Need preschool IEP advice and more

[bauhaus]

Hi everyone. Thanks in advance for any help you can give me.

My DS started a 2 yo preschool program this year, for socialization since my husband and I work split shifts and he is mostly home with us. He has had some difficult behaviors (intense tantrums and hitting his head in frustration) and raised a few red flags at his 18 mo autism screening, but our doctor told us to just let her know if we were concerned about anything in particular. His behaviors have gotten much better at home, especially as he could express himself better with language, but he struggled in the beginning of the year at school, with tantrums and socializing with the other kids. (His baby brother was also born on the first day of preschool, to add to his stress.)

In January, his teacher suggested he should do a screening with the intermediate unit, since he just turned 3 in December. They decided to do a full evaluation due to his ADHD type behaviors and also have concerns about ASD as a possibility. They made an appointment with their developmental pediatrician this summer to check for ASD, but in the meantime are suggesting he do their special education program starting this summer and at least through the next school year.

Here is where I need advice:

-We have an IEP meeting scheduled for Monday. What can I expect? Setting short term goals--I'm not sure what to ask for. Should I wait to sign anything until we have a chance to think it over?

-Has anyone had experience with CHOP for ASD? (Where the dev pedi is affiliated) We can continue care with her after we see her this summer.

-Getting wraparound services--the intermediate unit only offers the special ed preschool and services during preschool. My DS will have speech therapy (for expressive speech) and possibly OT, but there is only 10 hours a week of preschool (4 mornings). The IU gave us info to contact the state's behavioral health services and to apply for medical assistance. How do you get extra services--through a program like this, through your insurance, or OOP? How do I know if the therapists are "good"? It looks like this is how the EI services are handled as well, so I assume it would be as good as it can get.

-Do you have a BCBA? How did you go about getting one?

-If you have a child with ADHD/ASD, what therapies are you doing?

Sorry for writing a book. I am still reeling from so much information and trying to make a plan for this meeting on Monday. I appreciate any advice I can get and am looking forward to participating on the board.

[auntie]

Apr 7, 2015 23:04:17 GMT -5 bauhaus said:

Hi everyone.


Hi.

My DS started a 2 yo preschool program this year, for socialization since my husband and I work split shifts and he is mostly home with us. He has had some difficult behaviors (intense tantrums and hitting his head in frustration) and raised a few red flags at his 18 mo autism screening, but our doctor told us to just let her know if we were concerned about anything in particular. His behaviors have gotten much better at home, especially as he could express himself better with language, but he struggled in the beginning of the year at school, with tantrums and socializing with the other kids. (His baby brother was also born on the first day of preschool, to add to his stress.)

In January, his teacher suggested he should do a screening with the intermediate unit, since he just turned 3 in December. They decided to do a full evaluation due to his ADHD type behaviors and also have concerns about ASD as a possibility. They made an appointment with their developmental pediatrician this summer to check for ASD, but in the meantime are suggesting he do their special education program starting this summer and at least through the next school year.


Wow. Your IU sounds awfully proactive. TBH, I've not seen kids locally get turfed to a developmental pedi on the IU's dime here in IU#22. It's great that they're willing to offer ESY at this point. Have they completed the district's portion of the eval?

Here is where I need advice:

-We have an IEP meeting scheduled for Monday. What can I expect? Setting short term goals--I'm not sure what to ask for. Should I wait to sign anything until we have a chance to think it over?

Have you had a chance to go over his evaluation results? They should have sent you a copy to review ahead of the meeting.

In terms of goals, the usual strategy is to look at where he's delayed or atypical and work on those educationally relevant skills to prepare for kindie. Educational skills are very broad at this point- they can include interacting with peers, asking an adult for help appropriately, playing games at recess, adaptive skills, etc.

You can always wait to sign, but in the absence of someone to look it over for you, it might not bring much to the party. In the early days of DS's IEP, I had his psychologist review them with me. It helps to have a list of what you think he needs going into the meeting. Ideally, as a team member, you and the rest of the CSE write the IEP at the meeting. In the earlier years, the district may come to the table with a proposed document. So long as it has what you want- I don't get my panties bunched up over it. 

It would be useful to bring his dad with you- two sets of ears are critical. Get a sitter for the baby, so you can both focus on the meeting. Don't go alone; bring a friend or family member if dad is out of town. I would find a copy of this book and read it before Monday-

www.amazon.com/Wrightslaw-Emotions-Advocacy-Education-Survival/dp/1892320096

-Has anyone had experience with CHOP for ASD? (Where the dev pedi is affiliated) We can continue care with her after we see her this summer.

