0:00:05.6 VB: Welcome to the Inclusive Education Project. I'm Vickie Brett.

0:00:08.1 AS: I'm Amanda Selogie. We're two civil rights lawyers on a mission to change the conversation about education, civil rights, and modern activism.

0:00:19.5 VB: Each week we're gonna explore new topics which are going to educate and empower others.

0:00:25.5 AS: And give them a platform to enact change in education and level the playing field.

0:00:35.7 VB: Welcome listeners.

0:00:38.0 AS: Hi friends.

0:00:39.0 VB: We are in it, for some people it's like the last six weeks of the school year.

0:00:44.4 AS: Yeah.

0:00:46.9 VB: We are in IEP meetings, I feel like I'm in an IEP meeting almost every other day.

0:00:49.0 AS: Yeah. Well, it's wild because like we used to feel this way at the end of the school year where it was like back to back to back. The last few years I feel like it's been a little bit lighter at the end of the school year. And this year it's like, okay, no, we're back to normal of IEPs all the time, which, I mean, in many ways is a good thing, like we want to have the teams have IEP meetings. We want to try to get information back and forth between the families and the school district. It's really important to not just have IEPs annually. So, we encourage it.

0:01:19.4 VB: Right. I mean, I just got an assessment plan and I'm like, how are you going to complete this? I mean, it's through assistive technology, so it's not like a lengthy one, but it's like, "We're gonna get this done... " Like, "So you're gonna speed through it?" Like what's gonna happen? So it'll be really interesting. And on that note, this is actually a part two. Our part one was a solo episode about English language learners. And we are so excited to have Dr. Tan, who is a board-certified clinical neuropsychologist and supervisor at Children's Hospital of Orange County, CHOC. And he's also in private practice. Dr. Tan, thank you so much for joining us.

0:02:00.7 Dr. Tan: Hi, yes, good to be here with you guys. I'm happy to be here.

0:02:04.2 VB: So we sought you out specifically because you provide bilingual services with your neuropsychologist evaluations, and I just kind of wanted you to introduce yourself a little bit to our listeners and how you came to CHOC.

0:02:20.1 DT: Sure, yes. Well, I have always been interested in the relationship between the brain and how that affects behavior. And so that's actually what, the lens through which neuropsychologists practice. And a distinction that I kind of actually wanted to make right from the beginning, related to my perspective as a neuropsychologist, we really evaluate the impact of a disability on cognition, on learning, and on behavior for the purpose of determining the optimal treatment plan. And that's a little bit different from an IEP evaluation, which determines... The function is kind of to determine whether a disability has an adverse impact on learning and whether there's a need for special education services. And I think that distinction is important because many times we, our neuropsychological evaluations become really helpful in advocating for IEPs. Because in IEP...

0:03:19.4 VB: Absolutely.

0:03:20.6 DT: Evaluation, we'll kind of look at, does a disability currently affect kind of the learning and education? We kind of have the lens of, how will this medical history, or how will this disability affect the trajectory of development and cognition? And so, that I think aligns well with the goals even your program, to help advocate.

0:03:44.4 AS: Yeah. Well, I mean, so much of education is developing the brain and developing skills. And if we try to take the perspective of this developmental is a medical side and educational is different, it's academic, we are separating things that really need to be talked about hand in hand.

0:04:04.3 DT: Right, definitely. And that kind of is really what led me to wanting to become a neuropsychologist. I was interested in the holistic functioning of children, not just their medical history, but also their cognitive development, their learning and their school environment, their behavior, their psychosocial functioning. I was interested in all of those things, and neuropsychology is the discipline that allows us to look at all of those aspects of a child holistically. And so it's very rewarding work. I have been at Children's Medical Center, Dallas, in Texas. I've been at Children's Health Care of Atlanta on the East Coast. And now I'm here at Children's Hospital, Orange County on the West Coast. So I'm clearly very, I love working with children, all the hospitals I've worked at have the name children in it. But that's...

0:04:53.3 VB: Yeah.

0:04:54.9 DT: Yeah.

0:04:55.9 VB: You've probably seen a range, of course, of the different states too. And I think the separation, if you will, of like medical history and diagnoses and like what the IEP team can provide, we still get this, "Oh, your child qualifies under autism, we cannot give you a diagnosis, as a school district, because we're not medical professionals, and... " But then the other way around, like when a parent does bring a diagnosis, it's like, "Well, we can... It has to impact the academics and the access," and we find so much value in the work that you do, because there's... You can't just like scream into the void, like there are other things that affect the child, and we feel with the most recent Supreme Court case of Endrew F where it's taking into the circumstances of the child, that could include homelessness, and that can include the effect of the brain on the child, so we were really excited to be able to talk to you in light of that, 'cause we have had neuropsychologists on our podcast talking about what their evaluations are, how they're presented, and how they've been in IEP meetings, and that was either right before Endrew F, or right in the wake of that, and of course, we've had some years to see how it... How we can use these evaluations in addition to all the other information that the school district themselves have uncovered. But I did want to kind of bring to light that you also speak another language, what language is that?

