Receipt Of Special Education Services Research Articles

16 Learning-Related Challenges and their Association with Special Education Receipt and Vocational Outcomes in Autistic Adults

Objective:Relative to their typically developing peers, autistic individuals experience greater difficulties in domains of functioning that are relevant to learning and adult outcomes, such as sensory sensitivities, anxiety, and social. However, little is known about how difficulties in these domains relate to the receipt of special education services as well as adult outcomes, such as vocational achievement. The current study sought to fill this gap by examining if difficulties in various learning-related domains as ascertained via the Learning Needs Screening Tool (LNST) were associated with historical special education receipt and vocational status.Participants and Methods:400 autistic adults, recruited via the Simons Powering Autism Research (SPARK) participant registry Research Match service, participated in this study (40.5% male, mean age=28.9 years). All participants completed the LNST, which collects responses to 13 core questions about learning (such as challenges with memorization, note taking, spelling and identifying arithmetic signs), as well as 7 additional questions with checkbox and free response options, and yields a total score from 0-30. LNST item 14 and its response options (1-9) capture suspected causes of learning difficulties (e.g., 'too much noise or activity bothers me,' 'I get nervous taking tests'). These individual questions as well as the total of endorsed learning related challenges were then evaluated in relation to historical special education receipt (“yes” vs. “no”) and vocational outcomes (“yes” vs. “no” engaging in 10+ hours of postsecondary education or employment without supports), as assessed via the Taylor Vocational Index.Results:Logistic regression was utilized to predict the dependent variables of interest. Models included sex assigned at birth and age in the first step as covariates. Then either the total of learning related challenges endorsed or the 9 individual learning-related challenges from the LNST were included as independent variables of interest. For historical special education receipt, two items - “It’s hard for me to work by myself” (B = .78, p<.05) and “I get nervous taking tests” (B = .49, p<.05) were positively associated with a history of special education services. For vocational outcomes, the total learning related challenges (B = -.25, p<.001) as well as endorsement of one item -“It’s hard for me to work by myself” (B = -.88, p=<.05) were associated with poorer vocational outcomes.Conclusions:These findings shed light on the possible learning-related challenges that are experienced by autistic adults. Further examination of the role these learning related challenges play in the receipt of special education and on vocational outcomes is warranted. In particular, difficulties with independence in work was related to both special education receipt and poorer vocational outcomes, indicating that it may be a fruitful area of focus for vocational training programs.

Medication Decision Making in Low-Income Families of Black Children With ADHD: A Mixed Methods Study

Objectives: The purpose of this study was to explore how and why some low-income Black caregivers seek medication treatment for their children with ADHD. Methods: Using a sequential exploratory mixed method design, Phase 1 comprised an indepth case study design of seven low-income Black caregivers of children receiving medication for ADHD. Based on findings from Phase 1, the second phase involved a secondary analysis of data on Black uninsured or publicly insured children age 6 to 17 with ADHD (n = 450). Results: Factors influencing medication decision-making included child safety and volatility, caregiver mental health, caregiver aggravation, family centered care (FCC), shared decision making (SDM), sole caregiver status, and school involvement. After adjusting for ADHD severity, previous receipt of special education services and experiences of FCC and SDM were independently associated with receipt of a medication for ADHD. Conclusions: Clinicians and school personnel can intervene to decrease disparities in the treatment of ADHD.

Secondary analysis of one State's Youth Risk Behavior Surveillance System (YRBSS) data by Individualized Education Program (IEP) status

