Search This Blog

Monday, February 29, 2016

Behavior Treatments First for Kids with ADHD?

From Smart Kids with LD

February 22, 2016

"... this is a very important study, and the take-home is that low-cost behavioral treatment is very effective, but the irony is that that option is seldom available to parents.”

Findings from a new study could change the way treatment is handled for children with ADHD. According to an article in The New York Times, two research papers published in the Journal of Clinical Child and Adolescent Psychology support using behavior techniques first, followed by medication for those who need it.

The study looking at the sequence of treatments for ADHD, “found that stimulants were most effective as a supplemental, second-line treatment for those who needed it—and often at doses that were lower than normally prescribed.”

Study Method

The study randomly assigned 146 children, ages 5 to 12 years old, to one of two groups: those receiving low-dose generic Ritalin, or those receiving no medication, but whose parents were trained in behavior modification techniques (e.g., rewards and consequences).

After two months, the yearlong study took an innovative turn. If a child had not improved, he or she was randomly assigned one of two courses: a more intense version of the same treatment, or an added supplement, like adding a daily dose of medication to the behavior modification. About two-thirds of the children who began with the behavior therapy needed a booster, and about 45 percent of those who started on medication did.

But the behavior-first group had an average of four fewer rules violations an hour at school than the medication-first group.

In a second paper comparing the cost of both approaches, behavior-first treatment was found to cost about $700 less annually.

These findings, if replicated, could change how children with ADHD are treated in the future. Yet the change in sequence from medication-first to medication as a second-line treatment raises other concerns:

“I think this is a very important study, and the take-home is that low-cost behavioral treatment is very effective,” said Mark Stein, a professor of psychiatry and pediatrics at the University of Washington, “but the irony is that that option is seldom available to parents.”

Related Smart Kids Topics

Flint Educator: Our Water Crisis Is a Crisis of Trust

From Education Week

By Arina Bokas
February 8, 2016

Grant Porter, 5, watches as his mother Ardis Porter, 26, has
her blood drawn for lead testing last month in Flint, Michigan.
Conor Ralph/The Flint Journal-MLive.com via AP

At Mott Community College, where I teach writing, the fall semester began as usual, with only one noticeable difference: Above the many drinking fountains frequently in use, now there were signs warning students and staff about the safety of the water.

This didn't come as a big surprise to many students, over 80 percent of whom are "in district," and many of whom have graduated from the Flint, Michigan public schools. Given the college's location in close proximity to downtown Flint, Mott's water was supplied by the now-infamous Flint water system.

During my class, as we explored the genre of argument, one student considered writing about the city's water issue. He looked hesitant, unsure whether it was a worthy subject. "They say the water's OK," he added. "I don't think it is. I live here."

He was right. In late September, just a few days after this class, Mona Hanna-Attisha, a pediatrician at Flint's Hurley Medical Center, released a report showing that for children under the age of 5, the rate of elevated lead concentration in their blood had doubled and, in some cases, even tripled since the city switched from Detroit Water and Sewerage Department water to Flint River water a year prior.


Within a couple of weeks, Dan Wyant, the director of the Michigan Department of Environmental Quality, announced that water at three public schools tested above the safety standard set by the federal government. The state called for parents and families to have their children's blood tested.

Understandably, Flint families were frightened for their kids, as the realization that the city's water had been poisoned for months started to settle in. Was it a mistake? An oversight?

The U.S. Congress and other arms of the government may still be working to determine who is responsible for the contamination, but my students have already figured one thing out. To them, it is not a "water" issue; it is a betrayal of trust, and it is deeply personal.

"Will the public come to trust the city again after this disaster?" wrote one of them. "Will the public come to trust our state?"

I can detect the pain of disillusionment and panic in their questions, as if some internal values had been shaken to the very core. They are losing this sacred, foundational faith that younger generations have always been taught to have in adults, especially those holding a public office with the power to serve and protect them.

In recent years, there has been a lot of talk in education about trust. To succeed in a world where social systems and cultures are quickly evolving, where nothing that happens in one part of the world can stay hidden from another part of the world, young people have to develop confidence in our institutions and in each other.

As educators, we nurture in our students dispositions for benevolence, honesty, openness, reliability, and competence. We explain to them why, in our interconnected world, we have to rely on one another and how important it is to do our part well. We encourage collaboration in our classrooms.

But it goes deeper than that. Student learning is profoundly connected to other processes happening inside a human body. Our experiences shape who we are. What students experience in their lives outside the classroom affects their disposition inside the classroom, influencing their ability to learn and have confidence in others. They are deeply affected by family beliefs and values.

For decades, research has shown that students learn best when schools and families work together. One of the main reasons schools struggle to create partnerships with the parental community is a lack of public confidence in school effectiveness, teacher competence, and the integrity of school leaders.

To foster family and community partnerships with schools, trust is not an option; it is the foundation.

As we-teachers, school administrators, and district leaders-strive to develop mutual trust with families and communities, there is one important thing to realize: We, too, represent the official power in the eyes of those who depend on us to do things right. When someone fails to live up to that responsibility, we all fail in the public's eye.

In 2007, ASCD's Commission on the Whole Child delineated six out-of-school factors that impede kids' learning: low birth-weight and nongenetic prenatal influences on children; inadequate medical, dental, and vision care; food insecurity; environmental pollutants; family relations and stress; and neighborhood characteristics. 

How many of these factors have been affected in Flint in the last 18 months as a result of lead consumption is still largely unknown.

What does seem clear, however, is that such a high-profile betrayal of trust by public officials has, to a certain degree, affected all of us.

...............................................................

Arina Bokas is a faculty member in the English department at Mott Community College, in Flint, Michigan. She is currently the vice president of Bailey Lake Elementary PTA and the host of a local cable-TV series, 'The Future of Learning.'

Sunday, February 28, 2016

Third-Grader to School Board: Why I Can’t Stand Going to School Anymore

From The Washington Post Blog
"The Answer Sheet"

By Valerie Strauss
February 16, 2016

"I should not have to see a counselor because of all that I feel at school. Having to take so much (high-stakes test) prep time is a waste, to pound all of this stuff in our heads, when it doesn’t even measure what we know and how smart we really are."

