they

are hanging out with kids who are similarly

troubled with severe conduct problems and the like

because other kids just don\'t want to be with them.

So what we are describing is a

condition that is incredibly pervasive, persistent,

chronic and impairing. And that\'s the key issue.

There are children would may forget things at

school, and we can provide them with some guides.

That is one aspect of the dysfunction of these

children, and they do it much more than other kids,

but it needs to be viewed in the broader context of

an impairment that effects almost all aspects of

the lives of these children.

COMMISSIONER COULTER: Once again, I

think in the description we were given earlier, the

testimony of a multi‑tiered model of providing

interventions for kids in varying contexts and in

varying degrees of intensity, it would appear as

though what you were talking about would fit within

that model once again, that in those instances

where the problems were pervasive, they would in

fact be more resistent to intervention, requiring

then more intensive intervention, if you would, in

order to address the problem in a variety of

environments.

DR. ABIKOFF: That\'s correct.

And the other thing that we need to

keep in mind is that for children for whom the

disorder is severe and is truly compromising

function in many settings, we need to recognize

something else, and the data speak to this better

than anything else, and that is that although I

think the types of psychosocial interventions that

I have tried to briefly take us through today are

an important part of that treatment package, the

bottom line is stimulant medication is a critical

component in the lives of these children. And

without it, the degree of improvement that we are

going to find for these children who do not receive

it is invariably going to be considerably less than

when a youngster is appropriately managed with

medication. And it is the issue of appropriate

that I would be happy to talk to you all about,

because the school place a critical role in that.

And if I could, I would like to mention

one finding ‑‑ am I coming through?

DR. FLETCHER: Loud and clear.

DR. ABIKOFF: Okay. There is an issue

that is very important here. I was involved in the

largest clinical trial ever done in the world for

children with ADHD, it is called the MTA study. It

was funded by the National Institute of Mental

Health and the Office of Special Education. It

took place in seven university sites in the United

States and Canada. Almost 580 children with ADHD

participated in this study.

The children received one of four

different kinds of treatment and they randomized to

it. A quarter of the children were treated with

medication by the clinicians in the studies at the

sites. A quarter of them received very intensive

behavioral treatment for 14 months. A quarter of

the children received a combination in the study of

behavioral treatment and medication. And a quarter

of the children were referred right back to the

community where they could get anything that the

parents were interested in obtaining for their

children.

At the end of the study, not

surprisingly, we found out that two‑thirds of the

families who were referred back to the community

ended up getting medication for their children.

But we had a quarter of the children in the MTA who

were also on medication. And it gave us an

opportunity to do some comparisons about how well

the children did in the community if they were

treated by community practitioners, versus being

treated in the MTA where we used a very specific

set of guidelines and algorithms. And the kids who

treated in the MTA did much better.

Why is that? Medicine is medicine.

Not so. There were a number of differences that we

found, and we are still working very, very hard to

tease out all of this. It is terribly complicated

statistically. But there are some issues to keep

in mind.

Not only were the children on very low

doses in the community, considerably lower than the

doses we used, but just as importantly, they were

seen every month by their practitioner and they

were monitored and the medication was managed

appropriately, and we got monthly feedback from the

school. We got it at the beginning, ever more so,

to help manage the dosage and regimen for the

child, and each month we spoke to the teacher. The

teacher told us how well or how poorly that child

was doing, and we made accommodations and

modifications in a child\'s medication regimen as a

function of feedback from the parent and the

school.

How often did that happen in the

community? Twice a year, sometimes once a year.

Which meant that we had many, many physicians who

were medicating the child and continuing to

medicate the child without getting feedback from

the school. I can\'t impress upon the Commission

enough how essential it is to get the school

personnel involved in working with clinicians who

are outside of the school in terms of treatment

planning and treatment monitoring of a child who is

being treated for ADHD.

COMMISSIONER COULTER: Thank you.

DR. FLETCHER: Commissioner Acosta.

COMMISSIONER ACOSTA: Thank you for

your excellent testimony. It is much more than we

have time for, unfortunately, but let\'s see if I

can get through this.

Puerto Rico, as we know, is a

Commonwealth of the United States, and what

concerns me is that impact of the children coming

from Puerto Rico to the mainland schools as well as

those schools from Nicaragua, Salvador, et cetera.

And when you talked about world‑wide prevalence,

Puerto Rico came out in very large numbers,

particularly here in New York City and in Ohio and

in other neighboring states, we do have a large

group of children who are linguistically different,

racially different. And we have already talked

about the danger of inappropriate categorization

and the influences of low expectations for these

children. And I am really curious about this

attitude, what is this, how do we measure for

partial remission?

I am not clear how we do that. I work

in a community where convincing African‑American

and Latino parents that their child needs to take

medication as an inclusive regime, if you will, of

other interventions is very, very difficult. The

resistance to medication by the minority community,

and Reverend Flake, you can help me out here, is

very high. So we have several issues, low

expectations being herald by statistics that say,

yes, Latino children are disproportionately high in

terms of having ADHD, and my basic question is, how

do we measure for partial remission and what is it?

DR. ABIKOFF: A number of very

important issues that you\'ve raised.

In terms of partial remission, again,

what that refers to is an individual who originally

met full diagnostic criteria for the disorder, had

ADHD, if you will, at some time in the past, and

now currently, if you were to do a full diagnostic

evaluation, what you would see is that they no

longer meet full criteria for the diagnosis but

they still continue to show many of the symptoms of

the disorder, some threshold for the diagnosis and

that those symptoms are still interfering and

impairing in the youngster\'s life.

In terms of the issue of high rates

among, at least in that study in Puerto Rico, and I

am trying to remember who the author was of that

and I can\'t get it. I don\'t know if it was Hector

Berg or someone else at Psychiatric Institute.

There are no differences in prevalence rates across

racial groups, ethnic groups or SES. In any one

sample, you may get a slightly higher rate than

another and part of it may be based on the

diagnostic criteria that are used. When you use

the same identical criteria, you are going to find

very, very similar rates across different settings.

However, if you have a youngster who

comes into a school setting and is linguistically

impaired because they are struggling with English

and they are now in a classroom where it is

difficult for them to follow everything that is

going on, that youngster is going to show some

disturbance in the classroom, rightly so, be it

inattention, be it looking around the room because

they are not following what is going on, they are

bored, they are starting to act up, they are upset

that they are not following it. And to some extent

what might happen is the teacher might say, \"Look

how him. Look how inattentive he is and overactive

he is. I wonder if he has ADHD.\"

Well, we know he is inattentive and he

is overactive. Does he have ADHD? Perhaps. You

would not base it on that. So, again, the

clinician needs to take into account cultural

issues and language issues, especially for

youngsters for whom English is not the primary

language, to understand to what extent that might

be implicated, if you will, in the difficulties the

child is having in that classroom. Does that

explain it all? Not at all.

There are youngsters who are

linguistically impaired and are ADHD as well. And

I think a good clinical diagnosis is necessary to

do it and a rating scale will not.

COMMISSIONER ACOSTA: One last

question, and I have had parents ask me this: My

child has ADHD today. If I give him Ritalin, if I

give him all these interventions, can he be cured?

DR. ABIKOFF: There\'s a Nobel Prize to

that question. We know that youngsters who are now

treated with medication for reasonably long periods

of time in a systematic way, my colleagues and I in

Montreal and in New York did a study in which, in

fact, we treated children for two full years with

medication. And what we found, in fact, was that

all the gains they got initially were maintained

completely through those two full years and there

was no decrease or attenuation in those effects,

which was a concern.

The clinical literature suggests that

people who took stimulants early on, and perhaps

took them for up to five years or so

intermittently, their outcome later on in life does

not appear to be very different than the outcome of

individuals who did not take medication.

I think what that says is several

things. Number one, the medication is not a cure

for the disorder. The disorder tends to persist in

most people through adulthood. For some it

desists. We don\'t know for whom it desists and for

whom it persists, if you will. We don\'t have that

answer yet. One possibility that we might need to

consider is we take a diabetes model, and we think

of this as a chronic disorder which benefits from

certain kinds of treatments, including medication.

And it may be that for some individuals, if we can

find a way to do so, it may mean that they need to

be kept on a maintenance medication regime in

addition to everything else that we are talking

about in order to glean the benefits of our

treatment.

We know that psychosocial treatments by

themselves tend to work not as well as medicine,

and work only as long as they are delivered. When

you stop those treatments when they are intensive,

the symptoms tend to reemerge, just as they do when

you stop medication, they tend to reemerge. So if

this is a brain disorder, if we can\'t change the

way in which neurons fire and chemicals are let out

in the brain, if you will, well, then, maybe we can

help to regulate it. And right now the treatments

that we have regulate it, but they don\'t cure the

underlying disorder.

COMMISSIONER ACOSTA: Thank you.

DR. FLETCHER: Thank you. In a sense,

I guess you are talking about the need to create

environments for the children in which they can

function in order to facilitate their persistence?

DR. ABIKOFF: Yes, that is very

important. But as I am sure you know,

Commissioner, no easy chore.

DR. FLETCHER: Right.

Dr. Wright?

COMMISSIONER WRIGHT: Again, I don\'t

have to say much and ask much because so many of

the other people have said a lot and have asked a

lot, so I don\'t know if I am batting clean up or

not.

I want to say that I am familiar with

your work, and I very much appreciate your

presentation. It has been wonderful. You have

covered it from etiology all the way through

characteristics of these children all the way to

remediation. I would like to just point out,

though, something. I am an old special educator.

Years ago, kids who had these kinds of

characteristics, we just called them MH. We just

called everybody mentally retarded. Finally, in

1963 when Sam Kirk came along, he said, \"These

children that have these characteristics are

learning disabled.\"

And now we have separated it out and

said they have some of the learning disabled

characteristics and they have some of the other

characteristics. I would like to point out, too,

that some adults have some of these

characteristics. I have some. I feel here, I just

want to sit up and blurt out, and that\'s part of

the characteristic.

These children can be very successful,

as you have pointed out, but, of course, they do

need some remediation. Also I think it was

Commissioner Acosta who asked the question about

the issue on using drugs with these children,

medical things with these children. That is

certainly a very big issue. I don\'t have to say

much because it is all here. You brought it out

and I am just thrilled with your presentation, and

I am not going to take up any more time.

DR. ABIKOFF: Thank you very much.

COMMISSIONER GRASNICK: Thank you for

precision of your presentation.

My question would surround what I

consider to be the indiscriminate use of

medication. There is almost a vogue now and the

fact that all of the children are labeled as

special education, almost all of them. And I think

that you have not, in your presentation,

homogenized these students. You have discerned the

difference between those who need specific IEPs,

et cetera and medications. So what are we doing in

terms of professional development so that teachers

don\'t communicate to parents, \"Put this child on

medication. This child needs an IEP,\" et cetera,

when, in fact, the child may simply need some

strong structuring both at home and at school.

What is happening in that arena?

DR. ABIKOFF: Yes, that\'s a very

important question.

I don\'t think it is the role of

teachers to tell parents that their children need

medication. Teachers are not physicians and they

are not clinicians. They are educators. Now, that

said, there is a role for teachers vis‑a‑vis

parents that is very important.

The teachers have these children for

the major part of the day. They have experience

with hundreds, if not thousands, of youngsters over

time, especially if they are experienced, and they

are quite good at recognizing a youngster who is

not doing well relative to his or her peers. And

that youngster may not be doing well for a number

of reasons. One possibility, based on what it is

that is presenting in the classroom might be ADHD.

The role of the teacher, as I see it vis‑a‑vis the

parent, whether it is through parent‑teacher

conferences, letters home or whatever, is to inform

the parent when there is a problem in the classroom

that the parent is not aware of but that is

troubling the teacher, and to bring that to the

recognition of the parent so that the parent is

then in a position to seek out, when necessary,

other types of assessments, including whatever is

going to be done in the school. Because if the

teacher is concerned about something going on in

the school setting, he or she is probably going to

speaking to SBS team members and the like to say,

\"Jimmy is not doing well with this,\" but I think

the parent needs to know about this as well.

And when the parent knows about it,

they are in a better position and better informed

to consider who they might want to seek out and

what kind of evaluation should be done. So to the

extent that a teacher has an unruly, unmanageable

child in the classroom, and thinks, well, the best

thing is to medicate that kid. Well, they have no

business making that decision, they are not in a

position to make it. They are in a position to

bring to the attention of the parent what it is

that is going on in the classroom that is not well,

so that the parent can then pursue it.

COMMISSIONER GRASNICK: I just want to

follow‑up on this, though.

Do you find that our teacher

preparation institutions in higher ed are

addressing this so that students are, number one,

being managed properly in terms of appropriate

interventions?

DR. ABIKOFF: I think they are not.

We spend a lot of time with teachers and educators,

and I think that the training they get in their

college classes does not prepare them to help

identify and work with these children. I think

they are underprepared, especially teachers in

general education.

To the extent that many of these

children are going to be maintained in general

education classes but are going to be given 504

plans and maybe resource room, well, the teachers

need to understand what this condition is and how

to work with these youngsters, but they can\'t do it

alone. They need the support of other school

personnel. This is not just the teacher problem;

it is a schoolwide system problem, and I think the

training needs to occur early on in undergraduate

and graduate school. There needs to be in‑service

training workshops all the time.

One of the things that the Child Study

Center does right across the river at NYU, we have

a contract with the New York City Board of

Education, we have been working for the past three

years with I don\'t know how many now, hundreds, if

not thousands of educators, teachers, guidance

counselors, psychologists alike, teaching them not

only about ADHD, but giving them training in

functional behavioral assessments and functional

behavioral analysis. And they come in to learn how

to do this in classroom settings.

Is it enough? No, but it is a start.

And this kind of work, I think, is absolutely

essential if we are going to have our teachers feel

comfortable and equipped to work with these

children in public schools.

DR. FLETCHER: Dr. Abikoff, are there

any written descriptions of that program?

DR. ABIKOFF: I think the NYU Child

Study Center has manuals on it.

DR. FLETCHER: I would just like a

description that we could share with our other

Commission members.

DR. ABIKOFF: I will ask my

colleagues when I get back for something, and,

Jack, should I contact you and find out how to get

it to you?

DR. FLETCHER: It would go to the

Commission staff, Mr. Jones here. But we are going

to leave the record open and ask for some

information about what your professional

development program consists of.

DR. ABIKOFF: Sure, okay.

DR. FLETCHER: Thank you.

COMMISSIONER WRIGHT: One other thing

I wanted to mention, and I had it written here,

about stereotyping.

Would you address that as a cause of

overrepresentation of minorities in LD and ADHD,

and all of that, racial stereotyping and racial

profiling. Could you address that?

DR. ABIKOFF: Well, I think that\'s a

very important issue. I think although there

hasn\'t been that much work, there has been some,

and I believe it is Edmond Sanuga Barke, his last

name is spelled B.A.R.K.E., and Edmond works in

England. And Edmond has looked at the impact of a

child\'s ethnicity on teacher judgments and ratings.

And I can\'t retrieve the specific reference, it

came out within the past two to three years. In

fact, he has done more than one study on it.

And I think he has demonstrated quite

clearly that that does have an impact. And as I

have mentioned before, the whole issue of

misbehavior, especially oppositional behavior to an

adult, is something that is viewed as very

aversive, rightly so, I guess, by parents and

teachers. When we show teachers videotapes of kids

behaving that way, the children tended to be rated

as inattentive and hyperactive, even though in fact

when one truly measured that on the videotapes,

that behavior was not there. It is a negative halo

effect and it is important for us to educate our

teachers to that phenomena.

It is not unique to teachers, it is a

universal human phenomena, but to the extent that

that impacts on their judgments, they need to be

aware of it, and that is part of what I think the

teacher training program needs to cover along with

many other things.

DR. FLETCHER: Again, Dr. Abikoff, you

have introduced some material that the Commission

finds of interest, and we are going to ask you to

provide that reference for the Commission because

it is very relevant to our work.

DR. ABIKOFF: The reference about the

halo effect is in the CV that I sent you.

DR. FLETCHER: Oh, it was your study?

DR. ABIKOFF: Yes, that one.

But the other two by Edmond Sanuga

Barke are not mine, but I can contact Edmond and

get it.

DR. FLETCHER: Well, or just give us

the references. That\'s all we actually need.

DR. ABIKOFF: Sure, I will be happy

to do it.

COMMISSIONER TAKEMOTO: Thank you for

your interesting testimony.

Part of the heartbreak of ADHD is, what

I hear from families, is a standard treatment for

ADHD as being containment, punishment, suspension

and expulsion, and I have a lot of questions. I

just want to, if it\'s a yes answer, I want a little

bit more, but if it\'s a no answer, is there any

evidence in research that this is an effective

intervention or treatment for ADHD?

DR. ABIKOFF: Probably the worst thing

you could do when working with a child with ADHD, I

would say the four things you just said.

COMMISSIONER TAKEMOTO: So there\'s no

research that says that what you ought to do with a

student with ADHD is you contain them, you punish

them, you suspend them and you expel them.

DR. ABIKOFF: Nothing whatsoever.

Nothing to show it\'s effective.

COMMISSIONER TAKEMOTO: My second

question is lack of treatment or inappropriate

treatment of the disability, I have a hypothesis

that this leads to some of the comorbidity, some of

the psychiatric disorders that you outlined here,

that the majority of students with ADHD have.

Could many of these students end up without these

other significant disabilities or comorbidities

with appropriate treatment?

DR. ABIKOFF: That\'s an interesting

question. I think you\'re right, in part. I\'ll

tell you what I mean. What we frequently find is

ADHD is a precursor to the more serious conduct

disorders, but why do children develop conduct

disorders? Part of it is that the simple picture

of ADHD, especially the impulsive behavior, makes

it more likely they\'re going to engage in those

behaviors, but the whole picture of ADHD, children

who are not doing well in school, who are shunned

by their peers, who tend to engage in risky

behavior, makes it more likely they\'re going to

stay with children who also misbehave in a conduct

disorder.

Now, that said, if in fact you treat

these children early on appropriately, that might

include for many of them medication, there\'s an

important question to ask. The MTA study mentioned

before is in the process of asking that right now,

because we\'re following those children up. They

started with us at age 7 to 9, now we\'re looking at

them here almost age 20. One of the things we want

to see is what happens to the course of the

development of comorbid disorders in children with

ADHD who are treated early on as a function of

which treatments, and as we treat them for their

ADHD, what happens to co‑occurring comorbid

disorders that are already there. So I think the

possibility exists that for some disorders,

treating the ADHD may change the course or even the

development of comorbid disorders, but not all.

COMMISSIONER TAKEMOTO: And then my

last question is a followup to the first question

by Dr. Fletcher about the ability for school

practitioners to diagnose ADHD, but at the same

time you\'re talking about the efficacy of the

drugs, the drug aspect of the treatment, so one is

an eligibility issue and the other is treatment.

DR. ABIKOFF: That\'s correct.

COMMISSIONER TAKEMOTO: For

eligibility issues, I want to clarify that many

practitioners, non‑M.D.\'s can make the diagnosis.

DR. ABIKOFF: Yes, they can. For

example, I\'m a licensed psychologist, a PhD, I\'m

not an M.D. I\'ve worked with families and children

with ADHD for most of my career, and I feel

confident in making that diagnosis.

However, I will even also have them

seen by my M.D. colleagues when there are other

types of possible neurodevelopmental problems that

I think might be there that I feel less equipped to

make a diagnosis about, but basically, if someone

is well trained in clinical diagnostic procedures,

they should be able to make that diagnosis, even if

they\'re not able to make some others, but well

trained means being able to rule out other

explanations for this as well.

COMMISSIONER TAKEMOTO: But in terms

of, that\'s for diagnosis. In terms of treatment,

would the school still have a role in insuring

access to a person with the ability to prescribe

appropriate medication?

DR. ABIKOFF: Well, there are, I think

a variety of models that are out there. I know in

the New York City school system certain districts

have one or more child psychiatrists who work with

the District, and I believe they are involved not

only in evaluating these children and in making

recommendations for medication. Whether or not

they prescribe I\'m not sure, I don\'t want to

misspeak, but I don\'t think so, but I think that

there are two ways in which we could do this.

One is that if ‑‑ well, this gets very

difficult. Let me back up. The school should work

with clinicians in a community who are medicating

the children who are attending that school. The

school can\'t necessarily refer a parent for

medication. What they could do is to say, \"I think

your child might benefit from additional

evaluations in addition to what\'s going on at

school. If you\'d like a list of potential people

or agencies to contact and you don\'t know who to

contact, we might be able to do so,\" so I think

there\'s some role for the schools vis‑a‑vis

treatment, but we need to be careful about this for

the reasons I\'ve stated before. The school should

not say, \"Get your child on medicine.\"

COMMISSIONER TAKEMOTO: But what

about those families that don\'t have access to the

ability to pay for the prescriptions as well as the

ability to find a person that\'s capable of

disposing or prescribing the medications that you

say are critical for treatment of ADHD?

DR. ABIKOFF: In terms of if they

don\'t know who to seek out, that\'s where I think a

list of appropriate professionals and practitioners

could be provided, assuming that was something that

the school system felt comfortable doing because it

means they feel comfortable with the merit of the

people they\'re suggesting. So it might be rather

than a person, it might be an agency.

The American Academy of Child and

Adolescent Psychiatry, the American Academy of

Pediatrics or Behavioral Treatment, the American

Society for Behavioral Therapy. In terms of cost,

that deals with a whole other issue in our country

that is I think a much bigger issue than perhaps

what we can address today.

COMMISSIONER TAKEMOTO: Thank you.

DR. FLETCHER: Dr. Pasternack had a

question.

DR. PASTERNACK: Thank you

Mr. Chairman. In the interests of time, I\'ll make

it brief.

Earlier today we heard exquisite

testimony about the need to perhaps disband our

categorical taxonomy and move to a noncategorical

system. In your testimony it seems you\'re

advocating that we would need to continue having a

category of ADHD. I\'m curious if you would help us

reconcile the two sets of testimony that we heard.

DR. ABIKOFF: I\'m not sure I heard the

first part of the testimony you said, but I could

understand that there are rationales and folks out

there who promote that position. I think for ADHD,

in fact, a categorical approach is still very

useful.

I listed the diagnostical criteria up

there for a reason. If we make it dimensional

criteria only, my concern is what\'s going to happen

is we are going to end up inappropriately labelling

children as ADHD who are not, because these are

children who may be extremely inattentive or

overactive or impulsive for a variety of reasons

having nothing to do with ADHD, or they may in fact

have no other co‑occurring condition, but the fact

that they\'re very impulsive and very inattentive is

still allowing them to function well enough that

it\'s not impairing and interfering with their

functioning.

I think we all know, if we think back

to childhood, kids who were antsy or kids who

seemed to daydream a lot, and maybe even kids who

called out a lot, who were bossy. The description

that I put up there of the symptoms, everyone shows

some of that some of the time and some people show

it even a lot of the time, but it doesn\'t interfere

with their functioning. If we keep this as a

dimensional criterion rather than categorical, and

the category allows us to do other things.

We\'re assessing frequency, chronicity,

duration, impairments and also ruling out other

explanations and I think it\'s critical to do that,

so from my vantage point, I still feel quite

comfortable with the categorizations of this

particular disorder.

DR. PASTERNACK: One of the

internships I had with a pediatrician, I trained

with at that time said what we ought to do is not

give medication to the kids, but we ought to give

tranquilizers to the parents.

Another question, I guess, is what do

we know about the differences in outcomes for kids

with ADHD that are placed in special education

versus kids with ADHD that are not placed in

special education? Apropos of the excellent

questions the chair asked earlier, there are

convincing data, I believe, that suggests that the

vast majority of students with ADHD are not in fact

in special education.