BackgroundChildren with disabilities may be at increased risk for engaging in health risk behaviors compared to their peers without disabilities. ObjectiveThis secondary analysis aims to assess if Individualized Education Program (IEP) status, a proxy for having a disability, is a risk factor for youth to engage in health risk behaviors such as alcohol use, marijuana use, other substance use, bullying or cyberbullying victimization, and sexual activity. MethodsData from Connecticut Youth Risk Behavior Surveillance System (YRBSS) 2013, 2015, 2017, and 2019 were combined for a representative sample of 9243 students, 850 reporting having an IEP. Having a disability was measured by an item that asked if participants received special education services as part of an IEP. Logistic regression that accounted for the YRBSS sample design was used to assess main effects. ResultsHaving an IEP significantly predicted the likelihood of being bullied (OR = 1.81), cyberbullied (OR = 1.49), and other drug use (OR = 1.65), but did not predict engaging in sexual activity. ConclusionsStudents with disabilities in CT, as defined by the receipt of special education services as specified on an IEP, are at increased risk to engage in health risk behaviors than are students without disabilities during their high school years. Further analyses and comparisons across sites, years, and type of disability are limited as there is no current item on the national YRBSS questionnaire that measures a participant's special education status or disability status.

"Effects of a statewide pre-kindergarten program on children's achievement and behavior through sixth grade": Correction to Durkin et al. (2022).

Reports an error in "Effects of a statewide pre-kindergarten program on children's achievement and behavior through sixth grade" by Kelley Durkin, Mark W. Lipsey, Dale C. Farran and Sarah E. Wiesen (Developmental Psychology, 2022[Mar], Vol 58[3], 470-484). In the supplemental materials for the article, there was an error in Tables S1 and S3. An incorrect reverse-coded version of the treatment condition variable was used in the logistic regression models, causing the signs of the coefficients to be reversed, although the magnitude and p values were correct. The reported coefficients and odds ratios have been updated to have the correct direction of effects. (The following abstract of the original article appeared in record 2022-18712-001.) As state-funded pre-kindergarten (pre-K) programs expand, it is critical to investigate their short- and long-term effects. This article presents the results through sixth grade of a longitudinal randomized control study of the effects of a scaled-up, state-supported pre-K program. The analytic sample includes 2,990 children from low-income families who applied to oversubscribed pre-K program sites across the state and were randomly assigned to offers of admission or a wait list control. Data through sixth grade from state education records showed that the children randomly assigned to attend pre-K had lower state achievement test scores in third through sixth grades than control children, with the strongest negative effects in sixth grade. A negative effect was also found for disciplinary infractions, attendance, and receipt of special education services, with null effects on retention. The implications of these findings for pre-K policies and practices are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Disparities in Special Education Services for Youth With Autism Spectrum Disorder in the United States

The current study aimed to examine racial, ethnic, and gender disparities in the receipt of special education services for students with a diagnosis of autism spectrum disorder (ASD) from a healthcare provider utilizing parent-report data from a large, nationally representative sample of U.S. youth. Binary logistic regression results indicated that females with ASD were significantly less likely to receive special education than their male peers; however, race and ethnicity were not significant predictors of school-based autism services. These results suggest that racial/ethnic disparities in educational support for ASD students may be improving, yet misunderstandings of the impact of gender on autism symptom presentation and school functioning persist.

Effects of a statewide pre-kindergarten program on children's achievement and behavior through sixth grade.

As state-funded pre-kindergarten (pre-K) programs expand, it is critical to investigate their short- and long-term effects. This article presents the results through sixth grade of a longitudinal randomized control study of the effects of a scaled-up, state-supported pre-K program. The analytic sample includes 2,990 children from low-income families who applied to oversubscribed pre-K program sites across the state and were randomly assigned to offers of admission or a wait list control. Data through sixth grade from state education records showed that the children randomly assigned to attend pre-K had lower state achievement test scores in third through sixth grades than control children, with the strongest negative effects in sixth grade. A negative effect was also found for disciplinary infractions, attendance, and receipt of special education services, with null effects on retention. The implications of these findings for pre-K policies and practices are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Academic Challenges and Concerns for Children with Sickle Cell Disease: Analysis of a Hospital-Based School Intervention Program