Cadence Mulrooney is in third grade in Hernando County, Florida. His mother, Kimberly Mulrooney, said her son has always struggled with his speech and has an Individualized Education Program to help him in school.

Despite her son sometimes being the target of bullies, his mother said that when the family lived in Virginia he loved school because of teachers who worked with him to make academic strides. But, his mom said, things changed this year when the family moved to Hernando County, where he found “incessant test prep” in third grade.

The “prep” is for the Florida Standards Assessment, the heart of the controversial, state-mandated “accountability” system that is so flawed that it has sparked a revolt among school superintendents, teachers and parents who have called for it to be replaced.


The administration of the FSA for the first time in 2015 was marred by severe technological problems, but students will be taking it again this year, with the results factoring into school funding and teacher evaluation.

For Cadence Mulrooney, the emphasis on the test scores in his class is so intense that, his mom said, it has made him hate going to school, and he is seeing a counselor to help him with his distress. He asked his mother if she could arrange for him to speak to the county school board so he could express his feelings — and she did.


The following is the video of his recent speech to the board, and the transcript. I am running it because this third-grader represents many students who find test prep to be the center of their school day.



Here’s the transcript:

"My name is Cadence Mulrooney and I am a third-grader at Challenger [K-8 School of Science and Math].

I used to love school and all the learning that took place. My best subjects were math and science. Ever since these so-called standards have changed, I am struggling even with my best subjects. I am in the process of seeing a counselor because I feel so stressed out, overwhelmed and sad about the changes that I am having to deal with that have taken place.

I as a child should not have to see a counselor because all of this that I feel at school. I no longer love school and no longer want to go. I wish my mom and dad had the means to have me home schooled. I feel with all of the talk about the FSA and having to take so much prep time is a waste, to pound all of this stuff in our heads, when it doesn’t even measure what we know and how smart we the children really are.


That time could be used for better things, such as extra help on the stuff that I may not understand fully or some other great learning options. I really hope you take what I have said and our parents say to heart. I want to love school and learning again.

That will not happen unless you help us and our parents make our schools better. Please also remember we the children are your future. Thank you for your time."

Schools Should Recognize Trauma as a Disability, Compton (California) Lawsuit Says

From KQED'ss Blog "State of Health"


By Robin Urevich
February 22, 2016

"You have to address trauma in order to do anything about the achievement gap."
--Anne Hudson-Price, attorney representing students


A group of middle and high school students in Compton have filed a first-of-its-kind federal lawsuit saying violence at home and in their neighborhoods has impaired their ability to learn at school.

The students, along with three teachers who are also plaintiffs, allege the Compton Unified School District has failed to recognize and address their trauma-induced disabilities, and therefore has denied their legal right to an equal education.

Lead plaintiff Peter P. (not his real name) was raped by an abusive stepfather, who also beat his siblings and his mom.

 
“We’d go to school with black eyes and busted teeth,” he said.
 
Peter’s neighborhood was as dangerous as his home. He was once mistaken for his older brother and shot in the street, and said he’s has witnessed his friends and others being shot.
 
“If you’re surrounded in an area that’s gang-affiliated, you go to school having to watch your back all the time,” Peter said. “You’re already scared senseless. That’s what affects studying.”
 
Peter said he has excelled in school at times, but often he’s been too preoccupied to focus. His rage led to a slew of suspensions and expulsions.
 
Other plaintiffs reported witnessing repeated shootings and being shot at themselves. One boy was mistaken for someone else, arrested at gunpoint and handcuffed at his elementary school when he was a sixth grader. Another watched his father point a gun at his mother, while a young woman said she’d been sexually assaulted on a public bus on her way home from school.
 
“You have to address trauma in order to do anything about the achievement gap,” said Anne Hudson-Price, an attorney with Public Counsel who represents the students.
 
Learning requires a state of attentive calm, Hudson-Price and her colleagues note in court papers. But it’s one that traumatized kids rarely if ever achieve.
 
May Be Eligible for Accommodations
 
Last September, District Judge Michael Fitzgerald allowed the case to move forward, ruling that the students could be entitled to accommodations under the Americans with Disabilities Act, just as learning-disabled students are.
 
If the plaintiffs prevail, they could pave the way for large-scale changes in school policies nationwide.
 
The lawsuit seeks consistent mental health support for students, as well as training and coaching for teachers to understand trauma and respond appropriately. The plaintiffs want to end punitive discipline like suspensions and expulsions, which they allege are counter-productive because they push traumatized kids out of school and into the criminal justice system.
 
Peter argued that throughout his school career, Compton school district teachers and administrators knew of the issues that caused him to act out and do poorly in school, but offered no help, even last year when he was homeless. He lived openly on the roof of the cafeteria at Dominguez High School for two months.
 
‘To Me, It’s a Civil Rights Issue’
 
Hudson-Price said the plaintiffs are not asking for screening of individual children. Instead, they demand that the district establish so-called trauma-informed policies for all of its 26,000 students because so many of them are affected.
 
More than half of the district’s students have experienced at least one traumatic event, based on an analysis of self-reported data by Christina Bethell, a professor of public health at Johns Hopkins University who directs the Child and Adolescent Health Measurement Initiative.
 
Homicide rates in Compton are five times the national average. A significant number of the districts students are homeless or in foster care and many are poor. Ninety three percent of the district’s students qualify for free or reduced price lunches.
 
“To me, it’s a civil rights issue,” said Marleen Wong, an associate dean and professor at the University of Southern California, School of Social Work, who’s filed a declaration in support of the lawsuit.
 
Compton school officials declined interview requests. But, District Superintendent Darin Brawley said in a written statement that school officials believe the lawsuit targets Compton for its “name recognition and publicity value.”
 
In court papers, Compton Unified School District officials contend that trauma isn’t a disability. They argue that attaching the stigma of disability to kids because they come from poor, high crime neighborhoods would be devastating.
 
What’s more, they say students’ bad behavior could be the result of immaturity or bad judgment, not the trauma they might have suffered. Still, they contend that the district is sensitive to trauma, citing trainings for teachers and school staff. An item posted last month on the district website highlights increased counseling services for students through a partnership with a local non-profit.
 