DR. ABIKOFF: I don\'t know if there

have been consistent studies that have looked at

that. As you might imagine, they have become very

complicated because the outcome to some extent may

be biased. If there was a real reason for putting

kids in special education so their functioning was

more compromised than kids that were not, you might

expect differential outcomes, not because they\'re

in special education, but because of the

characteristics that resulted in them being put in

special education, assuming that wasn\'t random.

However, I think the MTA study I mentioned before,

hopefully in a few years is going to be able to

look at that as well, because we have information

about children not only in terms of their treatment

history, but exactly what it is that they received

in school and in fact we\'re working with the Office

of Special Education in Washington right now to do

more exquisite evaluations of the exact services

that children are getting in classrooms.

What they\'ve gotten and what they\'re

currently getting, and our goal is to look at that

to see how well it predicts subsequent outcomes.

So I think right now the answer to your question is

probably not readily available, but it might be in

a couple of years.

DR. PASTERNACK: Mr. Chairman, I know

it\'s time for a break, but the Commission has been

made aware of I believe it\'s New Jersey and

Connecticut, which are states that have now passed

legislation prohibiting educators from getting

involved in the diagnosis of ADHD. Would you

comment on whether you believe that other states

should emulate that and whether in fact there

should be federal pools regarding that?

DR. ABIKOFF: By \"educators\" in those

two states, do they mean teachers or guidance

counselors?

DR. PASTERNACK: Yes.

DR. ABIKOFF: I would agree. I think

those folks in those professions are excellent in

what they do, but they\'re not trained clinicians

and they have no basis for making that diagnosis.

DR. PASTERNACK: The state of Mexico

just passed legislation, the Governor signed,

allowing psychologists to prescribe medication. Do

you believe that\'s something that should be

emulated?

DR. ABIKOFF: This is an issue that my

field has been grappling with for a number of years

and there have been suggestions that for

psychologists who want to go back to school in

essence and take seven years of courses in

psychopharmacology and courses related to that,

that there may be some situations where those

individuals might be appropriate in terms of what

they do, not unlike psychiatric nurse specialists

or clinical nurse specialists who are not M.D.\'s,

but take detailed courses in psychopharmacology and

anything related to it.

So I see no reason why that might not

be done, but I think the accreditation and the

requirements that would need to be met need to be

quite strict.

DR. PASTERNACK: And in the interests

of time, one last question. I know you\'ve gone

over this before, but could you just briefly

summarize for us the need for the students with

ADHD to receive special education as differentiated

from students with ADHD that would not need special

education?

DR. ABIKOFF: I think it depends on

the ‑‑ I\'ll use the word \"need\" ‑‑ on the needs of

the child. In the same way that clinically we try

to tailor treatment to the needs of a particular

child in terms of what it is that he\'s presenting

with, where is he having difficulty in his life.

In a school setting, it seems to me

that the same situation occurs, an ADHD kid is not

an ADHD kid is not a ADHD kid. They have all the

same diagnosis, they\'re all unique individuals.

Based on the cluster, the profile of

needs, deficits and strengths that they present

with, you would hope that in a meeting in which you

have educators sitting down and planning on what

the needs are of that particular child, some kind

of informed decision can be made about whether or

not this youngster may be able to be maintained in

a mainstream classroom with a 504 plan perhaps with

an aide, perhaps with special dispensation in terms

of test taking and the like, or is it the case that

given the picture of this child and the problems he

or she has, that a smaller, more contained

classroom with skilled personnel would be better.

I am reluctant to say this should be a

blanket decision that should be made. I think it

behooves the school in the same way it behooves the

professionals who work with these children to make

that decision.

DR. PASTERNACK: Mr. Chairman, is it

true that the NIH in the process they undertook

regarding ADHD did not come up with a diagnostic

strategy for ADHD or a diagnostic paradigm?

DR. FLETCHER: The short answer is

that\'s not true, but Dr. Abikoff might want to

comment on that.

DR. PASTERNACK: I thought NIH tried

to have a conference where they tried to arrive at

a consensus model paradigm for ADHD and were not

able to achieve consensus.

DR. ABIKOFF: I actually participated

and presented at that consensus conference. I

think at the end the statement that came out was

wonderful in terms of showing what the field knows

about the disorder and one of the main concerns at

the beginning had to do with whether or not it was

a valid disorder and we hope and we think that we

put that question to rest finally and forever.

In terms of the best way to make a

diagnosis, I think the AAP guidelines I referred to

in my talks as well as the American Academy of

Child and Adolescent Psychiatry tend to overlap and

are quite similar in terms of what I described on

our slide, that it becomes the ascertainment

through history and interview of current and past

functioning, as well as eliminating and ruling out

other possible explanations for that presentation,

and until we come up with a marker, and I think

we\'re ten to 25 years away from that, until that

happens, this is the best we can do.

DR. PASTERNACK: Thank you very much.

DR. FLETCHER: Thank you for your

testimony, Dr. Abikoff, and Dr. Pasternack will be

applying for CE credits later.

(Laughter.)

DR. FLETCHER: The Commission will

take a short break. We will be having lunch here

on the stand and listen to our guest speakers, but

we will try to get on track as close to our track

as possible.

Thank you very much.

(Brief recess.)

DR. FLETCHER: Ladies and gentlemen on

the Commission our next witness is Dr. Dorothy

Koerner Lipsky, the director of the Center for

Educational Restructuring and Inclusion at the

Graduate Center of the University of City of New

York. She is could author or principal author of

50 articles and five textbooks on the subject of

inclusion has worked around this country and around

the world as a former teacher, administrator,

School Board member and I think of importance to

some of the people on the Commission as well as the

audience, and is the parent of the young man with

spinal bifida, who is now thirty years old, so it

is my great privilege to introduce to the

Commission Dr. Dorothy Koerner Lipsky.

DR. LIPSKY: Thank you very much. I

appreciate the honor to address you, it puts a new

twist on a lunch speaker.

I was trying to think about in the

short time we\'ll have today what I might say that

are things you haven\'t heard before. In fact, I

know what you\'ve had an opportunity to do is hear

from some wonderful speakers about the efforts that

IDEA must now address. What I\'d like to do is just

tell you a little bit for a moment my own history

of how I come to this, because I think it\'s

important for you to know the hats that I\'ve worn

and how I come at the issues that I\'ll speak about.

My son Danny was born 30 years ago. I

have two other wonderful children as well. Dan was

the last child. He was at a public school in

Brooklyn, P.S. 91. I finally had a chance to do

some work there, so it was exciting to see what

happened in the school. I guess having a child

that\'s born with such a severe disability really

changes your life. There\'s no other way to say it

throws everything up in the air, you\'ve got to

reformulate your own thinking on so many issues.

Luckily, Danny did survive. This is

the group of kids, remember, that had spine bifida,

that were put in institutions. We were told that

there\'s really no reason to bring kids like Dan

home because it would hurt the family, divorce was

going to be absolute, the other children would not

be able to do well, and there would be no quality

of life for Daniel.

We did bring him home, and of course he

continued to grow and change, as so many of the

children that we counted out during those times. I

went back to school and have a doctorate in

research, so much of the things that we talk about

here will be research oriented, but comes from what

I have seen not only for Danny, but so many

children like Danny.

I\'ve worked with parent organizations

to hear from them what it is that we need to be

able to take the next steps in education for our

children. The fact is, I also went through

administration, I have been both a principal, A

Superintendent of schools and also sat on a school

board here in New York. So I come at this from a

number of different vantage points.

The National Center was established six

years ago because the Annie Casey Foundation wanted

to find out what was happening in special education

and how they could help make a difference. We

looked at every state in the country five years ago

to try to determine what was happening in the area

of inclusion. They identified what they thought

were their quality programs and we talked with

administration, parents, students, both general and

special education; State Ed directors and attempted

to determine what were the quality indicators of

inclusion, what was it that we should try to get

into the first legislation that IDEA was looking

at.

We were very, very impressed. The

research had two very large documents about

outcomes and what we were finding. The surprising

fact to us was that nobody started their programs

exactly the same. It was definitely school by

school approaches that were so important.

What we found was that teachers needed

professional development to be able to do the work,

but once they had that professional development, lo

and behold, it was not just good for special

education children, but the outcomes were

significant for both groups of students. You know,

the most important factor, perhaps the one we felt

really touched us, was that parents of special

education children said that for the first time

their children were invited to birthday parties,

that when they had been in self‑contained classes,

they were isolated from communities.

What do we want for our children? We

want the children to be able to be part of a full

society. And therefore inclusion was what most of

the parent groups were telling us they wanted.

What do we mean by inclusion? It\'s not

even in the law. What we mean by inclusion, and of

course we have definitions in all our books, but

there is, by the way, if you go out and do

training, you can\'t find two people who define

inclusion the same.

Let me read to you what we want

inclusion to be. Providing to all students,

including those with significant disabilities,

equitable opportunities to receive effective

educational services with the needed supplementary

aide and support services in appropriate classrooms

in their neighborhood schools in order to prepare

students for productive lives as full members of

society.

Once the research was done in terms of

determining that the outcome for both general and

special education students were effective, and

there\'s much research, Peck has done much research,

in terms of what we\'ve seen for research in terms

of academic outcomes, social outcomes, behavioral

outcomes, this is well documented, I\'m not going to

bore you with the numbers, they are definitely in

our books and many other books.

What we have found, however, and one of

the, you heard from the Chancellor here in New York

City schools, my partner who would have loved to

have been here, Dr. Gartner, is now going to be

part of his staff, I greatly miss him, but I\'m

telling you that one of the things that New York

City schools did is allow Allen and I to really

help develop their new continuum that I believe was

mentioned here this morning. When we looked at the

new continuum, at what was the old system versus

the new systems, there\'s no doubt the biases that

were built into the old system for children. We

don\'t have to tell you how many minority children

continue in self‑contained classes instead of

classes that are in general education and

inclusionary with the supplemental aides and

supports.

Visionary leadership is key for

effective inclusion. Principals for the most part

do not yet have the skills to do the job that we

need to see done. New York City schools is in the

process of developing a principals\' training

manual. There are easy steps to take to determine

how we can take our self‑contained classes that

presently are highly minority and now integrate

them into the general education mainstream, and

what we find in developing our unitary system,

non‑categorical approach, saying what do the

children need to be successful in the general

education class. How do we adapt the curriculum,

how do we modify the curriculum?

We know that when we\'ve done that now,

the data is clear and here in the New York City

schools they are looking at that specifically,

because they have been able to code it. You will

see great gains in the standardized testing for the

general education children, because now in those

collaborative classrooms, they\'re getting what they

need. There\'s no teacher that I\'ve ever done, I\'ve

trained across the country, there\'s no teacher that

tells us that our IEP is really helpful to them.

Isn\'t that sad? We put so much time and energy.

We were the parent group that fought to have this,

but I\'ve not found a teacher who said this has been

helpful to us.

And I must tell that you of all the

groups we tried to train, unfortunately, sometimes

our professional groups who are our psychologists

and our social workers who are geared into the old

system of separate are having a very hard time

crossing over into understanding instructional

requirements of adaptations and modification.

What do we do in the general education

classroom that can make you successful? We have

lots of data to show that the general education

teachers find training helpful, but then can work

with all children with all disabilities across the

country.

To the surprising results, it isn\'t

just one group of students that really we can look

at and say it\'s only our LD students that can go

into the general education classrooms and we should

be able to do that, because we have found that

there are some school districts that have found it

easier to integrate students with the most severe

disabilities and some who have started with the

most mild disabilities. There is not one

disability that we can say is the only group of

students that should be included. We can look at

what is needed for that student to be successful in

the class.

I would just like to stress before we,

I know you\'re on a tight schedule, I know I

promised to address my issues in fifteen minutes,

but I know I\'d like to leave time for asking

questions. What I see operating now with IDEA and

the strength of IDEA, because while it doesn\'t

mention inclusion, is very much supportive of

inclusion and I don\'t have to tell you, you know

the law more than I do, what\'s in there that

supports inclusion, but what I would like to find

out is the research based practices that IDEA can

reinforce, and it\'s related to school reform.

We are not talking about changing

special education. We are talking about changing

school systems. School reform and IDEA have to be

linked together. In fact, as we looked at the

major school reform movements in the United States

and other studies that we did, in the majority of

those studies we\'re not addressing students with

special needs. There is special ed and general ed

continuing to this day. We need to link those and

IDEA can do that.

Let me address a couple of points and

turn it to you in case you have any questions. The

first issue I think you have to address is the high

expectations and \"Leave No Child Behind.\" The

second issue would be the whole school approach; as

I said, it\'s one of the things that we\'ve done in

our book, but mainly others now are talking about

that as an issue. It\'s not a secret how to do it,

but it must be the whole school that we move

towards.

The third issue is that the need for

the special populations must be addressed as a

service. It\'s not the place, it\'s the service.

Collaboration between the particular group of

general or special education teachers, we have

found here in New York City and across the country,

that when those special ed and general ed teachers

and specialists that in the past had served only

one group of students now are collaborating,

there\'s great outcomes for both groups of students,

that includes speech, physical therapy,

occupational therapy, surety terms of academics.

For special ed teachers, the things

they told us most often when they now are in an

inclusionary class was to say, \"Oh, my goodness, I

didn\'t think the children could do that.\" They had

a whole shifting of thinking in terms of what the

outcomes for the special education could be and the

general education teacher most often talked about,

\"Hey, this isn\'t really all that different. Most

of the children in my class needed that, too.\" The

idea to have the two people work together in

collaboration is really critical.

The use of instructional supports needs

to be reinforced. You talk about supplemental

aides and services and now you have to continue to

push that concept. Accommodations and

modifications in assessment are not yet being done

well, and cooperative learning was one of the

things, by the way, that teachers told us across

the country, when you say what were the most

important things that helped you in an inclusion

classroom, it was cooperative learning and

technology. It isn\'t just putting two groups of

kids working together, but it\'s how you do that

effectively.

Many teachers talked to us about

needing more supports with behavioral. You heard

of the approach before of functional assessment.

In fact, in the State of New Jersey, what they\'re

looking at is many different types of approaches

and allowing the school to choose the approach

depending on what the types of children that were

there, the types of understanding that teachers had

about behavior modification approaches, it\'s not

one approach. Functional assessment is one and

it\'s a good one, but there are many others.

For the most part, there isn\'t a

teacher that I believe in the school system, I

believe there are some, but I\'m fortunate not to

have met them, that doesn\'t want to do a good job.

We go into teaching because we believe it\'s a

profession where we were make a difference. The

fact of the matter is professional development is a

key factor that needs to be done. But school by

school again, we\'re looking at now saying yes, we

thought it could be system wide, now we\'re breaking

it down to school by school approach.

I believe that IDEA already had most of

these concepts within it. I\'m suggesting that you

strengthen them and you give more reinforcement to

inclusionary practices that would make a difference

for both general education students and special

education students and I believe it\'s what the

parents want. Thank you.

DR. FLETCHER: Thank you. I believe

we have time for a few questions. I believe

Ms. Takemoto has a question.

COMMISSIONER TAKEMOTO: First of all,

I want to thank you for all the research that

you\'ve produced, because I\'m a consumer of that

information and have used it not only in my own

life, but also for other families that I refer your

work to and thank you for funding those studies.

Where I have a ‑‑ where there\'s a

disconnect for me with the inclusion issue,

however, is that a number of families are saying

that they want more restrictive environments, they

want a specialized setting to meet emotional,

behavioral, learning disabilities. We heard this

morning about Public School 75 where students get

really nice services when they go to that public

school environment.

Help me think through, you said we

might have to strengthen part of IDEA. How would

we strengthen IDEA to find more students to have

access, because we found not enough students have

access to that environment to safeguard, at least

their parents are telling me, I don\'t know, the

parents are telling me they need a more restrictive

environment.

DR. LIPSKY: Here in the City we\'ve

done a lot of work with District 75 to put the

curriculum together. We find that depending on the

age of the child, parents have a hard time

changing their attitude about inclusion and believe

that the self‑contained classroom their child was

in, if their child has been there a long time, is

the best possible placement.

In fact, we decided in the new

continuum to leave that group alone, because they

do believe very strongly that what they have has

been best for their children.

COMMISSIONER TAKEMOTO: So we still

need the full continuum?

DR. LIPSKY: I think at this point in

time we need to have those parents who have

children in a segregated placement who are older,

the children who are now aging out of our system,

those parents are going to have a very hard time

accepting that their students could be in a high

school inclusion program.

COMMISSIONER TAKEMOTO: Could you

speak to specifically strengthening IDEA so more

children have access to an inclusive environment?

DR. LIPSKY: Particularly those

children, we find the parents who have children in

inclusive preschool programs‑‑

COMMISSIONER TAKEMOTO: I have to

interrupt you a little bit, because my colleagues

are going to be angry they didn\'t have questions

answered, but strengthening IDEA, what would happen

to IDEA, what language would you recommend that

would improve access to inclusion to many students

who are not currently included?

DR. LIPSKY: I believe you have the

language. You say in there that the general

education curriculum‑‑

COMMISSIONER TAKEMOTO: But it\'s not

being implemented. So do you have any suggestion

for language. It\'s not being implemented across

the board. We found that.

DR. LIPSKY: Let me give this some

more serious response than a quick response and if

you will, I\'d like to write some thoughts to you on

this issue, how I would consider strengthening

specific wording that would allow for more

inclusionary practice.

COMMISSIONER TAKEMOTO: Thank you

very much.

DR. FLETCHER: That means that you owe

us a document for the record. So the record will

be open.

Just to follow up real quickly, last

week in Miami, we heard many examples of parents

opting out of public school inclusionary

environments for what were essentially

self‑contained placements, and I would say if

anything, the age range tended to be on the younger

side. I don\'t understand the disconnect between

the sorts of recommendations that you\'re making and

the practices that you\'ve implemented and yet the

choices that many parents seem to want to make.

DR. LIPSKY: Well, I think the

question is what do they mean by inclusionary

practice? We have gone now, not just here in New

York City, but across the country, I have to tell

you that there is not one specific way of looking

at inclusionary practice, so it will often depend

on what it is that\'s happened within the public

school setting, and many things that are called

inclusionary practice are not.

If a child\'s IEP says they\'re supposed

to get supplementary supports and are not getting

them, then really we\'re just giving lip service to

the word \"inclusion,\" as we have mainstreaming

previously. The fact is, inclusion is not being

implemented many places that we could feel

comfortable calling it inclusion. There are some

standards, however, there are assessments that can

be done. When you call it inclusionary, I want to

be able to call it inclusionary.

DR. FLETCHER: I don\'t think that\'s the

issue. In the examples that we heard, parents were

opting out of public education altogether in favor

of settings that were clearly not inclusionary,

were clearly segregated and self‑contained. So, I

mean, the issue of how effective the program was is

one thing, but parents were not opting for a less

restrictive environment, they were choosing a more

restrictive environment.

DR. LIPSKY: Well, I must say that

again I would have to come back with effectiveness

of the program. If a parent is opting out to a

program that isn\'t functioning to a high level, one

could almost understand their frustration. Here in

the City, I can tell you when parents have had an

opportunity to go from a more segregated into a

quality inclusion program, I can show you there\'s

much research to show you parents who have opted

into a quality inclusion, because I don\'t think

parents have really seen what quality inclusion

looks like, and in fact when we think about our

children first, Danny when he was first born, they

felt would have a quality separate program. They

thought I as a parent couldn\'t accept my

handicapped child if I wanted them in an

inclusionary type setting.

The fact of the matter is we have to

think of the children for the future, as well as

employment and into a full society and that\'s not

going to happen as much in segregated facilities.

So I think inclusion has to be looked at as to is

this quality and then let me hear that the parents

are still opting out.

DR. FLETCHER: Well, I mean, I

understand that, but I have to say I think that

reason is a little circular. It\'s ex post facto

reasoning, but I have to stop because I know that

Commissioner Acosta has a question and then we\'re

going to go on.

COMMISSIONER ACOSTA: I defer to you,

Dr. Fletcher.

DR. FLETCHER: I\'m done.

COMMISSIONER ACOSTA: I asked you, you

talked about District 75. Where is that located?

DR. LIPSKY: It isn\'t just one

location, it\'s a concept, and unfortunately, it is

now a concept that is very strong. Twenty years

ago it was the most severely disabled children here

in the New York City school system and when we

first came into the New York City school system and

did some work, they were segregated by disability.

And then when we moved across

categorical skill, those were the most severe were

put into what is called a district, but it is not

one placement. Those classes are also within the

regular public schools, although there are some

special schools. Those are the children who have

also been included into general education classes,

even with the most severe disabilities. They have

many children with emotional and physical

disabilities in regular classrooms and can show

their success.

District 75 itself has also integrated

children into regular classes.

COMMISSIONER ACOSTA: Do you have a

large number of Latino and minority children in

District 75?

DR. LIPSKY: Oh, yes.

COMMISSIONER ACOSTA: What is the

accountability measure, what accountability

measures are in place to insure that those children

in that District, for the sake of this

conversation, are served?

DR. LIPSKY: Well, since I don\'t work

in the New York City public schools, you

understand, I\'m at the Graduate Center of City

University, we just support the new continuum

efforts. I don\'t think I\'m the best person to

answer your District 75 question.

DR. FLETCHER: Thank you very much.

DR. WRIGHT: I\'d like to ask a

question.

DR. FLETCHER: Yes, Dr. Wright.

COMMISSIONER TAKEMOTO: In the

meantime, I wonder if we can ask New York City

Schools to answer some of those questions, as well

as some statistics on when they say there are

actually students physically located in these

schools, who those students are.

DR. FLETCHER: Of course we can. I\'m

sure staff picked up on that. Dr. Wright, please,

quickly.

DR. WRIGHT: I learned from your

presentation and enjoyed it, as much as I enjoyed

the hamburger that I was gobbling down, and I

apologize for eating while you were talking, but I

tried to give my attention.

What I wanted to ask you, I\'m sure that

you covered it, but you\'re at the university level,

you\'re a teacher trainer?

DR. LIPSKY: Yes, that, too, yes. We

do research, we do dissemination, we do

professional development.

DR. WRIGHT: Could you just speak for a

moment or so about your teacher training, your

staff development in inclusion? Are your teachers

being trained in the inclusion model? Could you

speak for a minute about that, please?

DR. LIPSKY: Well, I would be glad to

try to, but actually I\'d be glad to give you a copy

of what we do. That might help, because this is

also a school by school approach, what we see as

staff development for teachers and principals, so

if it would be all right I would be glad to let you

have a copy of this, since I brought it to use. Is

that okay?

DR. FLETCHER: Sure. Thank you very

much.

We need to move on to our next witness.

Doctor Julie Berry Cullen is an assistant Professor

of Economics at the University of Michigan and

she\'s a faculty research fellow at the National

Bureau of Economic Research. She\'s a Robert Wood

Johnson Health Policy Scholar from 1999 to 2001 and

Dr. Cullen is going to testify on how funding

formulas effective implication has had. Welcome,

Dr. Cullen.

DR. CULLEN: Thank you very much. I

noticed so far funding hasn\'t come up very often

and I think we wish it wouldn\'t matter how special

education was financed; that children would be

treated the in same way regardless of how much

state and federal funding there is. But as a

practical matter, the method of funding does affect

both how students are classified and the types of

services that they receive.

So there\'s a real tension in designing

a system between‑‑tension in financing special

education between targeting financing towards

districts that happen to have high rates of student

disability, so this is a concept that resources

should flow to where there\'s more needed, versus

the potential of that to lead to overclassification

of students.

So that\'s a tension that\'s increased

over time in special education just because of the

way that special education has changed.

Back in 1975 when federal funding for

special education was introduced, it was really

introduced to resolve the problem of the special ed

students being excluded from the public school

system. Since then the face of special education

has changed, so the rates of disability has grown

dramatically and most of the growth has been in the

category of milder disabilities. So currently

about 80 percent of the students who are disabled

are either learning disabled, speech impaired or

emotionally disturbed.

