Increasing the dialogue among stakeholders in New Jersey’s special education system
Archive for the Parents Category

Q&A: Apraxia of Speech

Posted by on April 16, 2012

“Children with apraxia often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.”

Apraxia of speech (called verbal apraxia or dyspraxia) is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the muscles of the face, tongue and lips. The severity of apraxia can range from mild to severe.

Q: What are the types of apraxia?

There are two main types of speech apraxia. Acquired apraxia of speech can affect a person at any age and involves the loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury, tumor or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).

Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to affect more boys than girls. This speech disorder goes by several other names, including developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia and childhood apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a child follows the “typical” path of speech development but does so more slowly than normal.

Q: What causes developmental apraxia?

The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related to a child’s overall language development. Others believe it is a neurological disorder that affects the brain’s ability to send the proper signals to move the muscles involved in speech. However, brain imaging and other studies have not found evidence of specific brain lesions or differences in brain structure in children with DAS. Children with DAS often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.

“Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves.”

Q: What are the symptoms of developmental apraxia?

Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include other speech problems, such as dysarthria; language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information; problems with reading, writing, spelling, or math; coordination or “motor-skill” problems; and chewing and swallowing difficulties.

The severity of apraxia of speech varies from person to person. Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or additional communication methods.

Q: How is it diagnosed?

Speech-language pathologists play a key role in diagnosing and treating apraxia of speech. There is no single factor or test that can be used to diagnose apraxia, and speech-language experts do not agree about which specific symptoms are part of developmental apraxia. The person making the diagnosis generally looks for the presence of some, or many, of a group of symptoms, including those described previously. Ruling out other contributing factors, such as muscle weakness or language-comprehension problems, can also help with the diagnosis.

To diagnose developmental apraxia of speech, parents and professionals may need to observe a child’s speech over a period of time. In formal testing for both acquired and developmental apraxia, the speech-language pathologist may ask the person to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired apraxia of speech, a speech-language pathologist may also examine a person’s ability to converse, read, write and perform non-speech movements. Brain-imaging tests such as magnetic resonance imaging (MRI) may also be used to help distinguish acquired apraxia of speech from other communication disorders in people who have experienced brain damage.

Q: How is it treated?

In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.

In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.

10 Considerations for an Appropriate School-Based Speech Therapy Program for a Child with Apraxia

  1. The clinician working with the child should have experience with childhood apraxia or at least an appropriate background.
  2. The child should get a full speech, language and cognitive evaluation. Most children with apraxia are at risk for co-occurring problems such as specific language impairments, reading problems and even some difficulty with social skill development.
  3. Treatment should be provided on as intensive a basis as possible when the child’s speech is affected severely or when they first start treatment.
  4. Treatment programs should include lots of practice: parents and speech aides should work with the child afterschool.
  5. A means of communication should be targeted from the start of treatment. Alternative-assistive communication devices and gestures should be used from the outset of therapy.
  6. Parents should be involved in the treatment plan and should receive training from the as to what to do when they help their child practice speech sounds.
  7. Speech should be targeted from the outset of treatment; avoid oral motor movement drills if possible.
  8. The speech-language pathologist should work with the teacher to provide assistance in how to best help the child with apraxia in the classroom.
  9. Consider the need for summer therapy as part of the treatment plan. Many children with apraxia regress if they do not get some treatment over the summer.
  10. Children should be evaluated at least two times a year and the IEP modified appropriately.

Resource:
NIDCD Information Clearinghouse, Bethesda, MD (800) 241-1044.
http://www.nidcd.nih.gov/directory

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Tourette Syndrome and Tic Disorders in the Classroom

Posted by on April 5, 2012

By: Dr. Meir Flancbaum

As a teacher, you can serve as the child’s “coach,” when he implements strategies in the classroom.

Sam is a bright, considerate, athletic middle school student, but he dreads going to school. Throughout his day, unintended movement and noises known as tics occur so frequently that it is difficult for him to concentrate in class. Sam has a disorder characterized by motor and phonic tics.

While Sam’s close friends and family have always understood and accepted his noises and twitches, lately he has become the target of bullies. They mimic his tics repeatedly, tell him to “shut up,” or call him insulting names, such as “Tourette’s boy.” As Sam’s tics have begun to interfere with his day-to-day life, his once high self esteem has plummeted, along with his grades. His parents and teachers have noticed he is spending more time by himself, and they are worried.