Introduction: Neurocognitive deficits are a well-known complication in patients with sickle cell disease (SCD) and are often associated with overt stroke and silent infarctions. However, cognitive deficits may be seen in patients even without apparent MRI findings as compared to non-affected controls. Studies have also shown the impact of socioeconomic status and parental education on school retention and cognition in patients with SCD. More specifically, rates of retention and special education service use through either an Individualized Education Plan (IEP, providing specialized education services) or 504 Plan (providing accommodations due to physical disability/medical diagnosis) are reported as high as 40%. However, these historical data have been limited to primarily adolescent patients. Thus, a more thorough analysis is needed to better determine the prevalence and types of academic challenges among children with sickle cell disease, particularly younger ages. Methods: The Cincinnati Children's Hospital Medical Center's Comprehensive Sickle Cell Clinic includes a school intervention program. This program includes 1-2 full time school teachers who engage directly with patients, parents, and school staff to ensure the provision of adequate school-based services and to address specific challenges or concerns. Children with SCD are referred to the school interventionist by the clinical team (including both medical and psychosocial providers) for any school-related concern. The interventionist completes the Brief School Needs Inventory (BSNI), a thirty-item tool that determines a patient's educational risk based on academic and psychosocial history and parental responses. The BSNI provides a numeric score from 0-20 and a categorical risk of 1 (low risk) to 3 (high risk). In this retrospective review, the BSNI for all patients with SCD completed during the 2018-2019 school year were reviewed. The prevalence of the receipt of special education services (SES), grade retention, neuropsychological testing, and number of school absences were captured. Basic demographic and disease-related data, including zip code, patients' disease history, use of disease-modifying therapy, and any notable brain MRI findings were also recorded. Median household income was extrapolated from the zip codes based on 2017 US Census Bureau reporting (the most recently published year). Results: A total of 78 patients (58 HbSS, 17 HbSC, 3 HbS/β+-thalassemia) completed the BSNI for the 2018-19 academic year; an additional 15 children were also referred but did not complete the evaluation. Nearly all (95%) of patients with HbSS were receiving disease-modifying therapy (hydroxyurea or transfusions); 41% of patients with MRIs showed abnormal findings. Median age was 9 years (range 14 months - 19 years, preschool - post-secondary education). Nineteen percent of patients lived in a zip code with a median household income below the federal poverty level ($25,750). The mean BSNI score was 7.6±5.5; 27 patients were deemed low risk, 32 moderate risk, and 19 high academic risk by the BSNI (Table 1). A majority (50%) of parents responded with concerns both with obtaining support/accommodations for their child and explaining their child's medical needs to the school. Of 59 recorded, 24% of patients had had at least 16 absences in the prior year. Despite the diagnosis of SCD for all patients, only 21% had established 504 medical plans. Academic concerns were common with 20% of referred children reporting an IEP, 14% of patients with a history of grade retention, and an additional 10% with concerns for possible retention. Conclusion: The prevalence of academic difficulties and challenges is high amongst patients with SCD even in the elementary to middle school years, with rates of grade retention ~20% as compared to the national average of <2-6%. Parents of children with SCD report their greatest concerns as obtaining accommodations for their child and explaining their child's medical needs to school personnel. Most parents and schools are inadequately prepared or resourced to identify and address academic and medical needs in the school-based setting, resulting in persistent academic struggles for many children with SCD. A school intervention program is a feasible way to facilitate interaction between parents and schools to optimize educational experiences and outcomes. Disclosures No relevant conflicts of interest to declare.

Long-Term Effects of Social–Emotional Learning on Receipt of Special Education and Grade Retention: Evidence From a Randomized Trial of INSIGHTS

Social–Emotional Learning (SEL) programs are school-based preventive interventions that aim to improve children’s social–emotional skills and behavioral development. Although meta-analytic research has shown that SEL programs can improve academic and behavioral outcomes in the short term, few studies have examined program effects on receipt of special education services and grade retention in the longer term. Using an experimental design, the current study leveraged administrative data available through students’ school records (N = 1,634) to examine the impacts of one SEL program implemented in kindergarten and first grade on receipt of special education and grade retention in fifth grade. The study further considered whether impacts varied for low- versus high-income students. Findings revealed no difference between treatment and control group students in grade retention. However, treatment group students were less likely to ever receive special education services by the end of fifth grade, with low-income students appearing to drive this effect. Implications are discussed.