Underpinning the plaintiffs’ case is relatively new research that shows repeated exposure to
trauma causes both long-term and immediate damage to developing brains and bodies.

The 1998 Adverse Childhood Experiences study, conducted by researchers at Kaiser Permanente in San Diego and the Centers for Disease Control and Prevention, showed that traumatic childhood experiences, like abuse or neglect, or living with alcoholic, drug-addicted or mentally ill parents raised the risk of physical and mental health issues in later life.

The more trauma a person experienced in childhood, the more likely she was to suffer health consequences like cancer, addiction or obesity as an adult.

Related Stories on Childhood Trauma

But repeated trauma also affects children profoundly during their earliest years, because of the plasticity of their brains, writes Joyce Dorado, a psychologist and professor at the UC San Francisco in her declaration supporting the lawsuit.
 
When the brain’s basic survival mechanisms of fight or flight or freeze and surrender are triggered again and again, the limbic system, which controls those responses is overdeveloped and the pre-frontal cortex, which is responsible for clear thinking and concentration is stunted.
 
The result, according to scientists, is that the brains of traumatized children are essentially re-wired so that the smallest upset can cause them to lash out in anger in a fight or flight state or to withdraw, removing themselves psychologically from a situation. Thus, traumatized kids can’t learn as well as those whose brains have developed in calmer circumstances.
 
Students in Washington state who reported three or more adverse childhood experiences were four times more likely to fail in school and six times more likely to have serious behavior problems, according to a 2015 study by researchers at Washington State University.
 
The good news is that trauma is treatable, USC’s Wong said.
 
She and her colleagues published a study in the Journal of the American Medical Association in 2003 that showed that students in South and East Los Angeles who reported PTSD saw their symptoms ease after just 10 weeks of group therapy.
 
Now, a handful of schools and school districts around the country, including some in Oakland, San Francisco and San Diego have gone farther, incorporating therapy, teacher training and restorative discipline policies to create trauma-informed campuses.
 
In San Francisco, the UCSF Healthy Environments and Response to Trauma in Schools or HEARTS establishes prevention programs to help kids deal with trauma and intervention efforts for kids who are at-risk or suffer from post-traumatic stress. In addition to training for teachers and parents, the program provides support for teachers who may suffer from stress and burnout because of their work with troubled kids.
 
Additionally, HEARTS has worked with schools and district-wide to create alternatives to punitive discipline like suspensions from school.
 
After five years in one school, Dorado said she’s seen an 86 percent decrease in physical aggression, a 95 percent decrease in suspensions, and an 87 percent decrease in referrals to the office.
 
Such transformations take three to five years, Dorado said.
 
“It would be misguided to think it happens quickly. If you think one year is enough, no. That flies in the face of what we’ve learned from organizational change research.”
 
There is no still no data on whether trauma-informed programs have improved students’ academic performance, Dorado said.
 
The HEARTS program has received a number of grants for its work, including one that contributed about $90,000 per year. But Dorado said she and others are creating a model for trauma informed schools that administrators can replicate at a more sustainable cost of about $50,000 or $60,000 annually, or what a principal might spend to hire a reading specialist or other support staff.
 
The students’ lawsuit is set for a hearing next January. Hudson-Price said that the two sides have engaged in mediation, which was recommended by the judge, but she declined to elaborate.
 
Lead plaintiff Peter P. said that he thinks the problem in Compton is that adults have simply ignored the problems of kids in need.
 
“How can you not tell a kid is worried? How can you not see it. You have to ask what’s going on?”
 
Meanwhile, Peter has left the Compton school district for his senior year, and hopes to attend a community college next year.

Saturday, February 27, 2016

Speech-Language Pathologists in the Public School Setting

From Speech Teach Therapy

By Heidi Maloney
January 16, 2016

"Let us continue to put our best foot forward and make decisions for what is right. Advocate for the children who need it and stop being afraid of the repercussions. Always remember that we made a promise to “do no harm” and to use best practice."


Public School SLPs and Their Changing Roles

School Speech Language Pathologists’ roles have changed throughout the years, for sure. As the No Child Left Behind Act came into play in school settings and educators started being held accountable and the “paper trail” began, so have the roles of the SLP in the school.

An SLPs Master’s level education has not changed ~ we still learn about receptive and expressive language disorders, communication and assistive technology, swallowing disorders, stuttering, motor-speech disorders, genetically- and other medically-based speech disorders, in addition to phonetically-based difficulties. We know a TON of things about speech and language!

SLPs can work in medical, educational, private, and administrative settings and all get much the same Master’s level education, with some also moving on to specialize in specific areas.

There was a time (not so long ago), in a public school setting, that I could talk about (and also treat) things like drooling, swallowing issues, apraxia of speech, low-muscle tone that affected overall production of speech, and a full gamut of speech and language issues.

In a team IEP meeting, I was able to recommend three, individual, half-hour speech sessions per week for a child who needed it. And I knew they needed it, because I spent many years of my life in school, learning what was necessary to treat these issues.

Now, let me fast-forward to 2016.

School SLPs are given caseloads of 50+ children (and I’m being very frugal here) in a 40-hour work week. That means GROUP, GROUP, GROUP. See as many children as you can at one time, and better yet, go into the classroom and sit next to them if you can. You are working on speech sounds with this child and aren’t supposed to interrupt the classroom? Pull the children to a back table, but DO NOT distract the other students.



And, while you’re at it, keep an ear open for areas where you may be able to help the teacher to modify the lesson for your student. (By the way, the teacher does not really like it that you are giving her advice, she is highly qualified herself and does not need your help for her lesson. This is NOT a jab at teachers, this is an accolade. They know what they are teaching and how to teach it!)

And don’t forget about those new referrals, screenings, evaluations that need to be done, meetings to attend, case management, Medicaid forms, and data-keeping. Maybe you should go in and observe that new student when you have time, he is struggling and may need a referral.

Don’t forget about that district-wide meeting after school that you have to attend. Can you come in early for an IEP meeting on Monday? We know you aren’t supposed to start until 8, but we need you to be here at 7. I’m sorry that you have to score and type your evaluations at home at night, but the teachers do that kind of thing too.