So what\'s happened is that the degree

of local discretion inside special education

programs has increased over time. So one of the

things critics worry about is that the dramatic

growth that we\'ve seen in the number of children

classified as disabled can partly be attributed to

the way we finance special education. The fact

that by classifying more students, school districts

are able to leverage more state and federal funds

could in part explain the high rates of disability.

So what I want to do today is I\'m going

to start with a simple review of the basic types of

funding mechanisms that we have for special

education, how each of those could differently

affect classifying students as disabled and then

turn to what the evidence is that we currently have

on how financial incentives relate to

classification of students and finally conclude

with a couple of recommendations from what I think

we\'ve learned so far.

First, turning to the methods of

finance, it\'s helpful to start with the big

picture, which is this is a really extensive

program. Some recent estimates estimate that one

in every five dollars in operating budgets goes

towards special education and it\'s a very

heterogeneous program, so the spending is

disproportionate to the number of students in

special education, because the excess costs are

fairly high.

On average, this is an estimate from

the late \'80s but it\'s held up, on average it costs

about 2.3 times as much to educate a student in

special education as opposed to regular education,

but beneath those numbers is a great deal of

homogeneity.

Recent estimates from data from the

University of Massachusetts suggests that ranges

from as low as 1.2 for students with the mildest

cases of disabilities up to 30 times for severely

disabled students with multiple disabilities.

That\'s one of the things I want you to

have in the background of your mind. That this

really is a very heterogeneous population that

we\'re talking about under the umbrella of special

education.

In order to support localities in

financing these excess costs, both the state and

federal governments provide substantial aid to

school districts. The federal share has never been

that important, so it\'s been traditionally less

than about 10 percent of total funding for special

education. State roles have been greater,

typically slightly above 50 percent. Again.

There\'s a lot of heterogeneity across states and a

lot of heterogeneity in the types of policies that

different states use.

So I\'m going to start by classifying

the types of policies that the federal government

has used and state governments have used into three

broad categories. I\'m going to draw parallels to

health insurance. I think we see the exact same

methods of cost reimbursement in health and they\'re

more used to thinking with the types of sort of

undesirable behavior, that those types of incentive

systems can create.

The first system is a cost

reimbursement system, which simply means that

districts are reimbursed based on some extent of

excess cost. And that has a very strong advantage,

which is that it does insure districts against the

possibility that they might have a high incidence

of student disability, so it provides a lot of

insurance to school districts, and it also targets

resources towards need.

The potential cost or the potential

negative is it really doesn\'t provide school

districts with any incentive for cost containment,

so the parallel to this in health insurance is a

fee for service plan. So it\'s essentially paying

providers of medical services based on the amount

of care they provide.

So if you think about it, they\'re

asking the person who is being paid for supplying

the service how much of that service you need and

that\'s the exact same problem that you can run into

in special education that by providing additional

services, by classifying more students, school

districts are able to generate more revenue through

this program and so it\'s a common problem, very

parallel to fee for service and not unique to

special education.

I think this first case highlights a

trade‑off we\'ll see in all finance methods, which

is there is this trade‑off of insurance, which is

making sure that resources get to the districts

that have higher needs than other districts and

these incentives, which is trying to remove

incentives to overclassify students or to make sure

that districts are providing the right level of

services.

So this form of reimbursement, which is

the partial cost reimbursement, is most appropriate

to severely disabled students, and the reason is

there we don\'t have a lot of debate about whether

the student should be classified as disabled or

not, and so we can look at this, and we might have

more debate about whether the level of service is

appropriate or not. There we can look at the level

or the number of students and that is a true

indicator of the underlying incidence of disability

and so it make sense to target resources based on

that signal of district need.

If instead we\'re looking at milder

disability categories, then the costs or the

expenditure of the School District partly reflect

underlying, incidence of underlying disability, but

also partly reflect practices of classification

that are district specific, and so what could

happen is two districts that really had the same

underlying incidence of disability could have very

different special education expenditures and so if

we\'re targeting resources based on expenditures, we

can end up having a very arbitrary pattern of

resource distribution to districts, based on what

their decisions are, the classification decisions

are of a district. That\'s one potential cost of

that type of system.

The second type of system is a system

that doesn\'t reimburse based on actual

expenditures, but reimburses based on program size.

This is like the federal system before the 1997

amendments, where school districts or states

received a fixed amount per student classified as

disabled. That falls under this category based on

the number of students who fall under this program,

and this is also the most common method that states

use to reimburse districts for special education.

Normally this happens to a people weighted formula

where the foundation aid or whatever method of aid

that the state uses includes a count of pupils, but

is not a strict count of pupils, it\'s a weighted

count of pupils, so the special education student

would count as more than one student and would

boost aid through the basic aid program.

This is, again, turning to the parallel

in health insurance, this is very similar to the

case mix form of reimbursement, where providers of

medicine are reimbursed based on the

characteristics or diagnosis of patients they

serve, so they\'re receiving some average payment

based on expected costs, but not based on actual

services that they provide. So this, unlike

reimbursing based on actual share of expenditures,

this does provide some incentives for cost

containment, and so the providers now benefit from

anything that\'s not expended over the average

expenditure level, but it can lead to the problem

what\'s been termed in the medical literature as

diagnosis creep and this is what happened following

the introduction of diagnostic resource groups back

in the 1980\'s under Medicare, where there are very

specific categories of diagnoses and each of those

was associated with a specific reimbursement,

following that introduction, patient creep, so

diagnoses moved into those categories that are

reimbursed, so the way that that kind of creeping

can happen in special education with this kind of

finance system is first of all on the border

between regular and special education, which is

since special education is reimbursed at a higher

rate, you have students on the margin between

regular and special education more likely to be

classified with special needs, and also within

special education, there\'s different categories of

disability or different instructional settings

carry different weights then districts also have

incentives to shift students to those programs that

are better reimbursed.

The third type, which is something that

both the Federal Government and several states have

moved to try to remove these kinds of incentives to

classify students as disabled, is what\'s known as a

prospective reimbursement system. And so the way

the federal system works currently is aid is

distributed based on 85 percent on total enrollment

and 55 percent on poverty rates and it\'s not based

on the actual count of students who are disabled.

And so the reason behind this is that there\'s some

underlying propensity for individuals to have

special needs, and that should be proportional to

the population of students and weighted up by other

factors that determine disadvantage like the

poverty rate.

In several states you\'re using systems

like this, too, which is based on prospective

expenditures not related to actual expenditures,

not related to professional education, not related

to actual program size. What this is parallel to

in the health care literature is to the per capita

payments that are received by HMOs. HMO will

receive a fixed flat fee regardless of what types

of services they provide to that enrollee, so this

has obvious very, very strong incentives to cost

control, is one of the big positives. Also allows

for a great deal of flexibility in the types of

services or for how the provider in health care

settings decides to allocate resources across

patients.

The negatives is it completely shifts

the risk to the provider. In this example, within

the context of health, it\'s now the provider of the

health care services who bears all the risk if they

happen to have, say, a sicker than expected

population. And that\'s the same concern that we

worry about in special education, is that

regardless of the characteristics of the students

that a district actually serves it\'s still

receiving the same amount of aid, say, from a

higher level of government so it\'s not at all

insured against happening to have a higher than

expected incidence of disability.

So that\'s probably the biggest negative

associated with this. What I would say is it\'s not

appropriate for severe disabilities where districts

can really impose a large negative shock on

district budgets and may be appropriate for the

milder disabilities because it does remove the

incentives to classify students on the margin.

There\'s now no advantage to manipulating the size

of a special education program at all. What some

people would worry about, there\'s no system that\'s

classification neutral. So this sounds like it

takes away all the issues about classification.

What it also does is it removes the incentives to

classify students as disabled and that\'s where we

started back in 1975, was with a system to make

sure that all students were being appropriately

served, so that\'s the trade‑off to keep in mind is

that no system is classification neutral.

The per capita system does remove the

incentives to overclassify, but provides no

incentives to students to be classified as

disabled. So that could lead to a positive outcome

where students are now treated in a more flexible

manner, not having to be labeled or a negative

label and these students are not receiving adequate

services.

I focused on the financial costs. This

is all across the backdrop of what goes into

determining whether a student is disabled or not,

so clearly ideology, fiscal and nonfiscal costs so

what we want to do is say, theoretically these kind

of reimbursement streams could effect whether

students are classified and how they\'re served, but

in practice are these financial incentives really

important or is it something that\'s dominated by

the other factors that determine whether students

are classified or not.

We don\'t have a great deal of evidence.

The evidence that I\'m familiar with is there are

two earlier case studies that looked at changes in

state reimbursement; one that went in the direction

of being more generous and one that went in the

direction of becoming less generous. The first was

an example from Oregon where the system moved to a

new reimbursement system where school districts

were reimbursed at two times the rate of regular

education students up to a cap of 11 percent. And

this was not a quantitative study, but was a

qualitative study where the researcher conducted

interviews and tried to figure out how special

education directors were responding to this policy

and what they found is the special education

directors were being pressured by the principals

and superintendents to bring the count of

disability up to that 11 percent cap and they said

that the ways that they had done this was by

pushing classification to earlier grades, so

starting to classify students in kindergarten and

before where they hadn\'t before.

In Vermont, the change went in the

opposite direction where they moved from a generous

special education system to the per capita

reimbursement form. Again, not a quantitative

study, but what the researchers found three years

following that reform, disability rates had fallen

by 17 percent. So these two studies looking at

movements in completely opposite direction show

there\'s definitely room for the rates to respond to

fiscal incentives.

I\'ve done some more quantitative work

looking at a specific state, so this has been

looking at Texas. And actually trying to measure

what is the change in the percent of students

classified as disabled for every change in the

margin of revenue that comes from the state for

classifying a student as disabled. The way the

system works there, it is one of these weighted

pupil systems, so having been a higher pupil count

increases both foundation aid and Texas has a

matching grant program. Both of those forms of aid

increase with the pupil count, so districts have an

incentive to generate revenue by classifying more

students as disabled.

There was an extreme policy change in

1994 that was not driven by special education, it

was driven by equalization interests. But because

of the way the special education is weighted, it

did change the relative incentives for very high

wealth districts and lower wealth districts to

classify students as disabled so what I was able to

do is ask what happened, so some districts had

sharp increases in the ability to classify students

as disabled other districts had sharp decreases or

their incentives remained flat. So I was able to

track how do the changes, how do they parallel

these movements in financial incentives, and they

actually tracked them really closely. You see a

close correlation between changes in disability

rates and changes in these relative financial

incentives and what the results implied is that if

you were to increase the reimbursement from the

state by about 10 percent, you\'d see a 2 percent

increase in the disability rate and that increase

is coming where you would expect it to come, it\'s

in the categories where the definitions are more

subjective, so it\'s in speech impairment, learning

disability.

Obviously, we\'re not seeing any effect

at all in the physical impairment categories.

And looking at the broad picture, what

does that mean about the role of financial

incentives. The change in financial incentives

over the six‑year period I was looking at could

explain 40 percent of the increase in disability

rates over that same six‑year period so it\'s not a

nontrivial factor. The way that special education

is reimbursed is a very significant determinant of

the number of students and the size of these

programs and composition of these programs.

So I think you could still ask well, so

what, is it a good thing or bad thing if more

students are classified as disabled and the direct

question is to say well what happens to the

students who are classified on the margin. Do they

seem to benefit from these services? Even if

that\'s a positive effect, we don\'t know what the

spillover effects could be to other students. It

could be positive or it could be negative.

In this same study I did have some

evidence on the direct effects where I could say it

looked like the students who are classified are

benefitting from being classified as special

education. There are two things that point to this

not necessarily being in the best interests of the

children who are being shifted on margin.

One is it tends to be, even given a

disproportionate rate at which minority students

are classified into special education, on the

margin they\'re shifted at disproportionate rates

into special education in response to these

financial incentives and more so, the less minority

the teacher population is, which is something that

you heard about earlier, so the less minority the

teacher population, the more likely minority

students were to be shifted in at disproportional

rates in response to these financial incentives.

The second thing is that it was the

school districts that were really financially

constrained that saw sharp cutbacks their aid to

the state that were most likely to respond to this

financial incentive. You might think this looks

like a good thing, it\'s more aid to special

education, generous programs, pulled down some of

the barriers so districts are now moving students

into special education that didn\'t have access

before, but it\'s actually those districts that are

fiscally constrained in other areas, so it looks

like it\'s being done for fiscal constraints not for

students shifted on the margin.

I tried to get more direct evidence on

what the welfare effects are in classifying

students in response to fiscal incentives and this

is using a national panel data set so now we can

ask is Texas unusual or do these results generalize

to other states. In looking at this national panel

data find a very similar magnitude of response of

disability rates to these sort of financial

incentives and what I\'m also finding, these are

just preliminary results and is it that the

increased resources are not showing up in quality

of special education programs, they appear to be

shifted to other programs, so that\'s another

concern is that these resources may not be going

where they\'re intended to go.

And so regardless of how we interpret

the fact that fiscal incentives do play an

important role, it\'s important to realize there are

two different programs really within special

education, so the classification response only

shows up for the milder disabilities, so the

evident disabilities, the physical disabilities,

the classification is evidence it\'s not being

responsive to physical incentives.

So from other research I think it\'s

worth highlighting that even though the rates of

disability do not respond to financial incentives,

that there can be big costs to this program being

underfunded. I found using Texas data that each

additional dollar that was spent on special

education in the short run reduced spending on

other programs by a dollar and this was for the

outlays, surprise, big outlays for severely

disabled students in Texas. It looked like there

was one for one crowdout of spending in special

education budget. Voters weren\'t voting to raise

these costs, it was coming out of a fixed education

budget.

And so researchers who looked at New

York have a similar finding, so it\'s one thing to

point out is that underfunding can have negative

effects on district budgets.

I want to conclude with a couple of

recommendations. Starting from an economist

perspective, what the justification is of having

special education programs. I really am thinking

of it as a form of insurance. Where at one level

it\'s insuring parents against the risk of happening

to have a child who is very expensive to educate

and that\'s justification for providing this in a

public forum, public schools and the justification

for having federal and state funding flow to the

schools to support data providing this is to insure

schools against the risk of having a higher than

expected or more costly than expected population to

educate.

So from that perspective, the behavior

that we\'re talking about is what\'s termed in other

insurance contexts as moral hazard. It sounds like

a value laden word, but all it means the size of

the program or the use of the program is a function

of the generosity of the program. So the better

reimbursed a special education program is, the

bigger special education programs will be and

that\'s a standard finding with insurance programs.

What that means is that if there is a

high degree of moral hazard, then you certainly

don\'t want to fully unsure, so you would not want

to fully fund this. You would like to have the

districts internalize the benefits when making

decisions about how many students to classify.

That\'s my first recommendation, that we

start by recognizing there really are two programs

within special education. There\'s one part of the

program which addresses severely disabled students

that are not subject to these same sorts of moral

hazard.

There\'s the second program where the

same classification where moral hazard is really

important. What that implies from a funding

perspective, one system of reimbursement is

probably not appropriate for both of these

programs.

So the more tenuous recommendations

that I had were how to finance into these two

halves and the first is thinking about the severely

disabled program. There I think it is reasonable

policy to fully fund this either at federal or

state level in order to insure localities against

the risk of having high costs for extremely

disabled students and the reason is that moral

hazard is not a big issue on the classification

side, these students will be identified in the same

way regardless of where they live, so it reflects

differences in incidences of disability regardless

of location and on the service side, where we heard

stories earlier today about high expenditures in

New York, we have a built in mechanism for the

severely disabled student through the private

system. So there\'s some degree of competition and

others argued that\'s one reason why vouchers would

work in the market of severely disabled students.

We have a well developed private market.

So I think even on the level of service

provision, there\'s not as much moral hazard with

the more severely disabled.

So both of those things would point

towards getting the benefit of insuring districts

and a fully funded program. For the mildly

disabled, fully funding is not an appropriate

option because moral hazard is so important in

terms of classification. So there, if we knew a

great deal about costs, knew a great deal about

appropriate interventions, then we might be able to

implement a system like a pupil weighting system

that basis the ability of a district receives on

the diagnosis of a student, but I think we probably

aren\'t there label wise. Probably there research

wise.

Once we set these weights and apply

them, if it affects behavior and instruction, then

we\'re really manipulating instruction policy. So

with the absence of a great deal of information

about the appropriate treatments, the level of

costs, what I think makes the most sense is using a

prospective reimbursement system where we recognize

somewhat similar to Title I, where we recognize

there are some districts that are likely to have

higher incidents of disability, we\'d like to target

more resources to those districts so they could

flexibly decide how to allocate them across their

special needs and other students.

The danger which I highlighted before

with prospective payment systems is we worry it may

return us to a system where students are not

receiving adequate services, and so what I would

recommend, which is a theme that I heard come up

earlier today, is combining this with some kind of

accountability system. So many states, and Texas

is one state that has in the past excluded special

needs students from testing, and I think that\'s a

real danger. Both change the system of finance and

not make it fully inclusive on the accountability

side.

So that would be a dual recommendation

if you move towards prospective payment to combine

it with some system of accountability.

Thanks a lot and I look forward to your

questions.

DR. FLETCHER: Thank you very much. I

have to say that was the most cogent and lucid

presentation on special education financing I\'ve

ever heard and I\'m afraid I heard lots of them,

unfortunately.

We\'re going to start with a question

from Dr. Pasternack, since he\'s the designated

Federal office for the expenditure of IDEA funds.

DR. PASTERNACK: Thank you,

Mr. Chairman. Thank you for the presentation as

well. I think there are a lot of people in the

country who would agree that it doesn\'t cost the

same to educate all kids with disabilities, yet we

have a federal finance system that provides the

same amount of money for all kids with

disabilities, so I think your comments are

particularly timely.

One question I\'m sure that other

Commissioners would have is how you would define

students with severe disabilities?

DR. CULLEN: If there was some

agreement that students with severely high

disabilities would be classified the same across

the schools, that\'s where we can say this isn\'t

subjective, it\'s something that\'s objective and

combined with perhaps knowing how to treat this.

Actually, I\'ve seen several studies that show if

you take the level of functioning of students

across different districts, that there are dramatic

variations as to whether that same student would be

classified in special education in one district

versus another in this mild category, so that would

be one criteria it would have to be something

stable across districts where whether a student is

served in special education or not or is classified

as disabled would not be a function of where they

live, that it would be more objective.

DR. PASTERNACK: How would you suggest

that we structure the system so that we would not

encourage people to label kids as having a severe

disability because of financial incentives, that

would be provided for students in order to serve

those students with severe disabilities?

DR. CULLEN: This is where what I

would define severe disabilities as those

categories that are not subjective so it would not

be subject to financial incentives.

DR. PASTERNACK: Are you aware of any

data that would indicate that there is a direct

correlation, positive correlation between the

amount of money spent and the outcomes achieved by

students with disabilities who are recipients of

those high cost services?

DR. CULLEN: No, we actually know very

little I would say about either the high incidence

or the low incidence, mainly because of

difficulties in controlling for selections. We

don\'t know what the outcomes for these students

would be in the absence of these services.

DR. PASTERNACK: In the private

schools that you were referring to, do we have any

data? I know you\'re a fiscal person as opposed to

a programmatic person, but in the fiscal reviews

that you\'ve done, have you encountered any

programmatic data which shows that people receiving

fiscal incentives in those programs would have the

same outcomes as those not receiving?

DR. CULLEN: This is based on

secondhand readings, but from what I understand

about reading from these programs, it\'s a

perception that it\'s pretty well known what

services need to be provided and there\'s where the

competition is more on the cost level and less on

the types of services that are provided to severely

disabled students.

DR. PASTERNACK: Your recommendation

to us to take back in terms of the structuring of

the finances for the IDEA would be those categories

you referred to; the mild disabilities, I think

that\'s the language you\'re using and severe

disabilities, is that correct?

DR. CULLEN: That\'s correct.

DR. PASTERNACK: Thank you very much.

Thank you, Mr. Chair.

DR. FLETCHER: Commissioner Rivas?

COMMISSIONER RIVAS: Thank you for your

presentation. What would be the separation between

the mild disabilities and the severe disabilities,

I guess, that they would be using as a guideline to

separate the financing of these? Are you talking

about like low incidence and high incidence cases

or‑‑

DR. CULLEN: I think this is the same

question so, I must not have answered it quite

before, which is you\'re saying if I think there

should be two programs where should be the line be

drawn between students which should be in each

program. And I\'m not qualified to say, but my

judgment would be that those disabilities that are

evident, that no one would debate whether a

disability exists or doesn\'t exist and that may

evolve with assessment, with knowledge, with

medical practice, but those cases where there would

be no debate about whether a student was disabled

or not would be the cases that I would count as

being objective, and not subject to the same level

of moral hazard, but does coincide with low

incidence.

DR. FLETCHER: Thank you. Dr. Coulter?

DR. COULTER: No questions.

Commissioner Acosta. Commissioner Wright?

DR. WRIGHT: I don\'t have much of a

question but I\'m a former director of special

education from Illinois and we just had so much

always needing more money, whether for funding, at

least partial funding and all that, so your

presentation has certainly given me another

perspective.

I remember and Dr. Pasternack could

probably relate to this, I remember back last year

when President Bush called in an about a hundred

black leaders from across the country to meet with

him, Secretary Page and some others and the first

thing I said to Secretary Page, Dr. Pasternack,

was, \"I came here to tell you and the President

that we must have more money for special ed across

the board, we must have full funding, and.\"

Dr. Page, if you ever met him, is very calm, cool

and collected. He said, \"You know, Dr. Wright, we

can\'t give you full funding, but we promise you we

will give you more money than you\'ve ever had for

special education,\" and that stuck with me.

You\'ve given me a perspective that it

doesn\'t have to be across the board. You\'re saying

that to separate it out into certain programs and I

want to thank you for giving me another perspective

to think about, and that\'s my comment.

DR. FLETCHER: Thank you. Nancy.

COMMISSIONER GRASMICK: Just a quick

question, I just want to understand in summary the

money follows the student. If you take as a

premise the two categories, the money follows the

students whether that\'s public or non‑public, et

cetera, is that correct?

DR. CULLEN: Do you mean through the

way financing these things work?

COMMISSIONER GRASMICK: I\'m

suggesting that these two categories that you\'ve

articulated that students who are low incidence,

high cost, go into non‑public facility for money

follows the student.

DR. CULLEN: Yes.

COMMISSIONER GRASMICK: Okay, thank

you.

COMMISSIONER TAKEMOTO: Thank you for

your comments and I was very intrigued by a piece

of what you said about the dollar for dollar. You

put one dollar into special education and you save

a dollar. What studies, what is your basis for

information on this?

DR. CULLEN: One is a study I\'ve done

myself and another is a study by Hampton Blakeford

and Kim Wykoff in New York. This really is a

separate analysis from what I was describing about

the milder disabilities, because in Texas those

categories are actually overfunded so that there\'s

excess revenue, based on my calculations from

classifying students as mildly disabled. The

severely disabled cases are greatly underfunded, so

what I was looking at was looking at district

budgets, changes over time if a district had to

serve a deaf blind student or a student with

multiple disabilities and trying to see how that

affected spending on regular education, so it could

mean in the long run there\'s less of a budgetary

impact, but one or two years after the extra money

that was expended for the severely disabled student

came dollar for dollar out of spending on regular

education students, so per people spending on

regular education was reduced directly in

proportion to the spending on special education.

COMMISSIONER TAKEMOTO: So when you

have a budget of \$100 and you spend \$51 on a

student with severe disability, regular education

for people, well, in general, it goes down, the

regular education side is \$49?

DR. CULLEN: That\'s right. So the way

I interpret it is that the education budget in the

short run is largely fixed, so the other

alternative is that the local government could

raise more tax revenue, so they could budget for

this year and residents could vote to pay higher

taxes. That doesn\'t happen.