Early Communication Skills and Special Education Outcomes at School Entry: Implications for Pediatric Care and Screening.

Objective. To examine whether children’s early communication skills at age 3 predict special education outcomes at kindergarten entry. Methods. Data from 139 children eligible for early intervention or early childhood special education services were examined. Early communication was defined separately as expressive and receptive language skills and was measured by the Vineland Adaptive Behavior Scales–Second Edition. Outcome variables were parent-reported measures of special education use and dosage as well as speech therapy receipt and dosage at kindergarten entry. Results. Better expressive language skills at age 3—but not receptive language skills—predicted a significantly reduced likelihood (odds ratio = 0.79) of receiving speech therapy at kindergarten entry. There were no effects of early communication on broader receipt of special education services as well as on special education dosage. Conclusions. Screening of specific domains of early communication skills during routine pediatric care, in conjunction with the evaluations of other professionals involved in the child’s education and health, might be an effective method for identifying children who are likely to receive speech therapy and other special education services at kindergarten entry.

Mental health outcomes among youth in foster care with disabilities

BackgroundThe mental health outcomes among youth in foster care with disabilities are under studied. Increasing our understanding of mental health risk and protective factors is essential for improving the mental health and quality of life of this population. This study tests the associations of risk and protective factors on mental health outcome variables of youth in foster care with disabilities. MethodsAll Oregon youth in foster care who were ages 16.6–18.5 and attending study school districts were invited to participate in a federally-funded longitudinal RCT evaluation, which sought to assess the effectiveness of self-determination enhancement on outcomes of youth transitioning from foster care to adult life. Only baseline data was used with a final sample of 305. Receipt of special education services was used as the proxy for disability status. The risk factors included trauma exposure, hopelessness, placement type, perceived placement restrictiveness. The protective factors included social support and self-determination. The outcome variables included internalizing and externalizing mental health symptoms, quality of life. Preliminary analyses organized by special education (SPED) involvement vs. study variables were conducted, and stepwise regressions were followed. ResultsFindings revealed SPED was associated with being in a restrictive foster placement. Youth involved in SPED reported higher perceived placement restrictiveness and hopelessness, but lower quality of life (QoL). Self-determination was a consistent protective factor. Post-traumatic symptomology was a consistent and strongest risk factor for all outcome variables. ConclusionsAlthough it is not possible to change previous adverse childhood experiences that result in currently experienced trauma, well-designed self-determination enhancement interventions and the support of caring adults may reduce negative mental health outcomes and improve QoL

Functional limitations and educational needs among children and adolescents with heart disease.

To examine how cognitive and motor limitations in children with heart disease are associated with education and participation in extracurricular activities. Using 2009-2010 parent-reported data from the National Survey of Children with Special Health Care Needs (NS-CSHCN), we examined prevalence of five functional limitations (learning/concentration, communication, self-care, gross motor skills, and fine motor skills) by diagnosed heart disease status using chi-square tests and multivariable logistic regression. Among CSHCN with heart disease, we examined the associations between severity of each functional limitation and missing ≥11 days of school in the past year, receiving special education services, and interference with extracurricular activities. CSHCN with heart disease (n = 1,416), compared to CSHCN without (n = 28,385), more commonly had "a lot" of difficulty in the five functional areas (P < .01; adjusted odds ratios: 1.8-3.3). Among CSHCN with heart disease, "a lot" of difficulty with learning/concentration was most common (35%), followed by communication (21%), self-care (14%), gross motor skills (12%), and fine motor skills (10%). Among CSHCN with heart disease, compared to those without, respectively, 27% and 15% missed ≥11 days of school, 45% and 29% received special education services, and 49% and 29% experienced interference with extracurricular activities (P < .01 for all). Level of difficulty with the five functional areas was associated with receipt of special education services and participation in extracurricular activities (P < .001). These results support the American Heart Association recommendations to screen children with congenital heart disease for age-appropriate development and provide services when needed.

