Screening for Special Diagnoses

Congress enacted Public Law 94-142, the Education for All Handicapped Children Act, in November, 1975. It requires that all children with disabilities receive a free and appropriate public education. Determining who has a disability and who is eligible for special services, however, is not an exact science. It is complicated by vague definitions and varying interpretations of how to identify specific handicapping conditions (Hallahan & Kauffman, 1991). Nevertheless, recent government figures indicate that 7 percent of children and youth from birth to 21 are identified as having a disability that requires special intervention (Hunt & Marshall, 1994).

While practices differ greatly both across and within states (Adelman & Taylor, 1993), screening is an important part of the assessment process mandated by Public Law 94-142. Screening for the purpose of special diagnoses begins at birth and continues throughout the school years. In the first few years of life, most forms of screening center around developmental norms for physical, cognitive, and language abilities. Many children with severe disabilities (cerebral palsy, spina bifida, Down's syndrome, autism, severe sensory impairments, or children with multiple disabilities, for example) are identified early in life by physicians and other health professionals. However, other children, such as those with learning disabilities, attention deficit disorders, behavioral problems, and so forth, are usually not identified until they start school.

School-Based Screening

Most public schools periodically "screen" large groups of students, typically between kindergarten through third grade, to identify children who may have a disability (as yet unidentified) or may be at risk for school failure. For example, a student with an extremely low test score on a standardized achievement test administered to all first graders in a school may become the focus of further inquiry to determine the validity of the screening observation and, if warranted, to determine the causes of the child's difficulties. This may lead to a recommendation to conduct a formal evaluation to decide if the child has a specific, identifiable disability. In addition to systematically "screening" students, children with a "suspected" disability may also be identified through referrals by parents, teachers, or other school personnel. Typically, a child who is having academic or behavioral problems in the classroom may be referred for further testing to determine if a disability is present. Before testing for diagnosis begins, however, the school must obtain consent from the child's parents to do the evaluation.

While most children with a disability are identified by third grade, some are not identified until the upper elementary grades or even junior or senior high school. In some instances, a problem does not become evident until the demands of school exceed the child's skills in coping with his or her disability. In other cases, the disability may not occur until the child is older. For instance, a disability may be acquired as a result of a traumatic brain injury or as a result of other environmental factors. A disability may also not be identified until a child is older because the procedures used for screening, referral, testing, and/or identification are ineffective.