COMMISSIONER TAKEMOTO: And then the

other part when you talk about students, it\'s less

costly to educate students in the regular

classroom, you were referring to, I just want to

clarify, you are not referring to students with

severe disability who have one‑on‑one services and

appropriate education for that severe disability,

yet are spending their full day, a majority of

their day in the regular education class, is that

correct?

DR. CULLEN: You mean when I

said‑‑excess revenue?

COMMISSIONER TAKEMOTO: No, now I\'m

talking about in general you said that students in

the regular classroom are less costly to educate

than students who are not in a regular classroom.

I just want to clarify, you are not speaking about

students with severe disabilities who are being

included in regular education, spending the

majority of their day in regular education classes,

yet have an intensive level of service needs.

DR. CULLEN: No. And a good source

for this is a chapter by Chambers in a recent book

that came out that analyzes Massachusetts data and

very carefully outlines the excess cost by

disability by setting. So when I say that the

expenses could be as low as many in excess of 24

percent over the amount needed to educate a regular

education student, that would be for a mildly

learning disabled student served in a regular

education setting and we have a very different

figure for students with severe disabilities served

in a regular education setting.

COMMISSIONER TAKEMOTO: In the

insurance environment, when insurance companies are

reimbursing per capita, they might reimburse

someone, let\'s just say someone who is deaf blind

differently than they would reimburse someone who

has cerebral palsy, different from someone, but

you\'re saying two tiered.

Can you tell me why you\'ve gone to

two‑tier, and I also need to know in doing so, are

you, let me just ask some categories. Are you

talking about blindness?

DR. CULLEN: As one‑‑

COMMISSIONER TAKEMOTO: As one of the

low incidence?

DR. CULLEN: Yes.

COMMISSIONER TAKEMOTO: Blindness,

autism, severe mental deterioration?

DR. CULLEN: Yes.

COMMISSIONER TAKEMOTO: I wondered

where your cutoff is there.

DR. CULLEN: I was hoping people in

the field could draw where this line is, but I

think conceptually we can split up these two types

of programs, but I\'m not the person to say where

that line is. I see that partly conceptually what

we would like to do and what ends up happening in

practice are different things. If we came up with

an ideal plan had a careful composite analysis and

decided what the appropriate categories are, how

you reimburse with each one once that\'s implemented

in the political realm, it ends up over time

diverging from what ideally we\'d like to see.

So the more parameters you put in a

program the more dangerous it is. I\'ve seen this

in places where the placement specific weights for

mainstreaming education have become politicized.

There are lobby groups that lobby for these weights

and it differs from what a cost analysis person

would say these placements should be.

I\'ve seen this in district size

adjustment. First there is a small adjustment,

then large districts, then midsized districts

lobbied for their own adjustment.. Again, it\'s

related to this moral hazard having too many

political players in a program.

COMMISSIONER TAKEMOTO: Thank you for

clarifying, that helps us as we\'re considering all

this.

DR. FLETCHER: Just a quick question.

You cited a paper by Moore that said that 13

percent of the costs of special education were in

evaluation costs. I note that the date on that

paper is 1988. Are you aware of any more recent

analyses of evaluation costs, because the

impression that many of us have is that these costs

have increased substantially, particularly for the

milder disabilities over the last ten years.

DR. CULLEN: I\'m not aware of any.

I\'ll take a look at that Chambers article again.

That\'s the first place I can look of to check.

DR. FLETCHER: Since he\'s a

Commissioner, we can ask him.

Then I have a comment and that is

simply that while I understand the distinction that

you\'re making between severe and mild disabilities,

if a child with a so‑called mild disability doesn\'t

receive adequate instruction, they will essentially

develop severe disabilities and the cost of

actually intervening with those kids, probably

exceeds what has been provided, which is

essentially where they had the difficulty to begin

with, but I appreciate the analysis very much.

DR. CULLEN: That\'s where I think the

accountability would come in, is replacing it with

careful monitoring.

DR. FLETCHER: Also the issue of the

number of kids that would never need this form of

instruction if we had the appropriate sorts of

early intervention programs in place.

I think Mr. Jones had a question.

MR. JONES: Yes, as part of your

research work and I don\'t know if it was

exclusively quantitative or through interviews and

so on, to gain a deeper understanding‑‑

DR. CULLEN: Quantitative.

MR. JONES: Qualitative. The issue of

the actual process that goes on, of referral or

overidentification or change in weight, I can

recall during the last Congressional debate on this

folks who appeared before the House and Senate

subcommittees said, \"Of course, I as a teacher or

no teacher would ever consciously do something like

that,\" and of course you would say, \"Of course not,

it\'s not a conscious decision, it\'s a reaction to

incentives and institutional pressures or

supervisory pressures.\"

I wanted to ask if there were any areas

identified as you investigated that were some of

the ways that plays out. So, for example, one of

the things I can remember hearing five years ago

was that, in fact something Chancellor Levy said

this morning, is for referrals out of the system

there becomes no incentive to actively scour the

needs, or review the needs of the kids that are

existing special ed students to determine if

they\'re no longer in need of services, so they stay

on the roll and that inflates the roll.

Were there discussions of things like

that and if so what were those things?

DR. CULLEN: I actually haven\'t been

able to look at that with the data I have. But I

know some individuals using Texas data at the

individual level are able to look at entry and

exit. I had aggregate percent of students to

special ed, but I think that\'s really likely that

there\'s less exit as well as probably more entry.

What I\'ve done can\'t distinguish that.

MR. JONES: Okay, thank you.

DR. FLETCHER: And we all know, just to

punctuate that, when students are excluded in the

accountability system, even Texas data is somewhat

limited because you\'re restricted to only those

kids who participate in the State accountability.

DR. CULLEN: I\'ve actually looked at

that just recently and am finding all kinds of

bizarre behavior in regard to who is classified as

special needs depending on how far from the next

target pass rate the school district is, so in that

context you\'re finding gating as well. Similar

principle to the financial, but it\'s just evident

that these categories are mutable and there\'s a lot

of discretion as to where the line is drawn between

able and disabled.

DR. FLETCHER: We\'ll finish with a

followup question from Dr. Pasternack.

DR. Pasternack: Thank you, Mr. Chair.

You asked the question I wanted to ask, but you

asked it much better.

A couple of questions I wanted to

follow up on. What do you think should be the

percentage of funds spent based on the research

you\'ve done and the percentage of funds we should

spend on accountability?

DR. CULLEN: That\'s a really tough

question for me to answer. I\'m not on the grand

level enough to know what the assessment costs are,

but my general suggestion would be is to shift

further away from assessment of specific

individuals and more assessment of all individuals.

So moving to more of a universal system with

universal accountability, individual specific and

have goals for each individual, maybe less on,

certainly less on deciding which categories of

disability apply, except in a context where we have

an intervention that we know works.

DR. PASTERNACK: What do we know about

the relationship between funding and outcome?

DR. CULLEN: In special education or

in regular education?

DR. PASTERNACK: Well, of course, since

we are the President\'s Commission on Excellence in

Special Education, our interest is in special ed,

but if the Chairman would allow, I\'d be interested

in a quick answer to both if we know something

about both.

DR. CULLEN: I was just joking,

because we know very little even at the level of

regular education of what actually translates into

better outcomes. I think that\'s part of the reason

that as a nation and across the states we\'ve

shifted from a system that\'s evaluated input where

you place emphasis on standards, class size,

teacher certification, shifting now to a focus on

outputs, such as student performance, dropout rates

is that we really don\'t know that much about the

process, we don\'t know what\'s effective, so we\'re

trying to let the bureaucracies of schools on their

own decide how best to allocate their resources and

evaluate them based on what comes out, but we don\'t

know very much about‑‑the regular ed process.

The only study now, this is not coming

from the education literature, but coming from the

economics literature, is a study from Texas done by

Rick Hanyushe (ph) and John Kanes, Steve Rifkind,

that just asks, again it\'s not resource based. It

asks does it look like students benefit from being

classified as special needs, and they find small

positive effects for some students, but that\'s

really the only systematic evidence that I\'ve seen

on the effects of special education.

DR. PASTERNACK: Are you aware of the

percentage of revenues which might be Medicaid

based that schools are receiving for educating

students with disabilities?

DR. CULLEN: What share is not local?

So on average, it\'s 60 percent, but it varies. On

average 60 percent would be federal plus state or

maybe about 65 percent and 45 percent is financed

locally, but that varies a great deal across the

state, so ranging, whether the locality is

responsible for a larger share, but that\'s on

average.

DR. PASTERNACK: Of the 83 percent

that is not federal, these non‑IDEA anyway, not

federal, you\'re saying that 65 percent of that is

state and the remainder of that is local?

DR. CULLEN: You\'re talking about

non‑special education?

DR. PASTERNACK: I\'m talking about

special education.

DR. CULLEN: Of total expenditures of

special education, about 45 percent on average is

local.

DR. PASTERNACK: And we don\'t‑‑well, I

guess the answer is we don\'t really know the

relationship between funding and outcomes, and that

would be as we move to our research agenda later

this week, that would be an area that would be

important for us to‑‑let me ask you this question.

Would you think that would be important for us to

know?

DR. CULLEN: That\'s one thing I want

to plug, we need data to answer these questions. I

tried before to get spending data. When I was

living in Massachusetts they made it very

difficult. I had to write it down by hand, I could

have gotten it. This is ten years ago. I notice

states are making more data available on the web,

but that\'s where we need to start to make the

financial data available so we can analyze this.

DR. PASTERNACK: Finally, Mr. Chair,

would you be in favor of giving the states the

ability to use, as was proposed in the SEA

reauthorization debate 50 or more of the IDEA money

for things other than providing special education

and related things to students with disabilities?

DR. CULLEN: This is essentially what

already happens with state funding, about half of

the states, actually 35 of the states do not tie

the receipt of special education funds to having to

expend those in special education, so it\'s a

smaller issue, but it\'s currently a smaller amount

of funding, but I would be in favor of a movement

that addresses students at need and at risk more

generally and places less of an emphasis in

identifying who is and who is not disabled.

DR. PASTERNACK: Has anyone done the

analysis of ranking states by the amount of money

they spend per student and the outcomes on things

like this? Is that simple a level of analysis that

you\'re able to start with?

DR. COLE: That\'s been done. The huge

problem is that there\'s so much selection, so

mainly people haven\'t looked at the state level,

but you certainly look at a school district that

has high spending compared with a school district

with low spending, then you have to ask what are

the backgrounds of the students in these two places

like how more or less involved are their parents,

so it\'s incredibly hard to separate resources from

other inputs.

DR. PASTERNACK: Thank you very much

for your testimony. Thank you, Mr. Chairman.

DR. FLETCHER: Thank you, Dr. Cullen.

I want to point out for the record the Hanshack

study, that found special education reading sites

maintain a gain of .04 standard deviations a year,

which means that if you replace the special

education second percentile, four years later he\'d

be reading at third percentile and many of us do

not regard that as particularly satisfactory. The

gain in math was a little bit larger, it was .12

standard deviations, but those of us in special

education really do not regard that as a terribly

actively significant conclusion as well.

DR. CULLEN: Thank you.

DR. FLETCHER: We\'re going to move on.

Our next witness is Dr. Joseph Webby, who is an

assistant professor in the Department of Special

Education Vanderbilt University. He is also a

Kennedy Center investigator and fellow. Dr. Webby

specializes in children and youth with behavior

disorders, observational assessment, functional

assessment of aggressive behavior and risk factors

in the development of problem behavior.

Thank you, Dr. Webby.

DR. WEBBY: Thank you, Mr. Chairman.

Given the previous testimony today, I think the

issue of teacher preparation is an important one,

given that for most teachers, the first nudge

towards special education comes from the general

education teacher.

Thank you for the opportunity and honor

to speak in front of his commission today. My

testimony will outline recommendations for

improving the training that general and special

education teachers receive to serve children with

severe behavior disorders (SBD) in school settings.

My recommendations are as follows:

1\. Increased behavior management training should

be provided to general education teachers, special

education teachers, school administrators, and

related service personnel. This training should

focus on evidence‑based practices that addressed

behavior needs at the whole school and individual

child levels.

2\. An emphasis needs to be placed on the

importance of quality academic instruction as a

critical component to any behavior management

program. Teacher training programs in the area of

severe behavior disorders should require at least

one primary course in the area of academic

instruction, specifically in the area of reading.

3\. For students with severe behavior disorders,

functional behavior assessment plans (FBA) and

subsequent behavior intervention plans (BIP) should

be the cornerstone of the individualized education

plans. Current federal guidelines emphasize the

use of FBA as a last step before removal from an

educational placement. Both the general and

special education teachers should receive training

that emphasizes the importance of behavioral

assessments to the initial development of defective

programming for these students.

4\. Given the poor post‑school outcomes reported

for students with severe behavior disorders,

teacher preparation should include transition

planning as an important piece of the training

process.

5\. Continued research on effective strategies is

needed to determine the efficacy of different

models of behavioral and academic intervention for

students with severe behavior disorders. As the

number of evidence‑based strategies increases this

information needs to be incorporated in both

preservice and in‑service training programs for

general and special education teachers.

My testimony will focus on each of

these issues. I will address the current state of

practice and will propose specific actions that

should be taken to meet the needs of children and

youth who are at risk or engage in severe behavior

disorders in school settings. Finally, the term

severe behavior disorders SBD will be used it to

describe this population of students. Although

this term is traditionally used to describe

students identified as emotionally disturbed under

IDEA, it certainly includes other children with

high incidence disabilities (LD, MMR) who engage in

unacceptable rates of problem behavior.

The issue of training teachers to work

with students with severe behavior disorders within

schools is incredibly complex. To date, there is

not an agreed‑upon knowledge base with the specific

sets of requisite skills to work with children and

youth with behavior disorders. In addition, it

appears that many personnel preparation programs

lack any empirical foundation. Schools and state

agencies continue to use unequal standards in

identifying children and youth for special

education services. Children and youth with SBD

are typically served by multiple agencies with

multiple theoretical bases, practices and

objectives (e.g., mental health, juvenile justice,

family services). Perhaps one of the greatest

challenges in the field is working within school

systems that continue to use, advocate, and promote

punishment and exclusion strategies in response to

behavioral challenges, while the evidence is clear

that these strategies not only failed to reduce

challenges, but may in fact increase problems.

An examination of recent policies and

trends directed at students with challenging

behavior provides a blueprint for educational

practices. To date, the field has not sufficiently

prepared children and youth with SBD to meet

benchmarks established through federal and state

policies. For example, all U.S. schools are to

provide a safe and drug‑free learning environment

for all students, according to the Goals 2000

Education Act. However, it is reported that one in

10 Americans schools had at least one serious

violent crime in the 1996‑97 school year, 57

percent of principals reported that one or more

incidents of violence resulted in police

involvement, and one‑third of parents in the nation

do not feel that their children are safe at school

or in their neighborhood. Specific mandates in the

recent reauthorization of the Individuals with

Disabilities Education Act also speak directly to

concerns common among students with SBD. IDEA

mandates that contingent upon disciplinary action

that results in a removal of a students with a

disability from school beyond 10 days, the district

must develop or revisit the functional behavioral

assessment (FBA) and the related positive

behavioral support plans (PSB) in an attempt to

successfully keep students in a less restrictive

environment.

The concepts of FDA and PBS are a

reflection of emerging evidence‑based practices

that have been identified over the last several

years. However, students with SBD continue to be

removed from school settings due to problem

behavior more so than any other disability group.

IDEA further mandates increased access and

participation in the general education curriculum.

However, students with SBD continue to be served

primarily in pull‑out programs, more so than any

other disability group. In sum, while improvements

in our approach to meeting the needs of students

with SBD has improved, there is still a great need

for improving services for these students.

Teachers and administrators alike have

expressed concern regarding the problem behavior

that is often exhibited in schools by students with

disabilities as well as those students who are

at‑risk for developing severe behavior disorders.

Unfortunately, schools have responded to problem

behavior in a manner that can best be described as

reactive. Students who exhibit problem behavior

are often removed from classrooms and schools,

usually after a crisis has occurred.

Unfortunately, numerous surveys have shown that

teachers, particularly those in general education

classrooms, and school administrators lack the

training to address severe problem behavior.

In response to educators\' and the

Public\'s concern over aggressive and violent

behavior in schools among children and youth with

disabilities, the 1997 and reauthorization of the

Individuals with Disabilities Act IDE provides

specific rules that are designed to promote

increased prosocial responding and avoids simply

removing students with disabilities from school.

For example, positive behavioral interventions,

strategies and supports, and functional behavioral

assessments FBA or components of a proactive

approach referred to as positive behavior supports.

Positive behavior supports, PBS, is a set of

strategies and systems designed to increase the

capacity of schools to A, reduce school disruption

and, B, educate students with problem behaviors.

The emerging literature on building PBS plans for

students with disabilities clearly points to the

need to build larger overall school systems of

supports to A, ensure that PBS plans are

implemented with a high degree of integrity and, B,

to prevent problem behaviors from developing into

chronic patterns that will ultimately require

specialized services. In addition, this literature

suggests that FBA and PBS technology should be

routinely used with non‑identified children to

prevent behavioral problems from developing into

chronic patterns that may then lead to special

education services.

Over the past several years, a model of

school‑wide PBS has emerged that is designed to

improve the capacity of schools to manage problem

behavior of all children. A three‑tiered approach

has been proposed. At the first level, a primary

school‑wide intervention is implemented with a

focus on developing a common set of behavior

expectations and a method for teaching those

behaviors in all settings within a school.. At the

second level (secondary), specialized interventions

are designed and implemented for small groups of

students who are nonresponsive to the school‑wide

intervention. At the third level (tertiary),

individualized programs of supports are developed

for those students who continue to demonstrate high

rates of inappropriate behavior. These plans are

often based on FBAs and may include students

currently receiving special education services.

This model of PBS is an extension of

evidence‑based practices developed in the area of

behavior analysis and has been the subject of a

number of research and clinical evaluations (many

of which have been funded by the Office of Special

Education Programs). This systems or community

model addresses some of the limitations in current

teacher preparation programs by providing basic

behavior management training to all school

personnel. Research on this model has demonstrated

its effectiveness in reducing general disruptive

behavior in schools as measured by office referrals

and disciplinary contacts with students. Although

continued research is needed, it appears that this

approach has broad acceptance with educators and

administrators in both general and special

education.

Recommendations in the area of behavior

management:

1\. Increased behavior management

training should be provided to general education

teachers, special education teachers, school

administrators and related service personnel. This

training should focus on evidence‑based practices

that address behavior needs at the whole school and

individual child levels. To this end, I suggest

that some specific areas need to be studied to

improve the capacity of schools to meet the needs

of students with SBD.

A. Identification of the

characteristics of children who are nonresponsive

to primary level behavior support programs. If a

common set of characteristics can be determined,

implementation of more intensive levels of support

can begin much earlier.

B. Implementation of longitudinal

evaluations of PBS models in order to determine if

durable changes in student outcomes can be

achieved.

C. Development of assessment

instruments that measure the impact of secondary

and tertiary levels of intervention that will be

adopted by administrators, teachers, and other

school personnel. Currently, the evaluation of

most school‑level interventions incorporates

readily available measures such as office referrals

and discipline contacts. These measures may not be

sensitive to changes in significant behavior such

as positive peer interactions and increased

academic engagement.

D. Development of training materials

for preservice teacher preparation programs.

Currently, training in the area of behavior

management appears to occur at the in‑service

level. To better prepare general education

teachers, special education teachers, and school

administrators to meet the needs of students with

SBD, relevant training and experiences should be

delivered as early in the preparation process as

possible.

Increased academic instruction:

It has been reported that teachers of

students with SBD use effective teaching practices

infrequently, thus exacerbating the academic

deficits of these students. Research indicates

that teachers\' instruction is both more limited and

characterized by easier tests for children

exhibiting problem behaviors than for those who are

not. While there are many reasons for the lack of

instruction given to students with SBD, a major

factor is the lack of specific training of pre‑ and

in‑service teachers in the area of instructional

methods, particularly in the area of reading. This

trend is unfortunate, given that there is

significant body of evidence that has documented a

common current relationship between academic

underachievement and emotional and behavioral

problems in school‑age youth. As a group, students

with severe behavior disorders exhibit academic

deficiencies in most subject areas. Although the

exact nature and directionality of the relationship

remains equivocal, it is evident that academic and

behavioral difficulties exist as highly correlated

characteristics.

It has been the contention of several

experts in the field of severe behavior disorders

that addressing the achievement needs of these

students through exquisite and direct instruction

may have the effect of improving student problem

behavior and, consequently, the quality of teacher

interactions with these students. In fact, there

is a small but growing body of literature

demonstrating that improvements in academic

achievement corresponds with improved social

behavior in schools. Since many students with

severe behavior disorders show significant

deficiencies in their reading ability, I believe

that teachers of students with or at risk for SBD

need to receive intensive training in the

evidence‑based approaches for teaching reading

skills and comprehension of material.

Recommendation in the area of academic

instruction:

1\. An emphasis needs to be placed on

the importance of quality academic instruction as a

critical component to any behavior management

program. Teacher training programs in the area of

severe behavior disorders should require at least

one primary course in the area of academic

instruction, specifically in the area of reading.

In conjunction with this recommendation, I propose

that additional research is needed in the following

areas:

A. Studies are needed on the efficacy

of different models of reading instruction for

students with SBD. A recent review of this

literature reported that there have been very few

intervention studies that have investigated the

impact of reading programs with this population of

students. Although the preliminary evidence is

somewhat positive, more research is needed to

determine whether particular types of reading

programs are more effective for these students.

B. Studies are needed on the factors

that influence the efficacy of reading

interventions with students with SBD. As mentioned

above, relatively few reading studies have been

conducted with this group of students. Given the

heterogeneity of this group it is possible that

students with SBD and similar reading difficulties

will respond differently to the same reading

program. We need to understand those factors that

might predict success or failure in this crucial

area and train teachers to use that information

when determining instructional programs.

C. In addition studies are needed on

the factors that influence the delivery of quality

reading instruction by teachers. As mentioned,

descriptive research has shown that there is an

absence of instruction in many classrooms that

serve students with SBD. A better understanding of

factors inhibiting instruction by teachers would

lead to the development of stronger preparation

programs for teachers interested in working with

this population of students.

Functional behavior assessments:

Aggressive and disruptive behaviors

often characterize children and youth with SBD and

set them apart from children with other primary

handicapping conditions. A comprehensive

understanding of the factors that maintain the

externalizing and internalizing behaviors

characteristic of this population has eluded

researchers and practitioners alike. Failure to

fully comprehend the stimuli that vocation and

maintain these behaviors has led to treatments with

limited promise for positive, long‑lasting

outcomes. Several factors have contributed to our

lack of knowledge about effectively assessing and

treating specific problem behaviors. The use of

comparative behavior rating scales and checklists

is pervasive in the identification of children with

psychopathology. The use of this type of

information is extremely important in identifying

who is deviated from normative samples of children.

It has been aptly noted, however, that these

assessment devices often provide little information

regarding the specific causes of the problem

behavior (i.e., why a child hit another child on

this particular date at this particular time).

Thus, the emphasis in behavioral assessment often

has been discovering who acts differently under

similar environmental conditions (e.g. home or

classroom) instead of determining why they act

differently.

Over the last 15 years, there has been

an expanse in literature identifying methods for

isolating the causes of severe behavior problems.

As described by several researchers, these

approaches can be categorized broadly either as

functional assessments or functional analyses.

Functional assessment relies on the identification

of apparent associations between specific problem

behaviors and environmental variables to develop

testable causal hypotheses about classroom or

social conditions leading to or maintaining problem

behavior. Functional assessments is extended to a

functional analysis when environmental variables

are directly manipulated to determine their effect

and relation to specific problem behaviors. For

the purpose of this testimony, the term functional

assessment will be used hereafter to denote

descriptive assessments or experimental analyses

conducted specifically to determine the operative

function of problem behavior (e.g., escape

motivated, attention motivated).

