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Tourette Syndrome and Tic Disorders in the Classroom

Posted by on April 5, 2012

By: Dr. Meir Flancbaum

As a teacher, you can serve as the child’s “coach,” when he implements strategies in the classroom.

Sam is a bright, considerate, athletic middle school student, but he dreads going to school. Throughout his day, unintended movement and noises known as tics occur so frequently that it is difficult for him to concentrate in class. Sam has a disorder characterized by motor and phonic tics.

While Sam’s close friends and family have always understood and accepted his noises and twitches, lately he has become the target of bullies. They mimic his tics repeatedly, tell him to “shut up,” or call him insulting names, such as “Tourette’s boy.” As Sam’s tics have begun to interfere with his day-to-day life, his once high self esteem has plummeted, along with his grades. His parents and teachers have noticed he is spending more time by himself, and they are worried.

Tips for Teachers

  1. Education increases acceptance: When a child in the class has Tourette syndrome, educate the other students about the disorder. Consider having the child make a short presentation or having a professional come address the class.
  2. Youth with TS are just like everybody else: If a child’s tics are noticeable, but only minimally interfering, the best strategy is just to ignore them.
  3. Behavior Therapy: If tics are more severe, the most effective course of action is to refer the child to habit reversal therapy, where he or she will learn skills to control tics during instructional periods. As a teacher, you can serve as the child’s “coach,” when he implements strategies in the classroom.
  4. Give breaks: If a child has severe bouts during class, consider offering him or her short, pre-arranged breaks that will ensure it is not misinterpreted as a punishment or a way to avoid work.
  5. Avoid telling a child to suppress his tics: This will likely trigger anxiety and stress, which increases a child’s urge to tic.
  6. Set a good example: Taking a supportive and accepting stance regarding a child’s tics demonstrates how you want his or her peers to respond.

Many people assume that tics are quite rare, and confuse them with Tourette syndrome (TS), but current research suggests that tics affect 12-18% of school-age children. Tourette syndrome, in contrast, is significantly less common: Actual diagnoses are being made in between one and ten cases per thousand individuals.

Tics are short, repetitive, stereotypic movements of muscles or vocalizations, including blinking, facial grimacing, leg twitching, sniffling, grunting or throat clearing. When a particular tic involves multiple muscle groups, such as extending one’s arm and then making a fist, it is called a complex tic. Only when an individual has multiple motor and at least one phonic tic, will he or she be diagnosed with Tourette syndrome.

Many young people with tics may not be bothered by them, so it is essential to wait and watch to see if they cause any interference at home or at school. Parents and teachers should remain vigilant, however, to make sure tics do not worsen with a child’s changing circumstances or age.

Stress can exacerbate the expression of tics, particularly in middle and high school, as social awareness and pressure mounts, thereby reducing a child’s ability to control tics, and causing serious self-esteem problems. Staying alert and watchful to see if the tics become more disruptive is critical. The child may become distressed by them if they interfere with completing school work, cause body soreness, or trigger feelings of embarrassment, especially if, like Sam, one is teased or bullied as a result.

If it seems like the tics are becoming a problem, the first place to start is by increasing parents’, teachers’ and the child’s knowledge of tics, the course of the disorder, what makes them worse, and treatment options. Simply doing this can help adults feel more comfortable around youth with tics and empowered to get them the help they need. Attending a consultation or in-service trainings about tics and related disorders can help reach this goal, too.

Most important: Never punish a child as a result of his or her tics. In fact, the stress a child experiences in response to such reprimands will very likely make the tics worse.

For decades, the treatment of choice for tic disorders, including Tourette syndrome, has been medication. While medications can be effective, many parents prefer their children not take them, unless necessary, either on principle or due to concerns about adverse side effects.

Recently, there has been a resurgence of research supporting a behavior therapy for tics called Habit Reversal Training (HRT), which can be implemented alone or in conjunction with medication management.