Tips for Teachers

  1. Education increases acceptance: When a child in the class has Tourette syndrome, educate the other students about the disorder. Consider having the child make a short presentation or having a professional come address the class.
  2. Youth with TS are just like everybody else: If a child’s tics are noticeable, but only minimally interfering, the best strategy is just to ignore them.
  3. Behavior Therapy: If tics are more severe, the most effective course of action is to refer the child to habit reversal therapy, where he or she will learn skills to control tics during instructional periods. As a teacher, you can serve as the child’s “coach,” when he implements strategies in the classroom.
  4. Give breaks: If a child has severe bouts during class, consider offering him or her short, pre-arranged breaks that will ensure it is not misinterpreted as a punishment or a way to avoid work.
  5. Avoid telling a child to suppress his tics: This will likely trigger anxiety and stress, which increases a child’s urge to tic.
  6. Set a good example: Taking a supportive and accepting stance regarding a child’s tics demonstrates how you want his or her peers to respond.

Many people assume that tics are quite rare, and confuse them with Tourette syndrome (TS), but current research suggests that tics affect 12-18% of school-age children. Tourette syndrome, in contrast, is significantly less common: Actual diagnoses are being made in between one and ten cases per thousand individuals.

Tics are short, repetitive, stereotypic movements of muscles or vocalizations, including blinking, facial grimacing, leg twitching, sniffling, grunting or throat clearing. When a particular tic involves multiple muscle groups, such as extending one’s arm and then making a fist, it is called a complex tic. Only when an individual has multiple motor and at least one phonic tic, will he or she be diagnosed with Tourette syndrome.

Many young people with tics may not be bothered by them, so it is essential to wait and watch to see if they cause any interference at home or at school. Parents and teachers should remain vigilant, however, to make sure tics do not worsen with a child’s changing circumstances or age.

Stress can exacerbate the expression of tics, particularly in middle and high school, as social awareness and pressure mounts, thereby reducing a child’s ability to control tics, and causing serious self-esteem problems. Staying alert and watchful to see if the tics become more disruptive is critical. The child may become distressed by them if they interfere with completing school work, cause body soreness, or trigger feelings of embarrassment, especially if, like Sam, one is teased or bullied as a result.

If it seems like the tics are becoming a problem, the first place to start is by increasing parents’, teachers’ and the child’s knowledge of tics, the course of the disorder, what makes them worse, and treatment options. Simply doing this can help adults feel more comfortable around youth with tics and empowered to get them the help they need. Attending a consultation or in-service trainings about tics and related disorders can help reach this goal, too.

Most important: Never punish a child as a result of his or her tics. In fact, the stress a child experiences in response to such reprimands will very likely make the tics worse.

For decades, the treatment of choice for tic disorders, including Tourette syndrome, has been medication. While medications can be effective, many parents prefer their children not take them, unless necessary, either on principle or due to concerns about adverse side effects.

Recently, there has been a resurgence of research supporting a behavior therapy for tics called Habit Reversal Training (HRT), which can be implemented alone or in conjunction with medication management.

HRT is a behavior therapy designed to help individuals reduce their tics. The first step is to teach individuals to become more aware of their tics, and specifically, the warning signs, which immediately precede them. Though tics may seem to come out of the blue, a behavior therapist can help someone learn to detect them before they happen. Next, individuals are taught to engage in an exact, specific behavior—called a competing response—that is incompatible with exhibiting the tic. The goal of this treatment is to try and teach the brain to resist the urge to tic, even when it thinks that it must. Eventually, the urge to tic may even go away. In addition to HRT, treatment will typically include relaxation training and strategies to reduce stressful situations that can make tics worse.

The most important support a child can receive is from the caring adults who recognize the tics have become a problem and that help is needed, and who then follow through with effective therapies to ensure the child can get on with living his or her life.

Meir Flancbaum, PsyD, is a post-doctoral fellow at Behavior Therapy Associates in Somerset, New Jersey, where he provides clinical treatment, school-based consultation, and training workshops. He specializes in the treatment of youth with Tourette syndrome and associated disorders, including disruptive behavior and anxiety, as well as trichotillomania, or hair pulling. Dr. Flancbaum also conducts research on behavioral treatment for tics at Rutgers University.

