- Many children with epilepsy experience academic and behavioral problems related to their condition or treatment. Educational assessment is important to identify specific issues and provide appropriate support. - Testing evaluates cognitive abilities, processing skills, academic achievement, language skills, memory, and other areas that may be affected. This helps determine appropriate educational interventions and services. - Children with epilepsy often qualify for special education under categories like learning disability, developmental delay, or other health impairment if they meet eligibility criteria related to how their condition adversely impacts educational performance.

1. Educational Assessment in
Pediatric Epilepsy
Thomas B. King, M.Ed.
Debbie Ramer, M. Ed.
Educational Consultants
Division of Child Neurology

2. Why Assess?

3. Incidence of Epilepsy
2,000,000 people in the United States have
some form of epilepsy
30 %, or about 300,000 are under the age of 18
6/1000, or approximately 0.5 % to 1% of
children in the US are diagnosed with epilepsy
Large numbers of children may have undetected
or untreated epilepsy.
(Epilepsy Foundation of America)

4. Incidence
Most common CNS disorder affecting
children
About 5% to 10% of children will have a
seizure within the first 20 years of life

5. Educational Implications
Most children with epilepsy test within the
Average IQ range and will remain in regular
education classes. (Epilepsy Foundation of America)
The majority of children with epilepsy will attend
their neighborhood schools.
However, some children with epilepsy will
experience academic and/or behavior problems.

6. Hidden Epilepsy
you don’t have to have a seizure
BECTS to LKS spectrum
about 8% of children with Rolandic
Discharges have epilepsy
most will have cognitive dysfunction
IQ may not be affected
processing disorders cause learning
disabilities and behavior disorders
Epilepsia. 2006 Nov;47 Suppl 2:67-70

7. Factors that effect school
performance
Type of epilepsy
Level of control
Any related medical condition
Age of onset is a factor

8. Problems that children with
epilepsy may face in school
Learning Disabilities are a common, but
frequently overlooked co-morbid condition.
(Pellock, 1999)
Almost 1/3 of children with epilepsy are also
identified as ADHD (Kanner, 2001)
Grade retention and special education
identification is more common in children with
epilepsy. (Bailet & Turk, 2000)
There is a higher rate of psychiatric disorders in
children with epilepsy (Kanner, 2001)

9. Problems that children with
epilepsy may face in school
Poor seizure control is associated with
decreased reading achievement.
(Bailet & Turk, 2000)
Nocturnal seizures are believed to have a
detrimental effect on language, memory,
and alertness. (Aldenkamp, 1999)

10. Reasons that children with
epilepsy have these problems
Underlying etiology – what is causing the
seizure may also interfere with one or more of
the child’s psychological processes.
Medicines for seizures may affect a child’s ability
to learn (side effects).
Unrecognized seizure activity in the brain may
interfere with attention.
Absence from school may affect academic
performance

11. Reasons that children with
epilepsy may face these problems
Behavior problems can result from the
seizure activity itself, medication, the
child’s own anxiety, or parental
overprotection.
Behavior problems are twice that of other
chronic disorders not involving the CNS
and four times that of healthy children

12. Questions a physician can ask to
determine if there are problems at
school
How is the child’s attention span? Have
any teachers ever mentioned attention as
a concern?
Is the child able to complete assignments
and homework within a reasonable
amount of time?
Can the child follow verbal and written
instructions?

13. Questions a physician can ask to
determine if there are problems at
school (cont.)
Is the child able to retain information
short-term and over time?
What were the child’s grades on the last
report card?
How many days of school has the child
missed this year?
Has the school referred the child for any
remedial classes or for any testing?

14. Questions a physician can ask to
determine if there are problems at
school (cont.)
Has the child ever repeated a grade?
Does the child have an IEP or 504 plan at
school?
Is there inconsistency in the child’s
performance from day to day?
How is the child’s handwriting and written
performance?

15. Why do we need to assess
children with epilepsy?
Needs of children vary greatly.
Long-term risk of learning problems requires
monitoring of educational progress,
neurocognitive screening, and possibly
comprehensive educational evaluation.
Testing conducted by a specialist knowledgeable
about epilepsy can determine whether the
child’s difficulty at school is due to a specific
learning disability.

16. School’s Role
The school must have a plan that outlines the
appropriate response to a seizure
The teacher can contribute to a child’s social
and psychological development by reassuring
other students and including the child with
epilepsy as fully as possible in regular classroom
activities.