HRT is a behavior therapy designed to help individuals reduce their tics. The first step is to teach individuals to become more aware of their tics, and specifically, the warning signs, which immediately precede them. Though tics may seem to come out of the blue, a behavior therapist can help someone learn to detect them before they happen. Next, individuals are taught to engage in an exact, specific behavior—called a competing response—that is incompatible with exhibiting the tic. The goal of this treatment is to try and teach the brain to resist the urge to tic, even when it thinks that it must. Eventually, the urge to tic may even go away. In addition to HRT, treatment will typically include relaxation training and strategies to reduce stressful situations that can make tics worse.

The most important support a child can receive is from the caring adults who recognize the tics have become a problem and that help is needed, and who then follow through with effective therapies to ensure the child can get on with living his or her life.

Meir Flancbaum, PsyD, is a post-doctoral fellow at Behavior Therapy Associates in Somerset, New Jersey, where he provides clinical treatment, school-based consultation, and training workshops. He specializes in the treatment of youth with Tourette syndrome and associated disorders, including disruptive behavior and anxiety, as well as trichotillomania, or hair pulling. Dr. Flancbaum also conducts research on behavioral treatment for tics at Rutgers University.

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When the Bully is the Teacher

Posted by on September 12, 2011

An Interview with an Expert on Bullying Provides a Thought-provoking Perspective
“Bullying by teachers
is enabled by a conspiracy of silence.”
- Dr. Alan McEvoy

By Jean Harkness

Many parents would advise a child that the only way to deal with bullies is to stand up to them. But, on reflection, this simple philosophy is not practical and can be dangerous. What if the bully is much bigger and stronger? What if there is a group of bullies? What if the bully is an adult? What if the bully is a teacher? Bullying in school is not a simple problem. It extends beyond students and includes the whole school community. Schools are being challenged to expand their thinking about what is involved in creating a more respectful and tolerant school culture. Despite state requirements that bullying policy and programs address the culture of the entire school, many school programs target only the student behavior. Scrambling to meet state requirements to provide researched and proven strategies to address the problem of bullying, schools are using the resources available.

The bulk of research and the resulting program models have been limited almost exclusively to student behavior. Students are the most important emphasis in any school but they are not alone in shaping its culture. Teachers, coaches, and administrators are at the forefront in implementing change and creating a culture of respect. Change begins with school leaders modeling respectful behavior; supporting a no-tolerance approach to bullying; and deploying anti-bullying strategies.

The behavioral expectations for students that promote tolerance and respect should apply equally to the school staff. School efforts to intervene in and prevent bullying should apply to all members of the school community. Preliminary research indicates that the same standards are not being applied or enforced when the bully is a teacher.

Dr. Alan McEvoy, professor of sociology at Northern Michigan University, is a leading authority on harassment and bullying. He has been a pioneer in research that focuses on teacher (and coach) bullying. In a recent interview Dr. McEvoy shared his views and research findings, including his pilot study, Teachers Who Bully Students: Patterns and Policy Implications.

Q: What are the similarities between teacher bullies and student bullies?

A: “Teacher bullying is a common problem that exists in most schools,” said McEvoy. His research found that 93 percent of the 236 teachers and students surveyed reported that teacher bullying occurred in school and the subjects were in agreement regarding who the bullies were within a school. Results from his follow-up study supported these results as well. According to McEvoy, when teachers bully it often involves public humiliation. Teacher bullying most often occurs in front of a classroom of students. “Bullying by teachers is enabled by a conspiracy of silence,” he noted. Students are often hesitant to report because they fear that disclosure will lead to reprisal. Though McEvoy’s research did not quantify this, many of the narrative answers clearly showed that the respondents were afraid:

“Nothing happened after I complained, but since I knew that my teacher knew I complained, I was scared to go to class.”

“I felt the teacher would hate me.”