We need coverage in the lunchroom for about half an hour today because we are short on staff, need you to step up, as you ARE an employee in this school. It is EXPECTED.

Okay, those are just some of the scenarios. But here comes the real topic at hand. Wait for it… Wait for it…

Are public school SLPS really able to provide the services that a child needs? 

The school SLP has really been backed into a corner. Our roles have been changed (by School districts, State education laws, etc.), yet our scope of practice has not. What we truly specialize in is not what we are now being forced to do in the public school system.

Here are some true concerns from school-based SLPs via a Facebook page:

“Is anyone to the point of being over-whelmed with the severity of disordered students entering public schools? I feel like so many kids need more than 45 minutes but due to my district assigning me to two elementary schools it is almost impossible. FYI: I am in an extremely high poverty/low socioeconomic school district. I also have gotten five new referrals in two days.”

“These students need us to advocate for them. If it is not treated early it may never be corrected. I believe that parents should be very assertive in getting services through the schools. Too often we pass the buck and what happens is detrimental to the child. I’m not sure that we are being truly ethical in not providing services….even if it’s RTI. What about our students who have no other option? I could not turn one away.”

“Honestly, in many cases, the kids need a heck of a lot more than what they are getting in schools…”

“I am also in the same situation with 2 districts, both in rural very low socioeconomic areas. I’m constantly feeling incredibly overwhelmed by the numbers of severe kids being referred and trying to figure and re-figure out how to schedule. This is my 5th year in this assignment and the need seems to increase every year. Thank you for helping me realize I’m not alone.”

“More medical issues, more low functioning children, more severe unintelligible kids, more syndromes, more non verbal kids and on and on. I feel like I fail my kids because each one needs so much. What is that saying …Jack of all trades, master of none. Sigh.”

“…the severity is overwhelming and they have so many problems. I am working with 6 spec. ed preschool classes, 14 Headstart classes and I travel to another preschool to see kids. I already see 65 kids and have 15 that I am in the process of evaluating. These kids need 90 minutes a week not 30.”

Yes, my SLP colleagues, I hear you. Loud and clear. And don’t think the parents aren’t aware either. There are plenty of parents who are vocal and who fight to get their kids what they need (and rightly so, because that’s what we are SUPPOSED to do for our children). But we are placed in a position where we have to make those parents our “enemy” instead of wholeheartedly agreeing with them.

Wouldn’t it be nice to say to a parent who is requesting more service time in an IEP meeting for their child, “You are absolutely right, your child WILL benefit from more therapy time. I will put him in for an extra half-hour individual session per week.” We know for SURE that this would not fly with administration. So we give them the answer we are now forced to give them. “We should keep him at twice a week, in a group setting, because it is MUCH better for him to be with his peers. I can train his assistant to do what I do for carryover”.

(HA!) (HA! HA! HA!)

Sorry, couldn’t hold it in. That is not to dismiss the awesome work that teaching assistants do, but I didn’t get my Master’s degree for nothing. We even had to come up with something called “5-minute Artic”. Although I am in total agreement with short sessions, more times a week, I think a minimum of 10 minutes to let the child sit down to breath for a minute or two would be nice. The model of 10-to 15-minutes INDIVIDUAL (or no more than two children), two to five times a week for articulation is a thing of beauty.

I would love to work more on swallowing, issues with drooling, real work on communication, functional vocabulary and skills, and to co-treat with OTs and PTs. Is that really too much to ask?

My frustration with the current “way things are” is only increasing. I am not sure that anyone is hearing us. Are they hearing us?

What the quotes from the real-life SLPs above say to me are “we are good at what we do, we want to help children more with what we specialize in, but we can only do so much.”

BUT…..WHY?

As I mentioned earlier, education (including special education) has changed and is changing. For the better? In some ways. For the worse? In many ways. Even teachers agree, because their hands are tied too. The Free and Public Education (FAPE) laws which state “children are not entitled to the best education that money can buy; they are only entitled to an appropriate education” are really not helping our children.

Some courts have required that the progress the child receives be “meaningful or more than the minimum”. The U.S. Supreme Court has ruled that “IDEA does not require states to develop IEPs that maximize the potential of handicapped children”. Administrators, who have to think of the budgets and are held accountable by tax-payers, are getting their direction from the top. And the top says “give them only what you absolutely have to”.

That does not mean, however, that they are allowed to put us in a position where we are unable to provide appropriate services.

My Hope for the Future

I know that most SLPs agree ~ this is not what we signed on for. Let us continue to put our best foot forward and make decisions for what is right. Advocate for the children who need it and stop being afraid of the repercussions. Always remember that we made a promise to “do no harm” and to use best practice.

I do think we are in a position to “fight back”. I’m not trying to get anyone fired, but I think if we consciously involve the right people in doing the right thing, we can make progress instead of continuing to go backwards. We are a crucial part of the system. We are needed. Letting them give us too many children on our caseloads is not okay. Too many children would mean we are not able to service them in an effective and ethical way.

Allowing them to bully us into standing down from our clinical opinion is wrong. Saying that aloud should be okay if we say it to the right people. Reminding them that we will be placing the district “out of compliance” in the child’s IEP. Letting lawmakers know about this struggle. Involving parents who are strong advocates. STANDING TOGETHER.

I do believe that we can make a positive change to this really messed up system, so we can have more time to do what we do best ~ provide the best services possible to children in need.

References
  • “Free Appropriate Public Education under Section 504”. Web. http://www2.ed.gov/about/offices/list/ocr/docs/edlite-FAPE504.html. Retrieved 2016-01-12
  • “Bd. of Educ. v. Rowley, 458 U.S. at 189”. Caselaw.lp.findlaw.com. Retrieved 2016-01-12 from https://en.m.wikidpedia.org/wiki/Free_Appropriate_Public_Education

Feds Propose New IDEA Rule Concerning Race in Identification and Discipline

From Jim Gerl's Special Education Law Blog

By Jim Gerl, Esq.
February 24, 2016

The U S Department of Education proposed a new rule today concerning racial equity with respect to IDEA. Data analysis by the Department reveals that more African-American students are identified as IDEA eligible and subjected to harsher discipline than their white classmates.

Read the entire 180-page proposed rule here.

