Jennifer Wiseman-Comps 2011

1. Theoretical Perspective and Case Conceptualization Although in most cases more than one theory is used to conceptualize a case and develop an intervention plan, for the purposes of this case I am choosing just one, behaviorism. Many of Sams behaviors can be explained using behavior principles, and are likely the result of conditioning. Behaviorism is a theory that believes that all learning is based on conditioning, which occurs through interaction with the environment. There are two types of conditioning: classical and operant. Classical conditioning occurs when a naturally occurring stimulus is paired with a response, and then a neutral stimulus is paired with the naturally occurring stimulus. Through several trials, the previously neutral stimulus comes to evoke the response without the naturally occurring stimulus. An example of this type of conditioning comes from Pavlovs experiment with his dog. In that experiment, Pavlov paired a bell and the appearance of food to provoke a salivatory response from the dog. Eventually, simply hearing the bell, without food appearing, was enough to cause the dog to salivate. The bell became the conditioned stimulus and the salivation was the conditioned response. The second type of conditioning is operant conditioning. Using this method, learning occurs through reward and punishment. After a behavior occurs, depending on the desired outcome, reinforcement or punishment is applied and the behavior is increased or decreased. For instance, when a child is playing with a jack-in-the box, every time that he or she turns the handle, the box opens and the toy pops out. In most cases, this is rewarding to the child and he or she will continue to turn the handle and look for the reward. If this is scary or unpleasant to the child, then he or she will eventually stop using the toy because the consequence is unrewarding to him or her. There are different types of reinforcement and punishment: positive reinforcement (positive consequences presented after a behavior), negative reinforcement (removal of unfavorable events or outcomes), positive punishment (presentation of unfavorable events or

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outcomes), and negative punishment (a favorable event or outcome is removed after a behavior occurs) (BEHAVIOR MGMT BOOK). There are several ways to make the conditioning stronger, and therefore make the associations between the behavior and the environment stronger. These include the types of reinforcement and the schedule of reinforcement. It is important to ensure that the rewards or punishment are motivating for the person. If you choose reinforcement that is not rewarding, such as choosing M&Ms for someone who dislikes chocolate, then learning will not occur. The same applies to punishment. If you remove M&Ms from that same person, then again, there will be no learning occurring. In terms of the reinforcement schedule, intermittent reinforcement is very powerful. In this type of reinforcement, the person does not know when the reward is going to occur, so they are more likely to perform the desired behavior (or to avoid the undesired behavior, if a behavior is being extinguished). Behaviors that are conditioned using an intermittent reinforcement schedule are much harder to extinguish (BEHAVIOR MGMT BOOK). Think about this in terms of a slot machine. There are rewards given to players, but they are on an intermittent or random schedule. A player who is reinforced once or twice and who does not know when they will be reinforced again will continue to play in the hopes that the reward will occur. In most cases, using reinforcement rather than punishment is encouraged, as it is more powerful in changing behavior and provides fewer detrimental side effects. These side effects can include things such as resentment or rebellion toward the person doing the punishing, and often only change the behavior in the moment, with few long-term effects. According to parent report and classroom observations, Sam has trouble focusing on tasks at hand, sitting in his seat, and completing work. He also reportedly hits other children, talks out in class, antagonizes the teacher, and complains of physical symptoms when asked to

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complete assignments. Using the aforementioned behavioral principles, these behaviors are reinforced, which increases the frequency. For instance, when asked to complete assignments, Sam frequently complains of headaches, stomachaches, or tiredness. When this occurs he is probably told to visit the clinic or told that he can finish the work at a later time. This negatively reinforces both Sam and the teacher. The unpleasant consequence, being forced to complete the work, is removed when he engages in the behavior, which then causes him to engage in that behavior more often. The same occurs with the teacher. When Sam complains when asked to finish work, this causes the teacher to feel frustrated with him, and likely causes the rest of the class be disrupted. If she allows Sam to avoid the work, then the class will function smoothly. Even if she occasionally forces Sam to finish his work, she is using an intermittent reinforcement schedule, and as mentioned earlier, those behaviors are the hardest to extinguish. His other behaviors at school can also be explained using behavior principles. For instance, his distractibility is also reinforcing to him. If he finds school to be unpleasant, boring, or difficult, then he is again negatively reinforced. By being distracted he can avoid what he finds unpleasant or boring, and that prevents him from listening to the teacher or participating in class. His other behaviors, such as talking out in class, antagonizing the teacher, and hitting other students are positively reinforced by the attention that he receives when he performs one of those behaviors. When he engages in those behaviors, he becomes the center of attention, which is important to him, as his parents stated that he attempts to control the situations and become the center of attention with his friends. His behavior at home, throwing up fruits and vegetables, and sleeping with his mother at night, are both positively and negatively reinforced, by both attention and the avoidance of unpleasant tasks. When he throws up his food, his mother or father likely reacts with concern and he is lavished with attention for a brief time. At the same time, he is probably