17. Role of the educational
consultant
Provide education for the school about the
child’s seizure type, seizure first aid, and
educational implications of the child’s condition.
Facilitate communication between the child’s
school, family, and the doctor.
Determine if learning problems exist and
recommend appropriate educational
interventions.

18. Role of the educational
consultant (cont.)
Guide the family and school in obtaining
appropriate school services for the child.
Provide workshops and programs to educate
school personnel and classmates about epilepsy
and educational implications.

19. Why do we need to assess these
children?
Once identified for special education,
appropriate educational services and
instructional techniques can be sought.
Early identification can lead to strategies for
compensation and lead to a more successful
school experience.

20. What needs to be assessed?
Overall Cognitive or Intellectual Ability
Processing Abilities
Academic Achievement

21. Overall Intellectual Ability
Verbal Abilities vs. Performance Abilities
or
What you know and how you show what you know
Weschler Intelligence Test (WISC-III)
Woodcock Johnson III (W-J III)

22. WISC-IV
Indices
Verbal Comprehension
Perceptual Reasoning
Working Memory
Processing Speed

23. WISC-R
Subtest Profiles
Children with epilepsy, as a group, tended to do
less well on the following WISC-R subtests
(Aldenkamp et al., 1990)
Vocabulary
Coding
Information
Digit Span

24. WISC-R
Subtest Profiles (Rodin et al., 1986)
Vocabulary
Coding
Information
Picture Arrangement

25. WISC-R
Subtest Profiles (Dodrill, 1986)
Arithmetic
Coding
Information
Digit Span

26. W-J III
Broad Cognitive Areas
Verbal Ability
Thinking Ability
Cognitive Efficiency

27. W-J III
Cattell-Horn-Carroll Factors
Comprehension-Knowledge
Long-Term Retrieval
Visual-Spatial Thinking
Auditory Processing
Fluid Reasoning
Processing Speed
Short-Term Memory

28. W-J III
Additional Clinical Test Clusters
Phonemic Awareness
Working Memory
Broad Attention
Cognitive Fluency
Delayed Recall
Knowledge

29. Processing Abilities
Factors of Cognitive Function
Auditory Processing
Visual Processing
Visual-Motor Integration
Processing Speed
Memory
Language Functions
Attention and Concentration

30. Auditory Processing
(Important in Temporal Lobe Epilepsy)
Auditory Analysis
Auditory Synthesis
Auditory Memory

31. Tests used to assess auditory
processing
(You might see the term CAP in your chart)
SCAN (given by an audiologist)
Filtered Words
Auditory Figure Ground
Competing Words
W-J III
Sound Blending
Incomplete Words
Sound Awareness
Auditory Attention

32. Phonological Processing
(Auditory Processing’s “Evil Twin”
Phonological Awareness
Phonological Memory
Rapid Naming

33. Tests to Assess Phonological
Processing
(Standard Audiometric Evaluations are not enough)
Comprehensive Test of Phonological Processing
(CTOPP)
Phonemic Awareness
Phonemic Memory
Rapid Naming
Test of Phonological Awareness (TOPA)
Lindamood Auditory Conceptualization Test

34. Processing Speed
(Is the child efficient with processing?)
Clerical Speed
Rapid Naming

35. Tests to Measure Processing Speed
(There is no one test, but tests within batteries should
be monitored)
WISC-IV
Processing Speed Index (Coding-Symbol Search)
W-J III
Visual Matching
Decision Speed
Pair Cancellation
CTOPP
Rapid Naming Index

36. Processing Abilities
Visual-Motor Integration
Visual Perception
Motor Coordination
Integration

37. Tests to Assess VMI
(Simple handwriting assessment can
also help)
Developmental Test of Visual-Motor Integration
Visual Perception
Motor Coordination
Integration
Bender Gestalt

38. Memory
(What you don’t process deeply, you
don’t remember)
Visual Memory
Verbal Memory

39. Tests to Assess Memory
(Memory should always be assessed in the
smallest possible slice)
Test of Memory and Learning (TOML)
Wide Range Assessment of Memory and
Learning (WRAML)
WISC-III
Freedom from Distractibility
W-J III
Long-Term Retrieval
Short-Term Memory
Working Memory

40. Language
(Where many processes intersect)
Oral Language
Receptive Vocabulary
Expressive Vocabulary
Written Language
Reading Comprehension

41. Tests to Assess Language
(Language is a part of most Verbal
Ability assessments)
WISC-IV
Verbal Comprehension
W-J III
Oral Language
Comprehension-Knowledge
Verbal Ability