Addendum: Geier, D.A.; et al. A Cross-Sectional Study of the Association between Infant Hepatitis B Vaccine Exposure in Boys and the Risk of Adverse Effects as Measured by Receipt of Special Education Services. Int. J. Environ. Res. Public Health 2018, 15, 123

The authors would like to update the “Conflicts of Interest” section of their previous paper [1] as follows:[...]

Using early indicators of academic risk to predict academic skills and socioemotional functioning at age 10.

Early indicators of academic risk were used to predict the academic skills, socioemotional functioning, and receipt of special education services at age 10 among children from low-income families who participated in the Early Head Start Research and Evaluation Project. Pairwise comparison of academic skills and socioemotional functioning among early academic risk indicator groups was used, and logistic regression modeling was used to predict receipt of special education services. Children who received early intervention or early childhood special education services or were suspected of having developmental delays before age 3 or at age 5 scored lower on academic skills and poorer on socioemotional functioning at age 10 than those without academic risk indicators. Children who had only biological risks before age 3 or at age 5 did not differ in academic skills or socioemotional functioning at age 10 compared to children without any academic risk indicators. Generally, children’s academic risk indicators identified later (at age 5) were stronger predictors of poor academic skills and socioemotional functioning at age 10 than were earlier academic risk indicators (before age 3). Only children who received early intervention services before age 3 or early childhood special education services at age 5 were more likely to receive special education services at age 10 than other groups. Early universal screening, monitoring, and continuous provision of appropriate services for children from low-income families and with academic risks are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

A Cross-Sectional Study of the Association between Infant Hepatitis B Vaccine Exposure in Boys and the Risk of Adverse Effects as Measured by Receipt of Special Education Services.

The National Center for Education Statistics reported that between 1990–2005 the number of children receiving special education services (SES) rose significantly, and then, from 2004–2012, the number declined significantly. This coincided with the introduction of Thimerosal-containing hepatitis B vaccine in 1991, and the subsequent introduction of Thimerosal-reduced hepatitis B vaccine in the early 2000s. This study examined the potential relationship between infant exposure to mercury from three doses of Thimerosal-containing hepatitis B vaccine and the risk of boys being adversely affected (as measured by receipt of SES). This cross-sectional study examined 1192 boys (weighted n = 24,537,123) 7–8 years of age (born: 1994–2007) from the combined 2001–2014 National Health and Nutritional Examination Survey (NHANES). Survey logistic regression modeling revealed that an exposed population receiving three doses of infant Thimerosal-containing hepatitis B vaccine (weighted n = 11,186,579), in comparison to an unexposed population (weighted n = 704,254), were at an increased risk of receipt of SES. This association was robust (crude odds ratio = 10.143, p = 0.0232), even when considering covariates, such as race and socioeconomic status (adjusted odds ratio = 9.234, p = 0.0259). Survey frequency modeling revealed that receipt of SES for the population that was exposed to three doses of Thimerosal-containing hepatitis B vaccine in infancy (12.91%) was significantly higher than the unexposed population (1.44%) (prevalence ratio = 8.96, p = 0.006, prevalence attributable rate = 0.1147). Despite the limitation of this cross-sectional study not being able to ascribe a direct cause-and-effect relationship between exposure and outcome, it is estimated that an additional 1.2 million boys received SES with excess education costs of about United States (US) $180 billion associated with exposure to Thimerosal-containing hepatitis B vaccine. By contrast, exposure to Thimerosal-reduced hepatitis B vaccine was not associated with an increased risk of receiving SES. Therefore, routine childhood vaccination is important to reduce the morbidity and mortality of infectious diseases, but every effort should be made to eliminate Thimerosal from all vaccines.

Cross-Cohort Evidence of Disparities in Service Receipt for Speech or Language Impairments

We examined the extent to which disparities in the receipt of special education services for speech or language impairments (SLIs) on the basis of race, ethnicity, or language use by kindergarten—when the delivery of these services might be expected to be most effective—have changed over a 12-year period in the United States. Logistic regression modeling of 2 nationally representative cohorts ( N = 16,800 and 12,080) indicated that children who are Black (covariate-adjusted odds ratios = 0.39 and 0.54) or from non-English-speaking households (covariate-adjusted odds ratios = 0.57 and 0.50) continue to be less likely to receive services for SLIs. Hispanic children are now less likely to receive these services (covariate adjusted odds ratio = 0.54) than otherwise similar non-Hispanic White children. Disparities in special education service receipt for SLIs attributable to race, ethnicity, and language presently occur in the United States and are not explained by many potential confounds.