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not forced to eat those foods because it causes such a problem for his parents, which negatively reinforces both Sam and his parents. The same occurs when he has a nightmare and is allowed to sleep in his mothers bed. He, for that time, is the center of attention, which positively reinforces his behavior. According to parent report, he does not sleep in his fathers bed, which indicates that he was not reinforced for that behavior in that environment, which decreased the frequency in his fathers home. But because is in reinforced in some way by his mother, that behavior will continue there. Although Sams academics are declining, there is a huge impact from his behavior that should be addressed first. If, by using the conditioning principles mentioned above, his negative behaviors can be reduced, then his academics will increase at the same time. It is important that Sam regard school as fun and entertaining, as well as see the need for learning. Without that, he will continue to find it unpleasant and engage in his current behaviors, which are having a negative impact on his education. An intervention plan based on operant conditioning will be created to reduce his negative behaviors and to increase positive ones. 2. Score Interpretation On the WISC-IV, Sams FSIQ was on the cusp of the Average and Below Average ranges. There was significant split between his verbal comprehension skills and his perceptual reasoning skills, with scores in the Below Average and at the higher end of the Average range, respectively. This was likely due to his distractibility and difficulty focusing. The verbal comprehension tasks lack tactile and visual aids, which likely made it difficult for Sam to focus enough attention on those tasks, while the perceptual reasoning tasks provide pictures and blocks to aid in answering those questions. While his working memory was in the Average range, he displayed a significant weakness in his processing abilities, with a score in the Borderline range. On the processing speed tasks, as stated in the behavioral observations, Sam would stare into

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space and required reminders to focus and to remember the timer. This definitely contributed to his lower scores. Again, these tasks were likely not interesting to him, and did not provide a challenge or reason to focus on them. Therefore, he did not respond in a proactive and interested manner. In addition, these tasks may have been difficult for Sam, which would lead to his not providing his full attention to those tasks. Because of his deficit in processing speed, the General Ability Index (GAI) should be utilized to provide a more accurate overall representation of his abilities. His GAI was calculated to be a standard score of 95, which is in the Average range. Even with calculating the GAI, these scores are likely an underestimation of his abilities, and he would likely do better with a test that was more hands-on and fast moving. In terms of cognitive scores, his processing speed was also a concern on the WJ-III COG, with a score in the Very Low range. While this is likely a function of his attention, it may also be causing difficulties in the classroom if he is taking longer than other students to process what is being said. A cluster composed of subtests that measures four different aspects of attention (selective, sustained, and divided attention, and attentional capacity) was obtained, and Sams score in that area was in the Low Average range, with the most difficulty likely occurring on the subtest measuring selective attention (the ability to focus on one stimulus at a time, and to avoid extraneous stimuli). This score, which indicates some difficulty with attention and focus, is to be expected, given his referral for behaviors that stem from difficulty focusing and concentrating. Other clusters, such as the ability to shift between concepts and to control interferences (executive processing), working and short-term memory, were in the Average range, indicating that these abilities are adequately developed. An overall cognitive processing score, which is similar to the FSIQ, was not calculated because the selected subtests administered are not designed to calculate that score.