My son was initially dxd at CHOP's RAC. It wouldn't be my first choice. I love Dr. Levy, but the turnover rate at the clinic makes for gaps in the continuity of care. They're OK, but there are some superstars in private practice I like better. 

James Coplan is amazing.

www.drcoplan.com/

He's the author of this book-

www.amazon.com/Making-Sense-Autistic-Spectrum-Disorders/dp/0553806815/ref=sr_1_1?s=books&ie=UTF8&qid=1428490639&sr=1-1&keywords=making+sense+of+autism+spectrum+disorders

The downside is that he doesn't take insurance though he will give you a receipt for your insurance if you can go out-of-network.

I hear great things about Dr. Wendy Ross as well. Her families sing her praises.

-Getting wraparound services--the intermediate unit only offers the special ed preschool and services during preschool. My DS will have speech therapy (for expressive speech) and possibly OT, but there is only 10 hours a week of preschool (4 mornings). The IU gave us info to contact the state's behavioral health services and to apply for medical assistance. How do you get extra services--through a program like this, through your insurance, or OOP? How do I know if the therapists are "good"? It looks like this is how the EI services are handled as well, so I assume it would be as good as it can get.

Wrap Around generally comes via TeddyBear Coverage which is non-means tested Medicaid. This extra coverage is meant to help pay for extra OT, PT, SLP, behavior therapy, etc often supplemented by a TSS worker. How well it works depends on whether you can find professionals who take the insurance they offer. I know people who were thrilled with the services they receive in some parts of PA. We has it for one year about 15 years ago and it brought nothing to the party for us. Our psychologist doesn't take it and we didn't need OT or speech services beyond pragmatics which are best done in a school setting. YMMV.

-Do you have a BCBA? How did you go about getting one?

Depends. Some districts have ABA classrooms for some kids on spectrum. Some people in PA are able to access this through their insurance once they have an ASD medical dx. (self insured policies can be exempt) Some gets this via Medicaid. The social worker associated with CHOP should be able to help you. They were clueless when we went through, but I assume they've improved in 15 years. At least I hope they have. Dr. Coplan has someone who can help a parent navigate this territory as well.

-If you have a child with ADHD/ASD, what therapies are you doing?

I would be gobsmacked if you got an ADHD dx at 3. It's possible, but very few clinicians will "go there" until closer to school age. DS was considerably older and has an Aspergers dx- so no delays in speech or adaptive skills. His fine motor skills are ridiculously good, and his sensory and gross motor issues were so subtle he never qualified for services around these. DS current dxs are ASD (AS)/ADHD(combined type)/SLD(repaired dyslexia) and GAD. He's a 21 year old college sophomore who works part time at the local tourist railroad.

We did some Floortime under his psychologist's supervision to help DS with play skills and more flexible thinking and behavior early on. We also did CBT for the anxiety piece. DS also takes medication for his ADHD and his anxiety/tendency to depression. He attended a special school for his LD issues for a couple years early on and then had resource support for RELA and math until middle school. He was mostly mainstreamed, In school, most of his IEP was related to social skills, written expression (from a ToM perspective) and executive function issues that go along with ASD and ADHD. His SLT was primarily Michelle Garcia Winner's various Social Thinking Curriculum which is awesome stuff.  

Sorry for writing a book. I am still reeling from so much information and trying to make a plan for this meeting on Monday. I appreciate any advice I can get and am looking forward to participating on the board.

You're welcome over at the GBCbump/Then Comes Family Special Needs Forum as well. There are a lot of moms with LOs on spectrum who could be a lot more help than I am. It's a bit more active there than here. 


goodbyecb.proboards.com/board/25/special

[craftyone]

Depending on what your state allows, you might be able to get Medicaid for a disability, but I know for our state, my son was more moderate ASD, my younger son who is mild on the spectrum did not qualify. For our state we needed to have a disability waiver to get Medicaid because we were over the income limits.

Does your state have an ASD mandate?
www.asha.org/Advocacy/state/States-Specific-Autism-Mandates/

Since our state has a mandate, our group insurance (over 50 employees etc) is required to pay an X amount for ABA therapy. Generally you need an ASD diagnosis. I had my pediatrician write a script while we waited on a dev pediatrician appointment. I actually pulled my son out of public school and placed him in a private almost one-on-one aide preschool with typical peer inclusion. The school would of never been able to provide that level of care. My insurance actually pays for all of the school, I just have to provide transportation.