You may recall that in 2013, the Government Accountability Office issued a report highly critical of the racial disparity in special education. See our blog post here.

The Department states in support of the proposed rule that:

"In order to address those inequities, IDEA requires states to identify districts with 'significant disproportionality' in special education—that is, when districts identify, place outside the regular classroom, or discipline children from any racial or ethnic group at markedly higher rates than their peers.

According to a new analysis by the Department of data states submitted under IDEA, hundreds of districts around the country with large racial and ethnic disparities go unidentified. For example, 876 school districts gave African American students with disabilities short-term, out-of-school suspensions at least twice as often as all other students with disabilities for three years in a row. But, in 2013, states identified fewer than 500 districts in total with 'significant disproportionality.'"

The proposed Equity in IDEA rule would, for the first time, require states to implement a standard approach to compare racial and ethnic groups, with reasonable thresholds for determining when disparities have become significant. That determination is critical to ensuring students get the supports they need and deserve.

Once identified as having a significant disproportionality, the district must set aside 15 percent of its IDEA, Part B funds to provide comprehensive coordinated early intervening services. Further, the policies, practices, and procedures of the district must be reviewed, and, if necessary, revised to ensure compliance with IDEA.

The proposed rule would also provide identified districts with new flexibility to support the needs of students. The Department has proposed to broaden the allowable uses of the 15 percent set aside, currently used to fund early intervening services, to include services to students with and without disabilities, from ages 3 through grade 12.

Up until now, identified districts could only use these funds to support students without disabilities, and only in grades K through 12, severely limiting the use of interventions that might address early needs and reduce disparities in the placement and discipline of students with disabilities."

The Department of Education press release is available here.

Friday, February 26, 2016

Maltreatment Affects the Way Children's Genes are Activated

From the Society for Research in Child Development

July 24, 2014

In a new study, researchers found that maltreatment affects the way children's genes are activated, which has implications for their long-term development and health.

Children who have been abused or neglected early in life are
at risk for developing both emotional and physical health problems.
In a new study, scientists have found that maltreatment affects the
way genes are activated, which has implications for children's
long-term development. Credit: © olesiabilkei / Fotolia

The researchers examined DNA methylation, a biomechanical mechanism that helps cells control which genes are turned on or off, in the blood of 56 children ages 11 to 14. Disruptions in this system affect emotional behavior, stress levels, and the immune system. These findings echo those of earlier studies of rodents.

Children who have been abused or neglected early in life are at risk for developing both emotional and physical health problems. In a new study, scientists have found that maltreatment affects the way genes are activated, which has implications for children's long-term development.

Previous studies focused on how a particular child's individual characteristics and genetics interacted with that child's experiences in an effort to understand how health problems emerge.

In the new study, researchers were able to measure the degree to which genes were turned "on" or "off" through a biochemical process called methylation. This new technique reveals the ways that nurture changes nature -- that is, how our social experiences can change the underlying biology of our genes.

The study, from researchers at the University of Wisconsin, Madison, appears in the journal Child Development. Nearly 1 million children in the United States are neglected or abused every year.

Researchers found an association between the kind of parenting children had and a particular gene (called the glucocorticoid receptor gene) that's responsible for crucial aspects of social functioning and health.

 
Not all genes are active at all times. DNA methylation is one of several biochemical mechanisms that cells use to control whether genes are turned on or off. The researchers examined DNA methylation in the blood of 56 children ages 11 to 14. Half of the children had been physically abused.

They found that compared to the children who hadn't been maltreated, the maltreated children had increased methylation on several sites of the glucocorticoid receptor gene, also known as NR3C1, echoing the findings of earlier studies of rodents. In this study, the effect occurred on the section of the gene that's critical for nerve growth factor, which is an important part of healthy brain development.

There were no differences in the genes that the children were born with, the study found; instead, the differences were seen in the extent to which the genes had been turned on or off. "This link between early life stress and changes in genes may uncover how early childhood experiences get under the skin and confer lifelong risk," notes Seth D. Pollak, professor of psychology and pediatrics at the University of Wisconsin, Madison, who directed the study.

Previous studies have shown that children who have experienced physical abuse, sexual abuse, and neglect are more likely to develop mood, anxiety, and aggressive disorders, as well as to have problems regulating their emotions. These problems, in turn, can disrupt relationships and affect school performance.

Maltreated children are also at risk for chronic health problems such as cardiac disease and cancer. The current study helps explain why these childhood experiences can affect health years later.

The gene identified by the researchers affects the hypothalamic-pituitary-adrenal (HPA) axis in rodents. Disruptions of this system in the brain would make it difficult for people to regulate their emotional behavior and stress levels. Circulating through the body in the blood, this gene affects the immune system, leaving individuals less able to fight off germs and more vulnerable to illnesses.

"Our finding that children who were physically maltreated display a specific change to the glucocorticoid receptor gene could explain why abused children have more emotional difficulties as they age," according to Pollak. "They may have fewer glucocorticoid receptors in their brains, which would impair the brain's stress-response system and result in problems regulating stress."

The findings have implications for designing more effective interventions for children, especially since studies of animals indicate that the effects of poor parenting on gene methylation may be reversible if caregiving improves.


The study also adds to what we know about how child maltreatment relates to changes in the body and mind, findings that were summarized recently in an SRCD Social Policy Report by Sara R. Jaffee and Cindy W. Christian.
 
Journal Reference
  • Sarah E. Romens, Jennifer McDonald, John Svaren, Seth D. Pollak. Associations Between Early Life Stress and Gene Methylation in Children. Child Development, 2014; DOI: 10.1111/cdev.12270

Critical Shortages in Special Education Teachers. Sound Familiar?

From the InformedED Blog
via AIR - The American Institutes for Research

By Lynn Holdheide and Jenny DeMonte
February 17, 2016

Teacher shortages may be the most acute problem in special education. For years, states and districts have struggled to find qualified people to teach students with disabilities. In the 2013-14 school year, 47 states reported shortages of special education teachers. Though not a new challenge, its impact has intensified as the number of students receiving special education services has increased over the past two decades.

Part of the problem may be the recent decline in enrollment in all teacher preparation programs. And retaining special education teachers is especially challenging. Often, school administrators say, it’s difficult to keep new special education teachers for more than a few years.