42. Tests to Assess Language
(cont.)
Peabody Picture Vocabulary Test (PPVT-III)
Expressive One-Word Picture Vocabulary Test
Receptive One-Word Picture Vocabulary Test
Oral and Written Language Scales (OWLS)

43. Academic Performance
Areas to be Assessed
Reading
Decoding
Comprehension
Fluency
Writing
Basic Skills
Expression
Fluency
Spelling (encoding)

44. Academic Performance
Additional Areas to be Assessed
Math
Basic Concepts of Math
Math Operations
Math Applications
Language
Listening Comprehension
Vocabulary (expressive and receptive)
Oral Language Performance

45. Weschler Achievement
(WIAT)
Basic Reading (Reading Words in Isolation)
Reading Comprehension
Math Reasoning (Problem Solving)
Numerical Operations
Spelling
Listening Comprehension
Written Expression

46. W-J III
Areas of Achievement Assessed
Reading
Broad Reading (Including reading fluency)
Basic Reading Skills (Including word attack)
Reading Comprehension
Math
Broad Math (including math fluency)
Math Calculation Skills
Math Reasoning

47. W-J III
Academic Areas
Written Language
Broad Written Language (including writing fluency)
Basic Writing Skills
Written Expression
Oral Language
Oral Language Skills
Listening Comprehension Skills
Oral Expression
Spelling

48. Testing Younger Children
Examples of Achievement Tests
Test of Early Reading Ability (TERA-2)
Test of Early Written Language (TEWL-2)
Test of Early Math Ability (TEMA)

49. Other Achievement Tests of Note
There are a great many achievement tests
on the market
Kauffman Test of Educational Achievement
(K-TEA)
Peabody Individual Achievement Tests (PIAT)
KeyMath - Revised (KeyMath-R/NU)
Woodcock Reading Mastery Tests - Revised/NU
(WRMT-R/NU)
Test of Written Language (TOWL-3)

50. Post- Assessment
Now What?

51. Staffings
Staffings are offered to all families after an
educational evaluation is conducted
Staffings allow the parents, educational
consultant, and doctors to discuss all the test
results, address questions and concerns, and
develop a comprehensive treatment plan.
An educational treatment plan is suggested.

52. Common Learning Problems
Learning Disabilities
Mental Retardation
Developmental Delays
Slow Learner
Generic Learning Problem (sometimes the result
of motivation, interest, etc.)

53. Some children with epilepsy and learning
difficulties will qualify for special
education services in public schools.
(But not all kids)

54. Special Education
Special Education Services
Federal Regulations
IDEA 1997
State Regulations
(Must comply with IDEA 1997)
Local School Division Guidelines
(Must comply with IDEA 1997 & State Regulations)

55. Disability Categories in Virginia
Autism
Multiple Disabilities
Deaf-Blindness
Orthopedic Impairment
Developmental Delay
Other Health
(ages 5 - 8) Impairment
Emotional Severe Disabilities
Disturbance
Speech/Language
Hearing Impairment
Impairment/Deaf
Traumatic Brain Injury
Learning Disabilities
Visual Impairment
Mental Retardation

56. Most children with epilepsy and
learning problems qualify for special
education services under one of the
following categories:
Learning Disability (LD)
Mental Retardation (MR)
Other Health Impairment (OHI)
Developmental Delay
Speech-Language Impairment

57. Specific Learning Disability
“Specific learning disability” means a disorder in one or
more of the basic psychological processes involved in
understanding or in using language, spoken or written,
that may manifest itself in an imperfect ability to listen,
think, speak, read, write, spell or do mathematical
calculations. The term includes such conditions as
perceptual disabilities, brain injury, minimal brain
dysfunction, dyslexia, and developmental aphasia. The
term does not include learning problems that are
primarily the result of visual, hearing, or motor
disabilities; of mental retardation; of emotional
disturbance; or of environmental, cultural, or economic
disadvantage.

58. Specific Learning Disability
Criteria for Identification
In Virginia, a child may be determined to have a
learning disability if:
(1) The child does not achieve commensurate
with the child’s age and ability levels in one or more of
the areas listed in subdivision 2 … if provided with
learning experiences appropriate for the child’s age
and ability levels; and
(2) the team finds that the child has a severe
discrepancy between achievement and intellectual
ability in one or more of the following areas:

59. Specific Learning Disability
(cont.)
Oral Expression;
Listening Comprehension;
Written Expression;
Basic Reading Skill;
Reading Comprehension;
Mathematical Calculations; or
Mathematical Reasoning.