“Colleagues rarely report bullying because incidents are contained in the classroom, hidden from the observation of other adults,” he reported. Additionally, the students and faculty surveyed perceived that there was no effective or meaningful redress for complaints against teachers for bullying; and that there were seldom negative sanctions for teachers who were reported. The perception that school incident reporting and investigation mechanisms are complicated and ineffective perpetuates the silence and secrecy that enables bullying. Teacher bullying has serious emotional and social consequences that undermines the academic and social climate at school. Bullying is a fundamental corruption and violation of the teacher role. Two characteristics, to educate and to protect, are central to that role. Bullying is a violation of both duties. The emotional and social consequences of bullying carry over and adversely affect the victim’s performance in other classes and school activities. The student’s relationships with other teachers and students are disordered. “Teacher bullying often includes the tacit approval of the group,” McEvoy observed. Bystanders’ silence and/or responses (such as laughter) reinforce the legitimacy of the bullying and create a contagious atmosphere of abuse amplifying the experience of victimization.

Q: What are the differences between teacher bullies and student bullies?

A: Bullying by teachers is rarely physical. Most states have laws that prohibit physical discipline. Additionally, most schools have clear “hands off” policies and procedures that prohibit physical contact with students. Verbal and emotional abuse is a less defined area. A possible exception to this may be athletic coaches. “Active or passive abuses of the athletic training may be employed to cull team players—for example, when a football coach encourages larger team members to ‘go after’ (i.e., take cheap shots or physically hurt) another weaker athlete to get him to quit the team,” said McEvoy. “Bullying by teachers is almost always done in the context of the legitimate role of the teacher to motivate or discipline the student,” he said. “This masks the true nature of the behavior.” For example, a student may be singled out for ridicule or correction repeatedly in front of the class; assigned detentions or other legitimate sanctions; and even poorly graded. Bullying occurs when these legitimate functions are applied unfairly and inconsistently. There is a “gray line” between when discipline and motivational techniques become excessive. Because of the lack of definition regarding the proportionate and appropriate application of discipline and motivation, reported incidents are frequently denied and defended. “When confronted with a complaint of bullying, the action is justified as a legitimate discipline or motivational measure,” noted McEvoy. “Student bullies know what they are doing and that it is wrong,” he said. “Teacher bullies may not fully recognize the harm they are doing.” Once accused of crossing the line, many teachers sincerely contend that they were acting in the best interest of the class or student. Most schools today recognize that student-to-student bullying is a serious problem. In response, many schools have developed policies and procedures and have implemented programs to prevent bullying and promote a respectful school climate among the students. “There is a conspicuous absence of school policies and procedures dealing with teacher bullying,” said McEvoy.

Q: Why is teacher bullying a critical issue for a school community?

A: “It is the function of the school to educate,” said McEvoy. “Effective teaching is dependent on establishing effective and positive social and emotional relationships with students. Bullying by teachers interferes with and can destroy the development of such relationships and thereby disrupt learning.”

“Accommodations also need to be made for students who feel they are being bullied,” according to McEvoy. Schools can build flexibility into their programs to enable students to leave a class or situation that makes them uncomfortable without the repercussion of losing credit or missing work. Online learning opportunities, transferring to another class, or other accommodations should be made available.
The mechanisms exist for schools to address the problem of teacher bullying. Incident reporting and investigation are ingrained in our school systems for other kinds of behavior like sexual harassment claims. These existing policies and procedures can be reviewed and adapted to the problem of teacher bullying.

New Jersey is known to be a highly litigious state. Challenging a tenured teacher provokes fear of union involvement and expensive law suits. While these are realistic concerns for schools in the midst of cuts that limit staff time and district funding, school boards do have the authority to stand up to bullies by creating policies that can be effectively enforced. The topic needs to be addressed and the dialog needs to begin. A culture of respect can only be created when the entire school community—including teachers and administrators—supports the fair and consistent application of behavioral expectation.

Jean Harkness is a policy consultant with New Jersey School Boards Association’s Legal & Policy Services Department. She can be reached at jharkness@njsba.org. Reprinted with permission from the November/December 2010 issue of School Leader magazine. Copyright 2010 New Jersey School Boards Association. All rights reserved.

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When is the Right Time to Graduate?

Posted by on June 1, 2011

By Ira M. Fingles, Esq., and Elizabeth M. Roberts, Psy.D.

Under federal law, a student with disabilities is entitled to special education and related services until age 21, or until the student accepts a diploma – whichever comes first. The decision about when a student should gradate is made by the IEP team during the IEP process.