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In terms of achievement, Sams basic skills in each area were stronger than his application skills. In reading, Sams scores indicate that his basic reading abilities (phonics and fluency, Average range) are more strongly developed than his comprehension skills (Low Average range). This pattern continues with math (broad math skills in the Low range) and writing (written expression score in the Low range, and broad written language in the Very Low range). In general, this says that while Sam has the basic abilities, he has more difficulty applying those skills. The scores obtained in writing are consistent with referral information that describes Sams difficulty with writing, as well as with a family history of difficulty in this area. Behavior rating scales were completed by both parents and his teachers. In both the interview and the rating scales, Mr. Smith reported more problems than Ms. Smith. Both parents reported concerns in the areas of somatic complaints and attention problems, while Mr. Smith reported more concerns in the area of thought problems, as well as the overall composites of internalizing and total problems. On scales related to the DSM-IV-TR, both Mr. and Ms. Smith reported concerns with somatic complaints, and Mr. Smith also indicated concerns with anxiety problems, affective problems, and ADHD problems. Ms. Orange, Sams teacher, rated only somatic complaints as an area of concern. The other teachers, who are school officials who help in the classroom and know Sam well, indicated the same areas of concern as Mr. Smith, with the addition of aggressive behavior, externalizing problems, and the DSM-IV-TR scale of oppositional defiant problems. Both parents and Ms. Orange were also given the Conners Rating Scales-Revised, which specifically address ADHD and accompanying symptoms. Ms. Smith did not raise significant concerns in any area on the Conners. Mr. Smith, and Ms. Orange, in contrast, endorsed several problems areas. Mr. Smith indicated concerns in the cognitive problems/inattention area (may

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learn more slowly than others, have problems organizing their work, completing tasks, and concentrating), hyperactivity (difficulty sitting still or focusing on the same task for awhile, restless and impulsive), psychosomatic (report atypical amounts of pain and aches) and DSM: hyperactive/impulsive (an indicator of DSM-IV level of hyperactive or impulsive problems). Both Mr. Smith and Ms. Orange endorsed significant concerns on the following scales: ADHD (this is an indicator of whether a child is likely to have an attention problem), GI: restless/impulsive (indicator of hyperactive and/or inattentive behaviors), GI: emotional liability (tendency for pronounced emotional reaction, such as crying or getting angry often), GI: total (measure of overall problems in attention, hyperactivity, impulsivity or emotional liability), and DSM: Inattentive (indicator of whether the child is likely to have attention problems of the inattentive type as diagnosed by the DSM-IV). 3. Additional Information There are several inconsistencies in the cases study that should be addressed before making eligibility determinations. Sam should be screened for hearing and vision problems by the school nurse in light of parent and teacher reports that often misses the toilet seat, has had incidents in the bathroom at school that required the flooring to be replaced, and often complains of headaches. After being screened, it was determined that Sam did not have any problems with hearing or vision. Therefore, it is more likely that he engages in these behaviors because of difficulty focusing or distractibility, as well as escape/avoidance. It is also necessary to have additional and individual interviews with both parents. During those interviews it was determined that discipline is not consistent in both homes as Ms. Smith often feels guilty because she and Sams father divorced, so she acts in a more lenient manner when he misbehaves. She also reported that although Sam says that he is happy that he has a new baby brother, his actions do not always agree. The example she provides is that he uses any excuse to sleep with her at

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night, and often attempts to gain her attention when she is focused on the baby. She did admit that she frequently gives into these behaviors because she does not want Sam to feel left out or excluded. When asked about the differences between her ratings and Mr. Smiths ratings, she stated that she believes Sam is simply going through an adjustment period, and does not want to see him labeled as a problem child or something similar. Therefore, she downplayed her responses. Ms. Smiths actions are reinforcing to Sam, and his behaviors are generalizing to other situations, such as the classroom. Mr. Smiths interview yielded information about Sams relationship with his step-mother and step-sister. He does get along well with his new family, but at times attempts to become the center of attention by behaving in inappropriate ways. For example, Sam will run away in stores, throw up food, and fidget in his seat at all times. When this occurs, Mr. Smith stated that he attempts to avoid giving Sam the attention that he wants, but that it is very difficult at times. Certain behaviors have been extinguished, such as Sam asking to sleep in Mr. Smiths bed at night. When asked about discipline, Mr. Smith responded that he tries to be consistent, but does give in to Sam if his behaviors escalate. He is the primary disciplinarian in his home, and his wife supports his decisions, and often uses the same measures with her daughter. He was not aware of Ms. Smiths discipline procedures. However, he did state that they had agreed to continue the same discipline program that they used when they were still married. Both Mr. and Ms. Smith reported that getting Sam to complete homework was very difficult. He often complained of headaches or stomachaches, or would simply say that he did not have any homework. When he did agree to complete the assignments, he took a very long time as he complained with every problem, but did not often ask for help, unless the task was writing. He then would attempt to have his parents do the work for him. When asked about his distractibility,

