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Although more students with disabilities than ever are included in state testing programs, the task of giving these students high-quality assessments in the future that measure how adept they are at mastering the Common Core State Standards seems to have an endless number of hurdles to overcome before students face these new assessments in the 2014-15 school year.

And one of them has less to do with the test than with instruction, said Stephen N. Elliott, a professor of education at Arizona State University. Elliot spoke Tuesday at a U.S. Department of Education meeting addressing the challenges that remain in preparing new tests that all students are scheduled to take in 2014. This was the fourth meeting about the assessments.

In his research looking among several states, Elliott found that the most time any state was able to spend on teaching the standards was 81 percent of the time students were in school, and special education teachers covered even less of the content and standards.

"We get that test score and we make that big inference that kids have been taught this," Elliott told a collection of special education and testing experts, including members of the consortia that are designing common-core assessments and alternate assessments for students with significant cognitive disabilities. "Many students with disabilities need 30 to 40 more days of class time to get an equitable opportunity to learn."

That problem may only grow as the common-core standards are implemented.

"It's not that we can't improve assessments, [but] that can serve as a distraction from the critical need to improve instruction, said Lou Danielson, a managing director at the American Institutes of Research who focuses on special education policy and evaluation.

Progress, But More Work to Do

The major hurdle of increased, improved instruction aside, the technical and content issues with the exams are numerous.

While students with disabilities have become a bigger part of state accountability systems, albeit gradually, over the last 20 years, now even students with the most significant cognitive disabilities are included in state testing programs. "It's remarkable how far we've come," Danielson said.

One fundamental advantage to designing tests with students with disabilities in mind from the beginning is that for the most part, tests won't have to be retrofitted and adapted to work with students with disabilities after the fact, a situation that is typical with many current state assessments.

But there's still a long way to go, he said.

One big issue lies with computer-adaptive tests, in which students are given a question that's harder or easier depending on whether they answered the previous question right or wrong, pose a challenge for students with disabilities. Some students (with and without disabilities alike) may shut down if they miss the first question. And there's the risk that the computer will throw a student a question that's below his or her grade level because of one or multiple wrong answers, a situation that concerns special education advocates.

Another issue: Though it's not a universally popular idea, Danielson said the time has come to put an end to portfolio-style assessments, used in particular for students with severe cognitive disabilities. There are questions about how reflective the collections of work are of students' ability and how heavily influenced they are by teachers, who may be evaluated on their contents in some cases. Proficiency rates that are too high may indicate expectations for students with disabilities who are assessed this way are too low, he said.

"It's too tempting for teachers to help a lot with their [students'] work," Danielson said.

Accommodations Require Agreement

Yet another issue is that states using exams developed for most students by one of the two consortia working on those tests will have to agree on a common set of acceptable accommodations on those tests. One particular sore spot is whether, or how much, students should have test instructions or test content read aloud to them.

"I feel when reading reaches a point where it's about comprehension and they still have trouble decoding it, it becomes a test of decoding," Danielson said. "In earlier grades where decoding is being tested, it makes sense not to read aloud."

Students may waste a lot of their time when they hit unfamiliar proper nouns, reducing their fluency and comprehension, he said research shows. And students using digital text in class where read-aloud features are common may be stumped on tests where these features aren't allowed.

Keeping the principles of Universal Design for Learning in mind as the tests are developed is critical, said Sheryl Lazarus, a senior research associate at the National Center on Educational Outcomes, which is leading one of two groups of states in designing alternate assessments for students with severe cognitive disabilities. This will help ensure that test items measure what they're intended to measure, not students' test-taking or other abilities. Pictures and graphics should be clear and only used when essential. Text should be concise and clear. Test items could be designed to appear one at a time on a computer screen, and test items should be consistent in their format from one to the next. Navigating the exams shouldn't be confusing.

"This is an opportunity," Lazarus said. "I beg of... the consortia to take advantage of this opportunity and make the most of it."