When should a child with a disability graduate?

For students with complex, significant disabilities, the decision about when to graduate may be more obvious. The New Jersey Division of Developmental Disabilities (DDD) generally will not offer day services until age 21, so most students with disabilities who will likely be served by DDD should remain in school until age 21.
When is the cut-off date for turning age 21?

Students are eligible for services through the end of the school year in which they turn 21. For example, if a student’s 21st birthday falls on June 30, 2011, special education services will terminate then because it marks the end of the school year. If, however, a student’s birthday falls on July 1, 2011, services would continue through the end of that school year – June 30, 2012. Districts may, at their discretion, serve students beyond age 21.
When should students who are taking high school courses and earning credits graduate?

It is very possible for a student to have earned enough academic credits to graduate, but not have met his or her IEP goals related to transition. In such situations, the student should remain in school.

When considering whether the student should be given a diploma prior to age 21, the IEP team may not rely solely upon whether the student has completed credits and coursework for graduation. It must also consider whether the student is prepared for further education, employment and independent living. The IEP team must consider whether the student’s transition goals have been met and whether the student needs continued transition services in order to achieve his/her desired goal upon graduation.

What are Transition Services and when must they be provided?

Transition services are defined by federal law as a coordinated set of activities designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the student with a disability in order to facilitate the student’s movement from school to post-school activities, including post-secondary education, vocational education, employment, continuing and adult education, adult services, independent living or community participation.
Transition services must be based on the student’s needs, taking into account strengths, preferences and interests. They must include instruction, related services, community experiences, the development of employment and other post-school adult living objectives and, when appropriate, daily living skills and functional vocational evaluation.

Beginning at age 14 (or younger), each IEP must include measurable postsecondary goals related to training, education, social skills, employment and where appropriate, independent living skills. Beginning at age 16, the IEP must describe the transition services (including the course of study) needed to assist the student in reaching those goals. Such goals should be based on the student’s individualized needs.

What is the Summary of Academic Achievement?

Before a student graduates, he or she must be given a written summary of academic achievement and functional performance, which includes recommendations to assist the student in the achievement of his or her post-secondary goals. The intent of this summary is to provide crucial information to those people who may assist the graduate in the future.

My child accepted a diploma but still needs special education. What can I do?

In most cases, once a student accepts a diploma regardless of the student’s age, the right to special education and related services comes to an end.
What if the parent and district do not agree on a graduation date?

Graduation from high school is considered to be a change in placement for a special education student. Therefore, school districts must provide written notice to the parents of their intent to graduate a student. If a parent does not agree with a district’s decision to graduate the child before age 21, the parent can object and invoke protections under IDEA. Parents must make their objection in writing. If there is a dispute about whether the transition plan is appropriate or whether the student should receive a diploma, a parent may file for mediation and due process proceedings.

Ira M. Fingles, Esq., is an attorney with Hinkle, Fingles & Prior, where his legal work focuses on lifespan disability law. Elizabeth Roberts, Psy.D. is a Clinical Assistant Professor of Child and Adolescent Psychiatry at NYU Medical Center.

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Teachers’ Perspective: Traumatic Brain Injury in Special Education: Addressing a Neglected Disability

Posted by on June 1, 2011

The Symptoms of TBI

The symptoms of TBI vary and depend on a number of factors, such as the severity of injury, the location and extent of injury in the brain, the child’s age and many other factors. There are, however, many common symptoms presented by students with TBI.

At the physical level, symptoms include:

  • Dizziness
  • Headaches
  • Fatigue
  • Vision and hearing disorders
  • Seizures
  • Poor muscle coordination and weakness

Cognitive symptoms include difficulties with:

  • Attention and concentration
  • Memory
  • Processing speed
  • Organizational abilities
  • Language and communication

Emotional and behavioral issues include:

  • Difficulties with impulsivity and self-control
  • Emotional reactivity
  • Weakened self-awareness
  • Anger and aggression
  • Withdrawl
  • Poor social interactions
  • Loss of interest

By Dale Starcher, Ph.D., and George W. Niemann, Ph.D.

