Eligible or Ineligible: Determining Adverse Effect The Individuals with Disabilities in Education Act (1991), born out of the Education of Handicapped Children’s Act (1975), guarantees the delivery of a free and appropriate public education (FAPE) to all eligible children from birth until the twenty-second birthday. According to IDEA, a student is eligible for special education and ... Article
Open Access
Article  |   July 01, 2002
Eligible or Ineligible: Determining Adverse Effect
Author Affiliations & Notes
  • Linda S. Bowman
    Department of Speech Pathology and Audiology, Illinois State University, Normal, IL
  • C. Al Bowman
    Department of Speech Pathology and Audiology, Illinois State University, Normal, IL
  • Rita L. Bailey
    Department of Speech Pathology and Audiology, Illinois State University, Normal, IL
Article Information
Swallowing, Dysphagia & Feeding Disorders / School-Based Settings / Professional Issues & Training / Language Disorders / Articles
Article   |   July 01, 2002
Eligible or Ineligible: Determining Adverse Effect
SIG 16 Perspectives on School-Based Issues, July 2002, Vol. 3, 26-28. doi:10.1044/sbi3.2.26
SIG 16 Perspectives on School-Based Issues, July 2002, Vol. 3, 26-28. doi:10.1044/sbi3.2.26
The Individuals with Disabilities in Education Act (1991), born out of the Education of Handicapped Children’s Act (1975), guarantees the delivery of a free and appropriate public education (FAPE) to all eligible children from birth until the twenty-second birthday. According to IDEA, a student is eligible for special education and related services when, and only when, it is determined that (a) a disability exists, (b) the disability has an adverse effect on the student’s educational performance, and (c) the need for special education and related services to address the adverse effect(s) is present and documented (IDEA, 1997).
As a group, speech-language pathologists and audiologists are trained to determine the presence vs. absence of disabilities in speech, language, and hearing. They also determine whether and what type of special education and related services are required to manage disorders. However, a degree of uncertainty seems to surface when professionals are faced with the task of determining whether or not there is a documented adverse effect on educational performance. If they are to make appropriate recommendations and ensure FAPE for their clients, they must have a clear understanding of the legal and ethical issues surrounding this process.
The phrase “adversely affects a child’s educational performance” is found repeatedly in the definitions of disabilities in the federal regulations for Part B of IDEA (1997) . For example, speech or language impairment is defined as “a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” Although it is clear that the presence of an adverse effect is critical to determining eligibility, the law does not include a practical definition of either adverse effect or educational performance. As a result, many states have attempted to clarify these terms with their own rules and regulations. Twenty-three Illinois Administrative Code Part 226 (2000), which contains the rules and regulations for implementation of IDEA in Illinois, defines adverse effect as the “problems resulting from the manifested characteristics of the student’s disability which interfere with learning and educational performance in school.” It goes on to define educational performance as “a student’s academic achievement and ability to establish and maintain social relationships and to experience a sound emotional development in the school environment.” Such a definition helps professionals avoid the misconception that a child must be performing below grade level or failing in an academic area to be eligible for speech, language, and hearing services. Although academic success is easy to measure and failure is easy to document, this is not the whole picture. Expanding the definition of educational to include not only academic, but also social and emotional functioning, encourages professionals to look beyond the obvious effects of the disorder on academic performance and to examine closely the effect the disorder may have on the child.
The Illinois State Board of Education, in a technical assistance manual designed to guide speech-language pathologists in the delivery of “best practice” services, suggests that professionals use teacher checklists detailing behaviors of the student in the classroom to document teasing, self-consciousness, and limitations of social relationships and sound emotional development. Checklists might include specific questions such as: Does the student participate in class discussion? Does the student understand verbal directions? Does the student make errors in spelling on the same sounds he misarticulates? (ISBE, 1993). Speech-language pathologists might send similar checklists to parents, grandparents, and child care providers, as appropriate, asking questions such as: Does the child make self-deprecating comments related to his/her disorder? Does the child express reluctance to interact with other children or teachers due to his/her speech or language difficulty? Have you noticed any