Despite the renewed emphasis on

assessments conducted to determine the functional

purpose of specific problem behaviors, the

applicability of typical functional assessment

methodology is just beginning to be explored for

students with SBD. The majority of functional

assessment research has been conducted with a

population characterized as having severe

developmental disabilities and relatively high

rates of aberrant behavior. However, the

application of functional assessment strategies for

children and youth with SBD is increasing.

Although many positive results have been reported,

continued application and replication of functional

assessment methodologies within SBD populations is

needed before we can recommend a single best

practice. At best, the literature regarding

functional assessments with SBD populations is

emerging and along with it so will best practice.

However, several apparent inconsistencies in the

recent literature provide guidelines regarding how

best to implement functional assessments within an

applied treatment context for this population of

students. These guidelines point toward a

behavioral‑ecological approach to assessing

environmental determinants of problem behavior.

Emphasizing the social ecology of a classroom

(e.g., students, peer and teacher behavior,

physical arrangement of the classroom, classroom

daily schedule) has resulted in positive

improvements in social behavior. Thus, this

functional approach is more effective because it

minimizes inference, is contractually bound, and is

linked directly to ongoing behavioral and

environmental events that can be an apparently

tested and validated. Such factors have important

conceptual and practical implications for persons

working with students with SBD. If a functional

perspective is held, then assessment proceeds by

identifying, describing and analyzing environmental

correlates related to instances of problem

behavior. Once the correlates are reliably

identified (i.e., once the function of the problem

behavior is known), we then know exactly where to

target and how to develop our intervention or

remediation efforts. Simply put, a functional

perspective provides a pragmatic platform from

which teaching professionals can begin to

understand and effectively change their students\'

problem behavior. Because a functional assessment

approach may result in many of the aberrant

behaviors characterizing children and youth being

understood as purposeful, intervention approaches

are educational rather than simply reductive can be

designed and implemented.

For teachers to better understand

students with SBD, provisions should be made in

teacher education programs for explicit instruction

on the nature of problem behavior and the

opportunity to practice effective functional

assessments in the context of ongoing classroom

routines. Furthermore, ample instructional and

practical time should be allocated to learn how to

translate assessment results into classroom‑based

interventions. Given the increasing student (and

behavioral) diversity within special and regular

education classrooms, this training, either

incorporated within traditional behavior management

courses or through specialized instruction, should

be an integral aspect of preparing special

education teachers. Ignoring this aspect of

preservice preparation ensures that teachers will

continue to apply behavioral technology without

understanding why the behavior occurs.

At the policy level, school districts

need to incorporate assessment procedures within

their stated disciplinary plans for reducing

problem behavior. Assessment procedures should be

a required component of all behavior reduction

packages and/or disciplinary procedures. All my

support for these procedures is provided, it is

unlikely that teachers and other personnel within

school systems will incorporate these types of

assessment strategies into their behavior

management plans.

Recommendations in the area of

functional assessment:

1\. For students with severe behavior

disorders, functional behavior assessments plans

(FBA) and subsequent behavior intervention plans

(BIP) should be the cornerstone of the

individualized education plans. Current federal

guidelines emphasize the use of FBA as a last step

before removal from an educational placement. Both

general and special education teachers should

receive training that emphasizes the importance of

behavioral assessments to the initial development

of effective programming for these students. In

addition, research is needed in the following

areas:

A. As noted, much of the information

on the effectiveness of functional assessment

technologies is based on persons with severe

developmental disabilities. Although the number of

functional assessment studies conducted with high

incidence populations is growing, much more work is

needed. I propose that systematic research continue

in this area so that a set of empirically valid

functional assessment procedures can be developed

for students with SBD.

B. Procedures for incorporating

functional behavior assessments within ongoing

individualized education plans are needed. It has

been suggested that for many students, development

of behavior plans are being completed without

considering the goals and objectives for a

particular student. Guidelines are needed for

making functional assessments relevant to the

educational needs for each child with SBD.

Transition planning:

Longitudinal data from a number of

sources indicates that students with SBD may have

the poorest outcomes of any disability group.

These outcomes include having the lowest grade

point average of all disability categories, failing

one or more courses in their most recent school

year, failing the competency exam for their grade

level, and failing to complete school. Further,

students with severe behavior disorders are at

great risk for dropping out of school. In

addition, for the vast majority of adolescents with

SBD, the transition from school to work is marked

with disappointing employment outcomes. It has

been reported that four years after high school,

almost 20 percent of all young adults with SBD have

never held a job. Unemployment rates during the

first five years after leaving high school range

from 42 percent to 70 percent. Even among

participants of model demonstration transition

programs for adolescents with SBD, unemployment

rates still climb as high as 31 percent to 46

percent. These unemployment rates far exceed those

of high school graduates without disabilities and

those experienced by any other disability group,

including young adults with mental retardation,

visual disabilities or physical disabilities.

Little is known about secondary

practitioners\' training and qualifications for

preparing adolescents with SBD for the transition

to adulthood, particularly in the areas of

employment and vocational education. It has been

reported that teachers of students with SBD believe

it\'s very important to know about career education,

vocational education and vocational rehabilitation

agencies and to be competent teaching job

search/maintenance skills, administering vocational

assessments and selecting/evaluating

community‑based instruction sites; these teachers

reported only moderate knowledge of these issues.

Moreover, these teachers reported generally low

levels of involvement in many areas related to

vocational training (e.g., supervising students on

the job, planning community‑based vocational

programs, working with employers and employees,

identifying job sites).

There appears to be considerable

variation in the amount of preparation in

transition planning that teachers of students with

SBD receive. Data from teacher surveys suggest

that the majority of training takes place in the

form of in‑service training. These surveys also

suggest that a large percentage of teachers for

students with SBD are somewhat more highly

unprepared to transition students with SBD to

post‑secondary placements. Moreover, given that

paraprofessionals are likely to be delivering much

of the transition programming, we have very little

information regarding the skills that these

individuals possess.

These outcomes present a significant

challenge to secondary personnel who serve

adolescents with SBD. Given these students\'

underutilization of adult services, secondary

transition programs are likely to comprise the last

educational and vocational services that the

majority of students with SBD receive. Therefore,

it is critical that effective services be designed

and delivered within secondary programs, as these

services may play a critical role in improving

student outcomes. Secondary transition services

represented critical piece of effort aimed at

improving vocational outcomes. Several

federally‑funded model demonstration programs have

been implemented during the past decade with the

purpose of improving the vocational outcomes for

adolescents with SBD (e.g., Career Ladders; Job

Designs; Project RENEW). These programs clearly

demonstrate that adolescents with the SBD are

capable of obtaining and maintaining meaningful

employment. As mentioned above, there is little

evidence that the strategies developed in these

programs have been incorporated into personnel

preparation programs.

Recommendation in the area of

transition planning:

1\. Given the poor outcomes reported

for students with SBD, teacher preparation programs

should include transition planning as an integral

piece of the training process. In addition,

research on transition planning is needed to help

guide the preparation process.

A. Development of transition models is

needed for students with SBD. As with research on

functional assessment, much of what we know

regarding the transition from school to community

comes from students with development disabilities.

Whether the evidence‑based practices from that

population apply to high‑incidence students with

SBD is unknown. I recommended that research in

this area become a priority under part D of IDEA.

Identification of best practices in transition may

result in better preparation of teachers in the

transition process.

B. Research on inter‑agency

collaboration is needed in the area of transition

planning for students with SBD. It is logical to

assume that success transition would require the

coordination of a number of agencies (e.g.,

Vocational Rehabilitation) that currently focus

their resources on students with mental retardation

and other developmental disabilities.

Understanding barriers to those services for

students with SBD could lead to improve post‑school

outcomes for this group.

Research on defective strategies:

As outlined in my above comments, we

have made significant progress in the area of SBD

since the passage of 94‑142. However, the field of

SBD is still fraught with practices in the above

areas that have little evidence to support their

use. As we prepare the next generation of

teachers, we must provide them with a set of

empirically valid tools to meet the unique needs of

this population. Continued research on effective

strategies for addressing problem behavior is

needed to determine the efficacy of different

models of behavioral intervention. As the number

of evidence‑based strategies increases, this

information can be incorporated in both pre‑service

and in‑service training programs for general and

special education teachers. I have made some

recommendations in specific areas; however, this by

no means is an exhaustive list. I would like to

end this testimony by reiterating the important

connection between research and the preparation of

personnel to work with students identified as SBD.

The reauthorization of IDEA should reflect this

connection and provide the mechanisms necessary for

our field to continue in this process.

Thank you for your time.

DR. FLETCHER: Thank you, Dr. Webby.

I\'d like to start the questioning with Dr. Wright.

DR. WRIGHT: I have not prepared my

question, I would like to pass.

DR. FLETCHER: Commissioner Grasmick.

COMMISSIONER GRASMICK: Thank you

very much for your presentation. I think inherent

in your presentation is the notion of a standards

drift for teachers, particularly in the academic

areas working with these students, that they don\'t

hold the students to high standards and you spent a

considerable amount of time talking about reading.

I just wondered why you don\'t also identify

mathematics, since it\'s a gateway skill for success

in higher education, and many of these young people

are very capable.

DR. WEBBY: The primary reason I\'m

focussing on the reading, if you look at

developmental literature or risk factors or

comorbidity around the issue of these kind of

problems, by and large most research would suggest

that reading, maybe because they\'re not

investigating mathematics, I\'m not sure, reading

seems to come up as the most important academic

issue addressed in this population of students and

that\'s what we\'re addressing, that particular

issue.

Someone mentioned earlier, I think

given, with identified children behavior disorders

the limited amount of intervention research that\'s

being done doesn\'t even last as long as that, and I

could not stand up here and tell you that there\'s

been a single study, an intervention study, with

kids identified and receiving special education for

severe behavior disorders that look at math, and

math construction, particularly curriculum math.

COMMISSIONER GRASMICK: But you

certainly wouldn\'t be in opposition to look at

that?

DR. WEBBY: No. The bottom line I

think is reading, the importance of reading in

terms of school performance and postal outcomes is

well documented. For me the issue, though, is

academic instruction. As I mentioned earlier, I

don\'t think this is purposeful, I think it\'s a

training issue possibly, my experience has been

that historically if you talk with teachers who

work with students in special education or general

education setting and ask them about children who

have severe behavior disorders, the first thing

they will say on average we\'ve got to get the

behavior under control first before we can teach

them and I think the movement continues to go that

those two things are not two separate issues,

they\'re not mutually exclusive.

So to comment a little further, if you

think about the issue of behavioral assessments, I

think you need to broaden the context to understand

what\'s happening to these kids in the schools. Are

they getting quality instruction at the same level

as other students, and that\'s not to say that,

that\'s not to say anything specific. It happens

with kids who show problem behavior in the regular

general education classroom. You see different

treatment around instruction than you do for kids

in the general population.

COMMISSIONER GRASMICK: The second

part of my question has to do with the emphasis

which I agree with, on preservice professional

development, but I think there\'s a need given the

weak state of research at this point on continued

professional development and linked to that I guess

I would ask the question of as you ferret out the

best practices that can then certainly be

communicated to a wider audience of teachers, what

about the use of technology to identify important

classroom tools that would help in this ongoing

professional development.

DR. WEBBY: So the question is would I

support‑‑yes. I didn\'t mean to suggest that in

service training is not effective. In fact, if you

look at the work being done, the positive behavior

support model being implemented around the country,

their model is an in service model. They train

people a couple of days at the end of the year,

they have booster sessions during the course of the

year, you\'re seeing in the school wide level that

these programs seem to be having some impact.

COMMISSIONER GRASMICK: And you would

agree that with the developing state of the art of

technology that we ought to be using it more for

dissemination of excellent practices.

DR. WEBBY: Yes. And I\'m having a

really hard time hearing you all. Was that a \"yes\"

or \"no\" question?

COMMISSIONER GRASMICK: You answered

it, thank you very much.

DR. FLETCHER: Dr. Wright.

DR. WRIGHT: Mr. Chairman I was looking

for something in the presentation, but I didn\'t see

it so I\'ll ask the question. It\'s probably here,

and I didn\'t find it, you probably talked about it

and I didn\'t hear it. But my question has to do

with diversity training and cultural training,

cross cultural training of teachers of behavior

disorders, because as you know, certain cultures

have certain behaviors and other people might look

upon those behaviors as bad behaviors and they

really are not, they\'re just part of the culture

and the environment.

I was looking for that in your

presentation that\'s why I wasn\'t ready for the

question.

DR. WEBBY: It\'s not there, but I\'ll

highly support within the context of talking about

behavioral expectations what behaviors to support,

what behaviors to look to remediate that issue of

cultural expectation within different socioeconomic

levels, different regions of the country is

implicit in that training and it needs to be

provided as we try to support schools in dealing

with severe behavior disorders.

It\'s not there explicitly, but for the

record I\'ll support that.

DR. WRIGHT: In teaching methods,

showing teachers how to teach the behavior

disorder, I use the Walker Shea textbook, James

Walker/Thomas Shea textbook and there is a really

good chapter on there on diversity. Talking about

diversity, the different cultures and all, saying

okay, we might, some cultures it\'s okay to talk a

lot and to talk out loud, to look some people right

in the eye and in other cultures it\'s different, so

I really wanted to address that, but the Walker

Shea textbook really addresses that, and I use that

when I taught the methods of teaching behavior

disordered children.

DR. WEBBY: Thank you.

DR. FLETCHER: Commissioner Takemoto.

COMMISSIONER TAKEMOTO: I love those

two words put together, \"functional\" and

\"behavior.\" I think about, mostly a couple of

situations. One that you highlighted quite well,

which is if you\'re not performing academically, it

is actually functional if you get to go somewhere

else, get kicked out time out and those sorts of

things.

When you\'re talking about assessment,

you\'re not only talking about the child, you\'re

talking about environment, also saying this is not

dysfunctional, it\'s not going to help them in the

long run, but at the time it\'s serving a function

of getting away from an environment of failure.

DR. WEBBY: Exactly. I think we\'re

starting to do that better. I think historically

in the field of behavior problems and

identification, the first, at least it\'s always

been what\'s wrong with that student, not what\'s

happening in this environment to support or not

support that student.

COMMISSIONER TAKEMOTO: The other

student that worries me is the student who has a

diagnosis of a severe emotional disability is a

well behaved student with an emotional disability,

goes to those schools where that good behavior is

dysfunctional because they in essence will

disappear in that classroom.

So again, there are some environmental

issues, it\'s not just the diagnosis of a child,

there are some environmental issues that contribute

to things that aren\'t really functional in the

world out there, but become functional in

dysfunctional classrooms.

DR. WEBBY: I think you\'re exactly

right. You\'re beyond the child, but looking within

the school systems, classrooms, hallways, lunch

rooms but looking at how the support is being

provided.

The issue you raised, which again I

didn\'t address in the comments and I\'ll be glad to

take somebody else\'s time to address them, but the

issue of internalizing behavior problems, kids that

are depressed, socially withdrawn, we know a lot

less about those students and that is certainly an

area of need not only with training but research.

COMMISSIONER TAKEMOTO: Because

they\'re not bothering anybody, so they\'re in there

quietly failing.

DR. WEBBY: Exactly.

COMMISSIONER TAKEMOTO: That brings

me to my final question in terms of practice. We

heard from, I\'ll call them advocacy organizations,

who say give us the opportunity to do what we need

to do to teach our own kids. If they\'re being

disruptive, if they\'re keeping us from educating

our students, let us get them the heck out of

there, let us remove them from the classroom. It

doesn\'t sound like that\'s what you\'re saying here.

DR. WEBBY: What I would be saying is

that before I would go towards removing a child for

disruptive behavior, I would conduct these sort of

assessments of the behavior, the environment. I

think the nice part within this proposed model, I

think it\'s similar to any sort of nonresponsiveness

or responsive identification, responsive treatment,

if you provide a school wide support plan across

the board, and kids aren\'t responding to it and you

know it\'s being faithfully implemented. That

should be an indication that he\'s not a responder

at that level go to the next level; provide small

group or individual attention. If that works,

great; if not, go to a more individual level.

So with some students it might be

necessary to remove them into classroom with small

teacher ratios and intense individualized academic

behavior and instruction, but that is sort of a

first choice is inappropriate unless these other

types of functional assessments have been

conducted. So I don\'t want to say‑‑

COMMISSIONER TAKEMOTO: I don\'t think

anyone is saying never. The reason this is all

coming up is that teachers have told us that the

regulations last time around went way too far, all

we\'re doing is we\'re having to document, document,

document how we\'ve tried to do the right thing and

at the same time this child is disrupting,

disrupting, disrupting. And they\'ve complained to

Dr. Pasternack over here and say they want those

regulations out of there. Can you tell me how that

plays with your research and what you would

recommend? You\'re familiar with the regulations

and what you have to do, the manifestation and all

the other‑‑

DR. WEBBY: Exactly. We\'ve been

working on primarily looking at these students and

looking at if you do provide, trying to add to the

literature and look at academic instruction

particularly in the area of reading and see what

impact it has on children\'s behavior.

COMMISSIONER TAKEMOTO: Which is part

of the regulations.

DR. WEBBY: Right.

COMMISSIONER TAKEMOTO: Is there

anything in the regulations that you would change

that would help these teachers who want to get

these kids the heck out of there or feel like we\'re

usurping their teaching authority or what?

DR. WEBBY: The emphasis as I read the

regulations is the functional assessment process

seems to be we\'re going to remove the child from

the setting. It seems to me that should be sort of

the first step. If kids aren\'t responding to

primary levels of intervention or they\'re showing

significant behavior problems that make them stand

out, we should look at the functional assessment

process sort of here\'s what we need to do, not to

determine whether or not a child should be removed

from an educational setting, but determining what

the program should look like.

COMMISSIONER TAKEMOTO: So in terms

of results for students with disability, in terms

of those students with behavioral disorders, you\'re

saying from a results basis the regulations, with

the exception of possibly moving the functional

behavioral assessment forward are high?

DR. WEBBY: If you could tell me

specifically which part of the regulations you have

questions about, then I would feel more comfortable

in answering them. I\'m trying to be cautious about

it. My interpretation‑‑

COMMISSIONER TAKEMOTO: I was told to

be specific about what I think and ask you if you

agree. Do you agree or disagree if I made that

into a statement, that the regulations as currently

stated with the possible exception of moving the

functional behavioral assessment step forward has

foundation, it\'s recommended practice? And I\'ve

been limited to agree or disagree.

DR. FLETCHER: Just \"yes\" or \"no\",

please.

DR. WEBBY: No. I don\'t think there\'s

a strong research base.

DR. FLETCHER: But it does sound like

it\'s consistent of what you would think likely in

viable practice, just \"yes\" or \"no\".

DR. WEBBY: Maybe.

DR. FLETCHER: Thank you. Real

quickly, one of the characteristics of your

research that we\'ve been saying from our other

witnesses is frequent calls for research. My

question is, is it a problem that we actually need

more research or we don\'t implement the research

that we have?

DR. WEBBY: I think we need more

research, primarily because in two areas that I

focused in on, academic interventions there\'s

limited research on academic interventions with

kids who have real severe behavior disorders. For

me to stand up here and say the literature on

reading instruction that\'s been shown to be

effective for kids who are low achievers or have

learning disabilities, does that also apply to kids

with severe behavior problems, that\'s tentative at

best. There\'s not enough out there.

In addition, while we do have an

emerging growing number of studies that have looked

at functional behavior assessments for children

with high disabilities, the majority of that

research was done with students with developmental

disabilities, autism, and I\'m talking about the

removal of assessment students. We need more

research before I can say here\'s the best

functional basis of practice.

The functional perspective is logical,

I think it makes good sense, but we need to look at

the broader picture for these students and the

primary reason is that most of the functional

behavioral assessment literature with children with

severe behavioral disabilities has been conducted

when children engage in high frequency behaviors.

For most children with severe behavior

disorders, significant occurrences of physical

aggression or violent behavior is a rare

occurrence. That\'s a much more difficult behavior

to assess. So for me to say the high frequency

technology applies to low frequency behavior, it

seems to be, but we still need more work.

DR. FLETCHER: I guess I\'m a little

confused, because I have some idea about how much

money is spent on research under the IDEA, and I\'m

also aware one of the major emphasis of OSA is on

essentially the three tier model and problem based

learning, things of that sort.

Are you saying we don\'t have enough

research on the three tier level? Is that what

you\'re really saying, because I\'m aware of several

large scale implementations of the three tiered

model, for example, that\'s been really built on

OSAC research.

DR. WEBBY: The research on that

model, the reports we\'re seeing now have been

reports at the primary level. At the secondary

level if you look at research on secondary

interventions like social skills training, meta

analyses would suggest those studies have moderate

impact. If you look at secondary and tertiary

level interventions that are outside this model,

yes, we\'ve been effective.

What I\'ve not seen and why I think

that, and whether or not this is coming out, again,

I\'ve just seen the reports that come out on the

primary level, is looking at kids who don\'t respond

to the primary level within that system of support,

determining who needs secondary level interventions

and how those are chosen. I\'ve not seen that

literature within the context of that model yet.

I\'m anticipating it\'s coming, but I\'ve not seen

that literature yet.

DR. FLETCHER: That\'s something that

should be part of our research agenda to reduce

what I believe are the enormous expenditure of

research funds on the primary level, but spend more

at the secondary and tertiary level?

DR. WEBBY: My recommendation is

research dollars should continue to look at the

impact of the primary level in terms of general

disruptive behavior, but the research still needs

to be continued about the model and that\'s my

point.

DR. FLETCHER: I\'m confused, because as

I understand it, at least the three tier model is

being widely implemented in I think I heard 640

schools, for example. I\'m not trying to put you on

the spot, but I\'m genuinely confused over the state

of research in this area, and certainly have the

impression that some fairly significant claims

about all three tiers being made on the basis of

research you\'re saying that we haven\'t even done

enough on the primary level at this point?

DR. WEBBY: What was that last?

DR. FLETCHER: We haven\'t done enough

on the primary level at this point?

DR. WEBBY: Seems to me there\'s a

pretty good database on the primary level.

DR. FLETCHER: Probably should begin to

focus on research dollars on secondary and

tertiary?

DR. WEBBY: That I would agree.

DR. FLETCHER: Dr. Pasternack, do you

have a question?

DR. PASTERNACK: I will yield my time,

Mr. Chairman.

DR. FLETCHER: Dr. Coulter?

DR. COULTER: I want to thank you for

the presentation, also want to thank you that you

have your coat on at this time. While the rest of

us are heat challenged, you seem to be doing very

well, especially given the heated questions.

I\'m going to add a little bit to the

heat, so if you want to take your coat off, that\'s

fine with me.

You\'ve mentioned a number of times

about the importance of a functional behavioral

assessment. I think you made a good and effective

argument for that. One of the things I was

concerned about in listening to your testimony is

that given the current status of implementation of

those practices, we certainly as Commissioners have

heard a number of complaints about the fact that

teachers are not doing it, and I didn\'t necessarily

see any comment in your testimony on the frequency

or veracity of implementation of these

requirements, so I guess let me ask you a couple of

specific questions:

First of all, are there currently

accepted measures of implementation integrity of

functional behavioral assessment? In other words,

can we determine who\'s doing it right and who\'s not

doing it right?

DR. WEBBY: At the research level, I

think there is an accepted set of steps that we

would expect a person to go through, including

observation, interview with teachers, looking at

different settings and situations where the problem

behavior is likely to occur. So I think at that

level, do I think that those same steps are being

implemented at the school level? No. I suspect

that often what we\'re seeing in schools we may be

seeing more paper compliance and less sort of

functional application of the assessment

procedures.