Alexa Posny, assistant secretary for special education and rehabilitative services at the U.S. Department of Education, said one proposed accommodation has already been the subject of concern: sign-language avatars. If students are used to live sign--language interpreters in class, the avatars could be startling and awkward to use. "Students shouldn't suddenly encounter an accommodation they haven't used in the classroom," Lazarus replied.

And Dan Wiener, administrator of inclusive assessment for the Massachusetts Department of Elementary and Secondary Education, asked about situations in which meeting the needs of one type of student with disabilities conflicts with what another student needs, such as colorful graphics for a student who is deaf or hard of hearing that would be difficult to work into a Braille version of the test. Will every test item have to be scrutinized for its accessibility, he wondered. And would this time-consuming process have to be repeated yearly? "It really does sound like pie in the sky," he said.

Lazarus mentioned the Accessible Portable Item Profile Standards, or APIP, which can help to tailor tests to different kinds of students

Of note: The meeting made several references to a format of tests allowed to an extent under No Child Left Behind: alternate assessments for another group of students with disabilities, tests that are expected to disappear when No Child Left Behind, the current version of the Elementary and Secondary Education Ac, is reauthorized.

There was an entire presentation by Shelley Loving-Ryder of Virginia's education department on this version of exams her state has developed. She showed examples of how test questions have been modified, such as by providing only three choices instead of four on multiple-choice questions, providing graphics when students have to calculate something about a figure such as a cylinder, providing formulas required to solve some problems, color-coding some test items, and so forth. Presumably these are the kinds of modifications to exams we could see on future common core assessments, even if these tests in particular are obsolete by then.

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Republican Presidential hopeful Mitt Romney is expected to officially unveil his education platform as early as this week, but my colleague Alyson Klein already has a sneak peak at what he may pledge to do in the education arena if elected president.

Among the proposals is one regarding expanding school choice options for low-income students and students with disabilities, the document circulated over the weekend shows.

Romney says these parents would be able to choose which school their children attend, and the federal funds allocated to their education would follow them to their chosen campus, including any district public or charter school, online school or courses, private schools, or to a tutoring company.

There's a caveat: the Romney campaign document says the choice of a private school would be offered "in accordance with state guidelines."

Does that mean states would have to have private school voucher programs in place? Only eight states now offer vouchers for students with disabilities: Arizona, Florida, Georgia, Indiana, Louisiana, Oklahoma, Ohio, and Utah, according to the National Conference of State Legislatures. I guess we'll have to wait and see.

Some special education advocates warn that parents who use vouchers to send their children to private school don't realize they are giving up protections under federal disability education law when they do so.

The document also says states would get incentives to adopt open enrollment policies for these groups of children, something Arizona has offered for 20 years. And he would ask states to eliminate caps on the number of charter and online schools.

Romney would also expand the D.C. Opportunity Scholarship Program to serve as "a model for the nation," his message points say.

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Although early detection and intervention of disabilities can often make a dramatic difference in a child's life, parents of children with autism say they don't put their faith in the people on the front lines of treating and caring for their children.

A small new study discussed at the International Meeting for Autism Research in Toronto last week found that parents didn't expect their pediatricians to provide autism-specific treatment, and many pediatricians don't view autism treatment as within the scope of their work.

The study involving families and doctors in Philadelphia, also found that even doctors who want to help families manage their children's diagnoses lack the training to do so.

"This study validates what previous studies and parents have told us: Many pediatricians are not prepared to provide the kind of advice and information that parents need after receiving a diagnosis of autism for their child," Geraldine Dawson, chief science officer for Autism Speaks, told HealthDay News.

"Without advice and information from their primary care provider, families must navigate treatment options on their own, which can be confusing and complex," Dawson told HealthDay News. "This adds to the already high levels of stress that families are experiencing. We need greater emphasis on autism training for primary care physicians so they can help parents make informed decisions about their child's care."

