Exhibit 4 - Emotional Disturbance - IEP Format WITH Explanations of the NASET Coding System and Guide Codes
[EXHIBIT 4]
Emotional Disturbance
NASET Coding System and Guide IEP Format WITH Explanations
INDIVIDUAL EDUCATIONAL PROGRAM
School District/Agency: Newtown School District
Name and Address: Newtown Province, IL
Section 1- Background Information
Student Name: David Morris
Date of Birth: 2/5/05Age: 11
Street: 14 River Rd.
City: Newtown Zip: 16753
Date of Referral for Committee Review: March 17, 2016
Telephone: 768–0943 County of Residence: Newtown
Male _X_ Female __ Student ID#: 8786Y Current Grade: 5
Dominant Language of Student: English Interpreter Needed: Yes___ No _X__
Medical Alerts: none
Mother’s Name/Guardian’s Name: Mary
Street Address: same
City: same Zip: same
Telephone: same County of Residence:
Dominant Language of Parent/Guardian: English Interpreter Needed: Yes__ No_X_
Father's Name/Guardian's Name: Paul
Street Address: same
City: same Zip: same
Telephone: same County of Residence: same
Dominant Language of Parent/Guardian: English Interpreter Needed: Yes__ No__X_
Section II-Type of Meeting:
A-Initial Evaluation
1. Date of Initial Evaluation Meeting: March 8, 2016
2. Area of Suspected Disability - (NASET Coding System and Guide Level I Diagnosis)-Emotional Disturbance
3. Origin of Evaluation used in determining classification:
- In-school ___X____ Non-school Personnel Evaluation ___X__
4. Components of Present Evaluation:
- Individual Standardized Testing _____X____
- Informal Assessment Measures ____X___ (i.e. Portfolio Assessment)
- Observation ___X___
- Social History ___X___
- Teacher Reports ___X___
- Interviews with Child ___X___
- Review of Medical Records ___X____
5. Specific Areas Covered in Evaluation:
- Intelligence Testing ___X____
- Academic Testing ___X___
- Medical Evaluation ____X____
- Speech Language Evaluation _______
- Occupational Evaluation _______
- Other (Be Specific) _______
- Audiometric Evaluation _______
- Psychiatric Evaluation ____X___
- Psychological Evaluation ____X___
- Portfolio Assessment ___X____
- Curriculum Based Assessment _______
- Authentic Assessment ___X_____
- Task Analysis ____X____
- Outcome Based Assessment ________
- Learning Styles Assessment _____X______
6. Committee Recommendations:
Classification (NASET Coding System and Guide Coding):
Level I-Emotional Disturbance ED
Level II-Anxiety Reactive Disorder ED 6.00
Individuals with this disorder havea tendency to develop fears associated with personal or school problems.
Level III- School Avoidance Anxiety - ED 6.02
Reactive disorder
Specifically, David hasa type of Anxiety Reactive Disorder characterized by extreme anxiety manifested in an avoidance of school.
Individuals with this disorder may become very upset or ill when forced to go to school. They may stay in close contact with their parents or caregivers, and are frequently (although not always) anxious and fearful. Truants may be distinguished from this group by their antisocial or delinquent behaviors, their lack of anxiety about missing school, and the fact that they are not in contact with parents or caregivers when they are avoiding school.
Level IV Not Applicable
Level V Moderate
This suggests that the David’s disability has a moderate adverse effect on his or her educational performance. He should receive special education and related services outside the regular classroom for at least 21% but no more than 60% of the school day.
Level I-Emotional Disturbance ED
Level II-Anxiety Reactive Disorder ED 6.00
Individuals with this disorder havea tendency to develop fears associated with personal or school problems.
Level III- Panic Reactive Disorder ED 6.01
Specifically, David suffers from panic reactions. Individuals with this disorder may tend to exhibit in school high anxiety that is very sudden, appears unprovoked, and is often disabling.
Level IV Not Applicable
Level V Moderate
This suggests that the David’s disability has a moderate adverse effect on his educational performance. He should receive special education and related services outside the regular classroom for at least 21% but no more than 60% of the school day.
Level I-Emotional Disturbance ED
Level II-Inappropriate Behavior or Feelings ED 3.00
Individuals with this disorder exhibitinappropriate types of behavior or feelings under normal circumstances.
Level III-Disruptive Behavior Disorder ED 3.02
David suffers from inappropriate behavior feelings which exhibit themselves in the form of disruptive behavior. This disorder may be characterized by defiance, hyperactivity, over activity, making noises in class, calling out, touching other people or other people’s property and showing a complete disregard for the rights and property of others.
Level IV Not Applicable
Level V Moderate
This suggests that the David’s disability has a moderate adverse effect on his educational performance. He should receive special education and related services outside the regular classroom for at least 21% but no more than 60% of the school day.
Level I-Emotional Disturbance ED
Level II-Relationship Problems Disorder ED 2.00
Relationship problem disorder is characterized by an individual’s inability to build or maintain satisfactory interpersonal relationships with peers and teachers. Further, the individual exhibits inappropriate types of behavior or feelings under normal circumstances.
Level III Not Applicable
Exhibits painful shyness in social situations and as a result withdraws from social activities or interaction on the playground, physical education, and other social interactions with peers.
Level IV Not Applicable
Level V Moderate
This suggests that the David’s disability has a moderate adverse effect on his educational performance. He should receive special education and related services outside the regular classroom for at least 21% but no more than 60% of the school day.
Level I-Emotional Disturbance ED
Level II-Physical Complaints Disorder ED 5.00
Specifically, David has a Physical Complaints disorder. Individuals with this disorder havea tendency to develop physical symptoms associated with personal or school problems that significantly affect a child’s ability to function in school. These physical systems are not connected to any medical problems but are considered psychological in nature. This disorder may be characterized by frequent headaches, stomachaches, somatic complaints, nausea, vomiting, diarrhea, preoccupation with one’s health
Level III Not Applicable
Level IV Not Applicable
Level V Moderate
This suggests that the David’s disability has a moderate adverse effect on his or her educational performance. He should receive special education and related services outside the regular classroom for at least 21% but no more than 60% of the school day.
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