SWU SPED

IDEA DISCIPLINE RULES ENSURE CONTINUED SCHOOLING FOR VIOLENT STUDENTS

2009-04-19T03:35:00.000-07:00

WASHINGTON -- Schools can no longer drop educational services for special education students while they are suspended from school for violent incidents, under new regulations approved this spring for the 1997 Individuals with Disabilities Education Act. This may become a difficult issue for schools that do not have the resources to continue educating a student in an "alternative setting," as prescribed by the law, American Institutes of Research Senior Research Scientist Mary Magee Quinn says.

Outlining the new rules during the American Federation of Teachers' QuEST '99 Conference, Quinn noted the rules require a school district to continue educating a suspended student in an alternative setting if the suspension lasts longer than 10 days. The students must get all services required for them to continue progressing under their individualized education plans, and any therapies prescribed in the IEP must also be provided as scheduled, the rules state.
The continuation of services rule, as well as several other complexities in the new regulations, helped draw dozens of teachers and other faculty members to hear Quinn speak at the four-day teachers' conference. As deputy director of the Center for Effective Collaboration and Practice, Quinn and her staff have studied the new regulations and consulted with government officials and attorneys to clarify the new rules and help school districts implement the changes. The center also offers extensive information about IDEA '97 and other special education issues on its Internet site: www.air-dc.org/cecp/.
Defining the Problem
Among other confusing issues: determining whether the student's conduct is a manifestation of his or her disability and whether the conduct is part of a larger pattern. For the purposes of determining how a school district can discipline special ed. students who exhibit violent behavior, those questions can determine whether the student is treated like a mainstream student or one who is not accountable for his or her actions. For example, if the student's action is deemed not a manifestation of his or her disability, the student can be suspended for as long as school policy says a general ed. student would be suspended. The difference, however, is the special ed. student must receive educational services after the first 10 days of the suspension.
If the student frequently or repeatedly breaks rules, even if they seem like different rules and separate incidents, the student may be exhibiting a pattern of behavior that calls for a change in his or her IEP, Quinn noted. One red flag that could indicate such a pattern is the repeated suspension of the student. While special ed. students may be repeatedly suspended for up to 10 days at a time for various rule violations, they must be reevaluated if those suspensions constitute a pattern of behavior.
Getting to the Root of the Problem
If a special ed. student is removed for more than 10 cumulative days from school, a functional behavioral assessment must be conducted, according to the law. However, IDEA does not specify what the assessment should be, Quinn said. CECP offers what it calls "best practices" or guidelines to reevaluating students. Quinn also argued IEP teams should take the assessments seriously rather than consider it another mandatory set of forms to fill out to keep a child in school. "If you have to do a functional assessment, you might as well do it to the point where you are actually going to get information you can use from it," she told the teachers. "It's a long process, but it does yield very good information that will make your lives as teachers infinitely easier."

In addition to continuing services for suspended special ed. students and reassessing whether their IEPs are appropriate and effective, Quinn said the law requires IEP teams to add a behavioral intervention plan to students' IEPs if they do not already have them. Before IDEA '97, only 8 percent of students with behavioral problems had such intervention plans in place, she said. The intervention plan should be based on conclusions the IEP team draws from the functional behavioral assessment, Quinn said, and should incorporate other people and settings in the child's life besides school. For example, she said, families, peer support programs, speech and language therapists and community agencies, such as religious or community programs, can all reinforce the positive behaviors the IEP team is trying to teach a child.8

SPED Acronyms

2009-04-19T03:08:00.000-07:00

	A
	AAD AAT ABA ABD ABE AC ACROS ACT AD ADA ADC ADD ADHD ADL ADM ADR ADVOC-NET AEA AEP AFDC AFS AG AHSD AI AIDS AIT ALO ALS AMD AP APD APE APPE ARD ARP ASC ASD ASDO ASL AT ATC ATCP AU AUT AVTI AYP	adaptive assistive devices advanced academic training applied behavior analysis antisocial behavior disorders adult basic education alternative certification automated cross referencing occupational system American College Testing attachment disorder Americans with Disabilities Act; average daily attendance aid to dependent children attention deficit disorder attention deficit with hyperactivity disorder activities of daily living average daily membership alternative dispute resolution adult vocational network acquired eleptiform aphasia (Landau-Kleffner syndrome) alternative education placement aid to families with dependent children adult and family services annual goal adult high school diploma auditorily impaired acquired immune deficiency syndrome Agency for Instructional Technology alternative learning options advanced life support alternative mobility device advanced placement antisocial personality disorder; auditory processing disorder adaptive physical education average per pupil expenditure admission, review, and dismissal [committee] advisory review panel advanced study center autism spectrum disorder alternative service delivery options American Sign Language assistive technology area technical center; alternative teacher certification alternative teacher certification program autistic autism area vocational technical institute annual yearly progress


	BAC BASIS BD BEP BEST BETAC BI BIA BIL BIP BLS BMP BOCES	behavior adjustment class Basic Adult Skills Inventory System behaviorally disordered; behavior disorders; brain damaged behavioral education plan basic education study team bilingual education technical assistance centers brain injury Brain Injury Association; Bureau of Indian Affairs bilingual behavior intervention plan basic life support behavior management plan Board of Comprehensive Education Services (New York State)

	C
	CA CAI CAM CAP CAPD CAT CBA CBM CC CD CDA CDRC CDS CFLA CFR CHAP CHD CHI CIL CIM CLAS CLD CMHP CNS COTA CP CPPC CPSE CSA CSE CSEF CSPD CSS CTT	chronological age computer-assisted instruction certificate of advanced mastery central auditory processing central auditory processing disorders; see also APD (auditory processing disorder) committee on accessible transportation curriculum based assessment curriculum based measurement cross categorical communication development; conduct disorder child development associate child development and rehabilitation center child development specialist community and family living amendments Code of Federal Regulations child health assurance program center on human development closed head injury center for independent living certificate of initial mastery culturally and linguistically appropriate services culturally and linguistically diverse community mental health program central nervous system certified occupational therapist assistant cerebral palsy cooperative personnel planning council committee on preschool special education childhood sexual abuse case study evaluation; committee on special education Center for Special Education Finance comprehensive system of personnel development community support service community transition team

	D
	D&E DAP DARTS DAS DB; DBL DCD D DD DDC DDD DHHAP DHR DI DNR DoDDS DOE DON DREDF DRG DS DSM	diagnosis and evaluation developmentally appropriate practices day and residential treatment services developmental apraxia of speech deaf-blind developmental coordination disorder deaf developmental disabilities; developmentally delayed developmental disabilities council division of developmental disabilities deaf and hard of hearing access program Department of Human Resources direct instruction do not resuscitate US Dept. of Defense Dependent Schools Department of Education determination of need Disability Rights Education and Defense Fund diagnostically related groups direction service Diagnostic and Statistical Manual (for Mental Disorders)

	E
	EBD EC ECE ECI ECSE ECT ED EDGAR EEs EEN EFA EHA EI EI/ECSE ELL EMDR EMH EMR EMT EPSDT EQ ERC ERIC ESA ESC ESD ESE ESEA ESL ESOL ETP ESY EYS	emotional and behavioral disorders early childhood; exceptional child[ren] early childhood education early childhood intervention early childhood special education early childhood team emotionally disturbed; emotional disorders; US Department of Education Education Department General Administrative Regulations essential elements exceptional education needs experimental functional analysis Education for All Handicapped Children Act (since 1990, known as the Individuals with Disabilities Education Act [IDEA]) early intervention early intervention/early childhood special education English language learner eye movement desensitization and reprocessing educable mentally handicapped educably mentally retarded emergency medical treatment early periodic screening diagnosis and treatment program exceptional quality education resource center Educational Resources Information Center education service agency education service center education service district exceptional student education Elementary and Secondary Education Act English as a second language English for speakers of other languages effective teaching practices extended school year extended year services (ECSE)

	F
	FAIP FAPE FAST FBA FC FDAB FERPA FIPSA FLSA FMLA FR FSA FSHA FSD FTE FY	functional assessment and intervention program free appropriate public education functional academic skills test functional behavior assessment facilitated communication; foster care Fair Dismissal Appeals Board Family Educational Rights to Privacy Act (aka the Buckley Amendment) Fund for the Improvement of Postsecondary Education Fair Labor Standards Act Family Medical Leave Act Federal Register Family Support Act first source hiring agreement flexible service delivery model full-time equivalent fiscal year

	G
	GAPS GSE GT	guardianship, advocacy, and protective services generic special education gifted and talented

	H
	HBCU HI HOH HOTS HS HSC	historically black colleges and universities health impaired; hearing impaired hard of hearing higher-order thinking skills head start; high school high school completion

	I
	IASA IAES ICC ICD ICDP ICF ICFMR IDEA IDELR IED IEE IEP IEPC IEU IFA IFSP IHE IHCP IHO IHP IHTP ILC ILP ILT IMC IML IPE IPL IPP IQ ISP ISS ITH ITIP ITP	Improving America's Schools Act interim alternative educational setting interagency coordinating council international code of diseases individual career development plans intermediate care facility intermediate care facility for mental retardation Individuals with Disabilities Education Act Individuals with Disabilities Education Law Report (from LRP Pubs.) intermittent explosive disorder independent education evaluation individualized education program individualized educational planning committee intermediate educational unit individualized functional assessment individualized family service plan institution of higher education individualized health care plan impartial hearing officer individualized habilitation program or plan individualized habilitation and treatment plan independent living center independent living plan instructional leadership training instructional materials center instructional materials laboratory individualized plan for employment initial program load individualized program plan intelligence quotient individualized service plan in school suspension intensive training home instructional theory into practice individualized transition plan (similar to IEP)

	J
	JDRP JOBS JTPA JJAEP	joint dissemination review panel job opportunities and basic skills Job Training Partnership Act juvenile justice alternative education

	L
	LA LD LDA LDP LEA LEDS LEP LICC LIFE LoF LPTA LRE LSSP LTCF LTCT	language arts learning disabilities; learning disabled Learning Disabilities Association language development program local education agency law enforcement data system limited English proficient local interagency coordinating council living in functional environments Letter of Finding issued by the Office for Civil Rights (OCR) licensed physical therapy assistant least restrictive environment licensed specialist in school psychology long-term care facility long-term care and treatment

	M
	MA MBD MBO MDC MDT M/ED MESC MFCU MH MHM MHMR MI MIS MMR MMS MR MR/DD MR/MED MSDD MSRTS MST	mental age minimal brain dysfunction management by objective multi-disciplinary conference multidisciplinary team; manifest determination team mental or emotional disturbance migrant education service center medically fragile children's unit multiply handicapped multihandicapped mainstream mental health mental retardation multiple intelligences management information systems mild mental retardation mastery management system mentally retarded or mental retardation mentally retarded/developmentally disabled mentally retarded and mentally or emotionally disturbed (sometimes referred to as dual diagnosis) multisystem developmental disorder migrant student record transfer system multisystemic therapy

	N
	NCES NCLB; NCLBA NDT NEA NICU NSBA	National Center for Education Statistics No Child Left Behind Act neurodevelopmental treatment National Education Association neonatal intensive care unit National School Boards Association

	O
	O&M OCD OCR ODAS ODD OE OECD OH OHI OMI OSEP OT OT/PT	orientation and mobility obsessive compulsive disorder Office of Civil Rights occupational data analysis system oppositional defiant disorder open entries Organization for Economic Cooperation and Development orthopedically handicapped other health impairments other minorities Office of Special Education Programs, US Department of Education occupational therapy/therapist occupational therapy/physical therapy