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When the Bully is the Teacher

Posted by on September 12, 2011

An Interview with an Expert on Bullying Provides a Thought-provoking Perspective
“Bullying by teachers
is enabled by a conspiracy of silence.”
- Dr. Alan McEvoy

By Jean Harkness

Many parents would advise a child that the only way to deal with bullies is to stand up to them. But, on reflection, this simple philosophy is not practical and can be dangerous. What if the bully is much bigger and stronger? What if there is a group of bullies? What if the bully is an adult? What if the bully is a teacher? Bullying in school is not a simple problem. It extends beyond students and includes the whole school community. Schools are being challenged to expand their thinking about what is involved in creating a more respectful and tolerant school culture. Despite state requirements that bullying policy and programs address the culture of the entire school, many school programs target only the student behavior. Scrambling to meet state requirements to provide researched and proven strategies to address the problem of bullying, schools are using the resources available.

The bulk of research and the resulting program models have been limited almost exclusively to student behavior. Students are the most important emphasis in any school but they are not alone in shaping its culture. Teachers, coaches, and administrators are at the forefront in implementing change and creating a culture of respect. Change begins with school leaders modeling respectful behavior; supporting a no-tolerance approach to bullying; and deploying anti-bullying strategies.

The behavioral expectations for students that promote tolerance and respect should apply equally to the school staff. School efforts to intervene in and prevent bullying should apply to all members of the school community. Preliminary research indicates that the same standards are not being applied or enforced when the bully is a teacher.

Dr. Alan McEvoy, professor of sociology at Northern Michigan University, is a leading authority on harassment and bullying. He has been a pioneer in research that focuses on teacher (and coach) bullying. In a recent interview Dr. McEvoy shared his views and research findings, including his pilot study, Teachers Who Bully Students: Patterns and Policy Implications.

Q: What are the similarities between teacher bullies and student bullies?

A: “Teacher bullying is a common problem that exists in most schools,” said McEvoy. His research found that 93 percent of the 236 teachers and students surveyed reported that teacher bullying occurred in school and the subjects were in agreement regarding who the bullies were within a school. Results from his follow-up study supported these results as well. According to McEvoy, when teachers bully it often involves public humiliation. Teacher bullying most often occurs in front of a classroom of students. “Bullying by teachers is enabled by a conspiracy of silence,” he noted. Students are often hesitant to report because they fear that disclosure will lead to reprisal. Though McEvoy’s research did not quantify this, many of the narrative answers clearly showed that the respondents were afraid:

“Nothing happened after I complained, but since I knew that my teacher knew I complained, I was scared to go to class.”

“I felt the teacher would hate me.”

“Colleagues rarely report bullying because incidents are contained in the classroom, hidden from the observation of other adults,” he reported. Additionally, the students and faculty surveyed perceived that there was no effective or meaningful redress for complaints against teachers for bullying; and that there were seldom negative sanctions for teachers who were reported. The perception that school incident reporting and investigation mechanisms are complicated and ineffective perpetuates the silence and secrecy that enables bullying. Teacher bullying has serious emotional and social consequences that undermines the academic and social climate at school. Bullying is a fundamental corruption and violation of the teacher role. Two characteristics, to educate and to protect, are central to that role. Bullying is a violation of both duties. The emotional and social consequences of bullying carry over and adversely affect the victim’s performance in other classes and school activities. The student’s relationships with other teachers and students are disordered. “Teacher bullying often includes the tacit approval of the group,” McEvoy observed. Bystanders’ silence and/or responses (such as laughter) reinforce the legitimacy of the bullying and create a contagious atmosphere of abuse amplifying the experience of victimization.

Q: What are the differences between teacher bullies and student bullies?

A: Bullying by teachers is rarely physical. Most states have laws that prohibit physical discipline. Additionally, most schools have clear “hands off” policies and procedures that prohibit physical contact with students. Verbal and emotional abuse is a less defined area. A possible exception to this may be athletic coaches. “Active or passive abuses of the athletic training may be employed to cull team players—for example, when a football coach encourages larger team members to ‘go after’ (i.e., take cheap shots or physically hurt) another weaker athlete to get him to quit the team,” said McEvoy. “Bullying by teachers is almost always done in the context of the legitimate role of the teacher to motivate or discipline the student,” he said. “This masks the true nature of the behavior.” For example, a student may be singled out for ridicule or correction repeatedly in front of the class; assigned detentions or other legitimate sanctions; and even poorly graded. Bullying occurs when these legitimate functions are applied unfairly and inconsistently. There is a “gray line” between when discipline and motivational techniques become excessive. Because of the lack of definition regarding the proportionate and appropriate application of discipline and motivation, reported incidents are frequently denied and defended. “When confronted with a complaint of bullying, the action is justified as a legitimate discipline or motivational measure,” noted McEvoy. “Student bullies know what they are doing and that it is wrong,” he said. “Teacher bullies may not fully recognize the harm they are doing.” Once accused of crossing the line, many teachers sincerely contend that they were acting in the best interest of the class or student. Most schools today recognize that student-to-student bullying is a serious problem. In response, many schools have developed policies and procedures and have implemented programs to prevent bullying and promote a respectful school climate among the students. “There is a conspicuous absence of school policies and procedures dealing with teacher bullying,” said McEvoy.