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both parents stated that he only becomes distracted when doing school work, and is able to focus when playing video games or football, things that he enjoys doing. An interview with Ms. Orange was also conducted. Information from this interview concerned discipline procedures in the classroom, specific behaviors that Sam engages in, and questions concerning Sams social status in the class. Ms. Orange stated that, overall, Sam is a very enjoyable and fun-loving student. He participates in PE, music, and art, and gets along well with other students on the playground. He can become demanding when he wants to be the center of attention, and will at times act impulsively to gain that attention. She also stated that he has difficulty distinguishing between positive and negative attention, and will behave in ways that earn him negative attention (e.g. hitting other students, antagonizing people that he does not get along with, and urinating on the bathroom floor). She also provided more information concerning the accidents that Sam had in the restroom. She believes that he was attempting to gain attention from his peers, while at the same time avoiding his class work. Each classroom has an attached bathroom, and the mess was not discovered until the next student went to use the restroom. Once it was determined that Sam was the person who made the mess, he was taken to the office where his parents were called. This resulted in his missing the majority of the day in the classroom. Both messes occurred during writing time, which is, according to Ms. Orange, Sams most difficult subject. He reportedly complains of the most problems and provides the most distractions during those times. A Functional Behavior Analysis (FBA) should be conducted to determine the main cause of Sams behavior. During the course of this FBA, it is determined that the primary function of Sams behaviors is escape/avoidance, while attention is a secondary motivation. During classroom observations, it was discovered that Sam participated willingly during reading, but

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escalated his behaviors during math and writing. He would begin by zoning out and focusing on other students and objects in his desk, but would become increasingly restless and would then begin to complain of somatic ailments. In most cases, he would not even attempt the work, although he usually was holding his pencil. When his papers were examined later, Sam had drawn on the paper instead of answering the math problems or writing sentences. Ms. Orange stated that his was common behavior for Sam. To ensure that there was no physical reason for his difficulty with writing, an occupational therapist observed Sam and determined that there was no need for a full OT evaluation. In addition, his parents took him to see his doctor for a full medical checkup to rule out a medical reason for his headaches and stomachaches. No significant problems were found, but he will be monitored for a possible food allergy. In terms of additional assessments, Sam was given the Stanford-Binet Intelligence Scale, Fifth Edition as it provides several manipulatives and short subtests to keep his attention focused on the test. This provided a more accurate ability score in the high end of the Average range. Also, because he is having such difficulty with writing, a measure of Visual Motor Integration was administered. The score came out in the Low Average range, which indicates difficulty with eye-hand coordination. This likely impacts his ability to write, which in turn causes him to engage in behaviors that allow him to avoid performing this unpleasant and demanding task. 4. Diagnoses There are three resources that could provide Sam with services, and each has a different set of criteria. The first is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). According to the criteria Sam does not qualify for a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). To qualify for a diagnosis, a person must exhibit six symptoms of inattention or hyperactivity/impulsivity (or six of both for a

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combined subtype) within six months and in varied settings. Sam does exhibit several of the inattentive symptoms as reported by his parents as well as observed in the classroom and during testing, including trouble keeping his attention on tasks, difficulty listening when spoken to directly (has to repeat directions and he doesnt follow them), avoids, dislikes, or does not want to do things that require sustained mental effort (takes his time getting ready, complains of headaches and stomachaches), loses things needed for tasks and activities (looks for books and things for a long time before finding them), and is often easily distracted (often seems to be looking at other things or distracted by other objects). An additional symptom, difficulty finishing tasks and assignments, is not exhibited due to the underlying defiant behavior that Sam exhibits when this occurs. When asked to complete assignments, Sam complains of stomachaches, headaches, or being tired. Therefore, this is not evident of difficulty concentrating or focusing. He also meets several criteria for hyperactivity/impulsivity: fidgets or squirms in seat, often gets up from seat, blurts out answers, has trouble waiting his turn, interrupts or intrudes on others. For a diagnosis of ADHD, there also needs to be a severe impairment in academic, social or work functioning. While there is a behavioral impact on his academics, it is not severe at this time. His grades are declining, but are still passing. If his behavior continues then he will likely have more and more difficulty in school in the future. In terms of his social functioning, Sam reportedly has friends that he sees outside of school, and there are no indications that he has difficulty getting along with classmates. In addition, Sam displays these behaviors at school and at home, even though his mother does not report as many behaviors as his father or teacher. Because he does not meet DSM-IV-TR criteria, he also does not qualify for services under the Individuals with Disabilities Education Act (IDEA) of 2004 under the category of

