Doctors and Schools

Some of the most important professionals in your children’s lives are their teachers and their doctors. Parents strongly depend on the skills and knowledge that these folks bring to their jobs.

Teachers often have an opinion about what the doctor should do, and doctors often have an opinion about what the teacher should do for a child. It can be a real problem for parents to sort it all out, particularly since many medical professionals are not supportive of schools and school staff, and our culture gives doctors a much higher level of respect than teachers.

There is also a tendency to believe that an evaluation or an opinion you pay for is more accurate and thorough than what is provided through the school. In my experience, this isn’t necessarily so. I have seen many sloppy, low quality private evaluations over the years, and many excellent ones provided by school personnel. And remember – the school evaluations are not actually “free”. They are paid for by your tax dollars.

An experienced teacher has seen lots of children with lots of medical problems, and she can be very accurate in referring families for medical concerns. But all she should do is state the reasons for her concern – the symptoms she observes – and make the referral. It’s appropriate for teachers to tell parents what they think the possibilities might be, but teachers cannot make a medical diagnosis.

It’s also inappropriate for principals, school psychologists, and guidance counselors to make medical diagnoses. And nobody at a school should ever tell you that you have to put your child on medication. That’s actually against the law! The bottom line on medication is that it’s appropriate for school staff to give you their observations and their concerns, but after that the decision is between you and your doctor.

By the same token, an experienced pediatrician has seen lots of children with developmental problems, and he can be very accurate in referring families for educational concerns. But all the doctor should do is make the referral to the school.  It’s inappropriate for doctors to write “Billy Brown needs an IEP” or “Amanda Smith is learning disabled” on a prescription pad – and this happens all the time.

Doctors are used to giving orders in medical settings, but they cannot “order” a school to do anything. I’ve never met a doctor who understood the legal process for determining eligibility for special education services – and a doctor’s order does not supersede or replace that process.

The most helpful thing a doctor can do is send a letter to the school, stating any educationally relevant diagnoses and concerns. Doctors provide important information for determining eligibility for services, and that medical information must be considered in any educational decisions, but it is just one piece of a comprehensive evaluation.

When doctors diagnose developmental disorders in children, they use the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). For example, the section on Neurodevelopmental Disorders includes Intellectual Disability, Specific Learning Disorder, Language Disorder, Autism Spectrum Disorder, ADHD, and several others. The guidelines for these diagnoses are not always the same as those used by school psychologists, speech pathologists, occupational therapists, and educators when determining eligibility for school services.

Educators use the federal law IDEA (Individuals with Disabilities Education Act) and state laws to determine if children are eligible for special education services. IDEA describes thirteen disabling conditions. Eligibility has three prongs: the child has a disability, the disability adversely affects the child’s educational performance, and the child requires special education services in order to receive a free and appropriate public education.

Educators also use Section 504, another federal law, to determine if a child with a disability requires “reasonable accommodations” to participate successfully in regular education.

Doctors make diagnoses. Educators determine eligibility for services. Doctors use the DSM-V; educators use IDEA and Section 504. A doctor’s diagnosis alone does not make a child eligible for special education services or reasonable accommodations.

Just as school staff should never demand that a doctor give your child a diagnosis or medication, doctors should never demand educational services or an IEP. It’s inappropriate, and it’s overreaching.

Both the doctor and the teacher should respect each other’s knowledge and expertise, and understand that the medical system and the educational system have different rules and procedures. Both the doctor and the teacher should be focused on providing the information and expertise necessary to help you make the right decisions for your child.

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