0:06:23.7 DT: Yeah, so I actually provide services both in Spanish and in Mandarin Chinese. So we provide evaluations in three languages. I would say the Spanish is what comes way more often to me, especially at Children's Hospital of Orange County. We're a nonprofit hospital servicing, Santa Ana, Orange, Anaheim, very high percentage of Hispanic families. And also, working frequently with... We're actually the only neuropsychology team servicing Medi-Cal in Orange County as well, so.

0:06:57.8 VB: Oh, wow. I didn't realize that.

0:07:00.6 AS: That's so important. And one of the reasons we wanted to have you on in this, as we talked about the beginning of this episode, this is a part two, because we had an episode where we talked about designation as an English language learner and services regarding students IEP and how that relates, and one thing that isn't talked about enough is the assessment in the child's native language, it very rarely gets done, but often we find it is very important to have either components or full IEP in a student's native language, and so we wanted to kind of get... And we love that you provide services in other languages, because not all parents, not all students are proficient in English, and it's important that we get an accurate idea of their ability. So can you talk through what it looks like if you get someone who is, maybe a family is bilingual, or the student is learning English in school, and how you go about the process of determining, do you do parts or whole assessments in a language other than English?

0:08:02.5 DT: Yeah, these are all great questions, and there's so much I could say, and so just thinking about even how to frame this conversation, and so maybe I'll just start high level, and then we can go into different details. But from my perspective, first of all, just for us to conduct an individualized and responsible assessment with a diverse child, I think there's really two factors that I'm considering. And perhaps this could frame the conversation today. One is, we need to sufficiently account for the interaction effects between neurodiversity and English language learning. And I would also, side note, argue that there's, language is just one aspect of culture. And so really and so the interaction between neurodiversity and the accompanying cultural context, including, language. And then the second factor is, we also need to do our due diligence to minimize the limitations that are presented by our assessment tools that we use, of which there are many. And I can't tell you how many parents come to me with IEP assessments where either the child is incorrectly demonstrated to have cognitive impairments or learning disabilities, or conversely, to not need educational services, because of, both of them being because of insufficient consideration of language and culture, or because of inappropriate assessment methods. And I fully recognize that as a field, we are growing in this, I guess, in this way.

0:09:39.2 DT: And it's not necessarily realistic that we always find someone that literally speaks the language of the family, particularly if they're less commonly spoken languages. And even when we do have someone that speaks the language, or some of our tools are wildly becoming valid as well. So it's more so about really, I think, that their consciousness and the due diligence to make the assessment as individualized and responsible as possible as opposed to kind of these requirements of language or, etcetera, etcetera, so that's perhaps how I thought to introduce this conversation.

0:10:16.0 AS: Yeah.

0:10:17.7 DT: There's many details I could say.

0:10:18.0 VB: That's very helpful. And I think that consideration piece is so important because that is what we often find, like, you would think the amount of students that we get that English was not their first language, they go into the IEP process, and we get them middle to late elementary school, and they never had a bilingual assessment, not even their first, and we look back, and we talk to the families, and we say, "Was this something that was discussed? Did you guys talk about it?" And it seems like it just was never even something that crossed the school psychologist's mind to even consider this. It's like, we're checking a box saying that English isn't their native language, and that, or their first language, and that we are doing the standardized testing, the LD or ELL standardized testing that we have, but then we leave it at that, and we don't even... Like there's no analysis of why should we do more, or shouldn't do more, in this case, individualization, like, I just... We don't see it happening.

0:11:19.9 DT: Yeah, and I think that maybe one fundamental barrier is we, if we are going to do an evaluation, let's just say on a bilingual child, to really provide kind of a fair evaluation really requires some knowledge of how bilingualism interacts with the developing brain. We can't just be checking boxes, based on language. Bilingualism is a very multifaceted construct. There's a lot of different ways bilingualism can look. I mean, even just off the top of my head, when I get a child that, in their chart, it says they're bilingual, there's a lot of questions I need to ask. So, for example, was this a simultaneous language acquisition, or was it a sequential language acquisition. So if it was simultaneous, if both languages were being developed right from early childhood, then our research does show that these children typically do not differ from monolingual children in terms of initial developmental milestones or total size of vocabulary across languages. But then we need to use the correct tools to make sure that we're measuring that accurately. Whereas if we have a situation with sequential language acquisition, we have one language that was primarily spoken in the home, and then it's followed by a second language at a later age, a lot of times when a child enters school, they're starting to learn English, maybe.