	P
	P and A PACER PALS PAVE PCA PCD PDAS PDD PDD-NOS PEATC PECS PEIMS PEL PERS PET PIC PIQ PLATO PLI PLOP PPCD PPS PRE-K PT PTA PTG PTI PTSD PTT PVS PY	protection and advocacy parent advocacy coalition for educational rights center peer-assisted learning system parents advocating for vocational education personal care attendant perceptual communicative disability professional development and appraisal system pervasive development disorder pervasive development disorder—not otherwise specified parent education advocacy training center picture exchange communication system public education information management system present education level public employees retirement system pupil evaluation team private industry council performance IQ programmed logic automatic teaching operations pragmatic language impairment present level of performance preschool program for children with disabilities pupil personnel services pre-kindergarten physical therapy/therapist physical therapist assistant; post-traumatic amnesia parent teacher group parent teacher information post-traumatic stress disorder planning and placement team persistent vegetative state; private vocational schools project year

	Q
	QAFB QMRP	questions about functional behavior qualified mental retardation professional

	R
	RAD RCF RCH RDD R&D REBT REI RFP RMT RRC RSP R&T RTC RTH RTI RWQC	reactive attachment disorder residential care facility residential care home reading disorder-dyslexia research & development rational emotive behavior therapy regular education initiative request for proposal regional management team regional resource centers resource specialist (regional term) research and training residential treatment center residential training home response to intervention regional workforce quality committee

	S
	SAT SBE; SBOE SB L-M SBS SDA SDC SDE SE SEA SEAP SECC SECTION 504 SED SEMS SENCO SENG SERVE SI SIB SICC SIG SILP SIP SIS SLC SLD SLP SLPA SLR SPeNSE SOL SOSCF SPD SPED SPLD SSA SSBD SSD SSDI SSI SST STO	scholastic aptitude test state board of education Stanford-Binet, Form L-M (language/memory) schoolwide behavior supports service delivery area special day class self-directed employment special education state education agency; state education association state education advisory panel special education child count a part of the Rehabilitation Act of 1973 making it illegal for any org. receiving federal funds to discriminate against a person solely on the basis of disability seriously emotionally disturbed special education management system special education needs coordinator supporting the emotional needs of the gifted secondary education reporting of vocational enrollment speech impaired self-injurious behavior state interagency coordinating council state improvement grant semi-independent living program state improvement plan shared information systems structured learning center specific learning disability speech-language pathologist speech-language pathologist assistant state liaison representative study of personnel needs in special education standards of learning state offices for services to children and families semantic pragmatic disorder special education semantic pragmatic language disorder social security act; SSA Social Security Administration septimatic screening for behavior disorders social security disability social security disability income statewide systemic initiative; supplemental security income student study team; student support team short-term objective

	T
	TAG TBI TDD TESOL TIP TLC TMH TMR TPP TOVA TTY	talented and gifted traumatic brain injury telecommunication devices for the deaf teachers of English for speakers of other languages teacher improvement process therapeutic learning center trainable mentally handicapped trainably mentally retarded transition planning process test of variable attention teletypewriter (phone system for deaf individuals—see TDD)

	U
	UAF UCE	university affiliated facility university centers for excellence

	V
	VAC VCD VEDS VI VRD VSA	vocational adjustment counselor; vocational adjustment class volitional conduct disorder vocational education data systems visually impaired vocational rehabilitation division very special arts

	W
	WAC WISC-R WISC-III WOD WQC WRAP	work activity center Weschler Intelligence Scale for Children-Revised Weschler Intelligence Scale for Children-Third Edition written output disorder workplace quality council wraparound program

	Y
	YTP	youth transition program

What’s Special in a Diploma?

2009-04-13T01:52:00.000-07:00

Importance of Education
“Strive not to be a success, but rather to be of value.”

In the many years of our existence, we’ve oftentimes wandered into this notion. Come to think of it, education was non-existent since the beginning of time, correct? Adam and Eve never bothered to go get a book, researched, or even deciphered brain-crushing calculus problems and trigonometric equations, right? Wrong! Through the course of time, we have evolved and part of that evolution is adaptation (which the Philippines is currently striving but makes up for in labor exports). The very basic concept of education is learning and teaching. The previous, being readily conceivable when one has attained a change in attitude and the latter being in effect efficiently after application is perceived. How do you think Fleming discovered penicillin (Alexander and not Ian)? How did Einstein formulate the theory of relativity? Will the discovery of the Kuiper’s belt and the eventual distal placement of Pluto be fathomable without education? Or will the magnificent and profound gauge of Picasso’s works and Jay-Z’s (Mrs. Beyoncé) semantics still be appealing without education? Survival, appreciation, contentment, bridging gaps, settling differences and being able to make the world a happier place to live in for all are just some of the reasons for education. As for some, they study to get a better grasp of life and the deeper meaning that it conveys (what’s your reason?). Wouldn’t you want to understand why you are where you are right now?

Diploma vs. Certificate
“You have to learn the rules of the game. And then you have to play better than anyone else.”

The Diplomas are intended to provide the essential knowledge and skills for young people to operate confidently, effectively and independently in life and work (and eventually money—yeah baby, yeah!). The Diploma prepares young people for a range of progression routes. These can be within the sector they have studied, within another sector or in general education. By following the curriculum program for a Diploma, learners can develop the knowledge, skills and attributes expected by both employers and higher education (usually agencies and employers prefer credentials obtained in a University rather than some College). Certificates are generally different than diplomas because they are given out to students who have passed a particular course of study not necessarily related to a philosophical cognition of the course requirements (it takes lesser time to finish). Certificates show that students have mastered a particular skill usually associated with a job requirement. In simple analogy, a Diploma equals a Certificate plus more.

Diplomas can offer you:

 high-quality, credible, industry-related learning
 real opportunities to practice the skills you will need for employment and higher education
 diversity, opportunity and inclusion for all learners

Most migration agencies or law firms at the instance of seeing that you only have a certificate course in some college will immediately sever your application. Most if not all accrediting bodies in countries like Australia, Canada, United Kingdom, and America are looking for Diploma Courses (a Bachelor’s degree as they aptly calls it) rather than a Certificate Course (which will do you no good when you realize that you have to take a battery of tests to qualify for accreditation). This is just a heads-up on things to come for those who are planning to take that extra mile for a greener pasture (hypocrite?). Granted that you somehow passed the screening with a weak set of credentials, are your skills enough for your line of work?

Extraordinary Learning
“Education is what remains after one has forgotten what one has learned in school.”

After 6 courses (Health Science, Dentistry, Orthodontics, Nursing, Care-giving, Professional Education), I am down to lucky number 7 (Special Education). In my many years of studying I have never felt an authentic sense of a family, academic achievement, love for knowledge, and fulfillment than now. If education will be quantified, we could define it as an art that encompasses all the sciences in the world and a portal for philosophy for logical explanation.

Initially I studied in the paths of Professional Education to understand better the complexities of life, man’s behavior, society, and the quest for the true meaning of intelligence. The rest is history. There are a lot of people nowadays that are taking up special education (especially doctors and even nurses). The very thought of it is cliché (I think I need an even stronger word). At first, I didn’t have a good idea of what to expect but just an erroneous concept of a field dedicated to teaching the abnormal. We are the second batch of Diploma in Special Education Program students in the Southwestern University and are composed of passionate, enthusiastic, and charismatic mix of professionals in various fields (ESL teachers, primary teachers, social workers, HRM professionals, biologists, nurses, dentists, and administrative executives). We have various reasons but we are geared towards one pursuit.

It is best to know the program that I forehand didn’t have the slightest idea on what it really offers:

SUBJECT CODE TITLE DESCRIPTION
SPED 101 Introduction This is where you will learn the basics, history, and concepts of SPED
SPED 102 Arts & Crafts A subject dedicated to the propagation of creativity & expression
SPED 103 Current Trends Keeps us updated and informed on the trends of SPED
SPED 104 Methods & Materials Tackles on the ways & means on how to dynamically present the lesson
SPED 105 Dynamics of Learning Distinguishes and correlates the different learning disabilities to their appropriate learning or teaching strategies
SPED 106 Hearing & Visually Impaired Learn sign language & Braille
SPED 107 Remediation Discusses possible interventions in math & reading remediation
SPED 108 Assessment A step-by-step series on how to assess and delegate SPED students into the system

The whole program’s duration runs for 2 semesters. The first semester is allocated to the 8 subjects (theoretical aspect) and the second semester (15 days) is allotted for the practice teaching (practicum aspect). For most of us, every weeknight was a time to look forward to. We have come to discover that we share more similarities than differences. That common ground gave us the chemistry to conquer all odds despite the rigorous challenges that the program bestows on us. There are a lot of activities to look forward to when enrolled in this diploma course. Laughter, enjoyment, and camaraderie are regular commodities. These are some of our activities:

1. Learning the American Sign Language

- We had the opportunity to communicate with people with hearing impairments personally; after we learned enough concepts to really communicate with them, we had the opportunity to interview deaf & mute students.
- The method of instruction was so practical, concise, and purpose-driven that after our first lesson we could already sign several concepts.
- In one of our sponsored seminars, we were privileged enough to perform the Lord’s Prayer, Lupang Hinirang, and SWU Hymn.
- You can view our performance at:
http://youtube.com/swusped

2. Learning Braille

- As if learning the sign language wasn’t enough, we had ample time to be adept with the Braille system of communication.
- Actual Braille slates are used to write words, then phrases, and eventually paragraphs.
- An internet based flow of instructions was used that keeps us at par with the international standards.
- One of our internet resource for Braille can be visited at:
http://www.afb.org/braillebug/

3. Making Tons of Artworks

- From papers to crayons, watercolors, and crafts; you name it we made them.

4. Series of Seminars

- There are a lot of seminars that we attended and produced for our batch alone; here are some:

 Faces of Autism Seminar
 Multicultural Education Seminar
 Physical Education in SPED Seminar
 Pre-Practicum & Post-Practicum Seminars

5. Visits and Demo Teaching at affiliated SPED Centers

- SWU Teacher’s College is affiliated with several SPED Centers that make the demo teaching or the practicum experience a painstakingly hassle-free one.
- We had the opportunity to visit these SPED centers:

 DSWD
 Guardian Angels Foundation
 Adam Jennie’s Catholic Foundation for Special Children
 K.E.E.P.

- What’s good and interesting to notice is that, when we were tasked to do our demo teaching for the first time, we had no apprehensions because we are well prepared.
- Another aspect worth noticing is the availability and hospitability of most SPED Centers to SWU Practicum students; the affiliation of SWU to lots of SPED Centers makes it comfortable and creates a good learning experience for its students.

6. Practicum Teaching

- A good quality of the practicum teaching or the whole Diploma Program is its flexibility, which is very crucial and important to students who are also working such as us.
- We can even do it to the extent of having it at our most convenient place where everything is accessible. This is especially important nowadays when the cost of living is high and at a time when we could really feel the worldwide crisis affecting us.
- This is the real deal and even though we have some minor glitches, our program has really prepared us on how to manage a special education class in particular and a special education program in general.

If we can answer the question: “What makes special education (SPED) special?” If we can unravel the answer then we have arrived at the answer to our ultimate question: “What’s special in a Diploma?” In the very first day of our lesson in Special Education, our subject teacher asked us this question. By now we know that what makes Special Education special is four-fold:

 The Learner
 The Individualized Instruction
 The Teacher
 The Curriculum

So the Diploma that you acquire can only be special depending on how it is obtained.

Is your diploma special?

You can visit us at http://swusped.blogspot.com to see more of our experience.

'Eugenic Abortion’: With Pre-Natal Testing, 9 in 10 Down Syndrome Babies Aborted

2008-10-13T17:21:00.000-07:00

Megan Talbot, 19, who has Down syndrome, pins a boutonniere on a friend before the pair went to their high school prom. (Photo courtesy of Lucy Talbot.)

(CNSNews.com) – In 1972, a year before the Supreme Court’s Roe v. Wade decision legalized abortion on demand nationwide, virtually all children with trisomy 21, or Down syndrome, were born. Less than a decade later, with the widespread availability of pre-natal genetic testing, as many as 90 percent of women whose babies were pre-natally diagnosed with the genetic condition chose to abort the child.

The practice has been described by one physician as “eugenic abortion.”