Q: Why is teacher bullying a critical issue for a school community?

A: “It is the function of the school to educate,” said McEvoy. “Effective teaching is dependent on establishing effective and positive social and emotional relationships with students. Bullying by teachers interferes with and can destroy the development of such relationships and thereby disrupt learning.”

“Accommodations also need to be made for students who feel they are being bullied,” according to McEvoy. Schools can build flexibility into their programs to enable students to leave a class or situation that makes them uncomfortable without the repercussion of losing credit or missing work. Online learning opportunities, transferring to another class, or other accommodations should be made available.
The mechanisms exist for schools to address the problem of teacher bullying. Incident reporting and investigation are ingrained in our school systems for other kinds of behavior like sexual harassment claims. These existing policies and procedures can be reviewed and adapted to the problem of teacher bullying.

New Jersey is known to be a highly litigious state. Challenging a tenured teacher provokes fear of union involvement and expensive law suits. While these are realistic concerns for schools in the midst of cuts that limit staff time and district funding, school boards do have the authority to stand up to bullies by creating policies that can be effectively enforced. The topic needs to be addressed and the dialog needs to begin. A culture of respect can only be created when the entire school community—including teachers and administrators—supports the fair and consistent application of behavioral expectation.

Jean Harkness is a policy consultant with New Jersey School Boards Association’s Legal & Policy Services Department. She can be reached at jharkness@njsba.org. Reprinted with permission from the November/December 2010 issue of School Leader magazine. Copyright 2010 New Jersey School Boards Association. All rights reserved.

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Q&A: Eligibility for Special Education and Related Services: It’s Not Just About Grades

Posted by on September 12, 2011

By Ira M. Fingles, Esq.

“The judge noted that the student’s grades took into consideration effort, and were the result of a lot of prompting, cueing, and modifications.”

Many students have what is referred to as ‘invisible disabilities’ that manifest in ways that are not related to grades at all, but still impact their ability to make meaningful progress socially, emotionally, developmentally, and functionally. Students may be eligible for special education and related services if they have a disability that adversely impacts their learning—not just in academics, but in other areas of learning as well.

Last December, the New Jersey Department of Education issued a memo to school superintendents regarding students whose disabilities do not impact learning in every subject.

They emphasized that, for such students, goals and objectives must address “…other skill areas, including but not limited to social skills, communication skills, organizational skills, study skills, self-regulatory skills, transition skills, etc., in response to the individual student’s needs.”

Q: How is eligibility for special education determined?

A: In making an eligibility determination, the local school district’s child study team must use a variety of assessment tools and gather relevant information, including that provided by the child’s parent. A district cannot use any single procedure or measure, including a student’s grades, as the sole criterion for determining whether a student has a disability. A student is found eligible if he or she meets the criteria of one or more of the categories under the Individuals with Disabilities Education Act, or IDEA.

Q: Can a student with good grades be eligible for special education?

A: It is often wrongly assumed that students with good grades cannot be eligible for special education. In fact, many students have what is referred to as ‘invisible disabilities’ that manifest in ways that are not related to grades at all, but still impact their ability to make meaningful progress socially, emotionally, developmentally, and functionally. For example, some students with Asperger’s syndrome may earn high grades in class, but have difficulty participating in group activities due to poor social skills and poor communication skills. Other students with emotional or behavioral disabilities, such as depression or bipolar disorder may get good grades, but struggle with life skills, self-regulation, organizational skills, or coping skills. Others may have difficulty sustaining attention for extended periods of time or have school refusal or disruptive or oppositional behaviors.

These non-academic skills must be considered when exploring whether a student may be eligible for special education. If a student is unable to learn these skills through the general education curriculum, the student may be eligible for special education and related services under IDEA.

Q: What should a parent or concerned educator do if he or she suspects that a student performing well academically may need special education services?