DR. COULTER: So I take it from your

remarks, it\'s possible to construct an assessment

not just a functional behavioral assessment of the

student, but an assessment of the integrity or the

adherence to scientific procedures of that

assessment. We can tell who\'s doing it right and

who\'s not doing it right?

DR. WEBBY: Yes.

DR. COULTER: Okay, that\'s very

helpful.

Now, within that context I think one of

the things, I don\'t want to in any way diminish the

importance of what you\'re doing by focussing on

serious behavior disorders, because I think a lot

of comments you made are applicable to children in

general that would experience any kind of behavior

problem in school in terms of levels of

intervention. However, I think you know that a

percentage of children at school are actually

identified as having emotional disturbance as

specified in the regulations. That varies from

state to state. For instance, in Mississippi it\'s

2 percent who are considered mentally disturbed.

So with that in mind, I saw some

mention of academic instruction, some behavior

assessments, what are the accepted research

validated treatments for what would generally be

considered mental health issues for kids with

severe behavior disorders or severe emotional

disturbance?

DR. WEBBY: Mental health in terms of

traditional sort of counseling services?

DR. COULTER: Is there any data to

support the effectiveness of school counseling in

terms of dealing with behavior of children in

school?

DR. WEBBY: I\'m not familiar enough

with that literature to say one way or the other

how effective it is.

DR. COULTER: What about school

psychological services as it relates to students

with severe behavioral disorders?

DR. WEBBY: Again, I\'ll talk about my

peripheral experiences working with schools. I

think a comment was made by an earlier presenter in

terms of whether or not school psychologists were

trained from this perspective and from what I

gather from his testimony they weren\'t. They

should be if they\'re not, so I would agree while I

did not attend a school psych program, it seems

they give limited information on this from a

functional perspective.

DR. FLETCHER: We need to move on

Dr. Coulter.

DR. COULTER: Thank you, ran out of

time.

COMMISSIONER ACOSTA: We have been told

there\'s a national teacher shortage, and that\'s

certainly of general education teachers and we know

the shortage of special education teachers. Would

you just give me your opinion, what are some of the

incentives for teachers, regular ed teachers to

each special ed students in a general inclusive

classroom? What incentives would you recommend?

DR. WEBBY: I think the biggest

incentive would be support around issues of

behavior management and additional behavior

management training. Again, I don\'t believe that

as any exist that general education teachers at the

preservice level achieve strong behavior management

training, specifically when we talk about severe

behavioral disorders. So what incentive, I don\'t

know what incentive that would be, but what I heard

general education teachers tell me they need to

have more information, more support about working

with these types of children.

So if that was in place, I think you

might see at least more willingness to work with

these kids in general education settings.

COMMISSIONER ACOSTA: Thank you.

DR. FLETCHER: Thank you very much.

DR. WRIGHT: If I may, will you stay

during the break, I have one question to ask you

because I only asked you one and that took one

minute.

DR. FLETCHER: I\'m sorry, Dr. Wright, I

asked you twice if you have questions so I\'ll ask

you to reserve your question for the break. We have

to move on to our next speaker.

Thank you very much for your testimony,

Dr. Webby.

Our next witness is representative

Lenny Winkler, who is a State Representative, I

believe, from Connecticut. Representative Winkler

has played an instrumental role in addressing many

of the key issues facing Connecticut and as a State

Representative from the 41st district in 2001 she

was a primary sponsor of Public Act 0114, which has

been hailed as landmark legislation by medical

authorities throughout the United States. This

legislation is the first in the nation to address

what many health authorities feel to be the overuse

of psychotropic drugs by children and merited

national and international attention.

Welcome, Representative Winkler.

REPRESENTATIVE WINKLER: Good

afternoon, distinguished members of the President\'s

Commission on Excellence in Special Education. I\'m

very pleased to be with you today, and thank you

very much for inviting me.

I\'d like to take a few moments to

explain how Connecticut\'s psychotropic drug

legislation came about. As I often mentioned, in

my home state, I wear two hats; one as a legislator

and one as an emergency room nurse. While

performing my hospital duties, I recognized a

distinct problem with children arriving for

treatment. As patients are evaluated, we determine

what medications they\'re taking. What stood out to

me was a tremendous increase in the number of

children who have been prescribed psychotropic

drugs.

Before children started their

psychotropic drug therapy, the following baseline

tests are done. Metabolic and liver profiles, a

complete blood count, urinalysis and

electrocardiogram. During these procedures, I

noticed children as young as seven who were being

placed on these medications. It is important to

note that psychotropic drugs can affect all body

systems. Unfortunately, there are no long term

studies regarding the impact of these medications

on children.

As a nurse and as a legislator, I

realized this was a problem in Connecticut, and

after researching the subject, it was more apparent

to me that this is a nationwide problem and we need

to reassess the effects of psychotropic drugs on

children.

I am especially concerned with how this

is impacting our nation\'s future and troubled by

the possible connection between psychotropic drugs

and incidents of school violence. In many cases of

school violence, the offenders had been prescribed

and were taking psychotropic drugs. As you all

know, anyone using medication builds up a tolerance

over time and requires a stronger drug at some

point. After introducing this legislation, I

received many calls from parents who had been told

by school personnel that their child was disruptive

in class, had ADD or ADHD. Some were even told

that their child would not be allowed to attend

school if they did not place their child on

medication.

I have the utmost respect for teachers

in my state, but they simply are not qualified to

offer a medical diagnosis any more than I am

qualified to tell them how to teach a class. I

proposed the bill in January. It was unanimously

passed by the House of Representatives and Senate

in April, and signed by the Governor the following

month. And I will briefly describe for you what

this legislation does.

Beginning October 1 of this past year,

each local Board of Education is required to

develop and implement a policy that prohibits

school personnel from recommending to parents or

guardians the use of psychotropic drugs for

children under their care. It does allow a

designated school official to recommend to a parent

or guardian that a medical evaluation be performed

on their child. Also with the permission of a

parent, school personnel may exchange relevant

information with a child\'s physician.

Another clause in the legislation

prohibits the State Department of Children and

Family from removing a child from their home

because the family refused to place the child on a

psychotropic drug unless neglect or abuse was

determined under state statutes.

I would like to mention that this has

been dubbed the Ritalin bill by certain media

outlets. Although Ritalin is a psychotropic drug,

there are many other psychotropic drugs and the

legislation is relevant to each medication. I have

written to Connecticut\'s Congressional delegation

and asked them to ban direct advertising in

magazines regarding the use of psychotropic drugs.

Only physicians should receive this information and

base their treatment regimen after careful

consideration and a thorough evaluation.

I consider the legislation enacted last

year a good start and am very pleased that

Connecticut is the forefront of this issue. This

year, a followup bill has been proposed to help

clarify last year\'s legislation. It would specify

what psychotropic drugs are and give examples as to

who the appropriate contact personnel at schools

would be regarding medical and behavioral

evaluations.

I believe it\'s time that we consider

alternatives to psychotropic drugs. I believe

State and Federal governments should look at

establishing pilot programs of neurotherapy, which

would enable children to actually change and

improve their social skills, grades and hopefully

remove them from psychotropic drug therapy.

Through the process of neurotherapy,

the regulatory process of the brain can be

substantially improved. However, as I understand

it, we can customize each child\'s treatment through

the use of brain mapping techniques. Modern

database analysis allows the comparisons to normal

patterns to identify specific deficits to correct.

Properly applied modern neurotherapy provides a

traditional learning model which empowers each

child to develop personal self‑control and

regulation of their mental abilities and actions.

Neurotherapy offers the opportunity to

reduce the need for services in the ongoing years

as the child progresses through school. It\'s good

for the child\'s education, their sense of

achievement and the future.

It is not just a question of

educational opportunity. It is also about the

chance for effective learning to empower a child

for a lifetime of success. It is about optimizing

all of our teaching efforts in special education,

so that the child becomes a good learner, a good

student.

At the same time, we will be able to

reduce expenses for education and health care.

This is a genuine win‑win situation. We can do the

right thing to enhance the lives of children in

need and get a handle on our special education

costs.

I\'d like to say, Connecticut is a very

small state and our special education budget is

\$500 million a year and is going up. I think we

have to look at something to address this issue.

As more states recognize the need to

protect children from unnecessary medications and

address the behavioral and learning needs in other

ways, we will insure a healthy future for our

children and our country.

I\'d like to share with you three

recommendations that I would have that I would love

to see you look at. One of them would be to

require federal legislation that would prohibit

school personnel from recommending the use of

psychotropic drugs. I\'m personally not against the

use of them, but this is not the decision of a

teacher, it\'s the decision of a medical

professional.

I have received phone calls, e‑mails

from all over the United States. People have

shared with me some horrific stories on these

issues. I would also like to see drug

advertisement banned in magazines. The only people

that should receive these advertisements are people

who have prescriptive authority and can order the

medication. What good is it to advertise this

medication to a parents out there who have no

knowledge of the side effects and the

contraindications?

The last recommendation I would like to

offer is I wish you would consider offering grants

at the federal level to states to implement pilot

programs in the neurotherapy area.

With me today I have Dr. Jonathan

Marsalis, who is a neuropsychologist who I have

been working with in Connecticut to establish a

pilot program. He has the expertise and can answer

any of your technical questions on that issue.

Thank you very much.

DR. FLETCHER: Thank you very much,

Representative Winkler. We\'ll start with

Commissioner Acosta.

COMMISSIONER ACOSTA: Thank you for

your testimony. I just have a question, what is,

\$500 million?

REPRESENTATIVE WINKLER: \$500 million.

COMMISSIONER ACOSTA: Is there a

breakdown, where is that money spent specifically?

REPRESENTATIVE WINKLER: It is the

amount of money that is classified that is being

used for special education. I am sure we could get

a breakdown of this.

COMMISSIONER ACOSTA: Could you,

please? That would be very helpful. Thank you.

And that\'s all that I have, thank you.

DR. PASTERNACK: Thank you,

Mr. Chairman. Representative Winkler, could we

just get a brief description for the record of what

neurotherapy is?

REPRESENTATIVE WINKLER: Yes, and I\'ll

let Dr. Marsalis speak with you.

DR. PASTERNACK: Because of the

sensitive nature of the Commission and our

inability to endorse any particular model, I\'m just

going to profess my ignorance and just ask if you

could please provide a very brief description for

the record as to what we\'re talking about.

DR. Marsalis: Certainly, sir. You

have to understand, this is nothing more than a

formal behavioral intervention. It\'s using a form

of computer game in order to help the child learn

to self regulate their own brain wave activity.

One of the problems that we when we hear a lot of

what\'s been discussed here today about behavioral

interventions and the like, always there\'s the

underlying assumption that the child has willful

control of their behavior, that it may choose not

to engage in these disruptive oppositional

behaviors, they would be able to stop doing it.

The fact is, Dr. Abikoff today

referenced the fact these are neurological

disabilities. There\'s something wrong with how the

brain works. The child can\'t stop this disability

of oppositional behavior any more than he can sit

still in his chair. It\'s not a matter of teaching

your child control through a behavioral technique.

You have to help the child learn how to have

control over that brain wave activity. What we do

through a computer analysis is enable the child to

actually gain that behavioral control in the brain,

not just in terms of external behaviors and that\'s

in a very short form what this involves.

DR. PASTERNACK: Thank you.

Basically, would it be fair to characterize it as

some derivative of biofeedback?

DR. MARSALIS: Neurofeedback is part

of it, yes, but only a part of what you have to do

in the program. You have to do the other kinds of

work as well.

DR. PASTERNACK: Thank you.

Representative Winkler, there NAEP

data, I believe, which indicated that Connecticut

scores in the top of the United States in the

states out of the 39 states that volunteered to

take the national assessment of educational

progress. I wonder if you would be able to share

with us your view of what is working so well to

produce such good results for the students in

general education who take the NAEPs. As we have

not disaggregated those data, I can\'t tell you how

kids with disabilities on your state are doing on

NAEPs, but I\'m curious about your perception about

why is Connecticut doing so well?

REPRESENTATIVE WINKLER: It is very

difficult to hear your question. Was this

regarding how well they\'re doing with the state

mastery tests?

DR. PASTERNACK: National Assessment

of Educational Progress, the name, which is the

only national test that we have at this point,

really. States volunteer, as you know, to take

that test, 39 states participated last go around.

Connecticut scores 1 or 2 and I am curious as to

your perception or your sharing with the Commission

what is working so well in the public schools

within the State of Connecticut to produce those

kinds of results.

REPRESENTATIVE WINKLER: Connecticut, I

believe, has a wonderful special education

department, and when I met with them on this issue,

I shared with them that this is to be another tool

for them to use. It is not to replace what they\'re

doing. I think they\'re doing an excellent job.

But we\'re still seeing our dollars increase

tremendously and at this point we need to do

something.

DR. PASTERNACK: I guess I will thank

you very much for your comments and that\'s it for

now, Mr. Chairman.

DR. FLETCHER: To follow up on

Dr. Pasternack\'s question, we heard earlier

testimony that identification rates lead to

increased expenditures for special education. Do

you think there\'s anything unique in identification

rates in Connecticut that results in the increase

expenditure for special education? For example,

Greenwich, I believe, has one of the highest

identification rates for children with learning

disabilities in the country.

DR. PASTERNACK: 20 percent,

Mr. Chairman.

DR. FLETCHER: It is also one of the

most affluent areas of our country.

REPRESENTATIVE WINKLER: If you looked

at the breakdown of all the 169 towns in the state,

it would be very‑‑it\'s a real eye opener. The

special education is very high in many of the towns

that you would expect that it would not be. The,

obviously, the special education is higher in your

bigger cities such as Bridgeport, New Haven,

Hartford, Waterbury, and I think that\'s because, I

think that it\'s because a lot of the school

systems, there was a move to look at school choice,

to allow, to improve the school system. The

overall grades in these testing scores in these

grades are not that good. If you look at the

overall scores, you\'ll find that Connecticut is

down quite a ways on the overall list of mastery

tests.

DR. FLETCHER: I\'m not sure which

scores you\'re referring to.

REPRESENTATIVE WINKLER: I\'m talking

about the mastery scores at this point.

DR. FLETCHER: As a state? The state

or some of these districts?

REPRESENTATIVE WINKLER: The scores are

high in some of your more affluent areas and in

your poorer areas, the scores are quite low, so

that overall it brings the state scores down.

DR. FLETCHER: But in national

assessment Connecticut is traditionally at the very

top.

REPRESENTATIVE WINKLER: I\'m not sure.

DR. FLETCHER: I\'ll testify for the

record it\'s number 2 on the NAEP, Connecticut was

cited on the NAEP report for making the most

significant improvements in reading achievements of

any state in our country.

The other question I have is for your

expert on neurotherapy and I would like to know if

there are randomized clinical trials that

demonstrate efficacy for neurotherapy relative to

other interventions for children specifically with

ADHD?

DR. MARSALIS: Yes. The most classic

one is eight or nine years.

DR. FLETCHER: Randomized trials,

please.

DR. MARSALIS: Yes, specifically a

test of neurotherapy against Ritalin shows twenty

sessions had the same effect in terms of

controlling behavior that Ritalin did.

DR. FLETCHER: I\'m amazed at that

study. I don\'t believe it was a randomized trial.

DR. MARSALIS: I believe it was a

randomized trial, related to those conditions.

DR. FLETCHER: Maybe we\'re thinking of

different articles.

Would you agree that many reviews of

neurotherapy for children with many of the

conditions for which it\'s been recommended, which

range from children with attention deficit disorder

to autism to learning disabilities and so on, that

many reviews of the efficacy of this practice have

not concluded that it\'s terribly efficacious or

concluded that the research necessary to establish

it as a viable modality has yet to be completed?

DR. MARSALIS: I would not entirely

agree with that statement, no, sir.

DR. FLETCHER: Would you agree that

other people, other experts in the area like

Russell Barclay, for example‑‑

DR. MARSALIS: Russell Barclay has had

that position for a long time.

DR. FLETCHER: He would take that

position.

DR. MARSALIS: Absolutely.

DR. FLETCHER: There\'s no consensus on

that opinion?

DR. MARSALIS: No, sir, nor on

functional analysis either.

DR. FLETCHER: Functional behavioral

analysis for who? How about the use of

Methylphenidate?

DR. MARSALIS: There\'s agreement it

works on about 70 percent of the children.

DR. FLETCHER: 70 percent on the first

dose but‑‑

REPRESENTATIVE WINKLER: If you use

multi drugs, it raises 80 to 90 percent.

DR. FLETCHER: Does neurotherapy work

with 80 to 90 percent‑‑

DR. MARSALIS: Yes. Again, there\'s

not as many randomized trials as I would like to

see, I believe there are some.

DR. FLETCHER: And do other experts in

the area like Russell Barclay, for example, agree

with your assessment, the statement you just made?

DR. MARSALIS: Certainly Russell

Barclay would not.

DR. FLETCHER: In fact, there are

others who would not agree with that statement as

well.

DR. MARSALIS: Certainly some, but

there are many that would.

DR. FLETCHER: I\'m curious,

Representative Winkler with this level of discord,

why you would recommend to the panel that we

initiate state pilot grants for neurotherapy.

REPRESENTATIVE WINKLER: Because I go

back to what I see in the emergency room, where the

young children coming in more and more on

psychotropic drugs, and I don\'t mean just Ritalin.

I see them come in on Ritalin, Zoloft, Prozac,

Clonopin, Wellbutrin, any combination, multiple

drugs. And I question what we\'re doing to the

future for these children, for the State and for

the nation.

I\'m looking at school violence that has

occurred across the United States by children who

have been on psychotropic drugs. I mention you

build up a tolerance to anything when you\'re on

medication for any length of time, and I believe

eventually we are going to look at doing some

neurotherapy programs, because what we have is not

working all that well.

I realize what you said, and I\'m sure

Connecticut is doing a good job, but why are we

spending \$500 million in a small state on special

education costs?

DR. FLETCHER: Well, I frankly would

suggest that you read the testimony of our previous

expert on the economics of special education, you

might get a clue of how identification practices

drive the cost of special education, particularly

for children with mild disabilities, and I\'d also

like to indicate for the record that tolerance is

not the same thing as addiction, for example, or

withdrawal, and tolerance is not really a word

that\'s typically used in conjunction with

medications like methylphenidate for example.

REPRESENTATIVE WINKLER: I couldn\'t

hear you.

DR. FLETCHER: I said I do not believe

that tolerance is the same thing as indicated

dependence on a drug or that a drug like

methylphenidate, for example, specifically

associated with the significant development of

tolerance that changes in doses, for example, were

more related to growth in the child as opposed to

tolerance per se.

REPRESENTATIVE WINKLER: I would agree

with that.

DR. FLETCHER: Thank you.

Dr. Grasmick.

DR. GRASMICK: Thank you,

Representative Winkler. I\'d like to ask you how

teachers responded to your legislation,

psychotropic drugs.

REPRESENTATIVE WINKLER: There was a

very mixed feeling. Some teachers felt this was

not needed because it was not happening. Others

were very responsive and supported the legislation.

I received calls from my own district, from the

special education director, who commented that he

was very pleased to see the legislation going

forward. He said that he had told all of his 80

something special ed teachers never to make the

recommendation that a child be placed on

medication; that it was not under their purview.

It was well received.

However, he said that he mentioned to

me that in many instances he saw other teachers in

the school district, including guidance counselors,

make the recommendation and tell the parents that

their child needed to be placed on medication.

DR. FLETCHER: Commissioner Wright?

DR. WRIGHT: Thank you, Mr. Chairman.

Since we\'re horribly over time, I will not take the

time, I will just go with his five questions and

whatever else you can say that you have here and I

will not take the time to question you. Thank you.

DR. FLETCHER: We have fifteen minutes

for this particular witness, if you have some

questions. Are there any other questions for

Commissioner Winkler?

Thank you very much. We\'re next going

to open our public comment period, but we\'ll take a

fifteen‑minute break before we start that. We\'re

in recess.

(Brief recess.)

DR. FLETCHER: We\'re going to start

precisely at 4 so we\'re going to start to ask

everybody to start moving back. We\'re hoping our

public commenters have been given a number, because

we are going to go in the order in which you signed

up. We\'re about to start precisely at 4. Let the

chair note that the record is open for offers of

additional information from Dr. Webby that

Commissioner Takemoto requested. What was that

information, please?

COMMISSIONER TAKEMOTO: It was

related to the IBM regulations, recommended

practices, and I asked him if he would‑‑he wanted

the opportunity to respond more in detail to what

recommended practices were vis‑a‑vis the

regulations.

DR. FLETCHER: Thank you.

Dr. Pasternack?

DR. PASTERNACK: I just for the

record, Mr. Chairman, wanted to thank you for the

stellar way in which you conducted this hearing

today and I\'m just continually amazed at how much

you know and your actions and I wanted to state

that publicly. I also wanted to thank the people

who were kind enough to wait in the warm room here.

Shows their passion for these issues and we look

forward to hearing their insightful comments.

DR. FLETCHER: Thank you very much,

Dr. Pasternack, for the kind comments. I am

especially grateful to our troops who have endured

the increasing heat waiting to hear from the

public.

We\'re going to start and as I said

before, we\'re going to go right down the order in

which you signed up. We\'re going to ask our

potential speakers that are lined up on the side.

We already have our first four speakers. I want to

ask that you talk with the microphone and please

remember that you have three minutes to speak.

We have a timer right in front of us, I

believe that\'s a green dress that\'s she\'s wearing.

She has a timer that will go \"beep‑beep‑beep.\" She

will also hold up warning signs so you may want to

look at her periodically and we will be as strict

as we can about the three minute limit.

I will apologize in advance for

butchering people\'s names, but I come from a long

tradition of chair types who cannot pronounce

people\'s names. The first speaker I\'m told by

Dr. Pasternack is Tom DePaola. Welcome.

MR. DiPAOLA: Good afternoon. I want

to thank the Commission for this opportunity to

both comment on, suggest some strategies for the

improvement of special education in this country

this afternoon.

My name is Tom DiPaola, I\'m the State

Director of Special Education from the State of

Rhode Island. I\'m also the parent of three

children, two biological children and a foster son

and I\'m also a lifelong Yankees fan. So in

addition to being here this afternoon, I\'m hoping

to get to the Bronx this evening to watch the

Yankees play the Baltimore Orioles.

DR. FLETCHER: Be careful on the

subway.

MR. DiPAOLA: I\'m here this afternoon

representing my colleagues, we represent a loosely

knit consortium of twelve small states roughly

defined as having populations of under 1.3 million

people. I\'ve provided copies of a more detailed

summary. I\'m basically just going to highlight a

couple of the points that we think were important

in the consideration for improving special

education as we move forward with a reauthorization

of the IDEA.

Basically what we\'d like to do is

convey the message that for the small state we

actually operate as fairly large school districts,

so the two points we wanted to emphasize have to do

with funding and professional development. The

area of funding certainly we were in favor of the

proposals to have the full 40 percent of excess

cost funding reinstated or to be instated. But

short of that is we were hoping for some language

that would allow us to have sufficient funds at the

state level to be able to administer the programs

and to provide technical assistance to the

District.

Frankly, where we are in Rhode Island

with that is, because our percentage of holdback

money is so small at this point, it\'s likely to

have been cut for the past few years, so statewide

initiatives really aren\'t having the effect of

programs that could serve children in the state,

we\'re really not able to do successfully.

Relative to professional development,

our hope is to have a little bit more linkage

between professional development dollars to our

state improvement activities. When we identify

programs of services that need improvement in the

state, we need to have a little more authority.

Frankly, what happens at this point is the

institutions of higher ed are able to apply for

professional development funds. They may or may

not match up with our needs at the state level and

frankly we would like to have a little more control

over how those dollars are spent.

I appreciate the opportunity. Thank

you very much. Thank you.

DR. FLETCHER: Next speaker is Ron

Benner followed by Rosa Hagin.

