SPD for OHI eligibility

by Sara Jeisy
(Elgin, Illinois, USA)

Has anyone used SPD as the eligible medical diagnosis for an OHI label in special education? I just need a couple examples, preferably in Illinois, where this has happened as back-up for my argument. It is a medical diagnosis, given by a pediatrician, and the OHI law reads that way. Has anyone done this?


Thanks

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Oct 14, 2011
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ICD-9 Sensory Code and IDEA (OHI)
by: Anonymous

I am in the same situation. I think we are going to go with our pediatricians recommendation that we place my son on the spectrum (PDD NOS) because its the only sure way to receive services, I have been doing a LOT of research on this very issue. There is a diagnostic code in the ICD-9 DX 781.99 that is used in the medical community particularly for insurance coding for therapy. We have him qualified via speech delay but we have been researching other districts around the country. The ICD diagnosis is under the label Sensory Integration Dysfunction in much of the writings but there are some school districts that have recognized children with SID/SPD under the Otherwise Health Impaired (OHI) section of IDEA. In our case he qualifies for special education due to a Speech Delay but we are having trouble getting access to all the resources my son needs. So we are looking in to something stronger. We don't feel he really belongs on the spectrum we think he's a straight SI kid as his OT said but we don't feel like we have enough time to waste right now in working with him. He is going on four and the window of intervention is so important right now.

Apr 04, 2008
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SPD not used for OHI
by: Kristy in NJ

Hi Sarah, Unfortunately, SPD is NOT recognized as a medical diagnosis as per the DSM-IV. Thanks to all of the hard work done by Dr. Lucy- Jane Miller and her research teams, SPD has been submitted to the NIH for consideration to be included in the DSM-V. If by some miracle it is either included as a specific, primary diagnosis or a comorbid Dx (ie, ADHD, PDD, etc.) this won't take effect, I believe, for another 5 years-ish.

In terms of an OHI classification...since SPD is not a medically recognized disability, it unfortunately cannot be used as the eligible Dx for any classification including OHI. I taught special ed for many years and never saw it used as a primary Dx in terms of eligibility. And believe me, most of my kids had a lot of sensory issues! :) Your developmental ped. may indeed recognize that your child has SPD, as they should, and can even put that in writing. However, since there's nothing other than anecdotal information supporting a Dx of SPD at the moment, it's not going to be legally binding with the school system. ADD/ADHD do fall under that classification, though.

I have reports from our child psyc and neuro-develop. ped. that both clearly state that my just 5 year-old son has SPD as a **comorbid** Dx however, his **primary** Dx are ADHD and Anxiety Disorder. The Dx of ADHD is specifically what was used as the eligible Dx for the classification of OHI. Special Ed. code/law is the same regardless of what state you live in; it's federally mandated. So if I moved from NJ to IL tomorrow, my son would still have the same classification and be eligible for the same services as per his IEP. I hope that made sense.

FYI...Insurance companies typically don't cover related services (OT, speech) because 1) the therapy isn't needed to recoup lost skills (ie., from an accident) and 2) once the child is of pre-school age, insurance companies expect the school system to provide all of the related services. I am in the process of appealing this with my insurance company...fun! ;)

I hope this was helpful! Lots of luck!

Michele Mitchell adds... THANK YOU for such a thorough and well written response! Much appreciated!

Apr 04, 2008
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OHI
by: Joe Krok

As far as I know SPD is not considered, in NJ anyway. As long as it is NOT included in the DSM IV, school districts as well as insurance companies do not address it. My son is diagnosed by an OT/SI with SPD, his ped. neurologist diagnosed ADHD, go figure. At least he'll be getting an IEP with related services - OT through OHI that way. Unless the Illinois dept. of edu. recognizes it, in my opinion, I don't think it is possible. The two diagnoses mimic each other anyway for my son, so something is better than nothing.

Apr 04, 2008
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OHI eligibility {bySara Jeisy}
by: Joy

Hello Sara,

I haven't got a clue how things work in Illinois but I live in Georgia and to be honest with you I have been trying to get my son Trevor into Special Ed. all school year. I took my Son to The Marcus Institute in Atlanta where a group of specialists tested him and he came back with these Diganoses :

ADHD combined type
Sensory integration disorder
Expressive language disorder
Developmental Coordination disorder

Yet still no progress in getting him into the Special Ed program,even though he has yet to be able to write or spell his name or count past 3.

They did give me a meeting with a student Support team and nothing since has developed. My son is still sitting in a corner playing with clothes pins while the others are learning.

I wish you all the luck in the world with your child and I would love to hear the outcome in your state .

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