A: If a student is suspected of having a disability as a result of physical, sensory, emotional, communication, cognitive, or social difficulties, a teacher or parent can request that he or she be referred to the Child Study Team (CST) to be evaluated for special education services. Once the parent provides consent, the CST has 60 days to complete the evaluations and must hold an eligibility conference within 30 days thereafter. A student who is deemed eligible for special education and related services is entitled to an individualized education plan (IEP) providing specially designed instruction, including modifications and accommodations, and related services, such as counseling and social skills instruction, to address the student’s unique needs and enable him or her to make meaningful progress in all areas of curriculum. It is not enough to progress academically.

Q: What about placement for students who get good grades? Do they have to be placed in general education classes with supports and services?

It is important to note that student with “invisible disabilities” and disabilities that do not affect grades are eligible for the same range of placement options—including inclusive settings, private special education schools, and residential placement—as all other students with disabilities. The consideration of placement must always begin with the general education program, but if the program is not appropriate, or cannot be modified such that it is appropriate, the IEP team must consider other alternatives. Placement is always determined by a team, which includes the parents, as well as the student, if he or she is age 16 or over.

Q: What if there is a disagreement about services or placement?

A: As with any student with a disability, if there is a dispute about the eligibility determination or whether the IEP, including placement, is appropriate, special education laws provide parents with due process procedures to challenge the decisions made by the district. If parents are successful, they may be entitled to reimbursement of attorney’s fees.

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Milestones: A Parent’s Perspective

Posted by on September 12, 2011

By Lisa Shields

After a child is born, parents focus on the “milestones:” Sitting up. Crawling. First Words. Walking.

For parents of kids with disabilities, milestones hold their luster. We become less interested in the “time line” than we are in the actual achievement. Our children’s firsts are never taken for granted, and we celebrate them at times with gusto. My daughter was ten when she was classified and along with the baffling new language we all learned, came a new understanding about what milestones could mean.

Desi has a “hidden disability” because she seems just like anyone else, but eventually, her disability does show up. When Desi was in fourth grade, the district seemed unable—or unwilling—to address it. We found out what was different about her, but the child study team dismissed her as “one of those kids.” Our argument—that she was bright and capable of much more than they expected—was dismissed as “denial.” For years I had been warned about the “stigma” of special education, but the system was failing my child, so we accepted the classification, and found an out-of-district placement that could meet her needs.

Desi blossomed in her new school. There is no other way to put it. Inside of a few weeks, she was gaining on some of her educational deficits, and in six months, she had completely caught up on three years of learning. The teachers encouraged her, and everything she achieved gave her greater confidence. She graduated the 8th grade “on schedule”—a bonus no one expected—and proceeded to tear through high school with a 4.0 average. She scored beautifully on standardized tests and was inducted into the National Honor Society in her senior year.

That same year, Desi turned 17. Everyone expected her to get her driver’s license. She had taken courses behind the wheel. She had her permit. But, she wasn’t ready—something that became a huge issue with family and friends. I knew, in time, it would come. If Mom’s Taxi had to keep rolling for a few more years, so be it.

Desi went to a local college—a campus 10 miles away, with NO buses connecting us. She made the Dean’s List, and discovered a real passion for writing, but she still didn’t drive. Family and friends got upset that I was the one doing the driving, but like other milestones; I knew that she might not follow “the schedule.”

In truth, I didn’t mind driving Desi. She and I often talked, shared music—driving was social time for us, not a grueling task. I didn’t push her to drive because I knew that she put enough pressure on herself. She was her own worst critic and a harsh taskmaster.

When Desi announced that she was getting her license, we did some practice runs, but honestly, I was skeptical. I know my daughter and I know her ability to deliver can be amazing, but driving? That was major.

Even “high functioning kids” have a comfort zone, and like anyone else, they don’t like stepping out of it. Desi took driving seriously; her number one concern was that she might make a mistake, and hurt someone. Other kids equate driving with freedom – Desi considered it a big responsibility.

I watched part of her test. I knew she could handle the basic driving. But parking? Yikes. I couldn’t watch. I waited for her to return, planning my speech: “Don’t worry honey. You’ll get it next time.” And then they drove up, and the DMV man said: “She passed!” Jumping JIMINY!

She was happy and excited. And I felt a whole lot of things, many of them unexpected. Proud? Yes! But also a little worried. And a little sad. A driver’s license is freedom. In a very emphatic way, my girl no longer needed me to get her to where she wanted to go. She could get there herself. And for the parents of kids with a disability, that’s the gold standard. It doesn’t get any better. We drove home singing along with her “victory mix,” music she plays to celebrate her successes, ranging from “Go the Distance,” to the Carmina Burana.

