Not What the Doctor Ordered

Published on September 13, 2009 by Jennifer Laviano

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One of the most important, and complicated, things for parents of children with special education needs to understand is that there is a big difference between the educational and the medical models of treatment and intervention.  Often, parents of children with disabilities get caught right in the middle of these two systems.  The procedures and protocols are different; the funding mechanisms are different; even the terminology can be different for the very same disability.  It’s no wonder there is so much confusion!

In my experience, when a parent brings recommendations from medical personnel to the school district’s attention, they typically expect them to be honored.   Unfortunately, it just doesn’t work that way.

Virtually every time I speak with parents who have obtained documentation from their child’s medical providers which prescribe various services or accommodations which should be provided in school, they will sound shocked when I tell them that having such a prescription does not, necessarily, guarantee educational implementation.  “But this is her DOCTOR!” they’ll often say.  It’s around this time that I typically have to inform parents that, while school districts are absolutely obligated to “consider” any information brought by the parents to the Team, they do not necessarily have to follow the doctors’ recommendations.

The kinds of decisions that a child’s medical team may make can, and does, differ dramatically from the types of recommendations that come out of a special education IEP Team Meeting.

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As just one very common example, medical “diagnosis” is not the same thing as identification for eligibility under the IDEA.  So, if your son’s pediatrician has diagnosed him with ADHD, this does not mean necessarily that the school district’s IEP Team will agree that he is eligible for special education and related services under the IDEA.  Perhaps the only people more shocked than the parents that the recommendations of the medical professionals are not being accepted are the doctors themselves!

It is usually not helpful to have medical professionals send outraged letters to the school demanding to know why their medical judgment is being disregarded.

While it can be incredibly satisfying to read a letter that rips apart the school’s decision not to follow medical advice, it very rarely changes the outcome at the IEP Team level.  If you’ve reached the point where the administration is disregarding the determination of a psychiatrist from Yale in favor of the opinion of the school’s speech pathologist, as an example, you’re really past the point where reasonable minds are prevailing.  You have probably reached the stage where you’re going to have to get more aggressive by requesting a Mediation or Due Process Hearing.  In my experience, if you’ve gotten that far, the illogical actions of the school district in dismissing the recommendations of the medical team are, in and of themselves, far more convincing than a huffy letter from the doctor accusing the school district of incompetence.

The tension between the medical and educational models is even more reason why it’s important to select outside professionals who are familiar with the special education process.

It’s hard to sit idly by when school districts completely dismiss the input and recommendations of medical professionals simply because they aren’t “educators.”  Believe me, there have been times when it was all I could do not to yell, in the middle of an IEP Team, “really?  You’re saying that THE premier doctor at THE premier university in the country, whose entire Department focuses exclusively on THIS VERY DISABILITY is wrong about whether this child has the disability, but your staff is right?  Really?”   And while it might feel good, it won’t feel as good as posing the same question when they’re under oath.

5 Responses to Not What the Doctor Ordered

  1. jenn choi
    September 13th, 2009 | 9:15 pm

    True, true, true… while I don’t I’ve ever sat at a meeting asking “really, really?” I think I’ve had to pick up my jaw from off the floor several times not to mention going through half a box of Kleenex.

    Lucy Miller, SPD guru, once said that whether it’s at an IEP meeting or for insurance, never use the “S” word (SPD), rather use the “F” word (function). She said parents have to prove that their child can not function appropriately because proving that their child has SPD may not help at all.

    Hope you have a great ADHD awareness week!

  2. teacher education
    September 11th, 2010 | 3:47 am

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  3. engineering education
    September 24th, 2010 | 6:09 am

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  4. Visioneer
    April 10th, 2012 | 3:08 pm

    Great conversations. What time is it? I could sit here for hours.

    One topic I’m trying to locate is a discussion about the use of the terminology “diagnosis”. I think what frustrates me about this lack of conversation -anywhere that I can see – is that families who don’t have a clear understanding of district credentials, may recieve an inaccurate interepretation from the district.

    For example, a family told me “my son was “diagnosed” with Emotional Disturbance by the the school 10 years ago.” And I asked what has happened since then? Do you take him to a psychologist or other counseling? What do they say? Often the answer I will get is that the medical dr then prescribed medication based on the school’s diagnosis and the school is providing counseling. No one has ever questioned the diagnosis. Now the child is having significant other issues that actually look more like Asperger’s etc. and no one will listen to the family’s concerns because “well you know he has an ED diagnosis.”

    ARGGGG – Our families need to understand that no one has the right to diagnose your child with anything unless you ask them to consider it and at that the person must be credentialed by the state board of healing arts (in MO anyway). No school district has the right to be handing out medical diagnosis.

    For this reason, I believe that the word Diagnosis should be removed from IDEA and all State Plans as well as Standards and Indicators and Procedural Safegards. It is misleading to parents and puts schools in a position of undue authority. This would remove a lot of the ambiguous terminology that seems to cause extreme discourse in IEP’s.

    Just my 2 cents.

  5. Jennifer Laviano
    April 10th, 2012 | 9:15 pm

    Agreed that this is very confusing, and I say the following phrase a lot, hoping it will sink in…I encourage others to do the same: “Eligibility categories under the IDEA are separate and distinct from diagnoses under the DSM by medical and other outside professionals.” This will become incredibly important to stress when the DSM-V comes out; see my recent post on the DSM-V and fictitious thinking about autism. Thanks for reading!

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