The study found that pediatricians do refer patients to early intervention services and specialists, but that's not the ideal, said Dr. Susan Levy, director of the Regional Autism Center and the Center for Autism Research at Children's Hospital of Philadelphia.

It would be better if primary care doctors managed all aspects of the care of a child with autism—receiving reports, consulting with specialists and helping parents integrate autism treatments with the child's overall development and health needs.

Levy told HealthDay News that what makes this arrangement work is shared decision-making, in which pediatricians advise parents on, for example, evidence available about alternative treatments, and then parents and doctors decide together on the best course of action.

Many families, for example, turn to alternative treatments to help with autism, because no medications treat the core symptoms of autism.

But Levy said many doctors find it difficult to discuss those treatments frankly with parents because there is little evidence that they work even though some parents believe they do.

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Just a year after Arizona lawmakers created a school choice and scholarship program for students with disabilities, the program has been expanded to other groups of students, doubling its potential reach.

On Monday, Arizona Gov. Jan Brewer signed into law a measure that expands eligibility for empowerment scholarship accounts, which can be used to pay for private school tuition, tutoring, online courses, or saved and spent on college tuition.

Earlier this year I wrote about how school choice programs, especially private school vouchers, often begin with students with disabilities. Those programs, largely unchallenged, are then expanded to include other groups of students.

Why? Generally, it comes across poorly to protest programs intended for students with special needs, several experts told me at the time.

The additions to the Arizona program will allow the children at D-graded schools, children of active duty members of the military, and children adopted out of the foster care system to qualify for a scholarship account, said Jonathan Butcher of the Goldwater Institute, a free-market think tank based in Phoenix. He helped craft the bill, and tweak it, after Brewer initially vetoed it. (Students at F-graded schools would be eligible too; Arizona just doesn't have any of those yet.)

These students would be able to use the accounts for the first time during the 2013-14 school year and will boost the number of students eligible to about 200,000, Butcher said, with most of the additional students coming from D-graded schools. Brewer, the Goldwater Institute's education director, had said offering those students choice was a priority. Already, Arizona students can choose to attend any public school, although transportation is typically provided only if students attend their neighborhood school.

The 150 students with disabilities who have signed up for accounts have received on average about $13,000, but other students will get less, about $3,400, Butcher said, because of the way state funding works.

"Thanks to this program's expansion, more students in Arizona will be able to customize their education—something we could have only dreamed of just five years ago. We're not talking about just choosing a different school, but a complete school experience specifically designed for each student," Butcher said in a press release. "This is the future of education in the U.S."

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Nearly three years after U.S. Secretary of Education Arne Duncan first sent states letters asking them to review policies and guidelines on the use of restraint and seclusion in schools, the Education Department has issued its own nonbinding guidance on the practices.

Restraint and seclusion, often used on students with disabilities, are intended to be used in emergency situations, when students are in danger of hurting themselves or others. But several reports, including one by the U.S. Government Accountability Office have found that the practices are being used inappropriately and incorrectly, leading to injuries, or even the deaths, of students.

"There is a difference between a brief time out in the corner of a classroom to help a child calm down and locking a child in an isolated room for hours. This really comes down to common sense," Duncan said in a statement.

The Education Department said its long-awaited 15 principles about restraints and seclusion should be used as the foundation of policies and procedures created by states and districts, but it isn't binding or required. The principles were a collaboration between the department and the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

"These principles stress that every effort should be made to prevent the need for the
use of restraint and seclusion and that any behavioral intervention must be consistent with the
child's rights to be treated with dignity and to be free from abuse," Duncan wrote in a letter at the beginning of the 40-page document. "The principles make clear that restraint or seclusion should never be used except in situations where a child's behavior poses imminent danger of serious physical harm to self or others, and restraint and seclusion should be avoided to the greatest extent possible without endangering the safety of students and staff."