Traumatic Brain Injury (TBI) is often referred to as the “silent epidemic” because it is the leading cause of death and disabilities among children and adolescents. In spite of this, TBI often goes unrecognized, especially in schools.

In fact, research shows that only one percent of children who have had a severe head injury are identified and receive appropriate services within our schools. Many are identified with other learning disabilities or diagnoses such as attention deficit/hyperactivity disorder (ADHD) when the underlying issue may actually be TBI.

Because symptoms affect learning, behavior, socialization and physical well-being, it is crucial that educational professionals learn to identify children who have sustained a TBI. These children are often misidentified and classified as learning disabled or emotional and behavioral disordered, and are often viewed as unmotivated or having attitudinal issues.

Most TBI is a result of car accidents, bicycle accidents, falls and sports injuries. The severity ranges from mild concussion (mild traumatic brain injury) to severe, where hospitalization is necessary. Professionals treating TBI have become more sophisticated in recognizing the potential health and educational consequences, even in those suffering from supposedly mild injuries like concussion.

There are many common misperceptions about the long-term effects of TBI. Most school staff, including teachers, school psychologists and administrators believe that: TBI is easily observable; these children cannot accomplish normal tasks; there are always physical disabilities; behavioral features are extreme and bizarre; and there is always a significant decrease in intellectual functioning. All of these beliefs are false.

TBI Within a School Setting
Significant cognitive difficulties following brain injury are often not noticed by educators because these students, on the surface, often appear fine. Unfortunately, it is not the physical but the underlying cognitive, social and behavioral symptoms that can have the most serious consequences.
Some students can recover sufficiently from their injury to display pre-injury academic levels of functioning. The false assumption in such cases is that the recovery is complete, when this could not be farther from the truth. It is new learning after brain injury where great difficulties usually occur. In addition, there are usually discrepancies in overall performance where individuals may perform well in some areas, but really struggle in other very important areas of functioning.

A marked change in sense of self is also common among persons with TBI. There are two concerns in particular. The first is a lack of self-awareness concerning the effects of the TBI. It is not denial (which could also exist), as much as an inability to appreciate and observe the changes that the TBI caused. The second issue is that students will often report that they just don’t feel like themselves, or that they have lost a sense of what’s important to them with statements such as: “It’s like I’m in a void,” or “I feel numb inside.” These can trigger either anxious feelings, a sense of boredom or depression. They can also lead to difficulties with social interaction. One of the central issues facing adolescents returning to school after brain injury is the challenge of fitting in.
Since there are many variables contributing to brain injury symptoms in children, it is difficult to make general statements concerning cognitive deficits, patterns of impairment and behavioral manifestations. In addition, performance and behavioral functioning can fluctuate widely from hour to hour, day to day, and week to week. This can confuse teachers or other educational staff who are working with the student.

In addition, the initial severity of the injury does not always correspond to the degree of dysfunction following the injury. Even mild brain injury can have devastating effects on schoolwork, behavior and socialization. We find, for instance, that when greater demands are placed on the student, more severe symptoms will likely appear.

Assessment and Intervention Within the School
When a child has a TBI and returns to school, it is critical that the school be alerted. There are different ways this can happen, but in most cases, this contact is initiated by either the parents or hospital/rehabilitation center. Typically, they will contact the school nurse. One role of the nurse would be to request any medical records, rehabilitation reports and summaries, etc. Because TBI is a medical issue, the school nurse should have at least some understanding of the injury. In addition, the nurse should contact administration to make sure that other pertinent school staff are alerted to the child’s TBI. Once the nurse alerts administration, administration should then take the lead. This starts by informing the child study team members, who will also review the records. They may, and should, do an observation of the child and discuss the TBI with the teacher. They should also conduct an interview with the student’s parents. They should then make their recommendations to administration. Recommendations can vary dramatically, depending on the type of observations and assessments of the child. Of course, all of this depends on how well the child study team understands TBI and the kinds of interventions that may be most necessary.

What kinds of assessments and interventions should we expect from a child’s school? Here are a few examples of how schools can go about addressing a student’s needs.

