Virginia Regulatory Town Hall View Comments

Department of Education

State Board of Education

Regulations Governing Special Education Programs for Children With Disabilities in Virginia [8 VAC 20 ‑ 80]

Action	Revisions to comply with the “Individuals with Disabilities Education Improvement Act of 2004” and its federal implementing regulations.
Stage	Proposed
Comment Period	Ended on 6/30/2008

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6/30/08 10:50 am

Commenter: Katherine Williams, parent

Side by Side comparison of DSM-IV and VDOE Autism Eligibility Criteria

The proposed VDOE autism eligibility criteria is completely rewritten/reorganized from the DSM-IV (Diagnostic and Statistical Manual IV) diagnostic tool used by medical professionals to diagnose autism.

In my opinion, In terms of diagnosing autism, the proposed VDOE criteria is not simply more restrictive, it is a completely different diagnostic tool. It is my understanding t hat to diagnose a disease or medical condition, a medical doctor uses rules and symptoms and draws on extensive medical schooling to interpret data and observations. If the DSM-IV indicates that the definition of autism is defined in one way, and VDOE creates their own different way, then they have created a new diagnostic tool.

The fact that VDOE would choose to work outside of the medical community’s purview, and redefine a medical condition to suit their own needs, is of great concern. Certainly VDOE would not want their various degrees, educational research and tools and certifications to be disregarded, ignored or discredited. Educator’s should not be competing with the medical profession, or making up their own definitions of a medical condition. Autism should be diagnosed by doctors using medical tools which have their basis in research and are standardized. Should the way that autism is diagnosed in the medical community change over the years due to new information or scientific research then the diagnosis should change accordingly.

The DSM-IV criteria for Autism consists of three categories of characteristics. They are:

Category 1. Social Interaction,

Category 2. Communication and

Category 3. Restrictive repetitive and stereotyped patters of behavior, interests and activities.

The VDOE rewrite of the DSM-IV moves Category 3 into the intro language and then instead of requiring 6 characteristics out of all three categories it requires 6 characteristics out Category 1 (Social Interactions) and Category 2 (Communication). The DSM-IV medical diagnostic tool only requires 2 characteristics out of Category 1 and 1 characteristic out of Category 2 for a total of three characteristics in those two categories. So, the proposed VDOE diagnostic tool will require twice as many characteristics out of the first two categories and by incorporating Category 3 into the overview of autism they are perhaps requiring all of those characteristics as well. There are only 8 total characteristics within Category 1 and 2 and only 6 that apply to a child without language, so a child without language would be required to have all applicable characteristics from all three categories. A child with language would require all but one applicable characteristics from all three categories.

Take a look at the below side by side comparison of DSM-IV and the proposed VA Regulations Autism criteria.

DSM-IV criteria for a diagnosis of Autism

I. A total of six (or more) items from heading (A), (B), and (C), with at least two from (A), and one each from (B) and (C):

(A) Qualitative impairment in social interaction, as manifested by at least two of the following:

• Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression,body posture, and gestures to regulate social interaction.

• Failure to develop peer relationships appropriate to developmental level.

• A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people).

• A lack of social or emotional reciprocity.

(B) Qualitative impairments in communication as manifested by at least one of the following:

• Delay in or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).

• In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.

• Stereotyped and repetitive use of language or idiosyncratic language.

• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

(C) Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:

• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.

• Apparently inflexible adherence to specific, nonfunctional routines or rituals.

• Stereotyped and repetitive motor mannerisms (e.g. Hand or finger flapping or twisting, or complex whole-body movements).

• Persistent preoccupation with parts of objects.

II. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

(A) Social interaction.

(B) Language is used in social communication.

(C) Symbolic or imaginative play.

VA Proposed Special Education Regulation

L. Eligibility as a child with autism.

1. Any of the Pervasive Developmental Disorders, such as Autistic Disorder, Asperger’s Disorder, Rhett’s Disorder, Childhood Disintegrative Disorder, Pervasive Developmental Disorder – Not Otherwise Specified including Atypical Autism as indicated in diagnostic references, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), may be included under the eligibility category of autism. Students with autism demonstrate restricted repetitive and stereotyped patterns of behavior, interests, and activities such as encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus, apparently inflexible adherence to specific, nonfunctional routines or rituals, stereotyped and repetitive motor mannerisms (i.e., hand or finger flapping or twisting, or complex whole-body movements), persistent preoccupation with parts of objects.