We do speech therapy and OT with sensory privately, but we also qualify for speech and OT and through the school. We do one on one home based ABA therapy in addition through Medicaid.

[bauhaus]

Apr 8, 2015 6:22:22 GMT -5 auntie said:

Apr 7, 2015 23:04:17 GMT -5 bauhaus said:

Hi everyone.


Hi.

My DS started a 2 yo preschool program this year, for socialization since my husband and I work split shifts and he is mostly home with us. He has had some difficult behaviors (intense tantrums and hitting his head in frustration) and raised a few red flags at his 18 mo autism screening, but our doctor told us to just let her know if we were concerned about anything in particular. His behaviors have gotten much better at home, especially as he could express himself better with language, but he struggled in the beginning of the year at school, with tantrums and socializing with the other kids. (His baby brother was also born on the first day of preschool, to add to his stress.)

In January, his teacher suggested he should do a screening with the intermediate unit, since he just turned 3 in December. They decided to do a full evaluation due to his ADHD type behaviors and also have concerns about ASD as a possibility. They made an appointment with their developmental pediatrician this summer to check for ASD, but in the meantime are suggesting he do their special education program starting this summer and at least through the next school year.


Wow. Your IU sounds awfully proactive. TBH, I've not seen kids locally get turfed to a developmental pedi on the IU's dime here in IU#22. It's great that they're willing to offer ESY at this point. Have they completed the district's portion of the eval?

I am realizing how lucky we are the more I read about how some districts are not so cooperative. They did complete their evals--with general development, an OT, SLP, and psychologist. We just received the report last week. 

Here is where I need advice:

-We have an IEP meeting scheduled for Monday. What can I expect? Setting short term goals--I'm not sure what to ask for. Should I wait to sign anything until we have a chance to think it over?

Have you had a chance to go over his evaluation results? They should have sent you a copy to review ahead of the meeting.

Yes, with the psychologist that observed him and a little with our contact person/gen development observer.

In terms of goals, the usual strategy is to look at where he's delayed or atypical and work on those educationally relevant skills to prepare for kindie. Educational skills are very broad at this point- they can include interacting with peers, asking an adult for help appropriately, playing games at recess, adaptive skills, etc.

You can always wait to sign, but in the absence of someone to look it over for you, it might not bring much to the party. In the early days of DS's IEP, I had his psychologist review them with me. It helps to have a list of what you think he needs going into the meeting. Ideally, as a team member, you and the rest of the CSE write the IEP at the meeting. In the earlier years, the district may come to the table with a proposed document. So long as it has what you want- I don't get my panties bunched up over it. 

It would be useful to bring his dad with you- two sets of ears are critical. Get a sitter for the baby, so you can both focus on the meeting. Don't go alone; bring a friend or family member if dad is out of town. I would find a copy of this book and read it before Monday-

www.amazon.com/Wrightslaw-Emotions-Advocacy-Education-Survival/dp/1892320096

Thanks for the advice and book rec. My H will be coming. I think part of my anxiety is that we don't have a psychologist or dev pedi of our own yet to consult with. I do want a long-term doctor to monitor his progress and help us make decisions on which therapies and school situations we need to pursue. I can't see how he behaves at school, so it's hard for me to say what he will need, unless his sped teacher is good about keeping communication open with me. I am concerned with putting him in their special ed preschool--the ratio is 12 students to one teacher/one aide. He had the same ratio in his regular preschool--if he is too hard to handle in a class full of "easy" kids, how will he succeed and get enough attention in a class where everyone will need so much more attention?

-Has anyone had experience with CHOP for ASD? (Where the dev pedi is affiliated) We can continue care with her after we see her this summer.

My son was initially dxd at CHOP's RAC. It wouldn't be my first choice. I love Dr. Levy, but the turnover rate at the clinic makes for gaps in the continuity of care. They're OK, but there are some superstars in private practice I like better. 

James Coplan is amazing.

www.drcoplan.com/

He's the author of this book-

www.amazon.com/Making-Sense-Autistic-Spectrum-Disorders/dp/0553806815/ref=sr_1_1?s=books&ie=UTF8&qid=1428490639&sr=1-1&keywords=making+sense+of+autism+spectrum+disorders

The downside is that he doesn't take insurance though he will give you a receipt for your insurance if you can go out-of-network.