Response to intervention (RTI). This is a multi-tiered, problem-solving process designed to determine the level of intervention needed. Within public schools, RTI has become the national standard in addressing special needs.

Functional assessment: A problem-solving approach. With most TBI, an assessment directly related to TBI that addresses academic, emotional, and behavioral factors is highly recommended. This approach enables staff to set specific target goals and track whether improvements have occurred, as well as what will be done if the child is not progressing in particular areas. These plans and tracking devices should be discussed with all staff who interact with the student, as well as the student and parents. By structuring these goals as problem solving, we can create an explicit and practical sequence of steps for each goal. For example, for a child who has organizational issues, visual cues, written instructions, use of planners, etc., can be used to help the child stay on track. The teacher, parent, and others can review these approaches with the child to make sure they are working and being used in a very functional and adaptive manner. This provides a solid basis for future interactions.

Goal attainment: Making sure the functional assessment is student-centered. As part of RTI, an approach that will help a school track the child’s improvements, but within a child-centered framework, is through the use of a goal attainment tracking system. This approach, first used in mental health centers, is a way to evaluate the individual goals of the student concretely and systematically. Goals are first set within general domains. For sake of discussion, let us take three general domains: cognitive, emotional, and behavioral. To assess whether the student’s goals are achieved, a number of pre- and post-assessments need to be administered that will cover these domains. Within the cognitive domains, common goals are concentration, memory, planning, and organization. Within the emotional domain, one of the most common goals is the need for social acceptance. And in the behavioral domain, most students will want to focus on anger/aggression and/or depression/loss of interest.

Emotional support, stress reduction, and self-regulation. Emotional support for a child with TBI is essential. Anxiety, depression, a weakened sense of self, anger, as well as impulsivity, are some of the issues that will need to be addressed. Besides supportive counseling, stress reduction and self-regulation strategies can go a long way in helping a child process and develop effective coping mechanisms. It is important to mention that there is a direct relationship between stress and brain injury symptoms. In other words, the more stress a student experiences, the more likely certain symptoms will increase, especially those related to cognitive and emotional factors. Even when a student makes a good recovery and no longer shows any visible signs of injury, stress will often cause many of the previous symptoms to recur, at least temporarily. Because of this, it is critical that the child learn robust coping and stress management skills to help reduce the likelihood that symptoms will reemerge.

Family involvement. Research has shown that family involvement is critical in helping children and adolescents make the most progress. Guidelines for working with families would include recognition of the child’s developmental level, matching the intervention to the particular family’s needs, educating the family about TBI, offering family support and counseling, making the proper adjustments in the home, school, and community to accommodate the child, and providing training to the child and family around building new skills. Support groups for the person with TBI, as well as family members, has also been shown to be very helpful during recovery and re-integration into school and community.

How Schools Can be Better Prepared to Help a Child with TBI
Schools have a responsibility to take the issue of TBI seriously and not assume that it is the responsibility of outside services to address the child’s needs. Many school staff would be willing to be more involved if administration made it a priority and supported them in terms of additional training, as well as creating an organizational structure within the school that addresses TBI. Because many children who have sustained a TBI can be mis-classified under some other special education label, it is more imperative to actively identify such children and utilize all resources available to provide them with the most appropriate and effective program. It is through such measures that greater cost-effectiveness and educational gains can be achieved.

Resources:

Brain Injury Association of NJ (BIANJ)
http://www.bianj.org/
BIANJ is a statewide organization whose sole purpose is to educate and provide support for those with TBI, their families, and professionals. They offer a short introductory course for educators on-line and at no cost.

Brain Injury Association of America
http://www.biausa.org/
The Brain Injury Association of America (BIAA) has a nationwide network of more than 40 chartered state affiliates and hundreds of local chapters and support groups.

North American Brain Injury Society (NABIS)
http://www.nabis.org/
NABIS is comprised of professional members involved in the care or issues surrounding brain injury. The principal mission of the organization is moving brain injury science into practice.