One survey of 499 primary care physicians treating women carrying these babies, however, indicated that only 4 percent actively encourage women to bring Down syndrome babies to term.

Down syndrome, which occurs in individuals who have three rather than two copies of the 21^st chromosome, causes distinct physical characteristics such as low muscle tone and upward slanting eyes. It also causes mental retardation, which can range from mild to severe.

With the advent and increasing use of pre-natal testing, according to studies in the United States and United Kingdom, a diagnosis of Down syndrome has led to as many as nine out of 10 women choosing to abort the child.

A 2000 anonymous survey of 499 primary care physicians in the United States, published by Georgetown University, indicated that only 4 percent of physicians who attend women whose babies are pre-natally diagnosed encourage them to continue the pregnancy and allow the baby with Down syndrome to be born.

Thirteen percent of doctors attending pregnant mothers whose babies are discovered to have Down syndrome, this survey said, “emphasize” the negative aspects of Down syndrome and 10 percent said they “urge” the mothers to terminate the life of the baby.

Sixty three percent reported they “tired to be as unbiased as possible when delivering a pre-natal diagnosis” and 10 percent indicated they “emphasize” the positive aspects of Down Syndrome.

A 1998 study by the Department of Newborn Medicine at Brigham and Women’s Hospital at Harvard Medical School, published in Genetics of Medicine, concluded that in 1972, 1 in 1,000 babies were born with the extra chromosome that causes Down syndrome.

“There was no pre-natal detection between 1972 and 1974,” said the report, which then measured how many women aborted their Down syndrome babies between 1972 and 1994.

“Between 1972 and 1994 the percentage of infants with Down syndrome who were liveborn decreased dramatically,” the report said. “In the early 1980s, this decrease reflected the impact of amniocentesis among women 35 and older.

“By the late 1980s, pre-natal detection was common among women younger than 35 years and detection was by several modalities including AFP screening, sonography and amniocentesis. When the (Down syndrome) diagnosis was established before 24 weeks of gestation, 86% to 87% of the parents chose elective termination of the pregnancy,” it said.

Another 1998 study by Wayne State University published in the American Journal of Genetics concluded that almost 90 percent of Down syndrome babies were aborted between 1987 and 1997.

“In conclusion,” the report said, “our data confirm that most patients referred to a tertiary care center are likely to choose termination of pregnancy after the diagnosis of Down syndrome, even in the absence of severe ultrasound abnormalities.”

The 2004 annual report of the Down Syndrome Cytogenetic Register at the Wolfson Institute of Preventive Medicine in London found an even higher number of abortions were done after a pre-natal Down syndrome diagnosis in Great Britain. In 2003, 91 percent of cases with known outcomes resulted in abortion. The same percentage was recorded in 2004.

ACOG Wants More Testing

Studies show pre-natal testing for Down syndrome has become increasingly common over the last three decades, however, the American College of Obstetricians and Gynecologists (ACOG) in January 2007 called for even more testing.

“All pregnant women, regardless of age, should be offered screening for Down syndrome,” according to the new Practice Bulletin issued (Jan. 2, 2007) by the ACOG.

“ACOG also advises that all pregnant women, regardless of their age, should have the option of diagnostic testing,” the Bulletin states. “ACOG recognizes that a woman’s decision to have an amniocentesis or CVS is based on many factors, such as a family or personal history of birth defects, and the risk of pregnancy loss from an invasive procedure.”

But Dr. Will Johnston, president of Canadian Physicians for Life, reacted to ACOG’s pre-natal testing endorsement as another step toward eugenics.

“The progress of eugenic abortion into the heart of our society is a classic example of “mission creep,’ ” Johnson said in an article posted on the group’s Web site in February 2007. “In the 1960s, we were told that legal abortion would be a rare tragic act in cases of exceptional hardship. In the ‘70s abortion began to be both decried and accepted as birth control. In the ‘80s respected geneticists pointed out that it was cheaper to hunt for and abort Down’s babies than to raise them. By the ‘90s that observation had been widely put into action. Now we are refining and extending our eugenic vision, with new tests and abortion as our central tools.”

Today, women of all ages who seek pre-natal care with an obstetrician are offered screenings that can estimate the mother’s risk of carrying a Down syndrome baby.

These screenings include a blood test to find certain “markers” associated with the genetic condition and sonograms, which doctors can use to measure the fluid in the neck of the baby, or nuchal translucency, which also can indicate that the developing baby has Down syndrome.

If the results of these screenings indicate there is a higher risk that an unborn child might have Down syndrome, doctors offer the mother additional diagnostic tests, including amniocentesis, which requires inserting a needle into the womb to draw amniotic fluid so the chromosomes of fetal cells can be examined.

Another test, Chorionic villus sampling, or CVS, collects fetal cells from the placenta via the cervix. Both tests are almost 100 percent accurate in detecting Down syndrome in an unborn child.

Because they are invasive, however, both tests can cause a miscarriage. According to ACOG and the federal Centers for Disease Control and Prevention, for example, between one in 400 and one in 200 women have a miscarraige after amniocentesis. Other complications that can arise from amniocentesis include injury to the developing baby and infection.

The risk of miscarriage after first-trimester amniocentesis may be three times higher than the risk after second-trimester amniocentesis, according to the results of the Canadian Early and Mid-Trimester Amniocentesis Trial Group, which were published in The Lancet in 1998.

Results of a 2004 study published in Obstetrics and Gynecology suggested that early amniocentesis may also increase the risk of the deformity called clubfoot.

According to the Royal College of Obstetricians and Gynecologists (RCOG) in London, the additional overall risk of miscarriage from amniocentesis is approximately one percent. In other words, about one in every 100 women who have amniocentesis under ultrasound guidance after 15 weeks will miscarry.

RCOG also claims that the additional overall risk of miscarriage from CVS is approximately two percent. In other words, about two in every 100 women who have CVS under ultrasound guidance after 10 weeks will miscarry.

Dr. Lewis B. Holmes, a geneticist at Massachusetts General Hospital who participated in the 1998 study on pre-natal testing at Brigham and Women’s Hospital, said that some patients refuse pre-natal screening.

“The (patients) who have strong religious or cultural leaning … don’t take the test,” Holmes told CNSNews.com. “So they make their choice very easily.”

But many, Holmes said, use the pre-natal diagnosis of Down syndrome as a reason to end the pregnancy.

“Even though you encourage, ‘take your time, take your time,’ they usually display a real sense of urgency,” Holmes said.
Post-Test Resources

Some parents of children with Down syndrome told CNSNews.com that when they got their diagnostic test results, they did not get the information they needed about the condition and the resources that are available to them and their children.

Lucy Talbot, the mother of a Down syndrome child, is president of Families Exploring Down Syndrome, a support group of some 200 families in Michigan that have children with the genetic condition.

Talbot said her group’s Changing Lives program, developed by the National Down Syndrome Society, is designed to teach medical professionals how to give a compassionate diagnosis and provide the resources and support that parents need.

“(The doctor) says, ‘Your baby has these characteristics, we think your baby has Down syndrome,’” Talbot said. “They say, ‘We’re going to do some blood work,’ and they walk out of the room.”

“You’ve just changed a person’s life forever,” she said.

Dr. Holmes said he offers detailed information about Down syndrome to parents, as well as giving them the option of speaking with parents who have children with the genetic condition.

But Brian Skotko, a resident physician at Children’s Boston Hospital, said Holmes is the exception, not the rule. Skotko cited the results of a questionnaire sent out to 1,105 ACOG fellows and junior fellows in 2004.

Among the 60 percent that were returned, 80 percent said they felt qualified to counsel patients about genetic issues and pregnancy, but 45 percent rated their residency training regarding prenatal diagnosis as “barely adequate” or “non-existent.”

Skotko, who has a sister with Down syndrome and serves on several boards of Down syndrome advocacy groups, said pre-natal testing has put the fate of unborn children in their parents’ hands.

“Current testing affords couples to learn, if they so desire, pre-natally whether or not their fetus has Down syndrome,” Skotko said.

“I encourage all parents to think about and answer two essential questions, which I think can be their guideposts through all pre-natal testing that’s available during pregnancy. One, they need to answer for themselves when does life begin and then answer the question, what forms of human life are valuable?” he added.

“The first question will determine for them when life starts,” he said, “so what testing done at certain times may determine for them whether or not termination is allowable in their own moral compass.”

“And then once life begins, they then need to answer the other question, what forms of human life are valuable?” said Skotko. “Some people say, once life begins, all forms of human life are valuable--others say, once life begins, only certain characteristics are valuable.”

New tests Could Increase Abortions

Now, a new pre-natal blood test that could check a baby’s DNA has been developed by researcher Dr. Stephen Quake and his team at Stanford University. Quake said a broader test is needed.

Carol Boys, chief executive of the Down’s (sic) Syndrome Association in Great Britain, told the BBC that the less invasive blood test will make pre-natal testing safer and more common.

“There is no question that these non-invasive tests will be introduced in the next few years,” Boys said. “It’s therefore incredibly important that potential parents are given accurate information on Down’s (sic) syndrome before they make a choice about whether to terminate or not.”

But Alison Davis of the No Less Human group that is a part of the British Society for the Protection of Unborn Children said in an article on lifenews.com that the new test wasn’t a positive development.

“"The new non-invasive test for Down's syndrome will inevitably mean more pre-natal testing, leading to more abortions of babies with the condition. Describing this as a 'breakthrough' is offensive to people who live with Down's syndrome, and to all who recognize the equal right to life of disabled people,” she said.

SEMINAR: Faces of Autism

2008-08-25T17:34:00.000-07:00

You are cordially invited to the SWU's seminar on Faces of Autism: Early Intervention & Developmental Evaluation. Please see attached image for details.

For more information you can contact:

Dr. Carmelita Diamos
Cell No: 09209094771
e-mail: 0b75em80@gmail.com

Ms. Jessica Dela Cerna
Tel. No: 2562743
e-mail: vp.academics.swu@gmail.com

Dr. Deletah Polinar
Tel. No: 4155555 loc. 319
e-mail: polinar_d@yahoo.com

How to Download from Youtube?

2008-08-17T17:57:00.000-07:00

Lecture presentations or report works are best presented with animation or video clips to liven up the discussion. As such, the need for video files is imminent. How do we do it?

There are different ways. You can check these sites for details:

Or you could download these softwares:

SWU DSPED 08 List of Requirements

2008-08-17T16:26:00.000-07:00

I. SPED 101 - Introduction

(2) Reports
(1) Portfolio containing:

Class Reflections
Others

II. SPED 102 - Arts & Crafts

(1) Portfolio containing:

(10) Paper Art
(10) Crayon Art
(10) Water Color Art
(10) Craft Art

Art Demo

III. SPED 103 - Current Trends

(1) Report
(1) Portfolio containing:

Given Hand-outs
DSWD Visit
Adam Jennie's SPED Center Visit
Ideal School Organization
Written Report
(2) Movie Reaction Paper

IV. SPED 104 - Methods & Materials

Lesson Plan Criticizing
Nursery Rhymes
Visual Aides
Teaching Demo

V. SPED 105 - Dynamics

Movie Reaction Paper
Report

VI. SPED 106 - Remediation

Report
Demo

VII. SPED 107 - Hearing & Visually Impaired

ASL Book or Photocopy
(3) ASL Songs - Slow, Average, Fast
(1) ASL Poem - 3, 4, 6 Stanzas (Filipino / English)
(1) Describe a thing or tell a story

VIII. SPED 108 - Assessment

(1) Case Study
(1) Movie Reaction Paper
(1) Report
(1) Psycho-Educational Assessment
(1) IEP

NOTE: This information is correct as of Monday, August 18, 2008 pending further changes. Please keep up-to-date with the requirements and frequently update with this website.

Hearing Impairment

2008-08-07T21:45:00.000-07:00

A hearing impairment or hearing loss is a full or partial decrease in the ability to detect or understand sounds. Caused by a wide range of biological and environmental factors, loss of hearing can happen to any organism that perceives sound.