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Other Health Impaired (OHI). The criteria for that category states that if a student has a limited alertness to the educational environment caused by a chronic health disorder such as ADHD that adversely affects his educational performance, then he would be considered a child with a disability ([Link] This implies that a formal diagnosis of ADHD is required. Under Floridas Rules and Regulations, a medical diagnosis and formal report would be required to qualify for services under OHI for ADHD ([Link] PROGRAMS I&ID=6A6.030152). However, Sam would qualify for accommodations under Section 504 of the Rehabilitation Act of 1973. According to that criterion, a student must only have a handicapping condition that substantially limits one or more of his major life activities, which would include learning (ETHICS BOOK). Sam would then be eligible for accommodations to ensure that he receives the appropriate educational environment, such as additional time for tests, an alternate testing area. In terms of learning disabilities, according to the DSM-IV-TR, a student must have a deficit that is significantly below expected given their age, grade, and instruction level in one of the main areas of academics on a standardized assessment instrument. The DSM-IV-TR also requires an impairment to be present. Sams grades are declining and he frequently refuses to write in the classroom. Observations during testing also revealed a significant difficulty with writing tasks during that assessment as well. Therefore, based on his test scores, Sam qualifies for a Learning Disorder of Written Expression and Mathematics Disorder. Sam also qualifies as a child with a disability under federal IDEA criteria for learning disabilities, as he displays an imperfect ability to write and perform mathematical calculations and this difficulty is not the result of visual, hearing, or motor disabilities, mental retardation, emotional disturbance, or

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environmental, cultural, or economic disadvantage ([Link] Finally, according to Florida Rules and Regulations, Sam would qualify for Exceptional Student Education (ESE) services if the old rule was still in place. According to that rule, a student of Sams age would only have to demonstrate a discrepancy between his IQ and achievement scores of one standard deviation (15 points), which Sam does in both writing and math, when the discrepancy is calculated using his GAI, which is the best estimate of his abilities. However, according to the new rules and procedures, he would need to undergo intensive and individualized interventions while making little or no progress before making that determination. 5. Intervention Plan There are several interventions that are appropriate for someone who is having similar problems to Sams. Several of these are meant to be used in conjunction with each other, such as providing directed movement in the form of errands or tasks in the classroom, repeated and explicit reminders of the behavioral expectations at school and at home, and other tricks the teacher could perform that would benefit both Sam and the rest of the class. To begin with, the behavioral expectations should be clearly and explicitly explained to Sam and the class, and posted where they are clearly visible. This should include the actual rules, as well as the discipline procedures that will follow if they are broken. Mr. and Ms. Smith should be reminded of the importance of being consistent and firm with the rules at home. Ms. Orange should be reminded to state the rules several times during the day. To address Sams inattention and inability to stay in his seat, there are several small interventions that can be done. The teacher can call his name to get his attention before asking questions, stand near him or walk around the class, give him a time limit to find his book and the

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appropriate page or materials, have him pass out papers or send notes to the office (which allows him to use energy in an appropriate way as well as to receive positive attention), and take frequent breaks. During some of those breaks, the teacher should direct the rest of the class to stand up and do some basic exercises to ensure that the entire class is focused and attentive. To track intervention progress, Ms. Orange can use rubber bands or something similar to monitor the frequency of inattentive and hyperactive behaviors. At the beginning of each lesson (reading, math, writing, language arts, science, social studies, etc) the teacher will put 10 rubber bands on her arm or 10 paperclips in her pocket. Each time that Sam gets out of his seat or is inattentive, his teacher will move a rubber band or paperclip to the other arm or pocket. This will keep track of his behavior. After each period, Ms. Orange will write the number of objects that were moved on a chart. In the beginning, this will likely be a high number. To allow Sam to keep track and see his progress for himself, a simple monitoring chart should be taped on his desk. For each period that behavior is tracked, place a + in the box for that period if there is at least one object remaining at the end of the period. This allows Sam to have a tangible reminder of his behavior. At the end of the day, if there are at least five +s, then Sam earns a ticket that will go toward a weekly prize. He and Ms. Orange will create a rewards menu with corresponding ticket amounts. For instance, 1 ticket will be a toy; 5 tickets can be five extra minutes at recess, and 10 tickets can be 15 minutes playing football with the PE teacher, or something similar. It is important to make sure that the rewards that Sam has to choose from are things that motivate him. Without this motivation, Sam will not want to work at improving his behavior. A goal for this intervention would be only one object being moved per class lesson every day for one week. To ensure that the intervention is being performed with integrity, three times a week the school psychologist will observe for one period during the day and keep track of his behavior