Dale Starcher, Ph.D., is the Clinical Director at Garfield Park Academy, a state-approved private school for students ages 5-21 with disabilities in Willingboro, NJ. The school is home to the Compass TBI School Re-entry program. Starcher serves on the Executive Board of the NJ Association for School Psychologists and the Committee for Children and Adolescents for the Brain Injury Association of New Jersey.

George Niemann, Ph.D., is the Director of Clinical Development at the Center for Neurological and Neurodevelopmental Health (CNNH). He holds a doctorate in Neuropsychology from McGill University in Montreal, Canada. He developed community and school programs for brain injury and has established commissions on accreditation and professional training in the fields of brain injury rehabilitation and education.

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Helping Students While Reducing Special Education Costs

Posted by on June 1, 2011

By: Nathan Levenson

Special education costs are rising, as are the number of students with complex needs. In addition, “No Child Left Behind” demands higher levels of student achievement as school budgets are shrinking. While districts push state and federal government for more funds, they are largely on their own to tackle the dual challenge of controlling costs and improving student achievement.
 
We have a moral – and legal – imperative to not just cut services for these students; tough financial times don’t change the reality that students with special needs are often learning at a less-than-satisfactory level. Our challenge is to do more and spend less. What can districts do to balance the budget and improve student outcomes?

Step 1: Change the focus
Stop talking about cost-cutting and instead focus on cost-effectiveness. It’s a difference that cuts to the heart of the matter. Cost cutting assumes that districts are taking something away from children. Cost-effectiveness means getting the same or better results for less money.

Step 2: Ensure sufficient financial and logistic expertise
In most districts, special education is an island unto itself, but few special educators are trained in scheduling, financial analysis, forecasting and purchasing. These are the very skills that a district needs in order to make special education more cost-effective. By creating a team with diverse talents and partnering with general education, districts can often reduce special education costs and improve outcomes. General educators and administrators can bring “outside-the-special education-box” ideas and expertise to the table.

Step 3: Conduct an Opportunities Review
A ‘Review of Opportunities’ involves gathering data, surveying and interviewing staff, observing classrooms and crunching numbers. This information can be used to identify and analyze trends, compare findings to local and national benchmarks, and assess strategies to determine which hold the most promise for district.

Step 4: Reduce new referrals by shifting some remediation to general education
The best way to reduce special education costs and raise academic achievement is for fewer students to need special education services because they are learning in the regular classroom.

In most districts, children can’t get intensive reading support or limited speech or counseling without an Individual Education Program (IEP). At the secondary level, Math and English remediation are often reserved for special education students. Rather than push struggling students into special education, districts can choose to improve general education instruction.

One district built an extensive RTI (Response to Intervention) reading program and opened it to all students. The support was tightly connected to the everyday classroom instruction. Short-term counseling was provided. Math and English remediation was opened to all students. These programs were cost neutral in the short-run because they shifted resources from special education to general education without adding more staff. In the long run, they decreased costs by reducing the need for special education services. This strategy was controversial but the results speak for themselves: academic achievement by students in special education rose by 26% in English and 22% in Math.

Step 5: Teach all students to read in the early grades
About half of the referrals to special education are, at their root cause, for reading difficulties. Referral rates jump in third through sixth grades when reading problems make it more difficult for students to learn math, science and social studies.

If districts provide intensive intervention in reading in the early grades, and comprehension instruction in the later grades, they can eliminate eight years of future special education needs. Effective reading intervention must combine general and special education efforts, and general education should take the lead. Teaching kids to read is the single best thing a district can do for them – it is also the best thing they can do to control long term costs.

Step 6: Build and maintain quality programs
Students with severe disabilities constitute a small portion of special education students, but account for about half of all special education spending in some districts, in part due to out-of-district placements. Districts can serve more kids in local classes by making them similar to the out-of-district programs in terms of class size, student-teacher ratios, and high quality support services such as autism specialists, certified Wilson reading teachers, ABA behavior specialists, social workers, and drug and alcohol counselors.

Rethinking Paraprofessionals

1. Make sure aides aren’t being assigned for the wrong reasons, such as parental pressure, teacher pressure or as a ‘fix’ that masks the root cause of a problem. For example, an aide might be assigned to a student who is prone to outbursts in class. A trained behaviorist might be able to design a behavior plan for student and teacher, codify the warning signs, and coach the teacher so that eventually an aide is no longer needed.