MR. BENNER: Hi, I\'m Ron Benner, school

psychologist from Seymour, Connecticut.

We must change our current deficit

model to one of proactive intervention. We must

not wait until the student is failing to bring in a

model that may or may not work. We need to base

all our programs on data, research‑based, field

tested interventions with positive outcomes.

Now, particulars. Full funding of

IDEA. I recommend that we fully fund IDEA. For

now, let\'s fully fund only those areas of IDEA

where there is no controversy. This will start the

flow of funding dollars now.

Early intervention: We need to move

intervention timeline down till reading skills are

mastered by the end of the third grade. We need to

go below phenomic awareness to do a speech and

language evaluation. Without language, reading

does not happen. We need to use curriculum‑based

measures to adequately sample student\'s progress

based on this evidence, interventions could be

implemented.

We need the uncategorized label in all

states to the eight year old level. Identification

of eligibility consistency: We need to develop

criteria that will identify and service similar

students, no matter where they live. An LD student

in one town should be the same as an LD student in

another town.

Paperwork: I would suggest that the

government give us the individual education

programs forms they want filled out, make it

uniform across all states. Make the states have

their own forms for the information that they want

correct.

Discipline: If a behavior impacts the

education of a student, then there should be a

program to correct the problem. First, we need to

respond early to these behavioral needs so that

they have a better chance of positive outcomes.

Next, we need to offer continuum of services.

These should have multiple steps to allow movement

to and from the most restricted programs.

We need to provide funding formula that

does not penalize school districts by making them

wait until the end of the school year to receive

reimbursement. We need to hire administrators that

show skill at working with and changing the

behavior of these students. We need to train our

administrators to better handle these students. We

need programs that change the negative behaviors to

positive ones and not just look for programs to

lock away students.

Every student deserves education. We

must have mental health providers, school

psychologists, counselors and social workers in

every school.

Disproportionality: We need early

intervention with programs that are

researched‑based and field tested. We need to

start with birth to three, upping the services, and

our schools need to follow that service.

Lastly, I would like the Commission to

put out a draft report so the public can comment on

it before the final is published.

Thank you very much.

DR. FLETCHER: Thank you. Rosa Hagin

followed by Lynne Thies.

DR. HAGIN: In view of the time limits,

I will read.

My name is Rosa Hagin. I am a licensed

psychologist and a diplomate of the American Board

of Professional Psychology. I have worked in

public schools for ten years as school psychologist

and director of special services in inner city

schools in New Jersey, and for twelve years in

projects in prevention and remediation of learning

disabilities sponsored by the Learning Disorders

Unit of New York University School of Medicine in

schools in lower Manhattan.

This is a personal statement on

assessment issues, but it also reflects the beliefs

and policies of the 50,000 parents and

professionals of the Learning Disabilities

Association of America.

DR. FLETCHER: Could you speak into the

mike, please?

DR. HAGIN: Of the Learning

Disabilities Association of America, of which I

have been an active member since the very beginning

of its work.

In the interests of time, this is a

brief summary statement, a more detailed written

statement has been prepared for the consideration

of the committee.

I am concerned that the Commission,

disappointed that the promises of the 1975

legislation have not been fully realized, will turn

to new and untried approaches and ignore the

lessons learned in the 27 years since the laws have

been enacted. I would therefore draw attention to

what has been learned about learning disabilities

and show you hoe this knowledge can shape future

decisions.

One, learning disability is a

heterogeneous, lifelong condition that may manifest

itself in many aspects of language, literacy and

mathematics learning. The nature of these

manifestations depends on the unique individual

patterns determined by the age of the individual

and his or her strengths and needs.

Two, assessment must, therefore, be

broad based. No single diagnostic procedure can be

expected to identify all individuals who need help.

Comprehensive, multidisciplinary, clinical methods

have the value of telling us not only that a

student is failing, but also the causes of the

failure. It follows that no single instructional

procedure can be expected to serve all individuals

equally well. Comprehensive multidisciplinary

diagnosis can target structural methods, content

and have the greatest opportunity for success. A

one size fits all method will not suffice.

Learning disability is a hopeful

condition when appropriate educational and clinical

services are provided. Thank you.

DR. FLETCHER: Thank you, Dr. Hagin.

Lynn Thies, followed by Patricia Weathers.

DR. THIES: Hi. Thank you for the

opportunity to speak. I\'m here representing the

New York Association of School Psychologists, of

which I\'m the immediate past president. I\'m also a

member of the Government and Professional Relations

Committee of the National Association of School

Psychologists, but my comments are my own, but I\'m

here representing all of them, although these are

my unique comments.

My background is that I started off as

a special ed teacher working with learning disabled

children in the 1970\'s. Then I was trained as a

school psychologist. I\'ve been working as a school

psychologist for the past 22 years on Long Island,

a suburban community. I\'m also a part‑time trainer

of school psychologists at St. John\'s University,

so I\'m involved at both the practitioner and

trainer level.

I prepared my comments prior to today\'s

hearing, so I\'m talking about some things that were

addressed already, so I\'ll read what I wrote so you

can look at it as I prepared it beforehand.

Recently I heard Dr. Robert Pasternack

speak at the National Association of School

Psychologists annual convention in Chicago. He

described the future of special education as one

where all children would be taught with research

validated approaches and that failure to show

adequate progress after using such approaches would

be one the criterias for referral to special

education.

This implies that school personnel will

be familiar with the best practice literature on

strategies for teaching reading, writing and

mathematics. Unfortunately, my experience is and

those of my colleagues have indicated that

instruction is often based on the trends in the

local education community, rather than on

research‑based methods. Although we currently know

definitively which skills are necessary for success

in early reading, many of us have limited control

over decisions that are made by school districts

regarding curriculum choices. As one possible

remedy for this dilemma, I would like to discuss a

role function, two views that school psychologists

hold in our school; that of facilitator of database

decision making.

In our role as evaluators of students

with behavioral and learning difficulties students

we have been trained to use data from a variety of

situations and to rely on the most valid and

accessible instruments. This approach should be

taken when making decisions about instruction and

curriculum as well. School psychologists can

provide a valuable service for students in their

schools by using these research‑based decision

making skills to guide early screening and early

intervention programs and to evaluate the

effectiveness of such approaches in order to make

adaptations as necessary.

This focus will help us to reach

students whose weaknesses can be remediated prior

to referral for special education services and to

insure that the instructional practices are

accomplishing what they are supposed to accomplish.

And then I wrote a little bit about

programs in other states and I\'m not going to talk

about and then basically, I wanted to say that we

would like as school psychologists to work with the

Commission in making this paradigm shift from a

disability focus to a focus on teaching all

children with quality instructional approaches.

Thank you.

DR. FLETCHER: Thank you. Next is

Patricia Weathers, followed by Lisa Hyman than by

Sarah Sander.

MS. WEATHERS: My name is Patricia

Weathers. I am a mother from New York. I have a

considerable concern regarding the outcome of these

hearings. My son is profiled for ADHD, which led

to a classification of learning disabled. In 1997,

my son\'s first grade teacher filled out an ADHD

checklist and sent it to his pediatrician. This

checklist, along with a fifteen minute evaluation

by the pediatrician, led to my son being diagnosed

with ADHD and put on Ritalin. After a while my son

started to exhibit serious side effects from the

drugs. He was not socializing, became withdrawn

and began chewing on different objects. His

behavior became more bizarre. Instead of

recognizing the side effect of these drugs, the

school claimed he had a social anxiety disorder and

immediately produced the name of a psychiatrist.

Within another fifteen minute evaluation he was

diagnosed with social anxiety disorder and

prescribed yet another drug.

The drug cocktail caused even more side

effects, making his behavior even more out of

character. I could no longer recognize my on son.

Fearing what these drugs had done to him, I stopped

them. Once the school found out I was no longer

giving my son these drugs, amazingly enough, they

went as far as throwing him out of school and

calling Child Protective Services on me, charging

me with medical neglect, a charge that was ladder

ruled unfounded. Surprisingly, I found that many

parents have undergone similar coercion and

pressure to label and drug their children, which is

why I began publicly speaking out about this issue.

To date, my story has been featured in

The New York Times, Time Magazine, Good Morning

America and CBS Evening News, among many others.

Parents are coming forward from across

the country with similar stories and states across

the U.S. have begun implementing laws to curb the

pressure and coercion that parents received from

school personnel to label and drug their children.

The fact that states need to implement laws to

counter the federal law known as IDEA should be a

clear message to Congress. Today my son is being

home schooled and is doing well both academically

and emotionally. He is drug free. He never should

have been categorized as special education, all he

needed was standard academics and an intensive

phonics based reading program.

I wish to address several key points

that I strongly urge this Commission to consider

when making their final assessment. Parents are

never given an accurate portrayal of the

controversy ranging around ADHD. Parents are never

told that no legitimate tests exists to

scientifically prove that their child suffers from

it. Parents are never told that their school gets

additional funding for every child labeled with

this disorder and medicated. Parents are never

told that their child will be ineligible to serve

in the Armed Forces.

Unfortunately, all these points

eventually work their way into the realm of special

education. I am asking this Task Force to prevent

other American families from having to endure my

dilemma. They can do this by taking out school

district incentives to mix so‑called behavioral

disorders with true physical, provable organic

medical handicaps.

Please don\'t let other parents go

through what my family went through. Thank you for

hearing my story.

DR. FLETCHER: Thank you,

Miss Weathers. Next we have Elisa Hyman, followed

by Sarah Sander and by Cassandra, whose last name I

can\'t read.

MS. HYMAN: Hi, good afternoon, I\'m

Elisa Hyman, and I\'m the Deputy Director of

Advocates for Children, which is a parent training

information center in New York City. Advocates for

Children has thirty years of experience assisting

parents of public school children to attain quality

appropriate education services. We\'ve been a PTI

program for more than fifteen years. We focus on

supporting parents of children with disabilities

who face the greatest barriers for receiving

services, including those of poverty, race, limited

English fluency or involvement in the juvenile

justice system.

I have prepared some comments today

that I frankly abandoned in light of the testimony

and I\'m thinking of submitting more extensive

written comments at a later date. I realize the

Commission is under time pressure. I\'ll do my best

to get them to you quickly. Instead, I\'d like to

respond to what appear to be some key questions to

the Commission today and I\'m going to make those

responses very brief and broad.

Particularly Dr. Pasternack focused on

why aren\'t kids achieving and why is there

overrepresentation and stigmatization for many kids

in the school system. My overall response is very

simple. I think we need to insure that the law as

designed is actually in force and adequately

funded. In New York City, for example, there\'s

tremendous need for cultural competency in the

school system. There\'s also a need to support

teachers and administrators to manage behavior, not

only to use exclusion as a method to address

children with behavior problems. Certainly, I

think we need to insure that quality educational

and other kinds of evaluations are provided that

actually can give recommendations for instructional

methodologies.

Finally, perhaps most importantly, we

need to guarantee the promise of IDEA by enforcing

laws to ensure that districts used research‑based,

empirically valid state of the art practices in

teaching and behavior management and focus on

positive outcomes.

Finally, I\'d like to just, I know we

didn\'t talk about cessation of services for kids

who are suspended today, but I\'d really like to

stress that the Commission take a very hard look at

this issue, particularly in New York City there

were 50,000 suspensions last year. Half of the

long‑term suspensions, which means suspensions over

five days, were of kids with disabilities. Almost

70 percent of those suspensions were of African

American students. 98 percent of kids who are

getting alternative education services, which means

they basically get no instruction for almost a

year, are minority students, and I really don\'t

think that, leaving aside the issue of disability

discrimination from the juvenile justice prevention

perspective and looking at the disproportionate

impact on minorities, student cessation should even

be considered.

There\'s nothing worse than having at

risk students out of school for months

unsupervised.

I\'d like to conclude that I\'m sure the

Commission has a very hard job in front of them,

and I\'m sure they\'ll do the right thing. Thank

you.

DR. FLETCHER: Thank you. Next is

Sarah Sander, followed by Cassandra and then by

Ellen McHugh.

MS. SANDER: Hello, my name is Sarah

Sander. I am the mother of four children,

including the second one, Moishey, who has Downs

syndrome. I am also the founder and editor of a

magazine entitled \"Downs Syndrome Amongst Us,\" the

first of its kind within the Orthodox Jewish

Community.

Life with Moishey is truly wonderful

and he makes our family complete. We would never

wish to forego the experience of raising such a

wonderful child who lends so much joy to our

immediate and extended family. However, for years

we have been plagued with one area of distress;

Moishey\'s education. As an Orthodox Jewish boy

attending public school, Moishey was becoming a

stranger amongst his own people. His ignorance of

his rich heritage, culture and religion created a

gap between him and his family and community, a gap

that widened with each passing year.

Thank God my husband and I were

inspired enough to do something about it, and this

past September, 2001, we opened our very own

Yeshiva program, at tremendous personal cost and

sacrifice. A beautiful and large mainstream

Yeshiva in Brooklyn opened its arms and heart to us

and we are now a part of their Yeshiva. We hired a

professional staff of teachers and assistants,

recreation therapists, et cetera, who live, eat and

breathe with just the students on their minds. Our

children are mainstreamed for appropriate

activities daily. They eat lunch in a mainstream

cafeteria and have already established some very

close friendships with the quote normal students.

What shall I tell you? Our boys are

shining. They have finally come home. They now

receive Hebrew as well as secular instruction.

However, we are now paying thousands of dollars in

tuition to fund our son\'s Yeshiva education.

Already we are cutting out some very much needed

family projects that are deeply affecting our other

children.

We implore the distinguished

Commissioners to please take into account that our

son and his friends were in the public school,

where they cost the system hundreds of thousands of

dollars over the years. We opted to leave the

public school system because we couldn\'t bear it

that Moishey was not receiving a religious

education, which was so vital for him as an

integral family and community member.

We now ask that those thousands of

dollars be transferred towards his Yeshiva

education, thereby not generating new expenses for

our Government, just reallocating old ones to more

desired programs.

On September 11th our boys watched in

horror from the roof of their Yeshiva building as

the Twin Towers crumbled to the ground and like

Yeshiva students all across the United States, they

went into their classrooms and prayed. They prayed

for their country, their President and for all the

victims and heroes of that fateful day. This was

the first week ever that our boys were able to pray

at school.

My plea to the President\'s Commission

is as follows: Please take into consideration the

option of allowing us concerned parents to choose

the schools that we deem as best suited for our

special needs children and please, by all means,

help us fund our children\'s education.

I understand that parental choice is

becoming an ever more recognized alternative path

in American education, specifically in special

education.

DR. FLETCHER: Ms. Sander, please

finish. Thank you.

MS. SANDER: Thank you very much.

DR. FLETCHER: Next we have Cassandra,

I\'m sorry, I can\'t read your last name, so I\'ll ask

you to say your name for the record, please.

Followed by Ellen McHugh, and then Eytan Kobre, I

believe.

MS. ARCHEE: My name is Cassandra

Archee, and I am the Parent Information Center

project director.

DR. FLETCHER: Could you speak into the

microphone, please?

MS. ARCHEE: Yes. That\'s better? I\'m

Cassandra Archee, project director for the Advocacy

Center, Rochester New York.

I would like to immediately acknowledge

that all of the New York State PTI\'s are here in

the room with the CPRC, so we join our colleague,

the Commissioner, on this very important topic

here.

I\'m going to spend a minute and a half

on two halves. The first half will be that of the

PTIC director. When we look at the issues around

the reauthorization of Part D, we are very

concerned and involved about it being fully funded,

because the PT\'s are funded like every other IDEA.

We know it expires September, 2002.

The next piece I will talk about is my

parent role. I plan to bring into the room the

voice of an African American male, my son, to this

process of special education. I think\'s real

important that as we talk about overidentification

that we understand sometimes the cycles that exist

for African American males and I want to leave you

with his experience in the special education

process.

When he was very young in elementary

school, we had some testing done, they showed that

he needed some support in his performance and his

ability. And understanding that he needed those

supports, we were very concerned about how to get

those special education services became an option.

We knew that as an African American male he went to

school already needing to show up believing that he

could achieve and convincing staff that he could do

that, and when special education services were

considered for him, we said yes. He said no. He

vitally opposed being a part of the special

education services because of the label and the

stigma that was attached to it. We said yes.

He continued in the special education

process and his behavior became an issue. He was

saying no. We were saying yes. And as we said

yes, retention became the next step as he continued

in the process of special education. He said no

and finally we said no. We said no to special

education.

Today, he is a second year student at

the University of Central Florida in Orlando.

Thank you.

DR. FLETCHER: Thank you, Miss Archee.

Next we have Ellen McHugh, followed by

Eytan Kobree.

MS. McHUGH: Good afternoon, welcome to

the hottest day on record in New York City so far.

DR. FLETCHER: Speak in the mike.

MS. McHUGH: My name is Ellen McHugh.

I am the parent of an individual who has a

disability. He is deaf. I was not planning on

making a comment until the Chancellor spoke this

morning and I would like to make some

clarification.

This is still a system that blames

parents. The Chancellor blamed the parent forced

to exercise his or her due process rights. If you

look at numbers that currently exist in New York

City of 125,000 odd students receiving special

education services and the number of people who are

forced to go to impartial hearings, 1,240, you\'re

looking at 1 percent of a population that is forced

into a due process confrontational right.

Obviously, there are some positives.

In addition to this, the system evaluators often

characterize the parents and particularly the

mother as in denial and unable to accept the

child\'s limitation. The worst phrase that people

can hear in a school building is \"here comes the

mother\" or said in Brooklyn as \"here comes the

mudder.\"

Administrative staff grows separated

from students and the teaching staff and one of the

issues becomes how is a teacher supported. I don\'t

know any teacher that gets up in the morning and

says I would like to do damage to any child, nor do

I know any parent who gets up in the morning and

says, I want you to be dumb or poorly educated

which was shocking when the Chancellor seemed to

accept responsibility for a system that is

consistently failing and offering that consistently

failing baseline to those individuals who are

presently disabled.

Even though I might be temporarily

disabled, I had a knee operation, I am in more

sympathy than I have ever been with those

individuals who have to navigate systems.

In conclusion, I would like to say that

I fully support 40 percent funding, that I do urge

you to draft a report that can be commented on by

the public, and I do ask you to have, which may not

be one of the better parts of life, an information

session for parents only. I know we rant and rave,

and I know we can be difficult to deal with and

sometimes illogical and loud, but we also need to

have a voice that is not present here today because

of the formality of the meeting, and I would ask

that you could use the website that you created as

an interactive tool so that we can make comments

through that methodology.

I will be writing something now that

I\'m indignant. I have to tell you that I do

suffer from long standing self righteous

indignation, but I still have a child who succeeded

in a system that did not allow for participation,

but did allow for me to passively pass through,

should I have chosen to do that. Thanks.

DR. FLETCHER: Thank you, Ms. McHugh.

Next is Eytan Kobree, followed by

Brenda Townsend and then Leslie Jackson.

MR. KOBRE: Good afternoon. Thank you

for the opportunity to share my views with you

today, and for bringing the warm weather with me

from Miami.

I\'m Eytan Kobree, I\'m associate general

counsel for education at Agudath Israel of America,

a National Orthodox Jewish organization, which

among other functions, advocates for the interests

of students and families in Jewish religious

schools across the country, including more than

100,000 students right here in New York State.

Today\'s hearing is devoted to issues of

assessments and identification and I\'d like to make

some brief remarks in that regard.

IDEA\'s current funding formula, based

as it is on a ratio of public to nonpublic school

students within a population of students identified

as disabled, creates the financial disincentive for

districts to identify the disabilities of nonpublic

school students. This problem is not theoretical

but actually practical. To illustrate, we at

Agudath Israel are now conducting a detailed survey

on special education and the implementation of IDEA

in the hundreds of Jewish elementary and secondary

schools nationwide. The responses have just begun

to come in and when they\'ve all been tabulated, we

look forward to sharing them with the Commission

and Assistant Secretary Pasternack.

Judging from early returns in this

survey, however, one would never know that Child

Find and consultation regarding services are

unequivocal legal mandates upon LEAs. Almost three

quarters of respondents so far have never even

heard of Child Find and over half of them were

never even consulted by the District regarding how

best to provide the services that students are

entitled to by law.

These responses confirm oral reports

we\'ve received from around the country of

district\'s delaying or even refusing to evaluate

students referred to them, of district evaluators

consistently finding no disabilities present,

contrary to other professional opinion, and of

districts refusing to provide services arbitrarily

and based on capricious legal grounds.

We have the following recommendations.

One, base IDEA funding on the ratio of

total non‑public school students to public school

students, since the incidence of disability is

likely the same for both groups.

Two, strengthen the accountability of

LEA\'s to the Federal Government, including

requiring them to demonstrate compliance with their

obligations to non‑public school students as a

condition for receiving federal funding.

Three, provide early intervention

services to nonpublic school students, which will

catch and address problems before they become

learning disabilities, thereby saving the

government more money they already save due to

these students enrolling in nonpublic schools.

In closing, I note that earlier today

there was a discussion of the vexing lapses of the

special ed programs vis‑a‑vis minorities. Those

problems can and should be addressed.

There is, though, another minority that

needs to be addressed, and I refer to the 6 million

plus nonpublic school students in the U.S. today.

They deserve access to the full range of services

in the school as much as any other child, and we

trust President Bush will insure that they, too,

are not left behind.

Thank you for listening.

DR. FLETCHER: Thank you, Mr. Kobre.

Next is Miss Townsend, followed by Leslie Jackson

and Donald Lash.

MS. TOWNSEND: Good afternoon. I thank

you for the opportunity to address the Commission.

My name is Brenda Townsend. I\'m an associate

professor at the University of South Florida in

Tampa and I also address several projects which are

recruiting and preparing African American males for

urban special education teaching careers and a year

ago I started a center at the University of South

Florida, which is called CAESL Center, Center for

Action and Effective School Leadership.

I want to extend the conversation that

was begun this morning when Dr. Pasternack asked

the very timely question of over‑representation of

African Americans in particular, and he asked about

the possible causes, and when you said that, I

immediately thought, I reflected all the way back

to my childhood and a conversation with my

grandmother and I can remember breaking what I

thought was just an old plate of hers and it

happened to be a cherished piece of China and when

she asked me about it, I said I didn\'t know how it

got broken. Well, her admonishment to me was that

I cannot go through life throwing rocks and hiding

my hand.

So as I think about the

overrepresentation as a teacher educator, I want to

today reveal my hand in the role of

overrepresentation.

I think we at the universities have

much to do with overrepresentation.

I want to give a recommendation that

has pretty much been alluded to, but I really want

to underscore it this afternoon, that of teacher

quality. Now, any documents that we read lately,

the No Child Left Behind document and others, the

NRC report that was just released about

overrepresentation, all talk about the poor teacher

quality that minority children and impoverished

children in particular are subjected to. However,

the NRC report does not give that prominence.

Instead it gives factors such as tobacco usage and

lead poisoning and so forth. So I really want to

underscore the cultural competence piece.

I mean, we know the Reverend this

morning asked the question about teacher

expectations and we can remember, those of us that

are fairly young, I can remember the \'70s, those

studies on self fulfilling prophecy and the

Pigmalion effect, where they gave out locker

numbers to teachers and teachers were told those

were IQ scores and those teachers then in effect,

their interactions with those students pretty much

played out those low expectations.

So I want to say that the differences

in urban and suburban classrooms in teacher quality

are, teachers in inner city and urban classrooms

tend to not be prepared, both in the technology of

teaching or in culturally responsive pedagogy. In

suburban classrooms, I submit they, too, are ill

prepared to respond to their learner.

So I say we as teacher educators, if we

need to take the onus, then we need to insure that

no teacher is left behind.

Thank you very much.

DR. FLETCHER: Thank you. Next is

Leslie Jackson, followed by Donald Lash.