The Behavior Rating Inventory of Executive Function (BRIEF) to Identify Pediatric Acute Lymphoblastic Leukemia (ALL) Survivors At Risk for Neurocognitive Impairment.

Neurocognitive problems, including executive dysfunction, are potential late effects of pediatric acute lymphoblastic leukemia treatment. Surveillance for neurocognitive impairment in a timely and efficient manner is imperative to ongoing clinical care. We sought to determine if the Behavior Rating Inventory of Executive Function (BRIEF) Parent Form identified leukemia survivors with cognitive impairment. In this 28-site cross-sectional study, parents of 256 children, a mean of 8.9±2.2 years after treatment for standard-risk precursor-B acute lymphoblastic leukemia and in first remission, completed the BRIEF. We used a multivariate logistic regression to calculate the association between elevated scores on 3 composite BRIEF indices (Behavioral Regulation Index, Metacognition Index, Global Executive Composite [GEC]) and special education and attention-deficit/hyperactivity disorder (ADHD) outcomes. All BRIEF index scores were significantly associated with receipt of special education services or ADHD. The BRI was most strongly associated with ADHD (odds ratios=4.33; 95% confidence interval, 1.72-10.9). The GEC was most strongly associated with ADHD (odds ratios=4.46; 95% confidence interval, 1.77-11.22). Elevated scores on the BRIEF GEC were associated with low sensitivity (24.1 to 39.1) for detecting the outcomes but better specificity (range, 87.7 to 89.3). These results suggest that the parent-completed BRIEF is associated with clinical outcomes but is not a sensitive tool to identify leukemia survivors that require a comprehensive neuropsychological assessment.

Comparing Emotion Recognition Skills among Children with and without Jailed Parents.

Approximately five million children in the United States have experienced a co-resident parent’s incarceration in jail or prison. Parental incarceration is associated with multiple risk factors for maladjustment, which may contribute to the increased likelihood of behavioral problems in this population. Few studies have examined early predictors of maladjustment among children with incarcerated parents, limiting scholars’ understanding about potential points for prevention and intervention. Emotion recognition skills may play a role in the development of maladjustment and may be amenable to intervention. The current study examined whether emotion recognition skills differed between 3- to 8-year-old children with and without jailed parents. We hypothesized that children with jailed parents would have a negative bias in processing emotions and less accuracy compared to children without incarcerated parents. Data were drawn from 128 families, including 75 children (53.3% male, M = 5.37 years) with jailed parents and 53 children (39.6% male, M = 5.02 years) without jailed parents. Caregivers in both samples provided demographic information. Children performed an emotion recognition task in which they were asked to produce a label for photos expressing six different emotions (i.e., happy, surprised, neutral, sad, angry, and fearful). For scoring, the number of positive and negative labels were totaled; the number of negative labels provided for neutral and positive stimuli were totaled (measuring negative bias/overextension of negative labels); and valence accuracy (i.e., positive, negative, and neutral) and label accuracy were calculated. Results indicated a main effect of parental incarceration on the number of positive labels provided; children with jailed parents presented significantly fewer positive emotions than the comparison group. There was also a main effect of parental incarceration on negative bias (the overextension of negative labels); children with jailed parents had a negative bias compared to children without jailed parents. However, these findings did not hold when controlling for child age, race/ethnicity, receipt of special education services, and caregiver education. The results provide some evidence for the effect of the context of parental incarceration in the development of negative emotion recognition biases. Limitations and implications for future research and interventions are discussed.

