School-Based Interprofessional Team Assesses Student with ADHD and Developmental Language Disorder to Improve Literacy Outcomes
Work Setting: Schools
Summary
Morgan is a third-grade student with developmental language disorder and attention-deficit/hyperactivity disorder (ADHD). Morgan is currently on medication for ADHD and receives services for language through an individualized education program (IEP). A team of professionals at Morgan’s school created a plan focused on improving literacy, language, and executive functioning skills over the course of the school year.
Meet the Team
Background
When the interprofessional practice (IPP) team was assembled, Morgan was a third-grade student in the general education environment with services and supports given through an individualized education program (IEP). Family reported that Morgan had no concerns with hearing, articulation, or social skills. English is spoken at home. They reported Morgan was diagnosed with attention-deficit/ hyperactivity disorder (ADHD) and began medication last school year to improve focus and reduce impulsivity in the school environment.
Morgan received intervention for language by a speech-language pathologist (SLP) in school 40 minutes per week through an IEP due to a diagnosis of developmental language disorder (DLD) at age 6. She also participated in Tier 3 Reading Intervention via a multi-tiered system of support (MTSS) model to address concerns with reading raised by the general education teacher. Family reported some concerns with (a) progress in reading skills and (b) feedback on the most recent report card. Parents were concerned that Morgan may need more direct support with reading skills and wanted to make sure that the diagnosis of ADHD was not impacting academic skills
The IPP team assembled included the members of the IEP team, the MTSS specialist, and the school psychologist recognizing that Morgan’s case required joint communication and planning.
How They Collaborated
The IPP team met to review information on Morgan’s current progress in (a) speech-language interventions, (b) MTSS reading interventions, (c) standardized assessment data, and (d) the general education curriculum. The team determined additional areas of assessment that were needed to support Morgan’s academic needs.
The SLP reevaluated language and literacy skills—including phonological awareness, understanding and use of vocabulary and grammar, and language comprehension. Morgan’s results fell below those of their peers in grammar, syntax, and phonological awareness. Average or above-average scores on expressive and receptive vocabulary, vocal quality, fluency of speech, articulation, and hearing. The school psychologist and the SLP completed an in-class observation to examine Morgan’s skills in the classroom environment and determine the impact of ADHD symptoms and DLD in the classroom. Both the SLP and school psychologist noted Morgan’s time on task was below peers during an independent reading time in class but improved during an observed math time. Both professionals noted similarities to teacher reports regarding needing additional prompts for directions and support getting started on tasks.
The reading specialist provided progress monitoring data from interventions—including word reading, oral reading fluency, and pseudoword decoding. Progress monitoring data was used to assess growth in these areas across Tier 2 and Tier 3 intervention services. There was not substantial improvement noted in progress monitoring data around the timeframe when medication for ADHD symptoms began
The school psychologist began by reviewing existing data from Morgan’s academic history, including previous intervention data and universal screening measures to determine performance growth. The school psychologist gathered information from key team members to understand functioning in the classroom and in areas of need. and coordinated who would assess each area identified. The school psychologist coordinated with the IPP team including Morgan’s family about follow-up testing including:
- rating scales to examine impact of attention (Behavior Assessment Scale for Children, Third Edition (BASC-3); Conners 4)
- academic achievement measures (Weschler Individual Achievement Test, Fourth Edition (WIAT-IV word reading. pseudoword decoding, oral reading fluency, and reading comprehension); Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2 phonological memory and rapid automatized naming).
Formal testing found that ADHD symptoms were in the borderline clinically significant range in the home environment and clinically significant range in the school environments for inattentive symptoms, though hyperactivity and impulsivity were falling in the average range for their age while medication.
Academic testing identified significant needs in rapid automatized naming, pseudoword decoding, oral reading fluency, and low average skills in reading comprehension.
Information gathered on reading interventions was below grade level norms performance gap widening in Tier 3 (more intensive) services and while on medication.
The general education teacher provided information on progress in class. The teacher reported difficulty following multi-step directions, focusing on class, communicating effectively with peers, initiating tasks, and working to task completion. Since starting the medication, the school has noticed improvements in movement and impulsivity. Morgan reports wanting to do well and when engaged in a manageable task, Morgan engages to meet classroom expectations.
The family reported that Morgan often guesses when reading, difficulty memorizing sight words, and with spelling homework. In general, the family reports that Morgan spends significant time completing their homework because of frustration and a lack of focus.
After reviewing the evaluation results, the IPP team recommended that Morgan receive special education services of direct reading and language through an individualized education program (IEP). Once the IEP was finalized, Morgan began meeting with
- a classroom aid to address initiating tasks and working to task completion,
- a special education teacher to address reading fluency and comprehension,
- the school-based SLP to identify and implement strategies syntax and grammar.
Outcome
The school-based SLP and the special education teacher work closely together to identify and use the same or similar reading materials in their sessions—to target Morgan’s reading fluency and comprehension. They regularly share progress toward IEP goals with each other and with the larger team. The classroom aid supporting executive functioning skills shares progress with the special education teacher and the SLP to work on initiating tasks. Data shows that Morgan is making steady progress toward literacy and language goals and is beginning to apply skills in the classroom and at home.
Ongoing Collaboration
The IPP team sends at minimum monthly emails among team members and Morgan’s family. Progress and data is reported every 9 weeks along with report cards. In monthly communications, the team and the family share what is working and what needs adjustment. The IPP team checks in regularly with the special education teacher who serves as the case manager to ensure making progress toward meeting IEP goals and objectives.
