Attention deficit hyperactivity disorder leads the list of mental health issues captured in the first-ever report by the Centers for Disease Control and Prevention intended to monitor the mental health of youth ages 3 to 17.

The report, which uses information compiled from several different monitoring sources, found that about 8 percent of the youth in this population had ever been diagnosed with ADHD, as reported by their parents. The next most-frequent mental health disorder was "behavior or conduct problems" at 3.5 percent, and anxiety at 3 percent.

The report found that 13 percent to 20 percent of children living in the United States experience a mental disorder in a given year (the varying percentages are because of the different sources of information,) and the disorders appear to be growing more prevalent. Mental health treatment has an estimated annual cost of $247 billion, which includes the cost of special education, use of the juvenile justice system, and decreased productivity.

The report noted what many parents and educators already know: Many of these disorders can be present at the same time. For example, ADHD, "oppositional defiance disoder," and conduct disorders often co-exist.

Knowing how often these disorders occur is the first step in targeting resources to assist families and communities, the report said. My colleague, Nirvi Shah, who covers school climate issues, has pulled out additional statistics from the report.

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A state-by-state analysis of the most recent data on graduation rates for students with learning disabilities shows that while more of those students have been leaving high school with a standard diploma, many states are struggling to reach the national graduation rate average of 68 percent for students in that disability category.

Students with learning disabilities—dyslexia, dyscalculia, or auditory or visual processing disorders, for example—make up about 41 percent of the students who are covered under the Individuals with Disabilities Education Act. The New York-based National Center for Learning Disabilities combed through the data collected by the federal government on students with disabilities to produce a report called "Diplomas at Risk," which argues that despite improvement over the years, far too many students with learning disabilities, or SLDs, are dropping out of school or being shunted to an alternative certification path that leads to something other than a standard diploma.

"While things are moving in the right direction, we don't think we're moving in the right direction fast enough," said Candace Cortiella, the director of the Advocacy Institute and the report's author. "Some states have significant problems that need to be addressed."

The "Diplomas At Risk" page on the NCLD website will get you to the report after a free registration process. Registration will also allow the organization to invite you to a webinar discussing the findings at noon EST tomorrow.

Digging Into the Data

The exit data collected on students with disabilities includes only those who were covered by the IDEA when they left high school. Students who transferred into general education are not included in the calculation, even if they received special education services for most of their school career. The most recent data is for the 2010-11 school year.

The 68 percent rate of students leaving high school with a standard diploma marks an increase from 57 percent in the 2001-02 school year. But 17 states were below the 68 percent national average. Nevada, at 25 percent, had the lowest rate of SLDs earning a regular diploma.

Nationwide, the dropout rate for SLDs was 19 percent. But 22 states had dropout rates higher than the national average; South Carolina, at 49 percent, had the highest dropout rate.

Many states allow students with disabilities to leave school with some sort of completion document that does not meet the same requirements as a standard diploma. In Mississippi, the percentage of SLDs earning an alternative certification approached 60 percent.

The report also calculated graduation rates using the new "adjusted cohort graduation rate," which the U.S. Department of Education required for the first time in 2010-11. While students with disabilities are calculated separately for the purposes of comparison, they are not broken out by disability categories. States also have different ways of deciding who counts as a student with a disability, making comparisons across states difficult.

However, the calculations showed a wide graduation gap in some states—in Mississippi, for example, 75 percent of all students earned a diploma under this measurement, compared to 23 percent of students with disabilities, a gap of 52 percentage points. In South Dakota, the graduation rate for all students matched the rate for students with disabilities, at about 83 percent.

Recommendations for Policymakers

The report offered several possible explanations for the graduation rate disparities. For example, schools may decide as early as elementary school to take a student off a regular diploma track. States with multiple high school completion options also tended to be states that had a lower percentage of SLDs earning regular diplomas.

The NCLD said that states should consider limiting how many alternate certification paths are available. Other policy recommendations were to use the adjusted cohort rate for students by disability category, to enable more accurate tracking of the issue. States should also create incentives for school districts to tackle graduation rate disparities, the report says.

And districts need to avoid steering students into paths that lead to less exposure to the general curriculum, said Laura Kaloi, the public policy director for the NCLD.

"In some states, you can decide as early as 2nd or 3rd grade whether to go into an alternate assessment. You're making a decision very early that THE?--MB child will not have full access to the general curriculum," she said. Students with learning disabilities "absolutely should be part of the regular classroom, with the support and services they need."

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Student performance, not just procedural compliance, is the goal of a revised reporting system proposed by the federal office of special education programs.

The proposed revisions affect both Part B of the Individuals with Disabilities Education Act, which applies to about 6.5 million youth ages 3 to 21, as well as Part C of the act, which affects about 454,000 children from birth to age 3.