That day I cried. Happy tears mixed with the same ones I shed on the first day of kindergarten, when a plucky little girl walked up to her teacher, took her hand, and walked into the school, not looking back once. I was proud but with this tiny voice thinking: “Not yet!”

But now is the time. She’s ready, so I have to be, too. Desi has hundreds of milestones ahead of her, and I know I will not be there for every one anymore. She has truly arrived. And the best part? She drove HERSELF.

“For parents of kids with disabilities, milestones hold their luster”

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When is the Right Time to Graduate?

Posted by on June 1, 2011

By Ira M. Fingles, Esq., and Elizabeth M. Roberts, Psy.D.

Under federal law, a student with disabilities is entitled to special education and related services until age 21, or until the student accepts a diploma – whichever comes first. The decision about when a student should gradate is made by the IEP team during the IEP process.

When should a child with a disability graduate?

For students with complex, significant disabilities, the decision about when to graduate may be more obvious. The New Jersey Division of Developmental Disabilities (DDD) generally will not offer day services until age 21, so most students with disabilities who will likely be served by DDD should remain in school until age 21.
When is the cut-off date for turning age 21?

Students are eligible for services through the end of the school year in which they turn 21. For example, if a student’s 21st birthday falls on June 30, 2011, special education services will terminate then because it marks the end of the school year. If, however, a student’s birthday falls on July 1, 2011, services would continue through the end of that school year – June 30, 2012. Districts may, at their discretion, serve students beyond age 21.
When should students who are taking high school courses and earning credits graduate?

It is very possible for a student to have earned enough academic credits to graduate, but not have met his or her IEP goals related to transition. In such situations, the student should remain in school.

When considering whether the student should be given a diploma prior to age 21, the IEP team may not rely solely upon whether the student has completed credits and coursework for graduation. It must also consider whether the student is prepared for further education, employment and independent living. The IEP team must consider whether the student’s transition goals have been met and whether the student needs continued transition services in order to achieve his/her desired goal upon graduation.

What are Transition Services and when must they be provided?

Transition services are defined by federal law as a coordinated set of activities designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the student with a disability in order to facilitate the student’s movement from school to post-school activities, including post-secondary education, vocational education, employment, continuing and adult education, adult services, independent living or community participation.
Transition services must be based on the student’s needs, taking into account strengths, preferences and interests. They must include instruction, related services, community experiences, the development of employment and other post-school adult living objectives and, when appropriate, daily living skills and functional vocational evaluation.

Beginning at age 14 (or younger), each IEP must include measurable postsecondary goals related to training, education, social skills, employment and where appropriate, independent living skills. Beginning at age 16, the IEP must describe the transition services (including the course of study) needed to assist the student in reaching those goals. Such goals should be based on the student’s individualized needs.

What is the Summary of Academic Achievement?

Before a student graduates, he or she must be given a written summary of academic achievement and functional performance, which includes recommendations to assist the student in the achievement of his or her post-secondary goals. The intent of this summary is to provide crucial information to those people who may assist the graduate in the future.

My child accepted a diploma but still needs special education. What can I do?

In most cases, once a student accepts a diploma regardless of the student’s age, the right to special education and related services comes to an end.
What if the parent and district do not agree on a graduation date?

Graduation from high school is considered to be a change in placement for a special education student. Therefore, school districts must provide written notice to the parents of their intent to graduate a student. If a parent does not agree with a district’s decision to graduate the child before age 21, the parent can object and invoke protections under IDEA. Parents must make their objection in writing. If there is a dispute about whether the transition plan is appropriate or whether the student should receive a diploma, a parent may file for mediation and due process proceedings.

Ira M. Fingles, Esq., is an attorney with Hinkle, Fingles & Prior, where his legal work focuses on lifespan disability law. Elizabeth Roberts, Psy.D. is a Clinical Assistant Professor of Child and Adolescent Psychiatry at NYU Medical Center.

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Teachers’ Perspective: Traumatic Brain Injury in Special Education: Addressing a Neglected Disability

Posted by on June 1, 2011

The Symptoms of TBI

The symptoms of TBI vary and depend on a number of factors, such as the severity of injury, the location and extent of injury in the brain, the child’s age and many other factors. There are, however, many common symptoms presented by students with TBI.

At the physical level, symptoms include:

  • Dizziness
  • Headaches
  • Fatigue
  • Vision and hearing disorders
  • Seizures
  • Poor muscle coordination and weakness

Cognitive symptoms include difficulties with:

  • Attention and concentration
  • Memory
  • Processing speed
  • Organizational abilities
  • Language and communication

Emotional and behavioral issues include:

  • Difficulties with impulsivity and self-control
  • Emotional reactivity
  • Weakened self-awareness
  • Anger and aggression
  • Withdrawl
  • Poor social interactions
  • Loss of interest

By Dale Starcher, Ph.D., and George W. Niemann, Ph.D.