Sound waves vary in amplitude and in frequency. Amplitude is the sound wave's peak pressure variation. Frequency is the number of cycles per second of a sinusoidal component of a sound wave. Loss of the ability to detect some frequencies, or to detect low-amplitude sounds that an organism naturally detects, is a hearing impairment.

Loudness, frequency, and discrimination deficiencies

Hearing sensitivity is indicated by the quietest sound that an individual can detect, called the hearing threshold. In the case of people and some animals, this threshold can be accurately measured by a behavioral audiogram. A record is made of the quietest sound that consistently prompts a response from the listener. The test is carried out for sounds of different frequencies. There are also electro-physiological tests that can be performed without requiring a behavioral response.

Normal hearing thresholds are not the same for all frequencies in any species of animal. If different frequencies of sound are played at the same amplitude, some will be loud, and others quiet or even completely inaudible. Generally, if the gain or amplitude is increased, a sound is more likely to be perceived. Ordinarily, when animals use sound to communicate, hearing in that type of animal is most sensitive for the frequencies produced by calls, or, in the case of humans, speech. This tuning of hearing exists at many levels of the auditory system, all the way from the physical characteristics of the ear to the nerves and tracts that convey the nerve impulses of the auditory portion of the brain.

A hearing impairment exists when an individual is not sensitive to the sounds normally heard by its kind. In human beings, the term hearing impairment is usually reserved for people who have relative insensitivity to sound in the speech frequencies. The severity of a hearing impairment is categorized according to how much louder a sound must be made over the usual levels before the listener can detect it. In profound deafness, even the loudest sounds that can be produced by the instrument used to measure hearing (audiometer) may not be detected.

There is another aspect to hearing that involves the quality of a sound rather than amplitude. In people, that aspect is usually measured by tests of speech discrimination. Basically, these tests require that the sound is not only detected but understood. There are very rare types of hearing impairments which affect discrimination alone.

Types and causes of hearing impairment

Hearing impairment comes from different biologic causes. Most commonly, the ear is the affected part of the body.

Conductive

Conductive hearing loss occurs when sound is not normally conducted through the outer or middle ear or both. Since sound can be picked up by a normally sensitive inner ear even if the ear canal, ear drum, and ear ossicles are not working, conductive hearing loss is often only mild and is never worse than a moderate impairment. Hearing thresholds will not rise above 55-60 dB from outer or middle ear problems alone. Generally, with pure conductive hearing loss, the quality of hearing (speech discrimination) is good, as long as the sound is amplified loud enough to be easily heard.

A conductive loss can be caused by any of the following: Ear canal obstruction Middle ear abnormalities: Tympanic membrane Ossicles Inner ear abnormalities: Superior canal dehiscence syndrome

Sensorineural hearing loss

A sensorineural hearing loss is due to insensitivity of the inner ear, the cochlea, or to impairment of function in the auditory nervous system. It can be mild, moderate, severe, or profound, to the point of total deafness. This is classified as a disability under the ADA and if unable to work is eligible for disability payments.

The great majority of human sensorineural hearing loss is caused by abnormalities in the hair cells of the organ of Corti in the cochlea. There are also very unusual sensorineural hearing impairments that involve the VIIIth cranial nerve, the Vestibulocochlear nerve or the auditory portions of the brain. In the rarest of these sorts of hearing loss, only the auditory centers of the brain are affected. In this situation, central hearing loss, sounds may be heard at normal thresholds, but the quality of the sound perceived is so poor that speech can not be understood.

Most sensory hearing loss is due to poor hair cell function. The hair cells may be abnormal at birth, or damaged during the lifetime of an individual. There are both external causes of damage, like noise trauma and infection, and intrinsic abnormalities, like deafness genes.

Sensorineural hearing loss that results from abnormalities of the central auditory system in the brain is called Central Hearing Impairment. Since the auditory pathways cross back and forth on both sides of the brain, deafness from a central cause is unusual.

Typical causes are discussed in following subsections.

Long-term exposure to environmental noise

Populations of people living near airports or freeways are exposed to levels of noise typically in the 65 to 75 dB(A) range. If lifestyles include significant outdoor or open window conditions, these exposures over time can degrade hearing. The U.S. EPA and various states have set noise standards to protect people from these adverse health risks. The EPA has identified the level of 70 dB(A) for 24 hour exposure as the level necessary to protect the public from hearing loss and other disruptive effects from noise, such as sleep disturbance, stress-related problems, learning detriment, etc. (EPA, 1974).

Noise-Induced Hearing Loss (NIHL) typically is centered at 3000, 4000, or 6000 Hz. As noise damage progresses, damage starts affecting lower and higher frequencies. On an audiogram, the resulting configuration has a distinctive notch, sometimes referred to as a "noise notch." As aging and other effects contribute to higher frequency loss (6-8 kHz on an audiogram), this notch may be obscured and entirely disappear.

Louder sounds cause damage in a shorter period of time. Estimation of a "safe" duration of exposure is possible using an exchange rate of 3 dB. As 3 dB represents a doubling of intensity of sound, duration of exposure must be cut in half to maintain the same energy dose. For example, the "safe" daily exposure amount at 85 dB A, known as an exposure action value, is 8 hours, while the "safe" exposure at 91 dB(A) is only 2 hours (National Institute for Occupational Safety and Health, 1998). Note that for some people, sound may be damaging at even lower levels than 85 dB A. Exposures to other ototoxins (such as pesticides, some medications including chemotherapy, solvents, etc.) can lead to greater susceptibility to noise damage, as well as causing their own damage. This is called a synergistic interaction.

Some American health and safety agencies (such as OSHA and MSHA), use an exchange rate of 5 dB. While this exchange rate is simpler to use, it drastically underestimates the damage caused by very loud noise. For example, at 115 dB, a 3 dB exchange rate would limit exposure to about half a minute; the 5 dB exchange rate allows 15 minutes.

While OSHA, MSHA, and FRA provide guidelines to limit noise exposure on the job, there is essentially no regulation or enforcement of sound output for recreational sources and environments, such as sports arenas, musical venues, bars, etc. This lack of regulation resulted from the defunding of ONAC, the EPA's Office of Noise Abatement and Control, in the early 1980s. ONAC was established in 1972 by the Noise Control Act and charged with working to assess and reduce environmental noise. Although the Office still exists, it has not been assigned new funding.

Most people in the United States are unaware of the presence of environmental sound at damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise levels include car stereos, children's toys, transportation, crowds, lawn and maintenance equipment, power tools, gun use, and even hair dryers. Noise damage is cumulative; all sources of damage must be considered to assess risk. If one is exposed to loud sound (including music) at high levels or for extended durations (85 dB A or greater), then hearing impairment will occur. Sound levels increase with proximity; as the source is brought closer to the ear, the sound level increases. This is why music is more likely to cause damage at the same output when listened to through headphones, as the headphones are in closer proximity to the ear drum than a loudspeaker. With the invention of in-ear headphones, these dangers are increased.

Genetic

Hearing loss can be inherited. Both dominant gene and recessive genes exist which can cause mild to profound impairment. If a family has a dominant gene for deafness it will persist across generations because it will manifest itself in the offspring even if it is inherited from only one parent. If a family had genetic hearing impairment caused by a recessive gene it will not always be apparent as it will have to be passed onto offspring from both parents. Dominant and recessive hearing impairment can be syndromic or nonsyndromic. Recent gene mapping has identified dozens of nonsyndromic dominant (DFNA#) and recessive (DFNB#) forms of deafness.

The most common type of congenital hearing impairment in developed countries is DFNB1, also known as Connexin 26 deafness or GJB2-related deafness.
The most common dominant syndromic forms of hearing impairment include Stickler syndrome and Waardenburg syndrome.
The most common recessive syndromic forms of hearing impairment are Pendred syndrome, Large vestibular aqueduct syndrome and Usher syndrome.

Disease or illness

Measles may result in auditory nerve damage
Meningitis may damage the auditory nerve or the cochlea
Autoimmune disease has only recently been recognized as a potential cause for cochlear damage. Although probably rare, it is possible for autoimmune processes to target the cochlea specifically, without symptoms affecting other organs.Wegener's granulomatosis is one of the autoimmune conditions that may precipitate hearing loss.
Mumps (Epidemic parotitis) may result in profound sensorineural hearing loss(90 Decibel|dB or more), unilateral (one ear) or bilateral (both ears).
Presbycusis is a progressive hearing impairment accompanying age, typically affecting sensitivity to higher frequencies (above about 2 kHz).
Adenoids that do not disappear by adolescence may continue to grow and may obstruct the Eustachian tube, causing conductive hearing impairment and nasal infections that can spread to the middle ear.
AIDS and AIDS-related complex|ARC patients frequently experience auditory system anomalies.
HIV (and subsequent opportunistic infections) may directly affect the cochlea and central auditory system.
Chlamydia may cause hearing loss in newborns to whom the disease has been passed at birth.
Fetal alcohol syndrome is reported to cause hearing loss in up to 64% of infants born to alcoholism|alcoholic mothers, from the ototoxic effect on the developing fetus plus malnutrition during pregnancy from the excess ethanol|alcohol intake.
Premature birth results in sensorineural hearing loss approximately 5% of the time.
Syphilis is commonly transmitted from pregnant women to their fetuses, and about a third of the infected children will eventually become deaf.
Otosclerosis is a hardening of the stapes (or stirrup) in the middle ear and causes conductive hearing loss.
Superior canal dehiscence, a gap in the bone cover above the inner ear, can lead to low-frequency conductive hearing loss, autophony and vertigo

Medications

Some medications cause irreversible damage to the ear, and are limited in their use for this reason. The most important group is the aminoglycosides (main member gentamicin).

Various other medications may reversibly affect hearing. This includes some diuretics, aspirin and NSAIDs, and macrolide antibiotics.

Extremely heavy hydrocodone (Vicodin) abuse is known to cause hearing impairment. There has been speculation that radio talk show host Rush Limbaugh's hearing loss was at least in part caused by his admitted addiction to narcotic pain killers, in particular Vicodin and OxyContin.

Physical trauma

There can be damage either to the ear itself or to the brain centers that process the aural information conveyed by the ears.
People who sustain head injury are especially vulnerable to hearing loss or tinnitus, either temporary or permanent.
Exposure to very loud noise (90 Decibel|dB or more, such as jet engines at close range) can cause progressive hearing loss. Exposure to a single event of extremely loud noise (such as explosions) can also cause temporary or permanent hearing loss. A typical source of acoustic trauma is an excessively loud music concert.

Categories of hearing impairment

Hearing loss is categorized by its severity and by the age of onset. Two persons with the same severity of hearing loss will experience it quite differently if it occurs early or late in life. Furthermore, a loss can occur on only one side (unilateral) or on both (bilateral).

Types

As discussed above, there are three major types of hearing loss: neural/sensorineural, conductive, or a combination of both. Treatment depends upon the type of hearing loss that is present.

Quantification of hearing loss

The severity of hearing loss is measured by the degree of loudness, as measured in decibels, a sound must attain before being detected by an individual. Hearing loss may be ranked as mild, moderate, severe or profound. It is quite common for someone to have more than one degree of hearing loss (i.e. mild sloping to severe). The following list shows the rankings and their corresponding decibel ranges:

Mild:
- for adults: between 25 and 40 dB
- for children: between 20 and 40 dB
Moderate: between 41 and 55 dB
Moderately severe: between 56 and 70 dB
Severe: between 71 and 90 dB
Profound: 90 dB or greater

The quietest sound one can hear at different frequencies is plotted on an audiogram to reflect one's ability to hear at different frequencies. The range of normal human hearing (from the softest audible sound to the loudest comfortable sound) is so great that the audiogram must be plotted using a logarithmic scale. This large normal range, and the different amounts of hearing loss at different frequencies, make it virtually impossible to accurately describe the amount of hearing loss in simple terms such as percentages or the rankings above.

