Referring a Learning Disabled Patient
The Role of the Pediatrician
When, Where, and How are Learning Disabilities Diagnosed?
Children may be diagnosed with a disability by a medical provider.* However, one must understand that being simply diagnosed with a disability is not a guarantee of services under the Individuals with Disabilities Education Act (IDEA) and in turn public school districts set strict guidelines on accepting referrals from medical providers.
Having a disability is the first question when determining if a student qualifies. The pediatrician must also answer two additional questions:
- Does the disability impact the child’s educational progress?
- Does the child need specially designed instruction (which is the IDEA definition of special education)?
*If you diagnose a patient with a developmental delay or disability you as the medical provider must substantiate your diagnosis with a level of testing. A comprehensive evaluation that meets federal and state guidelines needs to be completed before children can qualify for supplemental school based educational services.
**A note from a pediatrician that a child has disability (e.g. ADHD) or emotional disability (depressed or anxious) will not be enough to qualify them for services.
***The earlier your patient receives this testing, the better. Testing for learning disabilities generally includes assessment by the School Psychologist. If your patient has not responded to typical school based academic presentation, it is time to evaluate for a learning disability or other delay.
- Patients who have physical disabilities or developmental delays are often identified early by a pediatrician or other medical providers. These children may have a wide range of academic difficulties depending on the severity of the delay, and some may have no difficulties at all. Fortunately, because they are often diagnosed before entering the school system, most children with physical disabilities or developmental delays enter school with special education structures in place.
- Patients with learning disabilities often face a different scenario. They may struggle through the first years of their education before their disabilities are identified. In addition, children with learning disabilities often lack the physical or social differences that identify them with physical impairments or developmental delays; that is, they look and act just like their peers without disabilities. Also, much of the instruction delivered in the lowest grade levels is skills-based. This means that your patient is learning skills such as reading, writing and basic arithmetic. If he or she can read a word or solve a basic math problem, he or she will have relatively few problems in these grades. Starting around the third grade, however, students are expected to apply those skills to learn more information, and those with previously undetected disabilities may begin to struggle.
- Regardless of his or her ability or diagnosed disability, your patient will find that school becomes much more difficult once he or she needs to build upon previously mastered skills to gather new information. This is especially true if your patient was not able to master some of the foundational skills. For instance, your patient may have been a B student in reading throughout first and second grade, earning an average of 80 percent on reading and spelling tests. However, if he or she is only able to read 80 percent of the words taught in first and second grade, how is he or she supposed to read and comprehend a textbook written at a fourth grade level? It is next to impossible and your patient will continue to fall behind in all subjects. This is referred to as a “widening gap”: the gap between what a child with a disability knows and what his or her peers know only widens as he or she advances to higher grades.
Insurance Coverage for Psychological Testing
Psychological assessment is typically covered under the medical coverage of your insurance plan when:
- Patient is referred by a physician. (pediatricians, neurologists, psychiatrists)
- If testing is conducted to establish a diagnosis as the basis for medical treatment, to evaluate the functional impact of a medical treatment (baseline testing), or to assist in selecting a treatment.
- For example, for some children the use of medication may be the best approach when behavior problems occur, while for other children the use of a behavior plan or psychotherapy is the best approach. Psychological assessment is usually covered if your child has learning or behavior problems and a history of brain injury, or has a current medical problem that may be affecting brain development.
- Many insurance plans will require a letter from your child's physician, indicating the medical necessity of the assessment. Medical necessity means that the physician needs more information to help provide care or diagnosis for the patient.
- Please note that most insurance plans will approve coverage for assessment, used if the question, prompting testing, is the relationship of the academic problem to some other medical problem(e.g. ADHD) or medical treatment.
Reasons for Pediatrician Referral for Psychological Testing and Evaluations
- Attention Deficit Hyperactivity Disorder--Child/Adolescent/Adult
- Learning Disorders/Disabilities/Dyslexia
- Autism Spectrum Disorders
- Emotional and Behavioral Disorders
- College Level Academic Accommodations
- To Obtain an IEP, 504, or SAT Accommodations.
- Eligibility for Special Education
- Eligibility for Advanced Placement or Gifted Classes.
LastUpdate: 2017-11-06 09:13:42