Among the principles:

•Preventing the need for restraining or isolating students should be a priority.
•Mechanical restraints should never be used to restrict a student's movement, and schools shouldn't use drugs or medication to control a student's behavior unless these have been prescribed by a doctor or other health professional.
•Students shouldn't be physically held down or restrained except when they are in imminent danger of hurting themselves or someone else.
•Policies restricting restraint and seclusion of students should apply to all students, not only kids with disabilities.
•Isolating or restraining students should never be used as a form of punishment or discipline, coercion, retaliation, or as a convenience.
•Restraining or seclusion of a child should not involve restricting his or her breathing or anything else that harms the student.
•Multiple uses of restraint or seclusion of the same student should trigger a review and if necessary, a revision of the strategies in place to address dangerous behavior; and,
•Teachers and other staff should be trained regularly about appropriate use of effective alternatives to physical restraint and seclusion, such as positive behavioral interventions and supports, and safe use of restraint and isolation.

The Education Department also suggests informing parents about policies on restraint and seclusion at their children's schools, when the practices are used, and all incidents should be documented.

U.S. Rep. George Miller, D-Calif., who has pressed for federal legislation about restraint and seclusion, applauded the Education Department's new document.

"Though some states have made progress developing policies on seclusion and restraint, the policies vary widely in what protections they afford students. A patchwork of protections, riddled with holes, is not acceptable when it comes to children. We cannot sit idly by as incidents of students being abused or inappropriately restrained continue to occur."

He said the 15 principles outlined in "Restraint and Seclusion: Resource Document" support the bill he first introduced in 2010, the Keeping All Students Safe Act.

The American Association of School Administrators, which has said it opposes federal legislation about restraint and seclusion, said it agrees with the tone and direction of the new guidance.

"The department's tone that seclusion and restraint are for student and employee safety not student discipline was important," said Bruce Hunter, the group's associate executive director, for advocacy, policy, and communications.

However the document may be overly reliant on the GAO report, he said, and AASA still prefers state-based policies on restraint and seclusion.

"State policy is more informed by the full range of stakeholders," he said. In addition, Hunter said the federal discussion on restraint and seclusion hasn't focused enough on injuries to teachers and other school employees that are serious enough to merit workers' compensation claims and sick leave, which is something his organization is researching now.

He said one of the best contributions the federal government could make regarding restraining and secluding students is by paying for training that would improve local practices and state policies.

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After reading this recent piece in the Chicago Tribune about students getting accommodations on the ACT, I couldn't help but wonder what the picture looks like nationally.

The Tribune's Diane Rado was able to drill down to the school level to find out how many students were getting extra time or other accommodations, factors that can make a big difference on the test, taken by all high school juniors in Illinois.

At one high school, she found that 1 in 6 test takers were granted extra time or a special testing format.

Nationally, as the number of students taking the ACT has increased in the last four years, so has the number of students asking for, and getting, extra time or other accommodations when taking the exam, the testing agency told me.

During the 2010-11 school year, 5 percent of all test takers were provided with some feature that was intended to adapt the test to their needs, ACT spokesman Ed Colby said, compared with 3.5 percent of test takers in the 2007-08 school year.

The numbers of requests have been rising among SAT takers, too, along with an increase in test takers overall. Once students are approved for an accommodation, they don't have to reapply. Of new requests—almost 80,000 during the 2010-11 school year, compared with 10,000 fewer five years earlier—about 85 percent are approved, said Kathleen Steinberg, the spokeswoman for the College Board. The ACT said roughly 90 percent of requests made are granted.

While the Tribune story delved into whether accommodations are too common, a Government Accountability Office report from late last year found that for some students with documented disabilities, getting accommodations can be a hassle. The testing companies have said that they have to be judicious in doling out special testing conditions to keep things fair.

Both companies said students with learning disabilities, followed by students with ADHD, are the most common among those requesting an adjustment to their testing experience. Most students want extra time, and in the last year, the SAT said at least one student was given four times the amount of time given to other testers to take the exam.

But are all students with learning disabilities or ADHD being accommodated? Or just the ones who can navigate the lengthy, and potentially costly, process? As I just wrote, the GAO found that sometimes getting the proper assessments testing companies require can cost from $500 to $9,000.