What drives them out? And how can we keep them?

Special education teachers leave for several reasons:

  • Isolation and lack of shared ownership. Students with disabilities receive services from a wide range of general and special educators in a wide array of settings. In fact, on any given day, a student with a disability may see a general education teacher, special education teacher, speech therapist, occupational therapist, and behavioral specialist, and the list could go on. At the end of the day, who is responsible for their progress? On average, more than 60 percent of students with disabilities spent more than 80 percent of the school day in general education classes—at times, with their own special education teacher team teaching alongside the classroom teacher. Yet, many special educators say that in this set up, they are often considered “extras”—pushed off to the side and not a real part of the class experience.
  • Role ambiguity and less instructional time. Under the Individuals with Disabilities Education Act, each student must have an individualized education program. These documents can run to 75 pages or more. This and other requirements can mean a staggering amount of mandatory paperwork. And special educators also play many roles. They can be co-teachers, resource room teachers, consultants, and classroom teachers—all on the same day. Little wonder that special educators often feel overwhelmed, with little clarity in expectations and shrinking instructional time.

Clearly, simply “fixing” special education won’t keep our special education teachers on the job. For that, we need to create school environments where special educators and their students can thrive. How?
  • Forging collaborative partnerships. State education agencies, teacher preparation providers, and school districts can work together to improve all educators’ capacity to support students with disabilities. Several teacher preparation programs keep groups of general education and special education candidates together in classes co-taught by both.
  • Creating collaborative school cultures. All educators should have the skills to support inclusive practices for students with disabilities. A collaborative school culture allows general and special educators and leaders to collaborate and problem solve around student needs. This approach can be modeled and implemented by states and districts and within teacher preparation programs.
  • Strengthening leadership support. Leaders should learn how to start and maintain inclusive schools and classrooms. Too often, school leaders’ preparation centers on the special education’s legal aspects. But if principals don’t know which type of instruction works best for students with disabilities, how can they be instructional leaders?

One resource available to help bring about this transformation is the Collaboration for Effective Educator Development, Accountability, and Reform Center, or CEEDAR.

Funded by the Department of Education’s Office of Special Education Programs and led by the University of Florida, CEEDAR works with state departments of education, teacher preparation programs, and local districts to create policy infrastructure and reform preparation programs that advance education for students with disabilities.

In fact, CEEDAR just released a State Policy Profile Map that provides an overview of various state policies (e.g. certification and licensure standards, program approval, induction, and professional development) that impact teacher and leader preparation in supporting students with disabilities in inclusive environments.

CEEDAR efforts have spotlighted the importance of supporting those who teach students with disabilities. But creating partnerships, promoting collaboration, and strengthening school leader’s skills will help all teachers and improve education for all students.

Lynn Holdheide is a former special education teacher and current AIR Project Manager for the CEEDAR Center, which is led by the University of Florida. She is also Co-Deputy Director for the Center on Great Teachers and Leaders and a technical assistance facilitator for the National Center for Systemic Improvement.

Jenny DeMonte is an AIR senior technical assistance consultant specializing in teacher preparation and licensure. She has worked on research and policy issues related to teacher quality and school improvement—first as a journalist and now as a researcher—for more than 20 years.

Thursday, February 25, 2016

Interview: NeuroTribes Author Steve Silberman on Autism

From Five Books

By Alec Ash
February 17, 2016

The winner of the Samuel Johnson prize for non-fiction for his book NeuroTribes, chooses his top five new books on autism.

Before we begin, the foreword to NeuroTribes is by Oliver Sacks, who passed away last summer. He was a great man, and a role model for science writers. Would you like to pay a short tribute to him?


Steve Silberman
One of Oliver’s favourite maxims came from a 19th century doctor named William Osler: “Ask not what disease the person has, ask what person the disease has.” Osler advised clinicians to observe and listen to their patients rather than to treat them as technical problems to be solved.

This is completely against the current trend in medicine to see patients as data banks to be mined and debugged with the appropriate pharmaceuticals. What we call personalised medicine is becoming a conversation between algorithms.

“We already understand the value of biodiversity in a rainforest. The same is true of any community of human minds.”


When was the last time you had a relaxed chat with your primary care doctor, instead of a brief, tense recitation of “worrisome signs” after half an hour in the waiting room? Oliver visited his patients at home, to listen to them play piano (or play piano for them), to watch them navigate the courses of their day-to-day lives, observing them in the environments in which they felt most comfortable. This was not just to pick up on novelistic details that he could use in his books – it also gave him a better idea of what his patients were learning to cope with.

To understand autism, Oliver didn’t just tell Temple Grandin to climb into a brain scanner. He went hiking with her in the mountains, visited the livestock facilities where she worked, and had dinner with her at her favourite steakhouse. The essay he wrote out of these experiences, which became the centerpiece of An Anthropologist on Mars, was the fullest, most nuanced portrait of an autistic adult ever drawn to that point in history.


Oliver was interested not just in studying what deficits and impairments his patients had, but also in what gave them joy, resilience and a sense of purpose. He would then ally himself with these sources of strength so they could learn to use their potentially devastating conditions as opportunities for adaptation, renewal, reinvention and growth.

Your own book carries forward Sacks’ legacy in bringing out the human stories behind human brains, in all their complexity. Why did you choose the autism spectrum and history of its discovery for your topic?



Buy
In 2001 I wrote The Geek Syndrome for Wired, one of the first mainstream news articles about the prevalence of autism in high-tech communities. Despite the fact that it was published immediately after the 9/11 attacks, the piece stirred considerable discussion, and then something very unusual happened.

Most magazine articles are like snowflakes – they melt away and are quickly forgotten. But I got emails about it for ten years, almost every week. These letters were mostly from autistic people and their families who were dealing with very serious day-to-day problems, such as poverty, lack of health care, inability to find classroom placements, kids “aging out” of services, unemployment, endless waiting lists for diagnosis, the high cost of interventions, lack of programs to help teenagers transition from school to the workplace, widespread stigma and discrimination.

“Now, when a reporter calls to ask me for a comment about autism, I often advise them to talk to autistic adults for the story.”

