How Pediatric Hematologic and Oncologic Patients Experienced Virtual Learning During COVID-19: Importance of Amplifying the Family Voice for Informing Future Recommendations

Background: With medical advancements in the detection and treatment of pediatric oncologic and hematologic disorders, survival and life expectancy rates continue to improve. However, the treatments themselves have been linked to long-term cognitive issues (e.g., attention, working memory, and executive functioning). These difficulties have particular salience to academic achievement and often necessitate educational accommodations to support learning. However, these plans are designed for the traditional school environment and may be insufficient for virtual learning. The purpose of this study is to investigate the perceived impact of COVID-19 in the context of virtual learning for children with hematologic or oncologic disorders to inform the development of appropriate recommendations for patients and schools this fall. Methods: Qualitative interviews assessing academic accommodations and COVID-19 adjustments to virtual learning were conducted separately with participants and their guardians by phone. Medical histories were obtained via electronic health record. Results: Thirty children (Mage=12.8 years, SD=1.4 years) with status post cancer treatment (n=17), sickle cell disease (n=11), or neurofibromatosis type 1 (n=2), with an IEP (n=15) or 504-plan (n=15) in place prior to COVID-19. During virtual learning, children reported a lack of interaction with teachers or other resource help. Guardians felt pressured to assist with schoolwork without sufficient support or qualifications. Anecdotally, families still expressed gratitude to their schools and teachers, revealing overall low expectations for virtual learning. Potential Impact: This pediatric population faces unique education challenges, specific to neurocognitive impairment secondary to their chronic health conditions. Unsurprisingly, families perceived that their educational needs were not met during virtual learning related to COVID-19. To prevent the cascading effect of insufficiently addressed academic needs, the inclusion of family’s perceived experiences is critical for informing individual recommendations and the Indiana Department of Education broadly during the transition back to school this fall, both in the physical and virtual classrooms.

Module 8: Working Effectively with the Schools

In Module 8, parents learn the importance of advocating for their children’s educational needs by developing and maintaining a collaborative working relationship with the school. The most effective outcomes come when parent(s) and school collaboratively work together toward the common goal of helping the child succeed. To be the most effective advocate for the child, parents must understand their educational rights. Parents should also be familiar with evidence-based strategies for addressing academic productivity and behavior management in the classroom (e.g., Daily Report Card [DRC]) so that they know what to ask for. Some parents will need support to appropriately assert themselves in this context, refraining from being either too passive or too aggressive. Other parents will need support with keeping organized records of their children’s psychological evaluations, records, and report cards, which is essential as they prepare for school (IEP, 504 Plan) meetings.

Symptom Level Associations Between Attention-Deficit Hyperactivity Disorder and School Performance

Attention-deficit hyperactivity disorder (ADHD) is associated with reduced school performance. To determine which ADHD symptoms and subtypes have the strongest association, we used type and frequency of symptoms on the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA) to create symptom scores for inattention and hyperactivity-impulsivity and define subtypes (ADHD-Inattentive [ADHD-I], ADHD-Hyperactive-Impulsive, ADHD-Combined [ADHD-C]). Regression methods were used to examine associations between symptoms and subtype and a composite measure of school performance. Children with ADHD-C and ADHD-I had higher adjusted odds of having reduced overall school performance (ADHD-C = 5.8, 95% confidence interval [CI] = 3.1-10.9; ADHD-I = 5.5, 95% CI = 3.1-10.1) compared with children without ADHD. All inattentive symptoms were significantly related to reduced school performance in reading, writing, and handwriting, while 6 of 9 symptoms were significantly associated in mathematics. Children with ADHD-I were significantly more likely than children with other ADHD subtypes to receive a school-based Individualized Education Program or 504 Plan. ADHD-I symptoms may be broadly linked to reduced school performance.

Eating and Feeding Disorders

Eating disorders, which encompass a broad spectrum of diagnoses, typically emerge in adolescence or young adulthood. This chapter focuses on eating or food-related disorders and malnutrition in children and adolescents. The chapter provides a general description of eating disorders in children and adolescents, assessment and treatment considerations, and resources for school-based clinicians who work with children and adolescents diagnosed with an eating disorder. Information about common school-related concerns, such as cognitive difficulties, frequent school absences, nutritional intake, and engagement in physical activities, is included, with specific strategies for the school-based professional to adopt when working with students with eating disorders. The chapter concludes with a list of helpful resources and a framework for guiding the development of an individualized education plan or 504 plan for students who need additional educational accommodations or interventions.

Effects of Grade and School Services on Children's Responsibility for Hearing Aid Care

Purpose We investigated trends in hearing aid maintenance and assumption of responsibility for hearing aids in school-age children who are hard of hearing. Specifically, we examined the extent to which families own necessary hearing aid maintenance equipment, whether and by whom hearing aid maintenance tasks are being completed, and the effects of grade and receipt of an Individualized Education Program (IEP) or 504 plan on a child's assumption of responsibility for hearing aid care. Method Participants included 167 children who are hard of hearing in 1st to 4th grade. Caregivers reported whether the families owned various types of hearing aid maintenance equipment (listening tube, battery tester, and dri-aid kit) and who normally completes various hearing aid maintenance tasks. Information about children's audiological characteristics was also collected. Results Thirty-two percent of families reported not owning at least 1 piece of hearing aid maintenance equipment. Using a battery tester and performing a listening check were the maintenance tasks completed the least frequently, with 49% and 28% of caregivers reporting that these tasks are not completed regularly, respectively. Children's responsibility for hearing aid maintenance increased with grade. After controlling for maternal education and degree of hearing loss, children with an IEP or 504 plan took more responsibility for hearing aid maintenance tasks than children without these services. Conclusion Important hearing aid maintenance tasks, such as listening checks, are not completed regularly for many children, even when families own the necessary equipment. Ensuring that children who are hard of hearing have an IEP or 504 plan throughout elementary school may support self-advocacy and encourage children to take responsibility for their hearing aids, which may lead to more consistent hearing aid functioning.

Predictors of Receipt of School Services in a National Sample of Youth With ADHD

Objective: The objective of the study is to describe the extent to which students with ADHD received school-based intervention services and identify demographic, diagnostic, and impairment-related variables that are associated with service receipt in a large, nationally drawn sample. Method: Parent-reported data were obtained for 2,495 children with ADHD aged 4 to 17 years from the National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA). Results: The majority (69.3%) of students with ADHD currently receive one or more school services. Educational support (62.3%) was nearly twice as prevalent as classroom behavior management (32.0%). More than 3 times as many students with ADHD had an individualized education program (IEP; 42.9%) as a Section 504 plan (13.6%). Conclusion: At least one in five students with ADHD do not receive school services despite experiencing significant academic and social impairment, a gap that is particularly evident for adolescents and youth from non–English-speaking and/or lower income families.

Finding and Serving Twice Exceptional Students

Gifted children with coexisting disabilities—the twice exceptional or 2e—exhibit complex patterns of strengths and weaknesses. Either exceptional ability or disability may mask the other, or combined exceptionalities may appear average. A case study illustrates how interpretation of changes in special education law may overlook 2e students who perform too well to qualify for services yet have disabilities significant enough to undermine success as the demands of their education increase. Department of Education policy letters are discussed, especially regarding a state’s right to condition service eligibility upon below-grade-level performance and reduce access to assessment. The student’s comprehensive diagnostic testing is explored. A triaged approach, using observed characteristics of 2e learners, is recommended to determine when comprehensive evaluation is needed to interpret a complex 2e student’s learning challenges, guide interventions/accommodations through an Individualized Education Program or Section 504 Plan, and ensure a Free Appropriate Public Education.