In both cases, the federal government has suggested removing some reporting requirements and instead asking states to create a "State Systemic Improvement Plan." This plan is expected to be a "comprehensive, ambitious yet achievable plan for improving results for students with disabilities." States will be asked to use that document to develop a multi-year plan that will improve students with disabilities' performance on tests, high school graduation rates, and post-school outcomes. (For children covered under Part C, the systemic improvement plan would measure how well early-identification systems are implementing evidence-based practices that improve outcomes for babies and toddlers with disabilities.)

For the fed's explanation of its proposed changes, please see the links to "Rationale and Explanation" on the Part B page; there is also a rationale and explanation document on the Part C page. Both links also include a list of "directed questions" that the federal government is asking commenters to address. Comments will be accepted until June 14.

The Individuals with Disabilities Education Act requires the federal government to evaluate states on special education performance. A long-running complaint has been that the process of producing annual performance reports and state performance plans was burdensome and focused too much on procedural compliance and not the most important goal—improved education for students with disabilities. States have been asked to provide information on 20 performance indicators under IDEA Part B, and 14 indicators under Part C. The Part B indicators, for example, include data such as graduation rates, dropout rates, suspensions and expulsions, and disproportionate representation.

The federal government then evaluates each state's efforts and releases a determination letter noting if they "meet requirements;" "need assistance," "need intervention," or "need substantial intervention." (Part B determinations are here; Part C here.)

In an interview, Melody Musgrove, the director of the office of special education programs, said that the federal government was sympathetic to those concerns. Part of the rationale behind the changes is to try to ask information from the states the way that states are used to thinking about their own activities. For example, under the current performance system, states are asked to come up with improvement plans for individual indicators. But states generally try to develop improvement plans that could improve the performance of students with disabilities in several areas. The state systemic improvement plan attempts to capture those efforts, she said.

The education department started its work in revising its special education reporting system last year. Some of the current indicators will remain in place because Congress wrote into the law that certain data points have to be gathered; the federal government expects that a new computerized reporting system will help make collection of that data easier to manage.

"We've designed a system that is going to shine a bright light on students with disabilities," Musgrove said. "I have no doubt that five years from now, we'll be seeing some progress."

Nancy Reder, the deputy executive director of the National Association of State Directors of Special Education, said state special education chiefs are generally approving of the changes. The old reporting system didn't allow states to demonstrate easily the work that they were doing to improve student outcomes, Reder said, and some of the reporting requirements were redundant.

This system "is a balanced approach to focuing on both compliance and outcomes," she said.

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Monday is the last day to offer comments on the draft version of an accommodations manual developed by one of the groups tasked with creating Common Core tests. (The link takes you to a page that includes the draft manual, a narrated PowerPoint presentation, a link to share your comments, and a page of frequently asked questions. Comments will be accepted until 5 p.m. Eastern time.)

The manual was developed by the Partnership for Assessment of Readiness for College and Careers, or PARCC. Advocates for students with disabilities have seen some of this information before; Earlier this year, PARCC released drafts of specific policies that were incorporated into this comprehensive document.

Those earlier comments, which were solicited on issues such as how to handle read-aloud accommodations, calculator use and word-prediction software did drive changes that are reflected in draft manual, said Tamara Reavis, PARCC's senior adviser for assessment, accessibility, and equity.

For example, the draft of the comprehensive manual has removed terms that were used earlier, such as saying that the read-aloud accommodations could only be used by "virtual non-readers." That terminology was changed to "the student is virtually unable to read printed text and is at the beginning stages of learning to decode, not simply reading below grade level."

The manual also shows how the accommodations that are intended for students with disabilities fit into an overall model of providing support to all students, Reavis said.

Some disability advocates have the same problems with this draft manual as they did when earlier pieces were released, however. Laura Kaloi, the director of public policy for the New York-based National Center for Learning Disabilities, said in an interview Friday that the manual fails to explain how using certain accommodations, such as read-aloud, would invalidate the test items. "They have not explained why these restrictions are necessary on test items that are not yet designed," she said.

The Learning Disabilities Association of America has its own concerns with the manual—the organization contends that all of the test's accessibility features should be available to all students with disabilities, with an IEP team making the decision about which accommodations are appropriate for a given student.

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In 2011, the American Academy of Pediatrics released guidelines on how doctors should treat preschoolers with attention deficit hyperactivity disorder. The first step should be parent and/or teacher-administered behavioral therapy. If symptoms continue, the next step is medication with methylphenidate, better known under the brand names Ritalin or Concerta.