Measuring hearing loss in terms of a percentage is debatable in terms of effectiveness, and has been compared to measuring weight in inches. Though in specific legal situations, where decibels of loss are converted via a recognized legal formula, one can infer a standardized "percentage of hearing loss" which is suitable for legal purposes only.

Another method for determining hearing loss, is the Hearing in Noise Test (HINT). HINT technology was developed by the House Ear Institute, and is intended to measure an ability to understand speech in quiet and noisy environments. Unlike pure-tone tests, where only one ear is tested at a time, HINT evaluates hearing using both ears simultaneously (binaural), as binaural hearing is essential for communication in noisy environments, and for sound localization.

Age of onset of hearing impairment

The age at which the hearing impairment develops is crucial to spoken language acquisition. Post-lingual hearing impairments are far more common than pre-lingual impairments.

If the hearing loss occurs at a young age, interference with the acquisition of spoken language and social skills may occur. Hearing aids, which amplify the incoming sound, may alleviate some of the problems caused by hearing impairment, but are often insufficient. Cochlear implants artificially stimulate the VIIIth Nerve by providing an electric impulse substitution for the firing of hair cells. Cochlear implants are not only expensive, but require sophisticated programming in conjunction with patient training for effectiveness. People who have hearing impairments, especially those who develop a hearing problem in childhood or old age, require support and technical adaptations as part of the rehabilitation process.

Pre-lingual deafness

Main article: Prelingual deafness

Prelingual hearing impairment exists when the impairment is congenital or otherwise acquired before the individual has acquired speech and language, thus rendering the disadvantages more difficult to treat because the child is unable to access audible /spoken communication from the outset. It is important to note that those children born into signing families have no delay in language development and communication. Most pre-lingual hearing impairment is due to an acquired condition, usually either disease or trauma; therefore, families commonly have no prior knowledge of deafness.

Post-lingual hearing impairment

Main article: Post-lingual hearing impairment

Post-lingual hearing impairment where hearing loss is adventitious after the acquisition of speech and language, usually after the age of six. It may develop due to disease, trauma, or as a side-effect of a medicine. Typically, hearing loss is gradual, and often detected by family and friends of the people so affected long before the patients themselves will acknowledge the disability. Common treatments includes hearing aids and learning lip reading. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability.^{[citation needed]}

Hard-of-hearing

People who are hard of hearing have varying amounts of hearing loss but usually not enough to be considered deaf. Many people who are deaf consider spoken language their primary language and consider themselves "hard of hearing".^{[citation needed]} How one classifies themselves relative to hearing loss or deafness is a very personal decision and reflects much more than just their ability to hear.

The phrase hard of hearing, normally used as an adjective or adverb, can also be used as a noun, referring to people with hearing impairment as the hard of hearing. People who consider themselves culturally deaf, prefer the term "hard of hearing" or "deaf", and perceive "hearing impaired" as an insult.

Hearing impaired persons with partial loss of hearing may find that the quality of their hearing varies from day to day, or from one situation to another or not at all. They may also, to a greater or lesser extent, depend on both hearing-aids and lip-reading. They may perhaps not always be aware of it, but they do admit to it being important to see the speaker's face in conversation.

Many people with hearing loss have better hearing in the lower frequency ranges (low tones), and cannot hear as well or at all in the higher frequencies. Some people may merely find it difficult to differentiate between words that begin with consonantal sounds such as the fricatives or sibilants, z, or th, or the plosives d, t, b, or p. They may be unable to hear thin, high-pitched or metallic noises, such as birds chirping or singing, clocks ticking, etc. Often, they are able to hear and understand men's voices better than women's.

Others will find their condition so much worse if circumstances in their immediate environment affect the way they are able to use their hearing aids, or prevent them from employing their speech reading skills. A room with a high ceiling and a lot of reverberation will affect the sound of a speaker's voice adversely. The position of the listener, too, sitting at a right angle to the speaker at a long seminar table, thus being able to hear only with one, maybe the ineffectual ear, can make a difference. Difficulties can also arise for the listener trying to lip-read, if the speaker is sitting with his back against the light-source and is in this way obscuring his face. A rule of thumb is that bright lighting is to the hearing-impaired what noise is to the hearing; a source of distraction.

The speaker's accent; the topic under discussion, possibly with many unfamiliar words; the softness of his voice; possibly his having a speech impediment; a habit of holding a hand in front of his mouth or turning his face away at times: all these tendencies cause problems to the hard-of-hearing, especially when they have to rely on lip-reading. The rustling of papers, and notebook pages being turned are precisely the noises that will be the first thing hearing-aids pick up.

Noisy situations are especially difficult, because hearing loss affects not only the ability to hear sounds, but also the ability to localize and filter out background noise.

Unilateral hearing loss

People with unilateral hearing loss (single sided deafness/SSD) can hear normally (or better) in one ear, but have trouble hearing out of the other ear. Problems with this type of deficit is inability to localize sounds (ie. unable to tell where traffic is coming from) and inability to process out background noise in a noisy environment, such as in a restaurant.

Social impact

Pre-lingual impairment

See also: Prelingual deafness

In children, hearing loss can lead to social isolation for several reasons. First, the child experiences delayed social development that is in large part tied to delayed language acquisition. It is also directly tied to their inability to pick up auditory social cues. This can result in a deaf person becoming generally irritable. A child who uses sign language, or identifies with the deaf sub-culture does not generally experience this isolation, particularly if he/she attends a school for the deaf, but may conversely experience isolation from his parents if they do not know sign language. A child who is exclusively or predominantly oral (using speech for communication) can experience social isolation from his or her hearing peers, particularly if no one takes the time to explicitly teach her social skills that other children acquire independently by virtue of having normal hearing. Finally, a child who has a severe impairment and uses some sign language may be rejected by his or her deaf peers, because of an understandable hesitation in abandoning the use of existent verbal and speech-reading skills. Some in the deaf community can view this as a rejection of their own culture and its mores, and therefore will reject the individual preemptively.

Post-lingual impairment

Those who lose their hearing later in life, such as in late adolescence or adulthood, face their own challenges. For example, they must adjust to living with the adaptations that make it possible for them to live independently. They may have to adapt to using hearing aids or a cochlear implant, develop speech-reading skills, and/or learn sign language. The affected person may need to use a TTY (teletype), interpreter, or relay service to communicate over the telephone. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability. The challenge is made greater by the need for those around them to adapt to the person's hearing loss.

Many relationships have suffered because of the anger that occurs when there is general miscommunication between family members. Generally, it's not only the person with a hearing disability that feels isolated, but others around them who feel they are not being "heard" or paid attention to, especially when the hearing loss has been gradual. Many people opt not to choose hearing aids for fear of looking old, since hearing loss is usually associated with old age, which equals ineffectiveness in some societies. Family members then feel as if their hearing loss partner doesn't care about them enough to make changes to reduce their disability and make it easier to communicate.

Medical treatments

Approaches

In addition to hearing aids there exist cochlear implants of increasing complexity and effectiveness. These are useful in treating the mild to profound hearing impairment when the onset follows the acquisitions of language and in some cases in children whose hearing loss came before language was acquired. Recent research shows variations in efficacy but some promising studies ^[4]show that if implanted at a very young age, some profoundly impaired children can acquire effective hearing and speech.

Views of treatments

There is controversy in the culturally deaf community as to whether cochlear implants address wellness concerns, the overall health and psycho-emotional well-being of prelingually deaf children at all.

Gene therapy

In 2005, there was success of the regrowth of cochlea cells in test subjects by a research team led by Dr. Yehoash Raphael from the University of Michigan. This study was conducted using guinea pigs as test subjects.^[5] It is important to note however, that the regrowth of cochlear hair cells does not imply the restoration of hearing sensitivity as the sensory cells may or may not make connections with neurons that carry the signals from hair cells to the brain.

A team led by Dr. Stefan Heller from Stanford University are pioneering stem cell research in the prospect of regrowth in cochlea cells.^[6]....

Adaptations to hearing impairment

Many hearing impaired individuals use certain assistive devices in their daily lives. Individuals can communicate by telephone using telecommunications devices for the deaf (TDD). This device looks like a typewriter or word processor and transmits typed text over the telephone. Other names in common use are textphone and minicom. A videophone can be used for distance communication using sign language. In 2004, mobile textphone devices came onto the market for the first time allowing simultaneous two way text communication. In the U.S., the UK, the Netherlands and many other western countries there are Telecommunications Relay Services so that a hearing impaired person can communicate over the phone with a hearing person via a human translator. Wireless, internet and mobile phone/SMS text messaging are beginning to take over the role of the TDD. Other assistive devices include those that use flashing lights to signal events such as a ringing telephone, a doorbell, or a fire alarm. Video conferencing is also a new technology that permits signed conversations as well as permitting an ASL-English interpreter to voice and sign conversations between a hearing impaired and hearing person, negating the need to use a TTY or computer keyboard. In addition, there are many new Telecommunications Relay Service technologies including IP Relay and captioned telephone.

Resources

Many different assistive technologies, such as hearing aids, are available to people who are hearing impaired. People with cochlear implants, hearing aids, or neither of these two devices also use additional communication devices to reduce the interference of background sounds, or to mediate the problems of distance from sound and poor sound quality caused by reverberation and poor acoustic materials of walls, floors and hard furniture. Three types of wireless, one-way wireless exist along with hard-wired devices. A wireless device used by people who use their residual hearing has two main components. One component sends the sound out to the listener, but is not directly connected to the listener with the hearing loss. The second component of the wireless system, the receiver, detects the sound and sends the sound to the ear of the person with the hearing loss. The three types of wireless devices are the FM system, the audio induction loop and the infra red system. Each system has advantages and benefits for particular uses. The FM system can easily operate in many environments with battery power. It is thus mobile and does not usually require a sound expert for it to work properly. The listener with the hearing loss carries a receiver and an earpiece. Another wireless system is the audio induction loop which permits the listener with hearing loss to be free of wearing a receiver provided that the listener has a hearing aid or cochlear implant processor with an accessory called a "telecoil". If the listener doesn't have a t-coil or telecoil, then she must carry a receiver with an earpiece. The third kind of wireless device for people with hearing loss is the infra red (IR) device which also requires a receiver to be worn by the listener. Usually the emitter for the IR device, that is, the component that sends out the signal, uses an AC adaptor. The advantage of the IR wireless system, is that people in adjoining rooms cannot listen in on conversations, and thus it is confidential and necessary for situations where privacy and confidentiality are required or chosen. Another way to achieve confidentiality is to use a hardwired amplifier which sends out no signal beyond the earpiece that is plugged directly into the amplifier. That amplifier of the hardwired device also has a microphone inside of it or plugged into it.

Hearing dogs, a category of assistance dogs, are trained to help those with hearing impairments.
The advent of the internet's World Wide Web and closed captioning has given the hearing impaired unprecedented access to information. Electronic mail and online chat have reduced the need for deaf and hard of hearing people to use a third-party Telecommunications Relay Service in order to communicate with the hearing and other hearing impaired people.

Obsessive-Compulsive Disorder

2008-08-07T21:25:00.001-07:00

Obsessive-compulsive disorder (OCD) is an anxiety disorder most commonly characterized by obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions. OCD is distinguished from other types of anxiety, including the routine tension and stress that appear throughout life. The phrase "obsessive-compulsive" has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone.^[1] Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive-compulsive personality disorder (OCPD) or some other condition. Some symptoms of OCD and OCPD are consistent with what Sigmund Freud called an anal retentive personality type, although this is rarely diagnosed as a clinical condition by non-psychoanalytic therapists.

Diagnostic criteria

To be diagnosed with OCD, a person must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) states several characteristics of obsessions and compulsions:^[2]

Obsessions

Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress.
The thoughts, impulses, or images are not simply excessive worries about real-life problems.
The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.

Compulsions

Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviours or mental acts are not actually connected to the issue, or they are excessive.

In addition to these criteria, at some point during the course of the disorder, the individual must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning.^[2] OCD often causes feelings similar to those of depression.