reluctance on the child’s part to engage in certain activities or participate in certain events due to his/her disability? The competent, caring speech-language or hearing professional must spend the time and energy it takes to get to know the child’s learning environment to measure the true social and emotional effects of the disorder. Understanding what is in the mind of a child is never an easy thing to do, but it is absolutely essential if we are to identify adverse effects. It is the only way to answer the following types of questions: Is the real reason Michael hates reading because he stutters? Does Mary choose to play alone because her /r/ sounds like / w/? Does Randy stay home from the field trip because he fears placing an order at the fast food restaurant? As ISBE states in its technical assistance manual, “To the extent that a speech and language impairment affects the student’s ability to participate in active, interactive communication with others in the educational setting, (including peers as well as adults), the student is prevented from participating in the process of education.” (ISBE, 1993, p. 61).
Determining the manner in which children’s communication deficits affect them and the adverse nature of that effect is made more difficult when the disability is mild or when it is a low-incidence disability, such as severe feeding or swallowing problems. Recently, the management of feeding and swallowing impairments of school-age children has attracted attention on the ASHA member forum Web site. Numerous questions regarding the ethics of providing “medical services” in the educational environment and the educational relevance of feeding/swallowing therapy have been discussed.
The prevalence of feeding problems has been estimated to be as high as 80% in children with developmental delays (Manikam & Perman, 2000; Palmer & Horn, 1978; Sisson & Van Hasselt, 1989). Severe feeding problems, such as those that lead to marked nutrition and airway compromise, have been noted in 3–10% of children. Since the national trend toward the inclusion of children with disabilities has resulted in many children with severe needs returning to their home school districts and to general education classrooms, decisions must be made regarding the provision of appropriate therapeutic services.
Do feeding/swallowing problems present an adverse effect for children and youth? Are therapeutic feeding and swallowing services educationally relevant? The answer for both is a resounding YES. It is important to recognize that mealtimes provide more than just a way to ingest food. Mealtimes are social events. The act of sharing a meal with friends is typically a time of social enjoyment. There is an obvious negative social effect for a child with a feeding or swallowing deficit. Many children require special assistance and supervision during meals. They are often fed within the classroom, while independent eaters and their age-matched peers can eat in the lunchroom. This certainly affects their ability to interact socially during a meal.
There is evidence that the emotional well-being of people experiencing feeding and swallowing problems is negatively affected. Eckberg, Hamdy, Woisard, Wuttge-Hannig, and Ortega (2002)  studied the social and psychological burden of dysphagia in adult patients and found that the act of eating was an enjoyable experience for less than half (45%) of their subjects. Many subjects (41%) reported feelings of anxiety or panic during mealtimes, and more than one-third (36%) reported avoiding eating with others because of their feeding and swallowing impairment. While the psychological impact of feeding and swallowing impairment has not been studied in the pediatric population, it would seem to follow that the emotional effect is not likely to be dramatically different than that seen in adults.
Last, and perhaps most significant, feeding and swallowing impairments affect the academic performance of children. Pediatric dysph-agia has been linked to health compromise. Feeding disorders have been specifically associated with nutritional deficits (Bartz & Deubler, 1990; Kovar, 1997), growth retardation (Boddy, Skuse, & Andrews, 2000; Drewett & Wright, 1999), and respiratory complications (Arvedson & Brodsky, 1993). There is an obvious link between compromised health and a child’s school attendance, energy, motivation, and ability to attend to instruction. These factors are important variables that affect the learning process. Not surprisingly, researchers have also documented an association between impaired swallowing in childhood and significant developmental delays and disabilities (Heffer & Kelley, 1994).
Simply put, communication disorders, including feeding and swallowing impairments may adversely affect a child’s educational performance. Providing appropriate treatment for children with high and low incidence speech, language, and hearing problems may foster improved social and emotional functioning, independence, health, safety, nutrition, and growth. It is critical that speech-language pathologists and audiologists define adverse effect in a manner that conforms to the primary objectives of IDEA.
References
23 Illinois Administrative Code, Part 226, Special Education (2000).