School-Age Test Proficiency and Special Education After Congenital Heart Disease Surgery in Infancy

To evaluate test proficiency and the receipt of special education services in school-age children who had undergone surgery for congenital heart disease (CHD) at age <1 year. Data from Arkansas-born children who underwent surgery for CHD at Arkansas Children's Hospital at age <1 year between 1996 and 2004 were linked to state birth certificates and the Arkansas Department of Education longitudinal database containing achievement test scores in literacy and mathematics for grades 3-4 and special education codes. The primary negative outcome was not achieving grade-level proficiency on achievement tests. Logistic regression accounting for repeated measures was used to evaluate for associations between achieving proficiency and demographic data, maternal education, and clinical factors. A total of 362 of 458 (79%) children who underwent surgery for CHD were matched to the Arkansas Department of Education database, 285 of whom had grade 3 and/or 4 achievement tests scores. Fewer students with CHD achieved proficiency in literacy and mathematics (P < .05) compared with grade-matched state students. Higher 5-minute Apgar score, shorter duration of hospitalization, and higher maternal education predicted proficiency in literacy (P < .05). White race, no cardiopulmonary bypass, and shorter hospitalization predicted proficiency in mathematics (P < .05). Sex, gestational age, age at surgery, CHD diagnosis, and type and number of surgeries did not predict test proficiency. Compared with all public school students, more children with CHD received special education services (26.9% vs 11.6%; P < .001). Children with CHD had poorer academic achievement and were more likely to receive special education services than all state students. Results from this study support the need for neurodevelopmental evaluations as standard practice in children with CHD.

Evidence and Implications of Racial and Ethnic Disparities in Emotional and Behavioral Disorders Identification and Treatment

We summarize our recent findings that White children in the United States are more likely than otherwise similar racial or ethnic minority children to receive special education services, including for emotional and behavioral disorders. We show how the findings are robust. We explain why our findings conflict with prior reports in education that minorities are overidentified as having disabilities due to biased or discriminatory eligibility procedures. The prior reporting itself conflicts with a large and rigorous body of research in public health, possibly due to the use of comparatively weaker designs and analyses. We conclude with a discussion of implications of our findings of these racial and ethnic disparities for policymakers, researchers, and practitioners. Greater efforts should be made to ensure that children with emotional and behavioral disorders, irrespective of their race or ethnicity, are being appropriately recognized and provided with the supports and services to which they are legally entitled. Potential mechanisms that may limit minority children's receipt of special education services for emotional or behavioral disorders include families being ill-informed about the symptomatology and treatment options for these disorders, limited access to health care, and implicit bias by practitioners who may be more responsive to White, English-speaking families when making disability evaluations.

Congenital Heart Defects and Receipt of Special Education Services.

We investigated the prevalence of receipt of special education services among children with congenital heart defects (CHDs) compared with children without birth defects. Children born from 1982 to 2004 in metropolitan Atlanta with CHDs (n = 3744) were identified from a population-based birth defect surveillance program; children without birth defects (n = 860 715) were identified from birth certificates. Cohorts were linked to special education files for the 1992-2012 school years to identify special education services. Children with noncardiac defects or genetic syndromes were excluded; children with CHDs were classified by presence or absence of critical CHDs (ie, CHDs requiring intervention by age one year). We evaluated the prevalence of receipt of special education services and prevalence rate ratios using children without birth defects as a reference. Compared with children without birth defects, children with CHDs were 50% more likely to receive special education services overall (adjusted prevalence rate ratio [aPRR] = 1.5; 95% confidence interval [CI]: 1.4-1.7). Specifically, they had higher prevalence of several special education categories including: intellectual disability (aPRR = 3.8; 95% CI: 2.8-5.1), sensory impairment (aPRR = 3.0; 95% CI: 1.8-5.0), other health impairment (aPRR = 2.8; 95% CI: 2.2-3.5), significant developmental delay (aPRR = 1.9; 95% CI: 1.3-2.8), and specific learning disability (aPRR = 1.4; 95% CI: 1.1-1.7). For most special education services, the excess prevalence did not vary by presence of critical CHDs. Children with CHDs received special education services more often than children without birth defects. These findings highlight the need for special education services and the importance of developmental screening for all children with CHDs.