I hear great things about Dr. Wendy Ross as well. Her families sing her praises.

Thanks for these doc recs, as well.

-Getting wraparound services--the intermediate unit only offers the special ed preschool and services during preschool. My DS will have speech therapy (for expressive speech) and possibly OT, but there is only 10 hours a week of preschool (4 mornings). The IU gave us info to contact the state's behavioral health services and to apply for medical assistance. How do you get extra services--through a program like this, through your insurance, or OOP? How do I know if the therapists are "good"? It looks like this is how the EI services are handled as well, so I assume it would be as good as it can get.

Wrap Around generally comes via TeddyBear Coverage which is non-means tested Medicaid. This extra coverage is meant to help pay for extra OT, PT, SLP, behavior therapy, etc often supplemented by a TSS worker. How well it works depends on whether you can find professionals who take the insurance they offer. I know people who were thrilled with the services they receive in some parts of PA. We has it for one year about 15 years ago and it brought nothing to the party for us. Our psychologist doesn't take it and we didn't need OT or speech services beyond pragmatics which are best done in a school setting. YMMV.

I guess I will apply and see what happens. Thanks for your experience.

-Do you have a BCBA? How did you go about getting one?

Depends. Some districts have ABA classrooms for some kids on spectrum. Some people in PA are able to access this through their insurance once they have an ASD medical dx. (self insured policies can be exempt) Some gets this via Medicaid. The social worker associated with CHOP should be able to help you. They were clueless when we went through, but I assume they've improved in 15 years. At least I hope they have. Dr. Coplan has someone who can help a parent navigate this territory as well.

-If you have a child with ADHD/ASD, what therapies are you doing?

I would be gobsmacked if you got an ADHD dx at 3. It's possible, but very few clinicians will "go there" until closer to school age. DS was considerably older and has an Aspergers dx- so no delays in speech or adaptive skills. His fine motor skills are ridiculously good, and his sensory and gross motor issues were so subtle he never qualified for services around these. DS current dxs are ASD (AS)/ADHD(combined type)/SLD(repaired dyslexia) and GAD. He's a 21 year old college sophomore who works part time at the local tourist railroad.

We did some Floortime under his psychologist's supervision to help DS with play skills and more flexible thinking and behavior early on. We also did CBT for the anxiety piece. DS also takes medication for his ADHD and his anxiety/tendency to depression. He attended a special school for his LD issues for a couple years early on and then had resource support for RELA and math until middle school. He was mostly mainstreamed, In school, most of his IEP was related to social skills, written expression (from a ToM perspective) and executive function issues that go along with ASD and ADHD. His SLT was primarily Michelle Garcia Winner's various Social Thinking Curriculum which is awesome stuff.  


Thanks again for sharing your son's experience. This is very helpful.

Sorry for writing a book. I am still reeling from so much information and trying to make a plan for this meeting on Monday. I appreciate any advice I can get and am looking forward to participating on the board.

You're welcome over at the GBCbump/Then Comes Family Special Needs Forum as well. There are a lot of moms with LOs on spectrum who could be a lot more help than I am. It's a bit more active there than here. 


goodbyecb.proboards.com/board/25/special

[bauhaus]

craftyone - thanks for your experience. This is very helpful.

A question - how did you find your private preschool? I think that sounds great, I just don't know how to search for something like that. I will have to contact my insurance if we get the ASD dx to see what they will pay for.

The special ed preschool classroom they want to place him in is 12 students: 1 teacher/1 aide. I am afraid he will not get the attention that he needs to stay on task and waste this precious time without the right help. He has trouble staying in his seat and staying on task in the commotion of the classroom, so I am concerned with such a "large" student to teacher ratio.

They said they do open the classroom to the Head Start classroom next door two days a week, so he would get some NT peer inclusion.

Thanks again for your help.

[auntie]

bauhaus

Thanks for the advice and book rec. My H will be coming. I think part of my anxiety is that we don't have a psychologist or dev pedi of our own yet to consult with. I do want a long-term doctor to monitor his progress and help us make decisions on which therapies and school situations we need to pursue. I can't see how he behaves at school, so it's hard for me to say what he will need, unless his sped teacher is good about keeping communication open with me. I am concerned with putting him in their special ed preschool--the ratio is 12 students to one teacher/one aide. He had the same ratio in his regular preschool--if he is too hard to handle in a class full of "easy" kids, how will he succeed and get enough attention in a class where everyone will need so much more attention?