The newspaper analysis found that in the case of Illinois juniors taking the ACT, "schools in wealthy enclaves with predominantly white students were at the top of the list when it comes to students getting ACT testing accommodations." The colleges that students apply to are never told if a student was granted any alternate conditions for taking the test.

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Two members of Congress with children who have dyslexia recently created a new caucus devoted to the learning disability.

In a letter to fellow members of Congress, Rep. Bill Cassidy, a Louisiana Republican, and Rep. Pete Stark, a Democrat from California, note that dyslexia is the most common disability.

"All too often dyslexics are either misdiagnosed or misunderstood, and as a result their true skills and abilities go ignored," the pair wrote, noting a Government Accountability Office report released late last year that explored accommodations on standardized tests such as those required for college.

Disability experts and applicants also told us that, in some instances, they found testing companies' documentation requirements on providing a history of the disability to be unreasonable. ... For example, one applicant was asked to obtain a new evaluation of her disability even though school evaluations conducted every 3 years consistently showed that she has dyslexia. Applicants and disability experts we spoke with told us that obtaining these assessments can be cost prohibitive, and applicants reported costs for updating these assessments ranging from $500 to $9,000.

The representatives said there is much work to be done in raising awareness about dyslexia and changing policy to create opportunities and remove barriers for the success of those with dyslexia. A new movie, "The D Word," approaches dyslexia as a neurological issue, explaining that the struggle with the written word is not an indication of one's ability to think, to create, or to solve problems, and highlights successful people who have dyslexia.

Other congressional caucuses exist to rally around specific disabilities. One example is the Congressional Down Syndrome Caucus, formed in 2008. And the Autism Caucus was created more than 10 years ago.

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More than 225,000 people are beseeching Massachusetts school that has used shock therapy for years to stop the practice, noting that some groups including officials from the United Nations have called the practice torture.

The Judge Rotenberg Center in Canton, Mass. is a residential school for students with disabilities and behavior problems. Many of the students who attend have been placed there by school districts in Massachusetts and other states who say it is the best option for students they cannot serve.

One of the school's methods to curb or stop behavior, such as a student's refusal to eat or their violent tendencies, is through shock treatment developed by the school's former director. In a video on the school's website (choose the first link here) the then-director Matthew Israel, who retired last year, describes the treatment as the equivalent of a two-second bee sting.

Now, former employee Greg Miller, has created an online petition to push for an end to the practice, which has been challenged in court but remains legal. As this 2007 in-depth piece about the school in Mother Jones notes, the school is named after one of the Massachusetts judges who allowed the practice to continue in the 1980s.

The federal Department of Justice launched an investigation into the school two years ago, and the agency has been urged to speed up its work.

Miller said he worked as an aide at the school from 2003 to 2006, while he was studying alternative medical approaches for the treatment of children with learning difficulties and autism. Miller, who had previously been a teacher, now lives in California where he is studying Chinese medicine.

"I went through this change process myself from believing this was a place that could save these students to where I realized there were so many other things they could do and were not doing," Miller said in an interview with Education Week.

The school says treatment is only used with parents' consent and only after each student goes through an involved legal process in which they are assigned their own lawyer. A team of therapists evaluates whether the therapy should be considered.

Miller claims that with parents scarce at the school, the shock treatments were used far more frequently than the school maintains, and having experienced a shock during his training, it was far more brutal than a bee sting.

In this (also disturbing) video, which the school battled to keep private, a student who has autism shrieks and begs not to be shocked. Last month, his mother settled a lawsuit against the school out of court.

"I never signed up for him to be tortured, terrorized, and abused," Cheryl McCollins says on the video about her son, Andre. "I had no idea."

On Wednesday, Miller delivered the signatures gathered on Change.org to Massachusetts lawmakers. Miller and McCollins met with several legislators including the state's house speaker.