But only about 10 percent of medical specialists responding to a survey on their treatment methods said that they followed those guidelines exactly. Many chose medication as a first-line treatment; others chose to prescribe different types of medication, or refused to prescribe drugs even when behavioral therapy was not showing success.

The findings were released at a recent meeting devoted to research in child development, the Pediatric Academic Societies.

Dr. Anthony Adesman, one of the study's authors and the chief of behavioral and development pediatrics at Cohen Children's Medical Center of New York, said that a survey was sent to 3,000 preschool ADHD specialists and received 714 surveys in return. The results were limited to 614 specialists who say they diagnose preschool ADHD in 4- and 5-year-olds, including child psychiatrists, neurologists, and developmental pediatricians. The full report is not available online, but Dr. Adesman shared with me his presentation, which offers a detailed breakdown of the numbers.

His survey found that of the 611 specialists in preschool ADHD who responded, about 20 percent said they recommended first-line treatment with medication "often" or "very often." The recommendations were made regardless of the availability of behavioral therapy options.

About 30 percent said they "rarely" or "sometimes" recommend medication if modifying the child's behavior has not been successful.

The survey also found that some doctors were choosing to prescribe drugs other than methylphenidate. Though the AAP recommends that only that particular drug be used with 4- and 5-year-olds, about 19 percent of the respondents are choosing to use amphetamines such as Adderall or Dexedrine, Dr. Adesman said. (Both drugs are approved in children ages 3 or older.) Another 18 percent are prescribing other non-stimulant drugs for ADHD treatment. One such drug, Clonidine, is FDA-approved for use in youth aged 6 or older.

Among the specialists surveyed, only about 10 percent said they followed AAP recommendations exactly. Those most likely to adhere to the AAP guidelines were child psychiatrists; 12 percent of the survey respondents who were child psychiatrists followed those recommendations. The general psychiatrists who responded to the survey were least likely to follow the guidelines exactly; only 4 percent said they did.

In an interview, Dr. Adesman said that the results could reflect that children who see specialists may have more severe symptoms, or that doctors are more familiar with medications. However, another explanation could be that some doctors "are reluctant to recommend behavior therapy, or to give it a chance."

Teachers can play a meaningful and important role in implementing behavior modification techniques with young children, Dr. Adesman said. He also added that medication has a place in treating ADHD if other methods are not successful. "Teachers may want to educate parents that the AAP does see medication as a possible option," he said.

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Cyrus Stoller (left) and Ryan Stevens, winners of the AT&T and Autism Speaks hackthon. Photo courtesy of AT&T.

People with disabilities and their families have long relied on word-of-mouth to find disability-friendly community businesses, but that recommendation system has been given a new twist after a "hackathon" sponsored by AT&T in partnership with the advocacy group Autism Speaks.

Ryan Stevens, 25, and Cyrus Stoller, 24, both living in San Francisco, won $10,000 for creating RevTilt, a review site that allows users to suggest businesses that accommodate people with autism.

For example, a Chinese food restaurant gets high marks for always having the same order ready to go for a patron. A hair salon was praised for gently easing a five-year-old through a haircut. The hairdresser "showed him the razor and put the trimmer side against her hand. He did not flinch or anything! It went quick! I think it was the owner, he was walking around and offered water. Everyone was just so nice," the reviewer wrote.

Stevens and Stoller compiled their results from real-life reviews, and say the website is ready for more contributions from around the country.

"Some of that information does exist on [the review site] Yelp but to find it is just dumb luck," Stoller said in an interview. "We should be able to find that information all in one place."

This is especially helpful for businesses that are accommodating but may not be marketing themselves specifically to the autism community, said Stevens.

Both developers have ties with the autism and medical communities; Stevens has a cousin with autism, and Stoller's mother is a pediatrician. The final project is open source, so the developers are welcoming other programmers who would like to enhance the product. The website will also be easy to expand to include other disability categories if there's enough interest, he said.

The hackathon event, held in mid-April, invited programmers to bring to life ideas that had been suggested by visitors to the Autism Speaks Facebook page. The category of apps geared towards the autism community is growing, according to a recent article in the Los Angeles Times. RevTilt was selected as the winner from 26 entries; the other prizewinners and descriptions of their apps can be found here. (You'll see RevTilt referred to by an earlier name, "Puzzled.")

On Special Education is on Twitter! Follow @OnSpecEd.

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The U.S. Department of Justice said Wisconsin private schools that accept taxpayer-funded vouchers must not discriminate against students with disabilities in a new guidance letter.

The Justice Department was prompted to investigate the situation in Wisconsin after a complaint from the American Civil Liberties Union and other state groups that claimed that Milwaukee was essentially creating a system of segregated schools.