Meanwhile, the whole world was having a very different conversation — about vaccines. The question of whether vaccines were responsible for the dramatic spike in estimates of autism prevalence that began in the 1990s swept virtually every other question about autism off the table for more than a decade. This wasn’t just a matter of a well-organised group of very angry parents monopolising comment threads on the Internet.

Fears of an “autism epidemic” – a phrase used over and over again by fundraising groups like Autism Speaks – dominated congressional hearings and helped set the federal research agenda. It was like a full-employment program for autism geneticists, while autistic people and their families were left to twist in the wind.

At the same time, the press coverage routinely referred to the spiking numbers as a “mystery,” a “puzzle,” and a “baffling enigma.” No wonder a million theories to explain the sudden increase cropped up of varying levels of credibility, from vaccines to Wi-Fi to video games to increasing paternal age.


I finally decided that someone was going to have to do the work of figuring out what really happened and making it comprehensible to general readers who hadn’t been following niche journals. I didn’t think it would take me five years to do it, but midway through I realised I had to keep going, just to save anyone else the ordeal of getting even that far. The world was desperately hungry for this information.

The central thread of the book is the simultaneous work of Hans Asperger and Leo Kanner in giving very different first definitions of autism, within very different contexts. For readers curious to get a taste, can you give us a potted version of who Asperger and Kanner were, and how and why their approaches differed?

I’ll try to give you a very condensed version, though important layers of nuance will inevitably be lost. Asperger believed that autism is a condition that requires life-long support from parents and teachers, and that autism and autistic traits are common and always have been. He also recognised that autism can convey some special cognitive gifts even in the presence of profound disability. He noted the prevalence of autistic traits among prominent scientists and believed that those traits helped them do their work.


He observed: “It seems that for success in science and art, a dash of autism is essential. The necessary ingredient may be an ability to turn away from the everyday world, from the simply practical, an ability to rethink a subject with originality so as to create in new untrodden ways.”

“One of the most insidious things about the anti-vaccine panic was that it rendered autistic adults even more invisible.”

Kanner took a much narrower and darker view of the condition he claimed to discover. He framed autism as a rare form of childhood psychosis – likely a precursor to adult schizophrenia – triggered by emotionally cold, hyper-ambitious “refrigerator” parents. This led him to see the shadow of family psychopathology even in the special talents and abilities that Asperger had praised.

For example, when one of Kanner’s young patients was able to correctly identify eighteen symphonies after hearing only a few bars before he turned two, Kanner theorised that he was desperately trying to please his parents, because what child could actually care about classical music at that age?

The differences between Asperger’s and Kanner’s views became very fateful, because Kanner’s view prevailed for at least four decades, largely because Kanner became world-famous as the discoverer of autism, though Asperger actually discovered it first, and Kanner studiously avoided mentioning Asperger’s work, which remained untranslated into English until 1991.


During that time the recommended course of treatment for autism became institutionalisation, which was a nightmare for autistic people, while their parents bore the burden of allegedly having caused their kids’ disability by not loving them enough. It was horrifying for everyone involved, except for clinicians touting their latest theories of autism causation.

Bruno Bettelheim became America’s first celebrity “shrink” by comparing the mothers of autistic children to the kommandantsof concentration camps who secretly wished their children dead.

Can you explain the word “neurodiversity” in the subtitle for us, and how it’s a good thing?

Short version: “Great minds don’t always think alike.” We already understand the value of biodiversity in a rainforest. The presence of a wide variety of life forms – each with its own distinctive strengths and attributes – increases the robustness and resilience of any living community as a whole, and its ability to adapt to novel conditions.


The same is true of any community of human minds, including workplaces, corporations, classrooms and society as a whole. To face the challenges of the future, we’ll need the problem-solving abilities of different types of minds working together.

As I explain in my book, the word “neurodiversity” was coined in the 1990s by an Australian sociology grad student named Judy Singer after reading a book about the social model of disability, which proposes that disability is a product of the way society is organised, rather than by limitations imposed by a person’s condition. In a world without wheelchair ramps and accessible buildings, wheelchair users have very few choices about where they can go.

But in a world that accommodates wheelchair users, they have many more choices. Neurodiversity extends the social model of disability into the realm of cognitive differences like autism, dyslexia, and ADHD. How can we make the world safer and more welcoming to people with these conditions so they can lead happier, healthier, and more autonomous lives? That’s the question that the neurodiversity movement asks.

Into your book recommendations: the first is Cynthia Kim’s Nerdy, Shy, and Socially Inappropriate: A User Guide to an Asperger Life.
#1. Buy
This is a warm, encouraging and deeply honest book by a woman who didn’t know she was autistic until she was in her 40s because the Asperger’s syndrome diagnosis didn’t exist yet. Instead of presenting this moment as a tragedy, Kim makes clear how empowering a mid-life diagnosis can be:

“Once it became clear that I was on the autism spectrum, my first reaction was relief,” she writes. “It explained so much that I thought was my fault – for not trying hard enough or being good enough.”

Then, Kim offers a multitude of practical tips for managing stress and sensory sensitivities, making sense of confusing social interactions, listening to your body’s subtle signals, coping with aging and navigating a world built for neurotypicals.

Is “neurotypicals” your term or hers, or Judy Singer’s? Is there such a thing as a “typical” brain?

The term “neurotypical” started out as a pointed parody that ended up being so useful that it has passed into general usage. I’ve even seen it in research papers. In 1998, an autistic woman named Laura Tisoncik launched an official-looking website credited to the Institute for the Study of the Neurologically Typical.


The pitch-perfect FAQ explained, “Neurotypical syndrome is a neurobiological disorder characterized by preoccupation with social concerns, delusions of superiority, and obsession with conformity. There is no known cure.”

The term subversively turned the medical lens back on non-autistic people, making the point that what is considered psychologically pathological is, at least in part, socially constructed. According to the Diagnostic and Statistical Manual of Mental Disorders, I suffered from a serious form of deviancy myself in high school: homosexuality. My parents even sent me to a therapist for the cure. Luckily, it didn’t take. Now I’m a happily married man who is no longer defined as deviant by the so-called bible of psychiatry.