Symptoms and prevalence

OCD manifests in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically-recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed.^[3] The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD. Another reason for not seeking treatment is because many sufferers of OCD do not realize that they have the condition.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, repeatedly washing hands at regular intervals throughout the day, touching objects a certain amount of times before leaving a room, or walking in a certain routine way. Physical symptoms may include those brought on from anxeties and unwanted thoughts, as well as tics or Parkinson's disease-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs.

However, the general idea of a person with OCD (washing hands, checking doors etc.) is not always the case. There are OCD sufferers who are convinced that reality is non-existent, that they are destroying people's souls merely by looking at them, that people are being possessed and many more.

There are many other possible symptoms, and it is not necessary to display those described in the lists below to be considered as suffering from OCD. Formal diagnosis should be performed by a psychologist, a psychiatrist or psychoanalyst. OCD sufferers are aware that their thoughts and behavior are not rational,^[4] but they feel bound to comply with them to fend off feelings of panic or dread. Although everyone may experience unpleasant thoughts at one time or another, these are short-lived and fade away in time.^[5]For people with OCD, the thoughts are intrusive and persistent, and cause them great anxiety and distress. ^[6]

Contamination

A major subtype of the fear category is the fear of contamination:(see mysophobia); some sufferers may fear the presence of human body secretions such as saliva, blood, sweat, tears, vomit, or mucus, or excretions such as urine or feces. Some OCD sufferers even fear that the soap they are using is contaminated.^[7] As with the other anxieties, these fears may cause a person to have significant distress, and they may make it hard for a person with OCD to work or go to school or interfere with social relationships.

Performing tasks

Symptoms related to performing tasks may include repeated hand washing or clearing of the throat; specific counting systems or counting of steps; doing repetitive actions -- more generally, this can involve an obsession with numbers or types of numbers (e.g., odd numbers). These obsessive behaviours can cause individuals to feel psychological distress, because they are very concerned about having "made mistakes" in the number of steps that they have taken, or the number of stairs on a staircase. For some people with OCD, these obsessive counting and re-counting tasks, along with the attendant anxiety and fear, can take hours of each day, which can make it hard for the person to fulfill their work, family, or social roles. In some cases, these behaviours can also cause adverse physical symptoms: people who obsessively wash their hands with antibacterial soap and hot water (to remove germs) can make their skin red and raw with dermatitis.

Intrusive thoughts and fears

Intrusive thoughts are unwelcome, involuntary thoughts, images or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to be free of and manage.^[8] Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, usually falling into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts.^[9] Most people experience these thoughts; when they are associated with OCD or depression, they may become paralyzing, anxiety-provoking, and persistent. Many people experience the type of unpleasant or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts.^[8] When intrusive thoughts co-occur with OCD, patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.^[8]

Violent or aggressive thoughts

Intrusive thoughts may involve violent obsessions about hurting others or one's self.^[10] They can include such thoughts as harming an innocent child, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or automobile, and urges to push another in front of a train or automobile.^[9] A survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including ^[11] imagining or wishing harm upon a family member or friend, impulses to attack or kill a small child, or animal, or shout something rude or violent. A person with OCD may meet up with their best friend, to whom they bear no ill will, and an image of them stabbing their friend may "pop" into their head.

While some individuals with OCD who have these unwanted images pop into their minds are able to dismiss the images as random "static" generated by the mind, others are tormented by the thoughts, and they may worry that they are actual desires that they may act on, or that they are "going crazy." In some cases, the person struggling with these horrible images may try to deal with them by developing compulsions. For example, a person who is tormented by unwanted thoughts of them stabbing their mother with a kitchen knife may ensure that all kitchen knives are kept locked away, to prevent the perceived danger that they may "act upon" the horrible thoughts.

The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts, and has never acted on them before, is an excellent predictor that they won't act upon the thoughts. According to Baer, a patient should be concerned that intrusive thoughts are dangerous if the person doesn't feel upset by the thoughts, rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others don't see; or feels uncontrollable irresistible anger.^[12]

Inappropriate sexual thoughts

Sexual obsessions involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", involving "heterosexual or homosexual content" with persons of any age.^[13] Like other intrusive, unpleasant thoughts or images, most people have some inappropriate sexual thoughts at times^{[citation needed]}, but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the bad thoughts, resulting in self-criticism or loathing.^[13]

One of the more common sexual intrusive thoughts occurs when an obsessive person doubts his or her sexual identity, a symptom of OCD called homosexuality anxiety or HOCD.^[14] As in the case of most sexual obsessions, sufferers may feel shame and live in isolation, finding it hard to discuss their fears, doubts, and concerns about their sexual identity.^[15] A person experiencing sexual intrusive thoughts may feel shame, "embarrassment, guilt, distress, torment, fear that you may act on the thought or perceived impulse and, doubt about whether you have already acted in such a way." Depression may be a result of the self-loathing that can occur, depending on how much the OCD interferes with daily functioning or causes distress.^[13] The possibility that most patients suffering from intrusive thoughts to sexually assault people will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts.

Related conditions

OCD is often confused with the separate condition obsessive-compulsive personality disorder. The two are not the same condition, however. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic — marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with anxiety; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.^[16] This is a significant difference between these disorders.

Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.

Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not.

OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life — particularly its substantial consumption of time — can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available.

Related disorders

People with OCD may be diagnosed with other conditions, such as generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, asperger's syndrome, compulsive skin picking, body dysmorphic disorder, trichotillomania, and (as already mentioned) obsessive-compulsive personality disorder. There is some research demonstrating a link between drug addiction and OCD as well. Many who suffer from OCD suffer also from panic attacks. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.^[17]

Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal antibodies become involved in an autoimmune process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that antibiotics may eventually be used to treat or prevent it.^[18]

Causes

Psychological

Scientists studying obsessive-compulsive disorder are split into two factions disagreeing over the illness's cause. One side believes that obsessive-compulsive behavior is a psychological disorder; the other side thinks it has a neurological origin.

From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were possessed by the Devil. Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism.^[19] In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts which manifested as symptoms.^[19] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".^[20]

The cognitive-behavioral model suggests that the behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges. Each time the behaviour occurs it is negatively reinforced (see Reinforcement) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time. For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle).

Biological

There are many different theories about the cause of obsessive-compulsive disorder. The majority of researchers believe that there is some type of abnormality with the neurotransmitter serotonin, among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain's response to OCD, and not its cause. Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as sleep and memory function. This neurotransmitter travels from one nerve cell to the next via synapses. In order to send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This suggestion is supported by the fact that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs) — a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells.^[21] For more about this class of drugs, see the section about potential treatments for OCD.

The Stanford University School of Medicine OCD webpage states, "Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to Group A streptococcal infection promises to bring increased understanding of the disorder's pathogenesis."^[22]

Recent research has revealed a possible genetic mutation that could help to cause OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety".^[23] In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established.

Another possible genetic cause of OCD was discovered in August 2007 by scientists at Duke University Medical Center in North Carolina. They genetically engineered mice that lacked a gene called SAPAP3. This protein is highly expressed in the striatum, an area of the brain linked to planning and the initiation of appropriate actions. The mice spent three times as much time grooming themselves as ordinary mice, to the point that their fur fell off.^[24]

Using tools like positron emission tomography (PET scans), it has been shown that those with OCD tend to have brain activity that differs from those who do not have this disorder.^[25] This suggests that brain functioning in those with OCD may be impaired in some way. A popular explanation for OCD is that offered in the book Brain Lock by Jeffrey Schwartz, which suggests that OCD is caused by the part of the brain that is responsible for translating complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move arm forward, rotate hand 15 degrees, etc.") failing to correctly communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt to consciously deconstruct their own prior behavior — a process which induces anxiety in most people, even those without OCD^{[citation needed]}.

It has been theorized that a miscommunication between the orbitofrontal cortex, the caudate nucleus, and the thalamus may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong.^[vague] When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension.^[21] This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to SSRI medication. The increased stimulation of the serotonin receptors 5-HT2A and 5-HT2C in the OFC is believed to cause this inhibition. ^[26]

Some research has discovered an association between a type of size abnormality in different brain structures and the predisposition to develop OCD. Through the use of magnetic resonance imaging (MRI), researchers at Cambridge's Brain Mapping Unit were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. ^[27] This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping motor response may ultimately aid researchers who seek to determine which genes contribute to the development of OCD.

Demographics and other statistics

In a 1980 study of 20,000 adults from New Haven, Baltimore, St. Louis, Durham, and Los Angeles, the lifetime prevalence rate of OCD for both sexes was recorded at 2.5 percent. Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9 percent versus 3.4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1 percent) than it is for those who have only some college background (2.4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females.^[28]

Violence is very rare among OCD sufferers, but the disorder is often debilitating to their quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.

Treatment

According to the Expert Consensus Guidelines for the Treatment of obsessive-compulsive disorder, behavioral therapy (BT), cognitive therapy (CT), medications, or any combination of the three, are first-line treatments for OCD. Psychodynamic psychotherapy may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of psychoanalysis or dynamic psychotherapy in OCD.^[29]

Behavioral therapy

The specific technique used in BT/CBT is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all — again, without performing the ritual behavior of washing or checking.

Exposure and ritual/response prevention has been demonstrated to be the most effective treatment for OCD. It has generally been accepted that psychotherapy, in combination with psychotropic medication, is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.^[30]

Medication

Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Seroxat, Paxil, Xetanor, ParoMerck, Rexetin), sertraline (Zoloft, Stimuloton), fluoxetine (Prozac, Bioxetin), escitalopram (Lexapro), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil). SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious. There has been controversy of efficacy with this class of drugs, recent studies of SSRIs have suggested a low profile for efficacy and high profile for dangerous side effects.

Benzodiazepines are also used in treatment. It's not uncommon to administer this class of drugs during the "latency period" for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and can be addictive.^[31]

Serotonergic antidepressants typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. Fluoxetine, for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases antidepressant therapy alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Other medications such as riluzole, memantine, gabapentin (Neurontin), lamotrigine (Lamictal), and low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD.

The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. This is most likely due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics — CYP2D6 — so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results.

Alternative Drug Treatments

The naturally occurring sugar inositol may be an effective treatment for OCD. Inositol appears to modulate the actions of serotonin and has been found to reverse desensitisation of the neurotransmitter's receptors.^[32] St John's Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St John's Wort and the placebo.^[33] Studies have also been done that show nutrition deficiencies may also contribute to OCD and other mental disorders. Certain vitamin and mineral supplements may aid in such disorders and provide the nutrients necessary for proper mental functioning. ^[34]

Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the use of them is not sanctioned for treatment and considered an "off-label" use, factors being physical dependence and long term drug tolerance. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as Ultram and Vicodin, though the off-label use of such painkillers is not widely accepted, research on this has been limited. Tramadol is an atypical opioid that may be a viable option as it has a low potential for abuse and addiction, mild side effects, and shows signs of rapid efficacy in OCD. Tramadol not only provides the anti-OCD effects of an opiate, but also inhibits the re-uptake of serotonin (in addition to norepinephrine). This may provide additional benefits, but should not be taken in combination with antidepressant medication unless under careful medical supervision due to potential serotonin syndrome.^[35]

Recent studies at the University of Arizona using the tryptamine alkaloid psilocybin have shown promising results.^[36] There are reports that other hallucinogens such as LSD and peyote have produced similar benefits. It has been hypothesised that this effect may be due to stimulation of 5-HT2A receptors and, less importantly, 5-HT2C receptors. This causes, among many other effects, an inhibitory effect on the orbitofrontal cortex, an area of the brain in which hyperactivity has been strongly associated with OCD.^[37]

Emerging evidence suggests that regular nicotine treatment may be helpful in improving symptoms of OCD, although the pharmacodynamical mechanism by which this improvement is achieved is not yet known, and more detailed studies are needed to fully confirm this hypothesis. Anecdotal reports suggest OCD can worsen when cigarettes are smoked as a way of obtaining nicotine.^[38]

Psychosurgery

For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30% of participants benefited significantly from this procedure.^[6] Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated.