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using the same objects as Ms. Orange. The number of objects the psychologist moves will be compared with Ms. Oranges. Any discrepancies will be discussed and, if necessary, the teacher will be reminded of the criteria for moving an object. To address his work completion and defiant behavior, a behavior chart should be implemented. This should be shared with Sam so that he can see what he is working toward. Ms. Orange will take all assignments for the week and split them into several steps. These will be shared with Sam and sent home so that his parents are informed as well. Sam will be told that these are the assignments he is required to complete during the week, and that he has seven days (until the next Monday) to complete them, using time in class and at home. Once he is completing 80% of the assignments within that time frame on three out of four weeks (monitored by simply counting the number of completed assignments and dividing that number by the total number, then graphing the percentage), then the amount of time that he has to complete the assignments will be shortened to five days (due on Friday afternoon before leaving for the weekend). Again, once he has reached the 80% mark on three out of four weeks, then the time frame will be shortened again, to having to complete the days assignments before school ends that day. The goal for this time frame is 90% of assignments completed on four out of five days during the week. To provide positive reinforcement, for every assignment that Sam completes appropriately (i.e. not rushing through it and done on his own) Sam will earn a ticket, which will be added to the tickets he earns for appropriate seat behavior and can be traded in for a prize on Fridays. To ensure intervention integrity, the assignment checklist that will accompany the assignments for the week will be compared to the number of tickets that Sam to ensure that he is receiving the appropriate amount of reinforcement for his performance.

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In addition, the teacher should use verbal positive reinforcement every day. When Sam is behaving appropriately, sitting in his seat and focused on the lesson, she should draw attention in a positive way to this behavior. Ms. Orange should be sure to say something that reminds Sam of the behavioral expectations that he is following at that point. An example would be Sam, I really like the way you are sitting still in your seat, and focused on the board. Because behavior plays such a large role in Sams academics, it is important to intervene in his behavior before his academics. Once his behaviors are under control, it will be easier to determine exactly where his greatest needs lie. When that occurs, interventions targeting those areas can be designed and implemented. For example, to provide extra support in math, if Sam is having the most difficulty applying skills to word problems, then providing small group practice in that area will be extremely beneficial. He can then be given a short worksheet weekly to monitor his progress. A goal for his math application skills would be to answer nine out of ten problems correct on three out of four trials. Intervention integrity will be maintained by having the school psychologist observe during intervention times to ensure that he is receiving the appropriate instruction daily. Similar interventions can be developed for his writing skills as well. The specific area that he is having difficulty in should be determined first. This is likely related to his problems with visual-motor integration, and will likely respond better to accommodations rather than interventions. Sam should be allowed to type his responses on the computer, while at the same practicing his writing using pencil and paper. Small group instruction should be started with Sam to ensure that he receiving adequate instruction in writing rules and guidelines. 6. Ethical and Multicultural Issues One of the relevant ethical issues in this case was the use of an out-of-date Conners Rating Scale. The current version, the Conners Third Edition, was published in 2008. The third

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edition has several updated features over the Revised version, including updated norms, a modified age range, the addition of three validity scales to ensure that the raters observations are valid and reliable, the addition of two DSM-IV-TR symptom scales for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), screening questions concerning anxiety and depression, critical items to ensure that students with immediate needs receive the appropriate help, and guidance in planning and monitoring interventions for the symptoms reported in the scale ([Link] _pageid=53,235050&_dad=portal&_schema=PORTAL). The Conners-Revised that was used in the current assessment has fewer questions and therefore does not provide the maximum amount of support and information that the current version does. It is Best Practices to begin using the new version of an assessment instrument or rating scale within 12 months of publication (ETHICS BOOK). This allows districts and clinics adequate time to order and receive the new materials, as well as time to appropriately acquaint themselves with the new versions. By using the newest versions, the students who are assessed using these instruments are evaluated using the newest research and newest norms. This allows the best and most accurate information to be used in making decisions regarding that students abilities. In the case of Sam, by using the new version of the Conners Rating Scales, important information concerning Sams behavior concerning criteria for ODD or CD as described by the DSM-IV-TR, or whether he is feeling anxious or depressed about recent changes in his life, would have been obtained. This information could have provided additional ways to explain and improve Sams behavior in the classroom. In order to overcome these issues concerning the version of the Conners, the newest version should be given to the parents and teacher to complete. 7. Response to Intervention (RtI)