0:12:44.3 DT: Then go into, well, what kind of language environment are they in? Is it an additive language environment where both languages are being fostered across everyday settings? Is it a subtractive language development where a child is losing skills in the first language because of the exposure to the second language just due to a loss of support for that first language outside the home? Is this an early bilingualism case or a late bilingualism case? There's a huge cutoff in neuroplasticity at around age 12. And so, when the sequential language is being acquired, it kind of determines also how much the second language is mediated by the first language. And there's, language we use for basic interpersonal communication, our language of social interaction, there's our cognitive academic language proficiency, so the language we use for educational achievement, and those processes look different too in terms of development in the brain. So I say all this, rapid fire, just to say, if the evaluation does not consider all these aspects of bilingualism, then are we fairly, are we accurately representing the child?

0:13:51.7 DT: And with an IEP, and maybe that's not their primary question, maybe the question is just, well, yes, all of that, but like, do they need these services? Whereas for me, the perspective I'm really looking at is, if I need to fairly represent this child to determine kind of what their trajectory is going to look like and what the optimal services, what services would be optimal for their development.

0:14:17.8 VB: And I mean, the way that you just even broke it down, I know you said it was rapid fire, but I don't think I've ever been in an IEP meeting where those considerations were even touched upon, and...

0:14:29.4 AS: No, not even after we've asked.

0:14:34.2 VB: Right, well, that... I mean, the man has a case right now where it's... Yeah, it's pretty apparent, like, they do not have the funding, resources, or expertise to even engage in a conversation. And it's unfortunate because I know that there's a lot of pressure for teachers to be a little bit of everything, but at the end of the day, we would hope that they would become the expert in the child similar to a parent so that they can say, "I think we need to dig a little bit deeper," because as you had mentioned, it's just... It's really almost like a box that they need to check off, whether the child needs services or not, we've said this several times on the podcast, most districts appear to be reactive rather than proactive. And it's almost like, "That's just the way we do things," and they're really not taking into consideration so many other things, unless you're trying to like blame a parent, right? Like, "Oh, well, he's overly emotional because you're going through a divorce," which we've heard that said. And it's really fascinating for us as we've dived in with several people about the brain and what we now know, and it's not fringe science anymore.

0:15:42.5 VB: We... The brain is plastic, neural pathways can be created, and to be able to have a picture of where that child is, which you provide, a clear picture, I would imagine would be such a vital piece of information. What has been your experience when you have provided the results to a parent? Do you kind of get a mix of relief, frustration, disbelief, denial? What has been your experience?

0:16:10.9 DT: I get the whole spectrum, and it just depends on the situation. But a lot of times, I think the frustration from the parent is, like, "I knew this." Like, "I knew that my kid wasn't cognitively impaired. It's just he's... Doesn't... Hasn't learned English."

0:16:29.9 VB: Right.

0:16:31.0 DT: And sometimes it's like, but, I guess the results are demonstrating, that they're kind of have these cognitive impairments, or the opposite. It's kind of like, like, "I knew there was something wrong, I knew there was... I knew there was a delay. But everyone was just telling me, oh, it's just because he's bilingual. Oh, it's because... "

0:16:48.0 VB: Yeah, yeah.

0:16:50.4 DT: So I see those things and, and both of those directions are quite frustrating to parents who know that the evaluation that they get is not painting a fair representation of their child.

0:17:05.0 AS: Right. And I think the same sometimes goes for also for behavior, right? 'Cause communication is a behavior, and we often see kids who have behaviors, and it's just thought, "Oh, it's just about that, the behavior," or it's a behavior because of this or that or attention, and we're forgetting the piece of they're trying to communicate, or they don't understand what you're asking of them.

0:17:28.1 DT: No, that's very well put. Actually, and that's part of what a neuropsychologist has to consider and why we always evaluate so comprehensively across cognitive domains, because the interaction effects between language and, for example, attention, or behavior, even for development, social, development of social functioning, that all comes into play, with their own kind of interactions, and so, I've had situations where a school comes back and says, "Hey, like, you should really evaluate them for ADHD," when really, it's like, "Hey, how are you supposed to pay attention in the classroom when you have no idea what's going on? And you're in the wrong setting." So I think the benefits of a neuropsychological evaluation, or just a fair evaluation that's culturally and linguistically responsive, really helps us to avoid some of these major, major risks. There's... I can think of a situation I had recently where the child was a simultaneous language acquisition situation, and so everyone was just saying, "Oh... " Even pediatricians are saying, "Oh, don't worry, it's just because they have two languages in the household, they'll catch up."

0:18:38.1 VB: Yes.