60. Specific Learning Disability
(cont.)
(3) The group may not identify a child as having a
specific learning disability if the severe discrepancy
between ability and achievement is primarily the result
of:
(A) a visual, hearing, or motor impairment;
(B) mental retardation
(C) emotional disturbance; or
(D) environmental, cultural, or economic
disadvantage.

61. Developmental Disability
“Developmental Disability” is defined in IDEA 1997 as a
disability affecting a child aged 3 through 9 who is
(I) experiencing developmental delays, as defined
by the State and as measured by appropriate diagnostic
instruments and procedures, in one or more of the
following areas: physical development, cognitive
development, communication development, social or
emotional development, or adaptive development; and
(II) who, by reason thereof, needs special
education and related services.
Virginia regulations do not specify any further criteria,
so the local school divisions are left to define the term
“developmental delays” for eligibility purposes.

62. Mental Retardation
The term “Mental Retardation” is not defined in IDEA
1997.
The Virginia state regulations define “Mental
Retardation” as significantly subaverage general
intellectual functioning existing concurrently with deficits
in adaptive behavior and manifested during the
developmental period that adversely affects a child’s
educational performance.
Virginia regulations do not set forth any specific criteria
for defining or determining what is considered
“subaverage.”

63. Mental Retardation (cont.)
The American Association on Mental Retardation (AAMR)
defines “subaverage general intellectual functioning” as
scores more than two standard deviations below the
mean on a standardized test of intelligence.
Most schools use the following scores to further define
the level of mental retardation:
(A) IQ = 50-55 to approx. 70 = Mild MR/ EMR
(B) IQ = 25 to 50 -55 = Moderate MR/ TMR
(C) IQ = Below 25 = Severe & Profound MR

64. Mental Retardation (cont.)
Many children with IQ’s that fall within the
70 - 80 range are considered “Slow
Learners”. Such students, in general, are
not found eligible for special education
services under the category of mental
retardation or learning disabilities, even if
they are struggling in school.

65. Other Health Impairment (OHI)
In Virginia, “Other Health Impairment” is defined as
having limited strength, vitality or alertness, including a
heightened alertness to environmental stimuli, that
results in limited alertness with respect to the
educational environment, that (a) is due to chronic or
acute health problems such as heart condition,
tuberculosis, rheumatic fever, nephritis, arthritis,
asthma, sickle cell anemia, hemophilia, epilepsy, lead
poisoning, leukemia, attention deficit disorder or
attention deficit hyperactivity disorder, and diabetes,
and (b) adversely affects a child’s educational
performance.

66. Other Health Impairment (OHI)
(cont.)
Virginia regulations do not set forth any
further criteria for eligibility under OHI.
IDEA 1997 does not define the term
“Other Health Impairment”

67. Educational Treatment Options:
The continuum of special
education services
Regular Education Curriculum -- with or without
accommodations and modifications
Regular Education Curriculum - in co-taught classes
(Both a regular and special education teacher)
Resource class - part of the day (<50%) is spent in
a separate classroom with a special education
teacher receiving instruction that is supposed to be
individualized to the student’s needs.

68. Educational Treatment Options:
The continuum of Special
Education Services
Self-Contained class -- more than 50% of the
day is spent in a separate class with a special
education teacher receiving instruction that is
supposed to be individualized to meet the child’s
needs.
Special Schools
Home-based Instruction
Instruction in hospitals and institutions

69. Educational Treatment Options:
The Continuum of Special
Education Services
Placement decisions are made by the IEP team,
which parents are members of, after goals and
objectives have been written to address the
child’s needs.
Children must be served in the “least restrictive
environment” possible.

70. Clinical versus School Realities
Unfortunately, some of the children we
see in the clinic who are having school/
learning problems and appear to need
special help in school, will not qualify for
special education services for a variety of
reasons.

71. Clinical versus School realities
These reasons include:
(A) the child does not meet the specific
criteria for eligibility under one of the 14
disability categories, which is further
complicated by
(B) differences between school system
definitions of eligibility criteria for certain
disability categories;

72. Clinical versus School Realities
(C) multiple interpretations of test
results; and
(D) the ambiguity of the language in
many of the definitions of the disability
categories.

73. Clinical versus School Realities
Schools are only required to provide an
“appropriate” education, not an “optimal”
education.
It is important to note that schools are
also limited, in many cases, by financial
and personnel resources.

74. Clinical versus School Realities
As such, even if a child is found eligible
for special education services, he/she may
not receive the “best” educational
treatment of program.

75. Clinical versus School Realities
The good news is, not all children with
epilepsy will need special education
services in the schools in order to be
successful.