2. Be very specific about what a student needs. Is math a struggle? Provide an aide during math, but not for art, music and language arts. Is transitioning from home to school the problem? Provide the aide for two hours in the morning, and then let the aide help in another room later in the day.

3. Schedule most aides on a building-wide basis, not student-by-student.
The decision to add an aide to a student’s IEP is typically made independently of what other supports exist in the classroom or building. Some classes have two or even three aides because the IEP does not consider whether an aide is already in that classroom. In some cases, districts might assign aides to classes rather than to individual students, or use student teachers when available to avoid redundancy.

As one district increased its commitment to include students with moderate disabilities in the general education classroom, the cost of paraprofessionals jumped 48% in just two years. Formal requests were submitted for another 15% increase the next year. By implementing the three steps described above, costs actually decreased by 6% over the next two years; students got the support of a second adult in the classroom for some part of the day; the aides knew exactly why they were there; and children had greater opportunity to interact with peers. Parents and principals appreciated the more structured criteria, which eliminated the sense that “getting an aide” was arbitrary.

Step 7: Rethink the role and schedule of paraprofessionals
The use of paraprofessionals for inclusion remains very popular but it’s a big budget item and research tells us to be wary1. An aide can create a social barrier, stifling peer interaction and defeating one of the primary benefits of inclusion. What’s more, a 1:1 aide can decrease the instruction a student gets from the classroom teacher who thinks a student with an aide already has 100% of an adult’s time. This means that the students with the greatest needs get the least attention from the teacher certified in the subject matter. In the worst case, the aide actually does the work for the student under the guise of helping. Yes, some students absolutely need aides for health and safety reasons, but aides are not a panacea.

Step 8: Benchmark staffing levels and service levels
Requests for more staff can be difficult to assess. Benchmarking—the process of comparing how others do the same thing—is a powerful tool available to districts because it shows what is possible. When district “A” learns that district “B” solved the same problem by doing XY & Z, staff may start to think differently about a problem.

In one district, there were requests for more therapists and testers, but the district was already exceeding the like-community benchmarks by 25% and 15% respectively. Still, the staff was working long days.

The district found that the issue was poor scheduling. By centralizing scheduling under the responsibility of an administrator with authority to make changes and balance caseloads more fairly, the need for more staff was eliminated.

Benchmarking can also be used the help assess service levels. Teams of therapists can develop objective criteria that can help guide IEP teams in determining who gets services and how often. While decisions still must be made on an individual basis at the IEP meeting, these guidelines can help districts gauge appropriate levels of staffing and services.

Step 9: Create a team to manage special education transportation
Although transportation to out-of-district placements may vary from district to district, they often have one thing in common: a poor flow of information and a lack of business savvy about the routing process.

Districts can save money when people with the right skill set (purchasing, logistics or transportation routing) are part of the team. It also helps to have very detailed information. For example, instead of simply stating a start time, look for the earliest and latest possible start time. A 15- to 20-minute window can be the difference between sharing a ride or not.

Districts might find new vendors by looking near the destination rather than near the district itself, and can save money by working with nearby towns to schedule students going to the same out-of-district school. A short weekly information-sharing meeting can fine tune plans and guarantee dialogue. Districts can also use mapping software to plot out-of-district schools and their start times, and identify opportunities for saving money.

Step 10: Get others to pay
Over the last two decades, schools have been asked to address an ever-increasing number of social problems. Many of them have ended up as special education services, including drug and alcohol counseling, adaptive technology, and treatment for rage, depression or school phobia. Fortunately, many social service agencies, the federal government, and private health insurance can help pay for these services.

This 10-Step Process has made bad budgets better, and has helped many students stay in the community, learn to read and make other academic gains. At the same time, it has allowed district leaders to show taxpayers that they are doing everything possible to meet the needs of all children and live within their means.

1. Guidelines for selecting alternatives to over reliance on paraprofessionals by Giangreco and Broer, US Office of Special Education, March 2003.

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