The complaint said that 1.6 percent of the students using vouchers in Milwaukee were classified as having disabilities, compared with 20 percent of Milwaukee's public school students. The 22-year-old program is administered by the state and enrolls about 24,000 students who receive vouchers of approximately $6,400 a year. (Here's some more facts and figures on the Milwaukee program.)

Students with even minor disabilities were routinely denied admission and pushed out of voucher-accepting private schools, the Wisconsin advocacy groups said. Also, families of students with disabilities were not told of their right to use the program, and the schools themselves were not monitored for adherence to the Americans with Disabilities Act.

The Justice Department letter, dated April 9 but released Thursday, says that the state must create a process for people to register complaints; monitor schools to make sure students are not being expelled or denied admission because of their disabilities; conduct outreach to parents about school choice options; and train new and existing voucher-accepting schools about their responsibilities under the ADA. These processes must be in place by the 2013-14 school year.

Gov. Scott Walker, a Republican, has proposed expanding the Wisconsin voucher program to students with disabilities statewide. He has also proposed expanding vouchers for all students to additional cities in the state.

"It would clearly be an irresponsible use of tax dollars and a disservice to parents to even discuss expansion of the current voucher program or implement a new special needs voucher at this time," said Lisa Pugh, the public policy coordinator for Disability Rights Wisconsin, in a press release. "A special needs voucher that leaves it up to the school to decide whether or not to accept a student will not solve this egregious problem."

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South Carolina scored a victory in court last week when a federal court said that the U.S. Department of Education would have to hear the state's appeal of a decision to cut its special education funding.

Under the Individuals with Disabilities Education Act, states are not allowed to cut their special education funding from year to year without permission from the U.S. Department of Education. South Carolina made cuts in three academic years, earning it a $36 million penalty in federal special education funds that was set to stay in place permanently.

However, Congress tweaked the rules last month, and now the penalty only lasts as long as a state was out of compliance with funding mandates.

The state is protesting the fact that it had to pay any penalty at all, but the Education Department refused to hear its complaint, saying that the IDEA does not have a provision for such a hearing. The 4th U.S. Circuit Court of Appeals decision, however, says that the Education Department must at least hear the state out.

"We've been partially exonerated," South Carolina Superintendent of Education Mick Zais told the Associated Press. "We contended all along we were entitled to a hearing and that Secretary Duncan acted improperly when he denied us a hearing."

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Last week, I wrote about a Tulsa World article that outlined the challenges of assessing students with severe disabilities on state standardized tests. This week, The Dallas Morning News explores the same issue, writing about how some Texas students with severe disabilities will not be marked as proficient on the state's new standardized tests.

Texas is replacing its former TAKS (Texas Assessment of Knowledge and Skills) program with the State of Texas Assessments of Academic Readiness, or STAAR. The STAAR-Alternate program is for students with severe disabilities, and allows students to be tested on simpler tasks that correspond to academic standards. However, students who are tested on only the most basic tasks will not be counted as proficient under state and federal accountability standards.

That non-proficient rating will not affect the child, but it will affect the school. The article explains that the state created the rule to nudge teachers in the direction of creating challenging assessments for students with disabilities. Educators say that in some cases, time spent trying to get students to master the tests takes away from life-skills instruction. From the article:

For kids whose ability to understand is far below the norm, spending time on academics is time not spent on life skills, some teachers complain.

"STAAR-Alternate is just a small part of what I think they need to know," said Jessica Warner, a special education teacher for the Duncanville school district.

But some national experts on special education and accountability say that having tests that push harder than some teachers feel is appropriate is not a bad idea.
Multistate studies have shown that many students actually understand more than some teachers may think, said Lindsay Jones, senior director for policy and advocacy for the Council for Exceptional Children. And proper testing can help identify those students.

But reaching those students requires communications tools, technology and other resources that represent extra costs for budget-strapped educators, she acknowledged. "It's an extremely difficult population to assess," Jones said. A test that too many students are passing may be evidence that "it's a little easy and we aren't challenging our kids as much as we should," she said.

But this story suggests that the issue will continue to be a struggle for students, parents, teachers and districts, particularly as states adapt to the Common Core State Standards (though Texas is among the few states that has not adopted the common core).

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Crossposted with Early Years.

The Maternal and Child Health Bureau, part of the U.S. Department of Health and Human Services, is hosting a webinar today at 2 p.m. ET on Maine officials' attempts to improve early-intervention services in that state through better coordination between doctors and early-childhood care providers.

The hour-long webinar will also feature a discussion about efforts in Massachusetts aimed at providing more early services to young children who may have autism spectrum disorders. The state is trying to cut down on the time that parents have to wait to have their children evaluated by specialists, and is also trying to stay in touch with parents through an email messaging system.

The webinar will be placed in the bureau's archives for those who can't tune in live.

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