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Using a response to intervention model, the first step would be to determine whether there was a class-wide, or Tier 1 problem. That is, is there a behavior and/or academic problem with the majority of the class? Or is at least 80% of the class functioning at a level that is appropriate for their age and grade in behavior and academics? If there is a class-wide problem, then the appropriate next step would be to determine what was causing the problem. For instance, if there is a behavior problem, then the teacher would be reminded to post the behavioral expectations and re-trained in ways to take control of the class. Modeling by the school psychologist and other trained professionals will aid the teacher in seeing the most effective ways to control the students. If the problem is academic, then both the curriculum and the teachers techniques should be evaluated. Any problems found with the curriculum or techniques being utilized should be addressed by collaborating with the teacher and administration as needed. If there is not a class wide problem, and the behavior and academics are solely with one or two students, then those difficulties should be addressed on an individual basis, with those students being placed in Tier 2. At that time, individualized interventions would be designed and implemented, with progress monitoring and data analysis also occurring. This is also the time when any diagnostic assessment would be completed. For instance, if reading is an issue, and the teacher is not sure whether it is phonics and fluency or comprehension that is the students main problem, then a reading diagnostic can be administered to aid in designing targeted interventions that are focused on the students specific problem. After gaining consent from the parents, a FBA should also be conducted at this point, especially if the problem is behavior. Classroom observations should also be conducted if the behavior is academic, to ensure that there are no underlying behavior problems that are impacting the academics, as there are in Sams case. After a sufficient amount of time of interventions being implemented with

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fidelity and no progress being made, then the committee can make the decision to place the student in Tier 3, where he would receive more intensive and more individualized interventions, such as one-on-one tutoring or counseling. If there is still no progress in the behavior or academics after that, then the decision may be made to proceed with placement in ESE. There are several benefits and challenges to RtI versus the old model of refer-test-place. The benefits include being able to be specific about the childs difficulties and create interventions that target that issue. This allows the student to work on that area and maintain abilities in other areas that are on grade-level. Using RtI also allows the child time to make progress and to try different techniques and learning programs without being labeled as learning disabled or behaviorally challenged. Being able to stay in the general education classroom with peers allows the student to feel more success without being singled out by other students or teachers. RtI requires the use of scientific and research-based interventions that have been proven effective for students with similar difficulties, which ensures that the student has the best possible opportunity to succeed. One of the components of RtI is universal screening, which requires schools to screen all students several times through the year to provide information about each students progress and abilities. This eliminates the wait to fail model that has been used in the past. There is no need to wait for a student to have significant difficulties in class before intervening, which causes parents to be assured that their students are receiving the needed supports. RtI also significantly reduces the number of students who are in special education. In the past, students may have been placed in ESE because of other factors, such as motivation, medical issues that had not been identified, or other environmental factors that may have affected their performance on standardized tests. Under this model, only the neediest and most struggling students are placed in ESE, and the process takes time, which allows the teachers

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and psychologists to develop a comprehensive profile of the student in different circumstances. The previous model was based on the results of a single administration or test, which is not always the most accurate. There are also several challenges in using RtI. These include things like school administrator buy-in. If the administrators do not believe in the benefits of RtI, then implementing it effectively is going to be difficult, as teachers are going to be less likely to believe in it as well. In addition, to properly implement interventions and monitor progress, significantly more time is required than the old model. This makes it difficult for teachers and parents to see the benefits. Teachers are accustomed to students who are behaving inappropriately, or students who are struggling being placed in ESE and taken out of their classroom quickly. Parents, because of the longer time involved, feel that their child is not receiving the support that he or she needs, and can become frustrated with the system. Therefore, it is very important for school psychologists to explain the benefits of RtI to both parents and teachers, and to guide them through the process. In addition, because RtI is so data-rich, teachers are required to do more work than before. They are responsible for implementing interventions, keeping records of those interventions, graphing data, and attending numerous meetings concerning the childs progress, in addition to their already full workloads. This can make it very difficult to effectively implement RtI, even if it is best for struggling students.