Traumatic Brain Injury (TBI) is often referred to as the “silent epidemic” because it is the leading cause of death and disabilities among children and adolescents. In spite of this, TBI often goes unrecognized, especially in schools.

In fact, research shows that only one percent of children who have had a severe head injury are identified and receive appropriate services within our schools. Many are identified with other learning disabilities or diagnoses such as attention deficit/hyperactivity disorder (ADHD) when the underlying issue may actually be TBI.

Because symptoms affect learning, behavior, socialization and physical well-being, it is crucial that educational professionals learn to identify children who have sustained a TBI. These children are often misidentified and classified as learning disabled or emotional and behavioral disordered, and are often viewed as unmotivated or having attitudinal issues.

Most TBI is a result of car accidents, bicycle accidents, falls and sports injuries. The severity ranges from mild concussion (mild traumatic brain injury) to severe, where hospitalization is necessary. Professionals treating TBI have become more sophisticated in recognizing the potential health and educational consequences, even in those suffering from supposedly mild injuries like concussion.

There are many common misperceptions about the long-term effects of TBI. Most school staff, including teachers, school psychologists and administrators believe that: TBI is easily observable; these children cannot accomplish normal tasks; there are always physical disabilities; behavioral features are extreme and bizarre; and there is always a significant decrease in intellectual functioning. All of these beliefs are false.

TBI Within a School Setting
Significant cognitive difficulties following brain injury are often not noticed by educators because these students, on the surface, often appear fine. Unfortunately, it is not the physical but the underlying cognitive, social and behavioral symptoms that can have the most serious consequences.
Some students can recover sufficiently from their injury to display pre-injury academic levels of functioning. The false assumption in such cases is that the recovery is complete, when this could not be farther from the truth. It is new learning after brain injury where great difficulties usually occur. In addition, there are usually discrepancies in overall performance where individuals may perform well in some areas, but really struggle in other very important areas of functioning.

A marked change in sense of self is also common among persons with TBI. There are two concerns in particular. The first is a lack of self-awareness concerning the effects of the TBI. It is not denial (which could also exist), as much as an inability to appreciate and observe the changes that the TBI caused. The second issue is that students will often report that they just don’t feel like themselves, or that they have lost a sense of what’s important to them with statements such as: “It’s like I’m in a void,” or “I feel numb inside.” These can trigger either anxious feelings, a sense of boredom or depression. They can also lead to difficulties with social interaction. One of the central issues facing adolescents returning to school after brain injury is the challenge of fitting in.
Since there are many variables contributing to brain injury symptoms in children, it is difficult to make general statements concerning cognitive deficits, patterns of impairment and behavioral manifestations. In addition, performance and behavioral functioning can fluctuate widely from hour to hour, day to day, and week to week. This can confuse teachers or other educational staff who are working with the student.

In addition, the initial severity of the injury does not always correspond to the degree of dysfunction following the injury. Even mild brain injury can have devastating effects on schoolwork, behavior and socialization. We find, for instance, that when greater demands are placed on the student, more severe symptoms will likely appear.

Assessment and Intervention Within the School
When a child has a TBI and returns to school, it is critical that the school be alerted. There are different ways this can happen, but in most cases, this contact is initiated by either the parents or hospital/rehabilitation center. Typically, they will contact the school nurse. One role of the nurse would be to request any medical records, rehabilitation reports and summaries, etc. Because TBI is a medical issue, the school nurse should have at least some understanding of the injury. In addition, the nurse should contact administration to make sure that other pertinent school staff are alerted to the child’s TBI. Once the nurse alerts administration, administration should then take the lead. This starts by informing the child study team members, who will also review the records. They may, and should, do an observation of the child and discuss the TBI with the teacher. They should also conduct an interview with the student’s parents. They should then make their recommendations to administration. Recommendations can vary dramatically, depending on the type of observations and assessments of the child. Of course, all of this depends on how well the child study team understands TBI and the kinds of interventions that may be most necessary.

What kinds of assessments and interventions should we expect from a child’s school? Here are a few examples of how schools can go about addressing a student’s needs.

Response to intervention (RTI). This is a multi-tiered, problem-solving process designed to determine the level of intervention needed. Within public schools, RTI has become the national standard in addressing special needs.