In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive-behavioral therapy with exposure and ritual/response prevention.^[39] Likewise, in the UK, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive-behavioural therapist has been carried out.

Transcranial magnetic stimulation

Though in its early stages of research, Transcranial magnetic stimulation (TMS) has shown promising results. The magnetic pulses are focused on the brain's supplementary motor area (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The TMS treatment is an attempt to normalize the SMA's activity, so that it properly filters out thoughts and behaviors associated with OCD. ^[40]^[41]

Neuropsychiatry

OCD primarily involves the brain regions of the striatum, the orbitofrontal cortex and the cingulate cortex. OCD involves several different receptors, mostly H₂, M₄, NK₁, NMDA, and non-NMDA glutamate receptors. The receptors 5-HT_1D, 5-HT_2C, and the μ opioid receptor exert a secondary effect. The H₂, M₄, NK₁, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex.

The activity of certain receptors is positively correlated to the severity of OCD, whereas the activity of certain other receptors is negatively correlated to the severity of OCD. Correlations where activity is positively correlated to severity include the histamine receptor (H₂); the Muscarinic acetylcholine receptor(M₄); the Tachykinin receptor (NK₁); and non-NMDA glutamate receptors. Correlations where activity is negatively correlated to severity include the NMDA receptor (NMDA); the Mu opioid receptor (μ opioid); and two types of 5-HT receptors (5-HT_1D and 5-HT_2C) The central dysfunction of OCD may involve the receptors nk1, non-NMDA glutamate receptors, and NMDA, whereas the other receptors could simply exert secondary modulatory effects.

Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1 antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor sensitizer). Also, the anti-Alzheimer's drug memantine is being studied by the OC Foundation in its efficacy in reducing OCD symptoms due to it being an NMDA antagonist. One case study published in The American Journal of Psychiatry suggests that "memantine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation."^[42] The drugs that are popularly used to fight OCD lack full efficacy because they do not act upon what are believed to be the core mechanisms.

Components of SPED

2008-08-07T21:04:00.000-07:00

Taken from: http://www.picnh.org/ssect/Steps_In_Special_Education_Process.html

Steps In The Special Education Process

Download Brief Overview (PDF, 80kb)

The special education process can be complicated and may seem overwhelming to parents. The law and regulations can sometimes be difficult to understand. This is especially true when a parent has just learned that their child may have an educational disability. The Parent Information Center (PIC) has developed this booklet so that parents of children with disabilities, young adults with disabilities and educators can be better informed about the special education process, and the steps to ensure that children with disabilities receive a free and appropriate public education (FAPE) in the least restrictive environment (LRE).

The special education process is most effective when parents and school personnel are well-informed and able to work together. If problems occur that cannot be settled easily, procedures are available to resolve them.

This booklet is based primarily on the state regulations, the New Hampshire Rules for the Education of Children with Disabilities, (formerly called the N.H. Standards for the Education of Students with Disabilities) in effect 7/1/01. While the New Hampshire Rules comply with federal requirements mandated by the Individuals with Disabilities Education Act of 1997 (IDEA) in some areas (timelines, for example), New Hampshire has some additional provisions and clarifications to the basic requirements of IDEA.

This booklet is an overview of parents’ rights and responsibilities. It is not meant to be a complete listing of rights or a legal opinion. Individuals wanting a copy of the New Hampshire Rules should access the N.H. Department of Education’s website www.ed.state.nh.us or contact them at (603) 271-3741. Persons wanting more information may attend one of the Parent Information Center's free workshops.

PARENTAL INVOLVEMENT

Parental involvement is a critical component of the special education process. Parents have a right to participate in all meetings with respect to the:

identification,
evaluation, and
educational placement of their child; and
the provision of a free and appropriate public education (FAPE), which includes the development of the IEP.

Additionally, in New Hampshire, parental written consent is required for evaluation, determining/changing the disability classification, the IEP, placement, and changing the nature or extent of the child’s special education or related services.

However, if a parent fails to respond to a request for his/her consent for:

a reevaluation,
the annual review of the IEP and placement,
determining or changing the disability classification, or
changing the nature/extent of the child’s special education or special education and related services,

the NH Rules give the school district or local education agency (LEA) the authority to implement its proposed changes as long as they took reasonable measures to obtain informed written parental consent (telephone calls and correspondence by certified mail). Parents may appeal any proposed changes.

To ensure that parents are able to participate in the special education process, the LEA must provide a 10 day advance notice of meetings. The notice must indicate the purpose, time, location and identification of the participants. Parents have the right to invite other individuals who have knowledge or special expertise about their child. If neither parent can attend, other methods of involvement can be used, such as individual or conference telephone calls.

The LEA must ensure that parents understand the proceedings at the IEP meeting, including arranging for an interpreter for parents who are deaf, or whose native language is not English.

IEP TEAM

The IEP team is responsible for making decisions throughout the special education process, including evaluation, eligibility, IEP development, placement and monitoring. Team members are:

The parent(s), guardian, or surrogate parent of the child with a disability
The child, if appropriate, or if he/she is an adult student (18-21, unless determined by a court to be incompetent, or an emancipated minor)
Note: Once a child with a disability becomes an adult, all parental rights transfer to him/her. A student with a disability may receive services until the age of 21, or the receipt of a regular high school diploma.
At least one regular education teacher of the child if the child is or may be participating in the regular education environment
At least one special education teacher or one special education provider of the child
A vocational education representative, when appropriate
A representative of the local education agency (LEA) who is qualified to provide or supervise specially designed instruction, and is knowledgeable about the general curriculum and the resources of the LEA
An individual who can interpret the instructional implications of evaluation results (may also be on the team in some other capacity)
Other individuals who have knowledge or special expertise regarding the child, at the discretion of the parent or school (such as a paraprofessional)
the student and representatives from any adult agencies who would be either paying for or providing transition services, if transition needs or services are considered

When eligibility is being determined, the IEP team must also include:

a teacher certified in each area of suspected disability and

a person knowledgeable about the child from having had contact with the child in school, or for preschoolers, in an appropriate setting.

TIMELINES

The NH Rules include clear timelines for each step of the process, including:

15 days from the receipt of a referral to the disposition of that referral by the IEP team
45 days from the receipt of written parental consent for evaluations until the evaluations are to be completed and a report given to the parents
30 days from the determination of a child’s eligibility for special education to conducting the meeting to write the initial IEP
10 days written notice for parents before an IEP meeting.

Note: Parents may waive the 10 day advance notice when the situation warrants.

There are two new exceptions to these timelines:

While parents must be given written notice no fewer than 10 days before an IEP meeting, meetings for a manifestation determination review for disciplinary reasons require 5 days written notice
Timelines for parental consent requiring a response within a specified timeframe begin when the district sends the request, not when the parent receives it.

Overview of the Steps in the
Special Education Process in New Hampshire

IDENTIFICATION - (CHILD FIND)

All school districts are required to identify, locate, evaluate and count all children who may have educational disabilities, ages birth to 22 (and name the category of disability for ages 3-21). This includes children in public and private schools, and other settings, as well as homeless and migrant children. Districts must ensure that children who are known or suspected to have disabilities are referred to the IEP team.

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REFERRAL

If parents suspect or know that their child has an educational disability, they may make a request to the superintendent, special education director, classroom teacher, building principal, or other appropriate individual to have their child evaluated for special education consideration. The referral should be in writing, including the child’s name and the reasons why you suspect the child may have an educational disability. Parents should keep a copy of this letter for their files. The student’s teacher, physician or other person who knows the student and suspects the child may have an educational disability may also make a referral.

SAMPLE REFERRAL LETTER

Date

Dear ___________:

I am making a formal request for a complete educational evaluation for my child (name of child), who is a student at (name of school) in (grade/class). I am making this request because I believe that my child may have educational disabilities. (Briefly list your concerns-see suggestions on next page.)

Please contact me in writing, within 15 days, with your plans for disposition of this referral. Let me know if I can provide any additional information to assist you in better understanding (my child’s) needs. I look forward to hearing from you.

Sincerely,

(Your name, address and telephone number)

cc: (List any others to whom you are sending a copy of this letter.)

Contact PIC for information about other sample letters used in the special education process.

Concerns leading to a referral may include, but are not limited to:

Short attention span or inability to concentrate
A medical diagnosis indicating an educational disability
Failure to pass a vision or hearing test
Unsatisfactory performance on group achievement tests or other assessments
Extreme, ongoing anxiety or reluctance to attend school
Performance well below expectations with no obvious reason
Multiple academic and/or behavioral warnings
Repeated failure in one or more academic subjects
Speech/language or physical issues
Inability to get along with others

Once the school has received it (unless the parent made the referral), the parents must be immediately notified, in writing, that a referral has been made.

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DISPOSITION OF REFERRAL
(How the concerns raised in the referral will be resolved)

Once a referral is received by the school, a decision must be made within 15 calendar days to determine whether the school can meet the student’s needs through regular educational services, or whether the student may have an educational disability and needs to be evaluated. Regular education services may include school counseling, team teaching, reading support, hands-on activities, a change in group/classroom, or modified workload. Within the 15 days, the school must give parents written notice of the team decision regarding the disposition of the referral, including the reasons. If the parents do not receive notice within 15 days, they should follow up with a call or letter to the school.

If the team determines that additional testing is necessary, they must notify the parent and obtain their written consent to conduct any needed individual evaluations. If the parents refuse consent, the school district may file for a due process hearing.

If the parents disagree with a referral decision, they may consider using informal methods to resolve their differences. This might include scheduling a team meeting for further discussion or providing the team with additional information about the child’s needs/issues. If informal means are unsuccessful, formal dispute resolution procedures are available, including mediation, neutral conference or a due process hearing (see page 20). Complaints may be filed by the parents with the Commissioner of Education if they believe that their or their child's legal rights have been violated.

If the parents disagree with a referral decision, they may consider using informal methods to resolve their differences. This may include scheduling a team meeting for further discussion or providing the team with additional information about the child's disability. If informal means are unsuccessful, formal dispute resolution procedures are available, including mediation, neutral conference or a due process hearing. All of these procedures are administered by the N.H. Department of Education. Complaints may be filed by the parents with the Commissioner of Education if they believe that legal rights have been violated.

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EVALUATION

Each child being considered for special education and related services must be given a full and individualized evaluation. The purpose is to determine eligibility for special education and to identify the child’s educational needs. Areas to be tested may include academic, communication, developmental, language, motor, self-help, social/behavioral, vocational, and others.

The team may use information, such as the following, about the student:

Educational history
Past opportunities to have acquired skills and information
Academic and achievement tests
Intelligence testing
Teacher recommendations
Physical condition
Other information from team members, such as medical records, observations, or independent evaluations

Note: Parent’s written permission is needed for any individual testing, as well as for the school to access copies of reports or other information developed by professionals outside of the school.

Evaluation requirements include the following;

Evaluations must be nondiscriminatory and generally in the child’s native anguage/mode of communication.
Standardized tests are to be validated, selected and administered to accurately reflect what the test measures, not the child’s impaired skills, unless that is the purpose of the test.
Students are to be assessed in all areas of suspected disabilities.
A single procedure may not be used to determine eligibility or an appropriate educational program.
The student’s current academic performance must be assessed.
Evaluations must identify all of the child’s special education and related service needs, whether or not commonly linked to the child’s disabilities.
Evaluation materials must assess specific areas of educational need and not merely provide a single general intelligence quotient.
Evaluations must include a variety of assessment tools and strategies to be used to provide relevant information that directly assists in determining the child’s educational needs, including information from the parents.
A vocational evaluator must assess students for whom vocational education is being considered.
Technically sound instruments must be used to assess the relative contribution of cognitive, behavioral, physical or developmental factors, including intelligence tests.
In New Hampshire, teachers or other specialists who are participating in the evaluation must be certified or licensed for each disability suspected.
Standardized tests are to be administered in accordance with the test instructions by trained and knowledgeable, certified or licensed personnel.
Note: The NH Rules list the type of individual who would be considered a qualified evaluator for each disability classification.
If an assessment is not conducted under standard conditions (ex: portions of the test were read aloud to the student), a description of how it varied must be included in the evaluation report.
For students suspected of having specific learning disabilities, the team must include at least one person qualified to conduct individual diagnostic examinations. An observation of the student’s academic performance in the regular classroom setting must be conducted and a written report developed.