2. A minimum of six characteristics from the following communication and social interaction areas shall be present to be considered for eligibility.

a. One or more impairments in communication, such as delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime), in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others, stereotyped and repetitive use of language or idiosyncratic language, or lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

b. Two or more impairments in social interaction, such as marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction, failure to develop peer relationships appropriate to developmental level, a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (i.e., by a lack of showing, bringing, or pointing out objects of interest), or lack of social or emotional reciprocity are noted. Delay(s) or abnormal functioning in social interaction, language as used in social communication, or symbolic or imaginative play, with onset prior to age three are also evident

With this newly created VDOE diagnostic tool, a child with the following characteristics. (let’s just call him “Tom”). would not be diagnosed with autism by VDOE and would not qualify under the new VDOE autism eligibility criteria for special education services.

Four year old Tom:

Tom doesn’t speak or communicate (Category B)
Tom doesn’t imitate (not even clapping or waving) or play make believe (Category B)
Tom has marked impairment in the use of eye contact, facial expressions, etc. (Category A)
Tom has a lack of joint attention (which means he doesn’t point at things or bring things to people or try to share experiences with other people and he can’t learn from being around peers) (Category A)
Tom is preoccupied with restrictive patterns of interest and (Category C)
Tom is inflexible with respect to nonfunctional routines or rituals (Category C)

Tom does not qualify as a child with autism for special education services in Virginia under the proposed autism criteria.

Tom would be diagnosed with autism under the DSM-IV and has very intensive learning problems that need to be addressed in research based ways specific to autism.

Obviously from the above example of “Tom.” even if the wording were changed from “diagnose” to “identify” the current proposed autism criteria would not be a good tool for identifying children with autism in need of special education services

Autism, as a label for special education eligibility, should be diagnosed by medical professionals.

I think that instead of trying to narrow the numbers of children diagnosed with autism by redefining the medical diagnosis VDOE should focus on the learning problems that are created by the various autism characteristics and come up with a set of criteria to determine the degree that the autism characteristics impede that child’s learning.

If you look at each possible characteristic in the table you will see that all characteristics will interfere in one way or another with a child’s ability to engage with other people and with their environment appropriately and therefore impede their learning. How can a child learn if they don’t imitate, or share attention or engage in and access their environment and interact with their peers?

At the most severe end of the spectrum you have children who have no imitation skills. It may take 500 or more manually prompted structured learning opportunities to teach one skill like a simple imitation of a gross motor action item to a child without the ability to imitate. If you walk through a typical classroom day (in either a regular education classroom or self contained classroom) you will find it would be impossible to provide enough learning opportunities within the classroom context, even with the use of constant 1:1 to teach a child who needs a large number of learning opportunities to acquire one skill. If a child needs more learning opportunities than the classroom schedule affords ,then the classroom learning environment is simply a distraction to learning.

Every child is different in this spectrum, but what is pretty clear is that they often need intensive 1:1 intervention to one degree or another to help them engage and to bring them to a point where they can learn from being in a classroom and from their peers. I suggest that another level (perhaps Level III) be established that would designate the need for intensive 1:1 instruction special education outside of the regular or special education self contained classroom to prepare children to be included with typical peers in the regular classroom.

Please consider adding Level III to the proposed changes to the Virginia Special Education Regulations.

Please allow the medical community to continue to diagnose autism.

I implore the VDOE and the Virginia School Board to take a closer look at the unique learning problems, research based strategies for autism, and services needed in order to ensure that all children with autism have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living. I suggest that the School Board create an advisory committee that would include extensive input from any parent who has a child with autism who is interested in contributing information. Parents of children with autism are the only people who really understand all aspects of autism. We live autism every day, 24 hours per day.

Thank you for your time and consideration in devising regulations that help our children.

Katherine Williams, parent

CommentID: 1685