Functional assessment: A problem-solving approach. With most TBI, an assessment directly related to TBI that addresses academic, emotional, and behavioral factors is highly recommended. This approach enables staff to set specific target goals and track whether improvements have occurred, as well as what will be done if the child is not progressing in particular areas. These plans and tracking devices should be discussed with all staff who interact with the student, as well as the student and parents. By structuring these goals as problem solving, we can create an explicit and practical sequence of steps for each goal. For example, for a child who has organizational issues, visual cues, written instructions, use of planners, etc., can be used to help the child stay on track. The teacher, parent, and others can review these approaches with the child to make sure they are working and being used in a very functional and adaptive manner. This provides a solid basis for future interactions.

Goal attainment: Making sure the functional assessment is student-centered. As part of RTI, an approach that will help a school track the child’s improvements, but within a child-centered framework, is through the use of a goal attainment tracking system. This approach, first used in mental health centers, is a way to evaluate the individual goals of the student concretely and systematically. Goals are first set within general domains. For sake of discussion, let us take three general domains: cognitive, emotional, and behavioral. To assess whether the student’s goals are achieved, a number of pre- and post-assessments need to be administered that will cover these domains. Within the cognitive domains, common goals are concentration, memory, planning, and organization. Within the emotional domain, one of the most common goals is the need for social acceptance. And in the behavioral domain, most students will want to focus on anger/aggression and/or depression/loss of interest.

Emotional support, stress reduction, and self-regulation. Emotional support for a child with TBI is essential. Anxiety, depression, a weakened sense of self, anger, as well as impulsivity, are some of the issues that will need to be addressed. Besides supportive counseling, stress reduction and self-regulation strategies can go a long way in helping a child process and develop effective coping mechanisms. It is important to mention that there is a direct relationship between stress and brain injury symptoms. In other words, the more stress a student experiences, the more likely certain symptoms will increase, especially those related to cognitive and emotional factors. Even when a student makes a good recovery and no longer shows any visible signs of injury, stress will often cause many of the previous symptoms to recur, at least temporarily. Because of this, it is critical that the child learn robust coping and stress management skills to help reduce the likelihood that symptoms will reemerge.

Family involvement. Research has shown that family involvement is critical in helping children and adolescents make the most progress. Guidelines for working with families would include recognition of the child’s developmental level, matching the intervention to the particular family’s needs, educating the family about TBI, offering family support and counseling, making the proper adjustments in the home, school, and community to accommodate the child, and providing training to the child and family around building new skills. Support groups for the person with TBI, as well as family members, has also been shown to be very helpful during recovery and re-integration into school and community.

How Schools Can be Better Prepared to Help a Child with TBI
Schools have a responsibility to take the issue of TBI seriously and not assume that it is the responsibility of outside services to address the child’s needs. Many school staff would be willing to be more involved if administration made it a priority and supported them in terms of additional training, as well as creating an organizational structure within the school that addresses TBI. Because many children who have sustained a TBI can be mis-classified under some other special education label, it is more imperative to actively identify such children and utilize all resources available to provide them with the most appropriate and effective program. It is through such measures that greater cost-effectiveness and educational gains can be achieved.

Resources:

Brain Injury Association of NJ (BIANJ)
http://www.bianj.org/
BIANJ is a statewide organization whose sole purpose is to educate and provide support for those with TBI, their families, and professionals. They offer a short introductory course for educators on-line and at no cost.

Brain Injury Association of America
http://www.biausa.org/
The Brain Injury Association of America (BIAA) has a nationwide network of more than 40 chartered state affiliates and hundreds of local chapters and support groups.

North American Brain Injury Society (NABIS)
http://www.nabis.org/
NABIS is comprised of professional members involved in the care or issues surrounding brain injury. The principal mission of the organization is moving brain injury science into practice.

Dale Starcher, Ph.D., is the Clinical Director at Garfield Park Academy, a state-approved private school for students ages 5-21 with disabilities in Willingboro, NJ. The school is home to the Compass TBI School Re-entry program. Starcher serves on the Executive Board of the NJ Association for School Psychologists and the Committee for Children and Adolescents for the Brain Injury Association of New Jersey.

George Niemann, Ph.D., is the Director of Clinical Development at the Center for Neurological and Neurodevelopmental Health (CNNH). He holds a doctorate in Neuropsychology from McGill University in Montreal, Canada. He developed community and school programs for brain injury and has established commissions on accreditation and professional training in the fields of brain injury rehabilitation and education.

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