23 Illinois Administrative Code, Part 226, Special Education (2000).×
Arvedson, J. C., & Brodsky, L. (Eds.). (1993). Pediatric swallowing and feeding: Assessment and management. Singular: San Diego.
Arvedson, J. C., & Brodsky, L. (Eds.). (1993). Pediatric swallowing and feeding: Assessment and management. Singular: San Diego.×
Bartz, A. H., & Deubler, D. C. (1990). Identification of feeding and nutrition problems in young children with neuromotor involvement: A self-assessment. Journal of Pediatric and Perinatal Nutrition, 2, 1–12. [Article] [PubMed]
Bartz, A. H., & Deubler, D. C. (1990). Identification of feeding and nutrition problems in young children with neuromotor involvement: A self-assessment. Journal of Pediatric and Perinatal Nutrition, 2, 1–12. [Article] [PubMed]×
Boddy, J., Skuse, D., & Andrews, B. (2000). The developmental sequelae of nonorganic failure to thrive. Journal of Child Psychology and Psychiiatry, 41, 1003–1014. [Article]
Boddy, J., Skuse, D., & Andrews, B. (2000). The developmental sequelae of nonorganic failure to thrive. Journal of Child Psychology and Psychiiatry, 41, 1003–1014. [Article] ×
Drewett, R. F., & Wright, C. M. (1999). Cognitive and educational attainments at school age of children who failed to thrive in infancy: A population-based study. Journal of Child Psychology and Psychiatry, 40, 551–561. [Article] [PubMed]
Drewett, R. F., & Wright, C. M. (1999). Cognitive and educational attainments at school age of children who failed to thrive in infancy: A population-based study. Journal of Child Psychology and Psychiatry, 40, 551–561. [Article] [PubMed]×
Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: Its impact on diagnosis and treatment. Dysph-agia, 17, 139–146. [Article]
Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: Its impact on diagnosis and treatment. Dysph-agia, 17, 139–146. [Article] ×
Heffer, R. W., & Kelley, M. L. (1994). Nonorganic failure to thrive: Developmental outcomes and psychosocial assessment and intervention issues. Research in Developmental Disabilities, 15, 247–268. [Article] [PubMed]
Heffer, R. W., & Kelley, M. L. (1994). Nonorganic failure to thrive: Developmental outcomes and psychosocial assessment and intervention issues. Research in Developmental Disabilities, 15, 247–268. [Article] [PubMed]×
Illinois State Board of Education. (1993). Speech-language impairment: A Technical assistance manual, Springfield, IL.
Illinois State Board of Education. (1993). Speech-language impairment: A Technical assistance manual, Springfield, IL.×
Individuals with Disabilities in Education Act of 1991, 34 CFR S 300.7 (1997).
Individuals with Disabilities in Education Act of 1991, 34 CFR S 300.7 (1997).×
Kovar, A. J. (1997). Nutrition assessment and management in pediatric dyphagia. Seminars in Speech and Language, 18, 39–49. [Article] [PubMed]
Kovar, A. J. (1997). Nutrition assessment and management in pediatric dyphagia. Seminars in Speech and Language, 18, 39–49. [Article] [PubMed]×
Manikam, R., & Perman, J. A. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30, 34–46. [Article] [PubMed]
Manikam, R., & Perman, J. A. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30, 34–46. [Article] [PubMed]×
Palmer, S., & Horn, S. (1978). Feeding problems in children. In Palmer S., & Havall S. (Eds.), Pediatric nutrition in developmental disorders (6th ed., pp. 56–87). New York: Springfield Thomas.
Palmer, S., & Horn, S. (1978). Feeding problems in children. In Palmer S., & Havall S. (Eds.), Pediatric nutrition in developmental disorders (6th ed., pp. 56–87). New York: Springfield Thomas.×
Sisson, I. A., & Van Hasselt, V. B. (1989). Feeding disorders. In Luiselli, H. (Ed.), Behavioral medicine and developmental disabilities (pp. 46–62). New York: Springer.
Sisson, I. A., & Van Hasselt, V. B. (1989). Feeding disorders. In Luiselli, H. (Ed.), Behavioral medicine and developmental disabilities (pp. 46–62). New York: Springer.×
Continuing Education Questions
  1. In order to show that a child is eligible to receive special education and related services under IDEA, speech-language pathologists and audiologists must document

    • that a disability exists.

    • that the disability has an adverse effect on educational performance.

    • that special education and related services are needed.

    • a, b, and c.

  2. Educational performance, as it is discussed in this article, refers to

    • academic functioning only.

    • social and emotional functioning.

    • academic, social and emotional functioning.

    • academic, social, emotional, and physiological functioning.

  3. The prevalence of feeding problems in children with developmental delays has been estimated to be as high as ____________ .

    • 20%

    • 30%

    • 50%

    • 80%

  4. A study that investigated the social and psychological burden of dysphagia (Ekberg, et. al.) found that ______ of adults with dysphagia reported avoiding eating with others because of their impairment.

    • 5%

    • 17%

    • 36%

    • 70%

We've Changed Our Publication Model...
The 19 individual SIG Perspectives publications have been relaunched as the new, all-in-one Perspectives of the ASHA Special Interest Groups.