It isn't clear whether any of them will be compelled to act. A bill to end the shock treatments has repeatedly passed the state senate, but not the house.

"These parents are desperate," Miller said of those whose children end up at the center. (Before and after photos and video of students on the school's website show stark changes between students who have had therapy, and they include one girl who says she volunteered for the treatment.)

"As much as they try to show how much these kids need this electric shock," Miller said, "there are other methods out there."

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Unprecedented numbers of American children are being identified with special medical and educational needs, and over the past several decades, the types of predominant childhood disabilities have shifted from physical disorders to mental health disorders, according to the latest edition of the Future of Children, a publication from the Brookings Institution and Princeton University.

The new report says that ADHD is about three times more likely than asthma to contribute to reported childhood disability.

Why does this shift matter? The authors said research shows that on average, mental health disorders in childhood have larger effects than childhood physical health problems on adult health, years of schooling, participation in the labor force, marital status, and family income.

The editors said that the term "disability" is not standardized, complicating researchers' ability to understand increasing disability rates. Regardless, the prevalence of mental health problems among children and their potential effect on human capital are worrisome, they said. Although mental disabilities make up a growing share of children's disabilities, services haven't grown at as quick a pace.

The report also talks about health care for children with disabilities and the complex role health insurance plays in access to and quality of care. Other sections are devoted to disparities among children with disabilities and the role technology can play in reducing disabilities if equitably distributed.

A key goal for modern society, the authors say, should be to devote resources to prevent, diagnose, and manage health conditions in children to improve their ability to function and their future trajectories. The report shows that the costs of not doing so may be greater than the costs of many interventions to prevent and reduce childhood disability.

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A new review of research tackles the effectiveness of different strategies that are meant to prepare young children, especially those with disabilities, for school. Early intervention can have a huge effect on whether students with disabilities are ready for school, and may even help them exit special education before or soon after they enter school.

In a recent review, the U.S. Department of Education's  What Works Clearinghouse found that something called milieu teaching appears to have no discernible effects on prepping young children for school, and more research is needed about another strategy known as play-based interventions.

When teachers use strategies embedded in regular activities to prompt students to do a specific thing, it may be a form of milieu teaching. For young children with disabilities, the method can be a way to prepare them in preschool for the rest of their educational life.

Here's an example from the Plano, Texas, school district.

"This might be placing favorite toys visible but out of reach, presenting the child with a new activity, or 'forgetting' to provide a key component of a familiar activity. When the child appears to want the item, the adult makes eye contact with the child. The adult may simply look expectant,anticipating the child's asking for the item. If the child makes the request (i.e. is able to produce the target skill), then he or she is praised by the adult and receives the item along with social praise. If he or she does not respond appropriately, then the adult may try one or more of a variety of prompts, usually starting with the least intrusive. These include: providing the child with a natural prompt ('What do you want?'), explicitly asking the child to make the request ('Make the sign' or 'Point to the picture'), modeling the request for the child, or physically guiding the child in making the request. ... When the child has produced the target skill using whatever assistance was necessary, he or she receives the item along with social praise. It is usually not a good idea to use too many prompts because this can confuse the child, or make the child prompt-dependent. ..."

The What Works Clearinghouse said it looked at 161 studies about milieu teaching, finding only one that met its criteria for research. Based on that study of 40 preschool children with developmental delays in Davidson County, Tenn., the WWC said there just isn't enough evidence out there to vouch for milieu teaching.

The agency also looked at research about play-based interventions. These are described as "practices designed to improve socioemotional, physical, language, and cognitive development through guided interactive play." (Please share an example if you have one.) An interventionist uses strategies to sustain and encourage child play activities, WWC says. "Through the use of appropriate play materials and the direction of the interventionist, the goal is for young children with disabilities to be better able to explore, experiment, interact, and express themselves."

But does it work? A review of more than 60 studies from the past two decades found that none met the WWC's criteria for quality research, (something that's been lamented in the past).

The agency says still more research is needed.

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