0:18:39.4 DT: But when I had my evaluation, there was a true language disorder that was missed. And imagine if we had, if someone had flagged it earlier, and we had caught it earlier, they could have benefited from speech-language therapy, from a much earlier age, when that would have an even better impact on the brain. But now we're in a situation where things just kept getting chalked to the bilingualism, and then now their actual language abilities have suffered. And that's a risk on one side, there's risks on the other side, where we've had situations where... I actually, this had happened to me recently, where it was a simultaneous language acquisition, and it was kind of a subtractive learning environment, so not only was the primary language of Spanish starting to fall behind, but also the English, the secondary language was not necessarily developing rapidly enough as well. And this was a kid that ended up getting kind of evaluated to be cognitively impaired. And so really, my evaluation was helpful in the sense of, I think, parsing all these different factors out. And sometimes I even do the same measures in both languages, just because there are some aspects of mastery in one language, for some things, and then some aspects of mastery for another.

0:20:01.2 DT: So all of these things are really, I think, are important to fully consider to accurately represent the patient, and that second case, it became about, "Hey, like, this isn't a cognitive impairment, this is like, this person needs ELL services." And...

0:20:15.8 VB: Wow.

0:20:16.5 DT: Which they weren't getting...

0:20:18.1 VB: Wow. Great.

0:20:19.3 DT: Imagine that had happened earlier, if that had been flagged, we wouldn't be in a situation where now they're failing school, they're not hitting milestones, etcetera. So anyway, forgive me for if my tone becomes increasingly frustrating but...

0:20:30.9 VB: No, this is exactly our jam. This is exactly...

0:20:36.2 AS: Yeah, I mean, and it's something that is just not talked about enough, that I think that there's a lot of parents that are likely listening to this that are probably like, "That was never even a thought." Because I recently had a client where the child was in fourth grade, and I asked... It was a brand new client, and I asked, looking through your file and looking through, initial assessments and seeing that English wasn't this child's first language, and there's no designation of ELL, "Did they ever do testing?" And she was like, "What even is that?" And that's a family who advocated and knew enough to come and get an attorney and had advocated for a number of things for years, but didn't even know that that was something that should be considered. And so I think it was so important for us to highlight it and stress the importance of it too that it's not just some minor notation on the IEP, that it is a very important consideration for a lot of these kiddos, and so we so appreciate you coming and explaining and talking through this with us.

0:21:39.4 DT: Yeah.

0:21:40.8 VB: I was just gonna say if parents wanted to reach out to you, how, what would be the best way?

0:21:46.7 DT: Yeah, sure. My private practice website is www.alexandertanphd.com. And so there is a way to contact me through that avenue. And so that's my practice that I use to serve the community outside of CHOC as well. I was going to, just based on what Amanda was mentioning, I wanted to... As I'm on this soapbox, just wanted to throw in another consideration, which is, language is not the only aspect of culture. It's something that could be the most obvious one. But the fear is where sometimes the language is sufficient. But then, because it's sufficient, then now suddenly none of culture is considered in the interpretation of the results. And I'll give you the most glaring example. I can't tell you the surprising number of times that an Asian child has come to me with a diagnosis of autism, when there wasn't a full account of the differences, not only in language mechanics between English and Mandarin Chinese, which we discussed on the first episode, but also beyond that, communication style. Use of nonverbal communication and eye contact and what that represents from a cultural standpoint, completely different. And so, I've had kids, Asian kids come to me with these diagnoses of autism, and it's like, if we had just given a culturally responsible evaluation, that...

0:23:20.6 VB: Exactly.

0:23:21.6 DT: Considers all the aspects of culture, not just language, but what about cultural values? What about economic issues affecting the family? Communication styles, even like what the concept of intelligence even means? Or what, or the comfort with a testing environment, I find that those factors are completely thrown out the window in many interpretations, when in fact, they have such a interaction effect as well with development and their performance on our evaluations.

0:23:57.8 VB: Absolutely. And I mean, with Endrew F, that I had talked about at the top of the episode, how are we creating an IEP that is reasonably calculated to enable that child to make progress appropriate in light of the child's circumstances. And that phrase there, like the children's circumstances has really enabled us to really, like you were just saying, take all those things into consideration. On top of that, the pandemic, in which there's a collective trauma that we all experience that I know Amanda and I constantly have to bring up in IEP meetings because even though we're four years out, it doesn't mean that the child wasn't affected in some capacity, and that could be a discussion for another day, we've already taken so much of your time. We want to thank you so much for coming on. And yeah, if you guys will have this information also in the show notes, and we will talk to you next week.

0:24:52.6 AS: Bye.

0:24:52.6 DT: Bye. Thanks for having me.

0:24:52.6 VB: Bye-bye.

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