MS. JACKSON: Good afternoon. I\'m

Leslie Jackson, I\'m with the American Occupational

Therapy Association. I also co‑chair the Education

Task Force of a national Washington, D.C. based

coalition, the Consortium for Citizens with

Disabilities and I just want to say to the

Commission, thank you all for hanging in with this

heat and the, all the things that have been going

on, so we appreciate your focus and attention as

well.

I actually want to make several points

in response to discussions that I heard this

morning. I\'m not speaking on behalf of my

association or CCD with this. I\'m speaking from

personal experience, as a person of color, as an

educator of color and as a parent of children of

color who are in public schools.

They do not have disabilities, but we

have to deal with the same issues that all parents

have to deal with in public schools. And one has

to do with the assumption that I think we need to

be very careful about making when we talk about

cultural competence. We need to be very clear

about what we mean by cultural competence.

Cultural competence does not mean necessarily

having someone who is of the same racial and ethnic

and diversity and linguistic background, because we

all know that that is no guarantee that persons who

look like me are necessarily going to be as

effective in teaching my children. So we need to

be clear what we mean by cultural competence.

We need to be clear that individuals

are socialized into particular disciplines. I\'m an

occupational therapist by training, I was trained

to think like an occupational therapist, but I

bring a whole lot of other things to that. So when

we talk about teachers and low expectations or no

expectations, whatever language we put to that, be

mindful of the fact that they were trained to

think, teacher trainers just talked about in the

teacher preparation program, they bring to that

their own personal values and beliefs about how

children learn, what parents are like, how parents

should be involved in schools, and so we\'re talking

and thinking about that, we need to be aware of

those kinds of issues.

I also have to say that when we\'re

talking about the use of effective practices, it\'s

not enough to think about disseminating information

down. We also need to be thinking about why

professionals may or may not adopt those practices

and there\'s lots of reasons for doing that or not

doing that. So it\'s not enough to say we\'re doing

research or not doing research.

You also need to make sure we help

folks adopt those practices and then give them the

supports to use those practices and then my

advocates hat on I have a question, and that is how

the Commission beyond these meetings what is the

deliberative process going to be for the

Commission, how are you going to come to agreement

about your recommendation and decide what you\'re

going to recommend and not recommend and how

involved is the public going to be in that process.

And with that, I thank you again for

your attention and this opportunity.

DR. FLETCHER: Thank you very much.

Next is Donald Lash followed by Barry Barbarach and

Dee Alpert.

MR. LASH: Good afternoon. My name is

Donald Lash. I\'m the executive director of

Sinergia, a nonprofit agency which, among other

things, operates the Metropolitan Parent Center

with state and federal support and the Long Island

Parent Center with state support. In 2000, we

completed a report based on an overrepresentation,

based on an analysis of three years of data,

corrected plans from seven districts that developed

directed plans and a series of community‑based

forums for parents teachers and community‑based

organizations.

I don\'t have a prepared statement, but

a copy of the report was submitted to the

Commission.

I just want to highlight a couple of

conclusions briefly from our experience of the

report. Because of the size of New York City and

the diversity of the population, it really isn\'t

one pattern and one trend. There are multiple

patterns and multiple trends because every district

has a different population, has different dynamics,

and I think it\'s appropriate that the burden of

defending corrective strategies for

overrepresentation be at a district level, be at a

small enough level that it\'s meaningful to the

population and the district.

I also wanted to say that measures of

disproportionality have to be varied enough to

encompass different aspects of the issue. If we

only speak about referral we\'re ignoring placement

and disproportionality is very relevant to

placement outcomes. Also integration, it\'s

important that corrective strategies addressed to

overrepresentation be integrated with other

education reforms, other activities within the

district.

Some New York City school districts

have a plan to address the implementation of the

new curriculum, the revision of the special ed

system. They have another plan to address

disproportionality and the two haven\'t been

coordinated and some personnel may not be aware of

both plans existing. There really is a close

connection.

Finally, I just as a suggestion for an

area for legislation, I see this as analogous to

the area of limited English proficient students and

the obligation of the district to develop a plan.

There are guidelines, it\'s going to be

individualized, to meet the needs of the district

and three brief suggestions to get to the end. A

corrective plan should demonstrate knowledge of

patterns and trends within the districts, there

should be a hypothesis about why patterns exist

within a district and there should be a rationale

for strategies that\'s identified and enacted on the

strategy and hypothesis.

Thank you.

DR. FLETCHER: Thank you, Mr. Lash.

Next is Barry Barbarasch, followed by

Dee Alpert and Rick Ostrander.

MR. BARBARASCH: Good afternoon. My

name is Barry Barbarasch. First, I\'d like to thank

the Chairman for pronouncing my last name

correctly.

DR. FLETCHER: Give credit where credit

is due.

MR. BARBARASCH: I\'m a school

psychologist from Harrison Township in New Jersey,

also a member of the Government and Professional

Relations Committee of the National Association of

School Psychologist and past president of the New

Jersey Association of School Psychologists.

Today we\'ve heard several references to

the role school psychologist played in the area of

identification and assessment, but I would like to

talk a little bit about the role school

psychologists play in the delivery of mental health

services in the schools.

Today there is an increased concern for

maintaining a safe and secure school environment.

School psychologists are uniquely positioned to

provide an array of mental health services to

address these concerns. The school psychologists

are trained to not only respond when a crisis

occurs, but also to recognize those characteristics

of students in the school environment which may be

a forerunner of a crisis.

School psychologists provide other

types of mental health services as well.

Individual counseling, including management,

conflict resolution and social skills training,

assist students in maintaining appropriate school

behavior as well as developing positive

relationships with peers and school staff. Of

equal importance are programs which prevent mental

health difficulties and school psychologists have

training and expertise in these services as well.

The provision that these services offer

other benefits to school districts; frequently

children, particularly those with behavioral and

emotional difficulties, are placed in out of

district school settings at considerable expense,

partly due to the greater availability of mental

health services in these settings. Given similar

availability of these services through district

school psychologists, many of these students could

be educated in school‑based programs, thereby

saving school districts the considerable resources

associated with these out of district programs.

In addition, with all students having

access to an array of mental health services,

including those programs which focus on prevention,

school districts may find they can greatly reduce

their reliance on self‑contained special education

programs, which is a frequent placement for

children with behavioral and emotional difficulties

and make greater use of lesser restricted programs

such as the use of supplementary interservices.

School psychologists also are in a

position to be involved with the training of

teachers in the area of classroom and behavior

management. They\'re knowledgeable in the use of

positive behavioral supports and can train teachers

to use these supports in the classroom for children

who exhibit behavioral difficulties.

School psychologists play a role in

providing student mental health services. They

provide an array of mental health services for

children\'s schools, school personnel and families,

which can be critical in maximizing achievement and

maintaining a safe school environment. Thank you

very much.

DR. FLETCHER: Next Dee Alpert,

followed by Rick Ostrander and Robert Silver.

MS. ALPERT: My name is Dee Alpert.

What I\'d like to do very briefly is just share some

information and sources of information that I think

the Commission doesn\'t have at this time and I

think that you need.

First of all, I have a request of

Dr. Pasternack. Previous to about three or four

weeks ago, the Board of Education\'s website had

school report cards for every school in the City

listing the standardized test scores and things of

that nature. Including for District 75, which is a

self‑contained district for children who are

moderately to severely disabled. The District 75

reports were removed when the state came up with

new data for this year.

Similarly, last year they removed the

district profile for District 75. Consequently,

parents of children who are disabled and who wish

to look at the data for schools and districts in

District 75 before they have their children placed

in it or before they continue having their children

placed in it no longer can get any objective

information whatsoever.

Both OSEP and State Ed have been

informed about this, as has Chancellor Levy.

Nevertheless, nobody will do anything about it and

I would like to point out that if you can\'t enforce

or if nobody is able to enforce the IDEA\'s data

requirements, data application requirements, then

I\'m not sure that there\'s a whole lot of hope for

it voicing anything else as the law stands now or

as it may be amended, so I\'d like to bring that to

your attention and point out that parents do need

that information.

Secondly, I\'ve given a few people

copies of the district 75 profile which was on the

Board\'s website, I printed it out, thank goodness,

before they removed it and I can put it in PDF form

and e‑mail it to everyone else. One of the reasons

they may want this data not to be available anymore

is because District 75 has the Board program so

that children who are autistic, and this states

that in April 2000, which is the period they were

measuring, 8 percent of the speech and language

services reflected on the IEPs of the children in

District 75 were actually delivered, which means

that 92 percent were not delivered.

I\'d like to point out that I cannot

imagine a program for children for autism, for

example, that only provides 8 percent of the

recommended speech and language services, and I

also should point out that I have reasons to

believe that they are medicated as per the IEPs not

as per the actual services delivered. I think

that\'s an area of legitimate inquiry, whether it be

fraud or whether children come in and don\'t go out.

Thirdly, the New York City Board of

Education has a special thing you should know

about. Office of Special Prosecutor New York City

Board of Education, telephone number is

212‑510‑1400. I\'m recommending that each of you or

jointly call that office, ask to sit with the staff

and discuss with them what I believe they will tell

you about the routine falsification of all kinds of

special education documentation on the individual,

group, school and program level. If you look at

the data, somebody looks at the data, I really

think you ought to understand the quality of what

you\'re looking at, particularly‑‑

DR. FLETCHER: Thank you, Ms. Albert.

MS. ALPERT: I will submit the rest of

this in writing, but they do have a number of

reports I think are particularly germane to the

issue of data quality. Thank you so much.

DR. FLETCHER: Rick Ostrander, followed

by Robert Silverberg and Diane Karvelas.

MR. OSTRANDER: My name is Rick

Ostrander. I\'m an assistant professor at

Georgetown Medical Center where I also serve as

chief of child psychology. I\'ve been a school

psychologist teacher, as a matter of fact as a

school psychologist I worked at Little Rock, not

too far away from some of your stomping grounds,

Dr. Pasternack.

I\'m also a parent of a child with a

disability. I just wanted to bring out a couple of

comments. I wasn\'t planning on speaking. But I

made a couple of notes, I think may bear your

consideration.

One is that I think that what we know

is probably a lot less than what we don\'t know, and

what I mean by that is if you look at the

interventions that were articulated throughout this

conference, we see a lot about interventions

related to identification interventions. Those are

pretty well established to be effective.

However, less is known about reading

comprehension, math, reading disabilities. The

studies available in those areas are really looking

at treatment versus nontreatment. Anyone who has

been a researcher knows you\'re very motivated to do

right by your data, make sure you do right by your

data. You want good treatment fidelity, treatment

sensitivity to the measures, you want to make sure

it works. So when you look at these research

findings, what you find is essentially that

treatment typically works better than no treatment,

but you have to be motivated to make it work and

that\'s what\'s lacking in our current educational

system.

There isn\'t the incentive, the same

incentives that researchers have in order to make

treatments work. And so one thing I would

encourage you to consider is there needs to be a

mechanism to make sure the incentives are there to

make treatments work effectively.

That can be done by two mechanisms.

One is the way it\'s currently done, which is to use

parents as a way of asserting a check and balance

system within the educational system. That is,

through due process hearings. And if you just

leave, if the means of identifying and

demonstrating special education placements purely

up to the schools, they may not do that. And we

see that in today\'s data, where you see the

generalizability of research findings to the

community is very poor.

The other way to do it, of course, is

to create incentives to make sure that the

outcomes, they must be concrete and that children

who achieve these outcomes or schools that achieve

these outcomes are rewarded in a concrete fashion

or demonstrating. Without that kind of incentive

approach, no matter what is tried will be diluted

within the school environment because they, A,

don\'t have the resources and, B, don\'t have the

incentive to change and many of us are

psychologists here, we remember that old joke about

how many psychologists it takes to change a

lightbulb. Just one, but the lightbulb really has

to want to change.

Okay. So let\'s hope that the schools

really want to change.

DR. FLETCHER: Thank you. Next is

Robert Silverberg, followed by Diane Karvelas and

James Wendorf. I\'m sorry, is Robert Silverberg

here? Calling Robert Silverberg.

Diane Karvelas, then James Wendorf and

then Tamika Williams Ortiz, if she\'s still here.

Thank you.

MS. KARVELAS: My name is Diane

Karvelas, I\'m a school psychologist with 22 years

of experience. I\'m a member of the New Jersey

National Association of School Psychologists. I

just want to briefly comment on my work experience,

as I feel it relates to the reauthorization of

IDEA.

I currently work in an upper middle

class school district in central New Jersey. A

majority of the parents in this district are well

educated professionals. The curriculum in this

district is quite challenging. There are high

district and parent expectations for academic

achievement. Teachers feel pressured to cover a

very comprehensive curriculum in a limited amount

of time. When students have difficulty, there is

little time for differentiation of instruction.

It\'s very limited.

There are some opportunities for

remediation for basic skills reading and math

programs. These programs have criteria, entrance

criteria based on test scores and ironically, what

I find is that at times a student may not meet the

criteria for basic skills program, but then they\'ll

be referred for special education classification.

This is due to the fact that this is seen as the

only way for students to get services or

accommodations. In fact, I feel that part of the

reason why there has been such an increase in ADD

diagnoses is this is a way to obtain special

education services for children who do not

otherwise qualify.

In fact, in my district many parents

seek special education classification on the basis

of ADHD diagnosis and they have gotten this on

their own. A reauthorization of IDEA needs to

address the dichotomy between regular and special

education. There needs to be more of a

collaborative approach in dealing with students

with learning and/or behavioral difficulties.

Reauthorization of IDEA needs to support

reinforcement in centralization. As a school

psychologist, I have been trained in the areas of

education, child development, behavior therapy,

cognitive assessment and consultation. I am able

to provide teacher and parent training, social

skills training and counseling services in the

schools. I collaborate with school staff to

develop strategies and programs for individual

students as well as school wide programs.

Finally, I would like to comment on the

earlier recommendation to eliminate IQ testing. I

agree that the sole purpose of a psychological

evaluation should not be to obtain an IQ score. I

also agree that the discrepancy model for

identification learning disabilities is not valid.

However, I do feel that it is possible to obtain

available information from many cognitive

assessment measures that directly relate to

instruction. Although writing psychological

reports can be time consuming, so can writing

increasingly lengthy IEPs. These seem to be

designed to meet the needs of state and federal

monitors rather than the needs of students,

families and educational staff.

Thank you.

DR. FLETCHER: Thank you very much.

James Wendorf? Is Tamika Williams Ortiz here?

Okay, thank you, you\'ll be next.

MR. WENDORF: Good afternoon, my name

is James Wendorf. I\'m the executive director for

of the National Center for Learning Disabilities

and I thank the Commission for the opportunity to

speak and be heard. Thank you very much.

NCLD is a nonprofit organization

founded in 1977 that promotes the widespread

implementation of research‑based practices while

also seeking to insure that students with learning

disabilities have access to those services. Our 25

year commitment to children with LD is based on the

guiding principle that federal policies should

reflect what research tells us, and from research

we know that learning disabilities are neurological

in origin, they affect some 5 percent of the

population based upon recent and long term studies,

they do not go away. They require early and

accurate identification and effective intervention

if students with LD are to succeed in school and in

life and we also know that up to 90 percent of

students with LD have primary problems in the area

of reading and hence, our own very special focus of

reading at the National Center for Learning

Disabilities.

Our primary goal in presenting

recommendations to this Commission is to improve

the unacceptably low academic outcomes that

students with LD currently achieve. They are

abysmal. If you look at dropout rates, if you look

at the low matriculation rate from high school into

higher education, these are areas that have to be

benchmarked, serious benchmarks that have to be

improved.

In that spirit, we urge Congress to

maintain access to a free and appropriate public

education in the least restrictive environment and

consider improvements to IDEA that are informed by

research and that focus on four areas:

One, improving early identification and

intervention programs. Two, improving

research‑based classroom instruction. Three,

increasing the numbers of qualified personnel for

students with disabilities, and four, strengthening

part D of IDEA to improve educational outcomes for

students with disabilities.

And for the purposes of oral comments,

I want to just focus on the first one, early

identification. The preamble to the 1997

amendments of IDEA encourages prereferral

intervention as an effective technique for assuring

that students with disabilities are provided

special ed services. There is also a wealth of

convergent gent research to suggest that any viable

conceptualization of intervention for students with

LD must encourage early identification before

school failure is experienced.

In kindergarten through 12th grade we

support the timely identification of students who

are thought to need special ed services and we

recommend a functional assessment in making

eligibility determinations. We support a model

that engages general and special ed educators in a

relationship working together with school

psychologists that employs curriculum based

measurement to pinpoint instructional needs and

measure a students\' responsiveness to education.

DR. FLETCHER: Thank you, Mr. Wendorf.

MR. WENDORF: Thank you and I\'ll submit

the rest of the comments for the record.

DR. FLETCHER: Our final public

commenter will be Tamika Ortiz. Thank you for

coming. Who is that with you?

MS. ORTIZ: This is my son Lorenzo. My

son was just recently evaluated on March 12th for

special education, so I\'m fairly new to what the

procedure is.

After the evaluation his classification

was emotional disturbance. Now they want to send

him to a SIE‑VII District 7 school here in New York

which I was told is the most restricted environment

that you can send a child to.

Upon visiting the school with my

husband, the school was gated, barred, the classes

were eight to twelve kids in a class with three

adults and I was told that was a fairly good day

and the children were running all about. Right now

I\'m standing to have an impartial hearing because

I\'m refusing to send my eight year old son to a

place where they were gated and there were numerous

high school children inside the building also.

I\'m just here today to say that there

needs to be a medium. My child is not violent.

He\'s only confrontational when someone is

approaching him and that\'s where the behavior

problem starts. He has above average IQ, his

reading level is low. He gets no extra help from

resource room because his reading level is low but

he\'s not classified as learning disabled, only

emotional disturbance, so the focus is on

counseling, which he gets outside counseling

therapy on his own. As a parent I take him to

another service.

Also, he\'s not, like I said, a violent

child and I run into parents where there needs to

be a medium where there can be children who have

high IQ but have emotional problems that is not

sent to a most restricted environment where they

can also develop their intellectual which they seem

to have.

I just want to hope that your

Commission would speak to whoever to decide there

needs to be a medium, instead of sending them to

somewhere where they\'re a gated community and send

them where they would have no help for their

intellect. Thank you.

DR. FLETCHER: Thank you very much for

your comments and thanks for bringing your child.

That concludes our public comment

section. We do have a little bit of time for

comment by the panel.

I\'d like to start by responding to the

question about what our deliberation process will

be. That was outlined in our Miami hearings by

Chairman Granstat and Mr. Jones. Essentially each

subcommittee will be responsible for preparing a

capsule report. These reports will be posted for

public comment prior to the Commission\'s next

public hearing.

The next hearing of the entire

Commission is at the end of May, at which point the

committee will continue the deliberation over the

next few weeks at that meeting and then

subsequently prepare the final report that will be

submitted to the President.

Did I leave anything out about the

process?

COMMISSIONER TAKEMOTO: Many of the

task forces are meeting, not only in these public

meetings but we\'re meeting via telephone and other

face to face to make sure, or to work very hard to

make sure that what it is that our task forces are

recommending are consistent with our testimony and

the people that have given us input. So your input

is very important to that process.

DR. FLETCHER: Does any other

Commission member have a comment they would like to

make.

COMMISSIONER RIVAS: Some people have

been coming up and asking about how soon we need to

have information and data submitted for our reports

and where to submit them to.

DR. FLETCHER: I would simply say that

you submit it as soon as you can, because the

committees are meeting and deliberating even as we

speak, but we\'ll certainly be accepting information

through the month of April and the submission is to

Mr. Jones, who is the director, the executive

director.

There\'s the website www.ed.gov ‑‑ I

don\'t think I can give you all this.

VOICE: It\'s actually outside.

DR. FLETCHER: Essentially, you submit

it to the executive director, Mr. Jones.

DR. PASTERNACK: There are copies of

the website address on the table outside where you

came in and please feel free to take them and send

e‑mail. Thank you.

DR. WRIGHT: A question.

DR. FLETCHER: Commissioner Wright.

DR. WRIGHT: One of my main concerns in

coming all the way here from Illinois is the

overrepresentation of minority children in certain

areas of special education, and I was glad to hear

some school psychologists speak to that and

particularly parents of American children.

I have a question, I did not get this

parent\'s name who said that her minority son is in

special or didn\'t get special or whatever, but he

is now at the University of Florida, and I wanted

to know how she extricated her child from special.

Does anybody here know how we can

extricate kids from special? Having been a teacher

of special. You know, it used to be and still is

that way. Once a child is labeled something and

put somewhere, sometimes it is very hard to get

them out of special. You get them there, never to

be heard from again, and I want to know from this

parent if she\'s still here whose child is now at

the University of Florida how did she accomplish

this. Is that parent still in the house?

MS. ARCHEE: I\'m still here.

DR. FLETCHER: Identify yourself again

for the record.

MS. ARCHEE: I\'m Cassandra Archee.

Yes, my son did receive special

education services. He went in two special

education services to really look at closely the

gap between his testing and his performance and I

think I mentioned before the cycle that happened

for him in special education which went from

behavior to actually suggest the retention piece

and finally we said no.

You talk about how did he get out of

special education. How did he stop receiving

services from special education. I think that\'s

more appropriate. It took extreme involvement on

my part to answer the question for me what do I

need to know, what do I need to do and how do I

need to do whatever I need to know to make sure

that he receives appropriate education.

We started very briefly with looking at

and talking to him, because he went in as a fifth

grader, in talking to him about issues related to

learning, issues related to the disconnect, the

cultural disconnect that he was having in the

classroom, issues related to the stigma of him

being identified as a special ed student, an

African American male in a predominantly white

school. We looked at all those factors and decided

that those factors had a bigger impact on him than

the factor of him going to school and learning and

he was spending too much time dealing with those

factors and we needed to get rid of those and so we

started very, very basically going to the school

with discussions about what appropriate services

are really impacting the bottom line for him and

any of those we see were not we got rid of them, we

actually discontinued.

He went from receiving special

education services to a 504 plan and we realized

what he really was a gifted child with special

needs. I\'m so glad we realized it and we hung in

there for a very long time.

The one thing I would say for all

parents who look like me and all parents

everywhere. We need the codes to the system. We

need to know how to navigate that system and we

need to share that information.

I would add that I didn\'t get your

recommendation, but I know there\'s been a lot of

research done. I would only add that research

needs to be done to include the voices of parents

or children that are overidentified so you get

feedback, comments, stories, best practices from

them to add to your report.

Thank you.

DR. FLETCHER: Thank you very much.

Commissioner Takemoto.

COMMISSIONER TAKEMOTO: I want to

thank everyone who set up this stage and ditto to

what Dr. Pasternack said and also speak to the

question or what I consider a challenge from one of

the people bringing up testimony this afternoon

about meaningful parent input and involvement in

this dialogue and this discussion.

I\'d like to encourage families and

folks who have access to families to submit

information for the record through the website as

well as to ask staff particularly at the San Diego

hearing, we have multi lingual translation for

families there who do not speak English. I would

also like to ask staff if they would get for the

record the information that was given to me about

Public School 75, because I think there\'s some

implications for our Task Force and monitoring on

that.

Thank you.

DR. FLETCHER: Thank you. Any other

comments to my left?

We\'re adjourned. Thank you very much

for staying with us during the day.

(Time noted: 5:14 p.m.)

C E R T I F I C A T E

We, MARGARET EUSTACE AND LINDA FISHER,

shorthand reporters and notaries public within and

for the State of New York, do hereby certify that

we reported the proceedings of the ASSESSMENT AND

IDENTIFICATION TASK FORCE HEARING, on Tuesday,

April 16, 2002 and that this is an accurate

transcription of what transpired at that time and

place.

Margaret Eustace,

Shorthand Reporter

Linda Fisher,

Shorthand Reporter