Tell us about your next choice, The Real Experts.

#2. Buy
The Real Experts is a book that couldn’t have existed 25 years ago. It’s a collection of advice for parents of autistic children, written by autistic adults, and published by an autistic-run publishing imprint called Autonomous Press.

Why is this important? For a long time, parents were told by clinicians that having an autistic child was a fate worse than death. They allegedly had no chance of ever living independently, of developing new skills, of making meaningful contributions to society, of forging intimate relationships, and, perhaps most devastatingly of all, of feeling love for their own parents.

Many of these dire predictions were based on the behavior of autistic people in institutions, because that was the default “treatment” recommended by alleged experts through the 1980s.

The Real Experts is a much-needed antidote to the poisonous misconceptions that have caused autistic people and their families untold grief for decades, and offers parents of young people on the spectrum something they never had in the past: role models of successful, empowered, radical autistic lives.

Your third selection, Uniquely Human: A Different Way of Seeing Autism by Barry Prizant and Tom Fields-Meyer, came out a couple of weeks after NeuroTribes and offers some different perspectives.


#3. Buy
I immediately recognised Uniquely Human as a perfect companion book to my own, and particularly suited for parents, educators and clinicians. If my book offers a panoramic overview of autism history, Uniquely Human is the lessons of that history applied.

One of its primary messages is that there’s no such thing as “autistic behavior”, there’s just human behavior. If a child is having a meltdown, it’s not particularly helpful to regard their distress as just another manifestation of pathology. Instead, Prizant and Fields-Meyer suggest asking whya child is behaving in a certain way, which can often reveal a source of discomfort that can be ameliorated, such as a scratchy garment or a buzzing fluorescent light.

It seems like a simple insight, but after decades of expensive, time-consuming and occasionally brutal interventions focused on training autistic children to suppress “odd” behavior that helps them regulate their emotions and anxiety, it’s a revolution. The authors also provide helpful strategies for enabling autistic children to build on their natural strengths, instead of dwelling on what they can’t do.

Next is a book that will be published in April (available for pre-order now), Autism Adulthood: Strategies and Insights for a Fulfilling Life. Why is this one on your list?


#4. Buy
The fear that keeps many parents of autistic children, particularly those with significant support needs, turning over and over in their beds at night is: “What will my son or daughter do when I’m no longer around to help them?”

In her frank and deeply touching new book Autism Adulthood, Susan Senator shares the intimate details of her journey with her son, Nat, as he takes his first steps toward maturity in a society that offers few resources for people on the spectrum after they “age out” of the meager level of services provided to school-age children.

She faces the big issues – housing, employment, relationships with siblings, finding trustworthy caregivers – head-on, and offers practical strategies for giving young autistic people the best chance to lead happy, safe, and secure lives, mapping a pathway to the future that offers autistic people and their families real hope, rather than false hopes built on misguided promises of a cure.

By doing so she offers a blueprint for a world in which people at every point on the spectrum are treated as fellow citizens who deserve respect and the ability to make choices, rather than as puzzles to be solved by the next medical breakthrough.

Finally we have a novel, The Eagle Tree by Ned Hayes, also out in the spring.


#5. Buy
Creating credible autistic protagonists is tricky for neurotypical writers. It took me about a year to drill down through the clinical clich├ęs in my head and be able to portray people on the spectrum with as little unconscious stereotyping as possible. One of the Jedi mind-tricks of NeuroTribes is that the autistic person in any scene is almost always the emotional center of the scene, even if clinicians or parents are also in the room: a subversive reversal of the usual framing of autistic lives.

But The Eagle Tree, a gorgeously written novel, features one of the most accurate, finely drawn and memorable autistic protagonists I’ve come across in literature: a boy named March whose passion is finding out everything he can about trees and then climbing them.

Instead of portraying March in the usual clueless-Aspie way – as “obsessed” with trees and “perseverating” on them to the exasperation of everyone around him – the hero of the book is like a 14-year-old Walt Whitman with autism, seeking communion with the ancient magnificent beings that tower over the landscape around Olympia, Washington.

Even when March is missing the import of the chatter of the adults who exert control over his life, Hayes plays with the conventions of the unreliable narrator so that you end up feeling like March is a very reliable narrator of glorious and terrifying aspects of the world that neurotypicals can’t see.

Having discussed the literature, what is the future of autism and how we accept it in our society? And how do we get to hear from more autistic voices besides the authors of these books?

We still have a long way to go, but part of that future is already happening. Six years ago, when I started writing NeuroTribes, it was almost unheard of to feature autistic voices in news stories about autism. The public conversation unfolded behind the backs of autistic people, in part because autism was still nearly universally framed only as a condition of childhood.


One of the most insidious things about the anti-vaccine panic was that it rendered autistic adults even more invisible than they’d been for more than half a century behind the walls of institutions. “There were no autistic adults in the past. It’s all now,” said actress Jenny McCarthy, who became the public face of a generation of “mommy warriors” who felt robbed of having a typical child by vaccines.

Now when a reporter calls to ask me for a comment about autism, I often advise them to talk to autistic adults for the story. Imagine stories about racism that only quoted white people or stories about blindness written entirely from a sighted perspective. Autistic-run organizations like the Autistic Self-Advocacy Network are also demanding a place at the table when public policy is set. It was ASAN that advised Hillary Clinton to incorporate an epidemiological survey of adults into her autism plan, which is decades overdue.


There’s a thriving autistic culture in social media and new books coming out all the time by great autistic authors like Judy Endow and John Robison, as well as by parents and clinicians who understand the importance of listening to autistic people. Two reporters who talked to me about NeuroTribes for national publications (Dylan Matthews of Vox and Eric Michael Garcia of the National Review) are on the spectrum.

I was also interviewed by Alex Plank of WrongPlanet.net, the biggest website for autistic people, and by Robyn Steward, an autistic author in England who hosts a community radio show called Autism Matters.” Leo Kanner would have found the concept of autistic media surreally improbable, but it’s Asperger’s world now – hopefully minus the Nazis.

I see myself as a transitional figure: a neurotypical science writer who promoted the inclusion of autistic voices in the global conversation at a crucial turning point in history. But that also means I need to know when to get out of the way.