Read more: pandce.proboards.com/thread/436262/preschool-iep-advice-more?page=1#ixzz3WkpfSuOh

DS had a psychologist and dev pedi. It's great to have the perspective of someone on your team exclusively, although ours didn't always agree on important issues. We had DS's psychologist observe him in class a couple times- many kids with DS's dx are better behaved in school and loss their shit at home where they know they're loved unconditionally. I had the other kind- he was pretty well behaved for me and a handful in school. It took a couple years before I believed some of what the teachers said as I'd never witnessed those kinds of antics.

A ECSE classroom might be a better fit- the teachers/para will likely be much more qualified as professionals and the class structure will be designed to set the students up to succeed. If they suggest a ECSE class, ask if you can observe it first.

[craftyone]

bauhaus

It was a process for me to find the services for my son. I actually did a lot of research online. I googled ABA school and my city. For instance my city is about 1 million, and we have about 3 or 4 schools that are private ABA based. Depending on your area, there may not be much choices.

Our public school system had a 8/2 ratio and got a waiver for 9 students/(1 teacher, 1 aide). My son was regressing and basically doing what he wanted which wasn't any normal classroom type activities. They wanted him to go into an ASD classroom of all severities and only have 3 periods a week of inclusion during music, pe, and art.

[bauhaus]

auntie - thanks again. I would love to have the perspective and advice from a dev pedi and psychologist to help guide us. That will be my next step.

They are recommending their ECSE preschool class and we are taking a tour on Monday before we sit down to write his IEP. He should be starting this month or next.

craftyone - Thanks for helping me with search terms. Nothing is very close to us, most look like an hour or so away. I think we might give this preschool a try for the summer and see how he does, to see if we need to take more drastic steps to get him into a better school program. I am glad we have other options if this school does not work out.

[craftyone]

Apr 9, 2015 10:01:38 GMT -5 bauhaus said:

craftyone - Thanks for helping me with search terms. Nothing is very close to us, most look like an hour or so away. I think we might give this preschool a try for the summer and see how he does, to see if we need to take more drastic steps to get him into a better school program. I am glad we have other options if this school does not work out.

I can understand. I drive my son 2+ hours a day to take him to school -the school is 30 minutes away. It is tiring, but I see such improvement. If you don't have a preschool nearby, I would look into if there are any ABA providers you can do one on one either at home or at their center that take your insurance (if you have ABA coverage).  Plus I would continue to look for resources, you never know when a new program starts. I know of 2 that evolved in my area in just that last year and half. Good luck!

[babe2331]

Bauhaus

Our son, age 2, was just diagnosed with ASD with expressive/receptive communication disorder. We just had an evaluation at CHOP with Dr. Riley. We thought she was ok. We are actually considering seeing someone else for a second opinion for recommendations only (we have no issue with the diagnosis, but felt she wasn't very clear in explaining what other things she wanted done and why). We may actually follow-up with Dr. Levy at the suggestion of some of you on the GBCbump/Then Comes Family Special Needs board (I'm a member over there as well) when we have to follow-up in 6 months. We have been seeing CHOP doctors for some other issues as well and are overall pleased. We have an appointment with GI/feeding in a few weeks for some feeding/constipation issues.

Our LO is currently in EI and we are having great difficulty getting him ABA therapy. We are in Philadelphia County which freaks me out immensely when it comes time to send LO to school. How did you find the 2 year old preschool, as I can't seem to find one within the city limits.

We just applied for MA. While the health insurance we have now has autism coverage, we are struggling to keep up with the premium (which just skyrocketed at annual renewal this month), so we will probably stick with MA as primary and drop the other coverage.

Good luck!

[bauhaus]

babe2331

Thanks for sharing your experience with CHOP and Medicaid. I need to finish my application.

The 2 yo preschool program is through a church in my town--they offer 2, 3, and 4 yo classes. Since my DS was having so much trouble, they recommended us when our IU came to do screenings. After the IU evaluations, they placed DS in the special ed preschool offered in our school district. They also have other classrooms throughout the county, so I don't know if they would let me request for him to go to another classroom in another school district. Maybe this could be an option through your IU when your DS turns 3?

DS has started his new preschool this week. It is really nice and he is doing great so far. I was so pleasantly surprised how well it's working out. I still want to address things the school can't, through ABA therapy and more socialization.