INDEPENDENT EDUCATIONAL EVALUATION

If parents disagree with the results of a school’s evaluation, they may request an independent evaluation at public expense. The request should be in writing to the school district, dated and include:

the reason(s) for the request; and
the names of any qualified examiners the parents would like the school district to consider.

Once a request is received, the school district must either agree to it and provide (pay for) an independent evaluation, or file for a due process hearing to show the school’s evaluation was appropriate.

Parents also have the right to obtain, at their own expense, an independent evaluation by a qualified private examiner. Sometimes, public or private health insurance may pay for assessments. The school must consider the results of independent evaluations when making decisions about the child’s program and placement.

As part of an initial evaluation or re-evaluation, the IEP team must review existing evaluation data on the child, including:

evaluations and information provided by the parents
current classroom-based assessments and observations
observations by teachers and related service providers

On the basis of that review and input from the parents, the team identifies what additional data, if any, are needed to determine:

whether the child is, or continues to be, eligible for special education and related services and under which category,
the present levels of performance and educational needs, and
for re-evaluation, whether any changes to the special education and related services are needed to enable the child to meet the measurable annual goals in the IEP and to participate, as appropriate, in the general curriculum.

Within 45 calendar days from the date the parents give their written consent, all evaluations are to be completed and a written report provided to the parents. Time requirements may be extended, if the parent and the school district agree, but should be reasonable and the exception, to prevent unnecessary delays in providing services to children who need them.

RE-EVALUATION

The school district must reevaluate every child with an educational disability:

at least once every 3 years, or more frequently
if the parent or teacher requests; or
if conditions warrant; and
before a child may be determined no longer eligible for special education except for termination due to high school graduation or reaching age 21.

If the team determines that no additional information is needed, the school district must give parents written notice of their decision, the reasons for it, and the parent’s right to request an assessment. In some instances, a full reevaluation may not be necessary. For example, a student who is blind may not need a re-evaluation of his/her visual impairment, but academic and other testing may be appropriate. If the parents request a reevaluation, it must be conducted.

The Parent Information Center’s IEP Organizer can help you set up an effective organizational system for your child’s important educational and medical documents. Contact PIC to purchase an IEP Organizer.

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DETERMINATION OF ELIGIBILITY

Once all the evaluations are completed, the IEP team develops a written summary of the test results. Next, the team, including the parents, meet to consider all available information, determine if the student has an educational disability, and whether the student requires special education, or special education and related services, as a result of that disability.

If the student is found eligible for special education, he/she is identified as having one or more categories of educational disability:

mental retardation
hearing impairment, including deafness
speech or language impairment
visual impairment, including blindness
emotional disturbance
orthopedic impairment
autism
traumatic brain injury
other health impairment
Note: this may include ADD/ADHD
specific learning disability
deaf-blindness
multiple disabilities
developmental delay for children, ages 3-9

To be eligible for special education, the child must be between the ages of 3 and 21, but not yet have achieved a regular high school diploma.

If the student is found not to have an educational disability, the student is not eligible to receive special education or related services under IDEA (the federal special education law). However, if the student has a disability, he/she may be eligible for services, supports, or accommodations under Section 504 of the Rehabilitation Act (a Federal civil rights law).

For more information on Section 504, request a copy of PIC’s free brochure, Section 504 and Students with Disabilities.

The NH Rules address the provision of special education to eligible incarcerated adult students with disabilities. If a person, ages 18-21 who is incarcerated in an adult prison, was not identified as being eligible for special education prior to their incarceration, he/she is not entitled to evaluation, determination of eligibility or special education services. Also, the special education services that an eligible incarcerated adult student with a disability may receive, as well as the placement, may be modified because of the individual’s status as a convict.

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DEVELOPMENT OF THE INDIVIDUALIZED EDUCATION PROGRAM (IEP)

If a child is found eligible for special education and related services, the IEP team meets to create an IEP within 30 days of the determination. Once a child has an IEP, it must be reviewed/revised annually and be in place by the beginning of each school year. The IEP must include the following components:

A statement of the child’s present levels of educational performance, and how the disability affects the child’s involvement and progress in the general curriculum (or in appropriate activities for preschoolers)
Measurable annual goa, including benchmarks or short-term objectives, which meet the child’s educational needs and enable the child to be involved and progress in the general curriculum (or in appropriate activities for a preschooler)
A statement of how the student’s progress towards annual goals will be measured
An explanation of how parents will be regularly informed of their child’s progress, and whether the progress is sufficient to meet the annual goals
An explanation of the extent, if any, the child will not participate with nondisabled children in the regular classroom
A statement of special education and related services and other supports for the student, or on behalf of the student, to enable him/her to advance towards his/her annual goals, progress in the general curriculum, participate in extra-curricular and nonacademic activities and be educated with non-disabled students. Examples of related services include special transportation, paraprofessional services, speech and language services, occupational or physical therapy, and parent counseling and training
The projected date for services to begin, and the anticipated frequency, location and duration of the services
The length of the school year and the school day required to implement the IEP
Modifications needed for the student to participate in state or district-wide assessments. If the team determines that the child cannot participate in these assessments, a statement of why, and what alternate assessments will be conducted
Beginning at age 14, a statement of the student’s transition service needs focusing on courses of study (see next page)
Beginning at age 16 (younger if appropriate) a statement of needed transition services, including any interagency responsibilities or linkages (see next page)
A vocational education component, if appropriate
At least one year before the student reaches the age of majority (18 in NH), a statement that he/she has been informed of the rights that will transfer to him/her at age 18
A list of individuals or service provider(s) who will be responsible for implementing the IEP
A statement of the party or parties financially responsible for implementing the IEP
Signatures of the representative of the LEA and the parent(s), legal guardian, surrogate parent or adult student (when appropriate) stating approval of the IEP

TRANSITION AND THE IEP

Transition services are required to better enable students with disabilities to move from school to post-school activities.

Beginning at age 14 (or younger, if determined appropriate by the IEP team), each student’s IEP must include a statement of transition service needs, which focus on the student’s courses of study (example: participation in college preparatory or vocational education classes).

Beginning at age 16 (or younger, if determined appropriate by the IEP team), the IEP must include a statement of needed transition services, including, if appropriate, a statement of the interagency responsibilities or any needed linkages.

Transition services are a coordinated set of activities for a disabled student that are:

designed within an outcome-oriented process, that promotes movement from school to post-school activities, including postsecondary education, vocational training, integrated employment (including supported employment), continuing/ adult education, adult services, independent living, or community participation.
based on the student’s needs, taking into account preferences and interests.

Transition services include instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and if appropriate, acquisition of daily living skills and functional vocational evaluation.

When transition services are being discussed, the student must be invited to the IEP meeting. If the student does not attend, the school district must take other steps to ensure that the student’s preferences and interests are considered. Representatives from other agencies which may be providing or paying for transitions services are also to be invited. If they are unable to attend, the school district must take steps to ensure that the agency’s information is available to the IEP team.

Although transition services are required at age 14, it is recommended that families begin planning for their child’s future as early as possible.

At least one year before a student reaches the age of majority under state law (18 in New Hampshire), the IEP must include a statement that the student has been informed of any of his/her rights under IDEA, which will transfer to him/her upon reaching the age of majority.

Note: A student may make a written request to the IEP team to enable his/her parents to continue to be involved in all educational decisions.

SPECIAL FACTORS AND THE IEP

The IEP team must consider the child’s strengths, the parents’ concerns for their child’s education, and the following "special factors" when developing the IEP.

If a child’s behavior impedes his/her learning, or that of others, appropriate strategies, including positive behavioral interventions, strategies, and supports to address the behavior need to be implemented. (Please refer to page 18 regarding discipline, suspension and expulsion.)
Note: If anyone on the IEP team has concerns regarding the behavior of a child with a disability, a functional behavioral assessment should be requested as part of an initial or reevaluation, to ensure the team has appropriate information to develop/revise the IEP.

If a child has limited English proficiency, the language needs of the child, as they relate to the IEP, are to be considered.

If a child is blind or visually impaired, instruction in Braille must be provided, unless the team determines that it would be inappropriate.

The communication needs of the child must be considered. For a child who is deaf or hearing impaired, that includes the opportunity for direct communication with peers and staff and for instruction in the child’s mode of communication and at the child’s academic level.

The child’s need for assistive technology devices and services are to be considered.

Parents have up to 14 days to review and sign the IEP. If parents disagree with the IEP, they may ask for another meeting, request mediation or request a due process hearing.

All individuals responsible for implementing the IEP, as well as the parent and student (if of age of majority), must be given a complete copy of the IEP, and a copy placed in the student’s file. Once the IEP is signed, the school district is responsible for providing the services in the IEP.

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PLACEMENT

Once the IEP has been approved and signed, the team decides where the student’s individualized needs (IEP) can be met in the least restrictive environment (LRE). LRE means that students with disabilities are to be educated with students who do not have disabilities, and removal to other settings occurs only when, even with supplemental aids and services, the student cannot be educated satisfactorily in regular classes.

When a student cannot be educated in the regular classroom, alternative placements must be made available by the team. The range of educational settings include:

regular classroom
regular classroom with consultative assistance
regular classroom with assistance by itinerant specialists
regular classroom plus resource room help (no more than 60% of the day)
regular classroom plus part-time special class
full-time special class
full-time or part-time special day school
full-time residential placement
home-based programming (time-limited for students over age 5)
Note: When a child with a disability, ages 6-21, requires home instruction, he/she shall be provided a minimum of 10 hours per week.
hospital or institution

When the team (including the parents) are considering placement, the parents may agree, disagree and ask for another meeting, disagree and ask for an impartial due process hearing, or agree with exceptions (stating what those exceptions are and indicating whether or not they wish to request an impartial due process hearing or alternative dispute resolution processes). Once the parents agree with the placement, and give their written consent, services for the student begin.

If the team makes a placement to an approved public or private program, the district is responsible for the costs. However, if the district offered an appropriate program and the parents choose to place their child privately, the parents are responsible for those costs. Private school children are only entitled to the special education services the district chooses to provide them. If the parents do not believe that FAPE was made available, they may access due process to attempt to obtain district payment for the private placement.

If the team places a child in an out-of-state program, it must be one with special education approval by the host state.

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MONITORING

The IEP team must meet to review and revise the IEP at least once each year. The IEP also serves as a monitoring tool to make sure the student's progress, program and placement continues to be appropriate. Other types of monitoring include:

reviewing the child’s schoolwork
tracking progress towards annual goals through report cards and other documentation, as required in the IEP
considering any new testing, or new information, available about the child
sharing information at parent/teacher conferences
maintaining home-school communication through communication logs, forms or telephone calls

If a parent or teacher/service provider notices that a child is not on track to meet his/her annual goals, a meeting to strategize solutions, and revise the IEP or placement, as necessary, should be scheduled.

EXTENDED SCHOOL YEAR PROGRAMMING

The school district must provide extended school year (ESY) services to any student with educational disabilities who qualifies. Most students with educational disabilities are able to receive a free appropriate public education (FAPE) during the typical school year without ESY services. To be eligible for extended school year services, it must be documented that a break in the school year (ex: summer or winter break) would cause the child to suffer harm or serious regression to the extent they would lose the progress made during the regular school year. The IEP team determines if a student needs ESY services. In cases of parent/school disagreement, procedural safeguards, including mediation and due process may be utilized. ESY services may involve a change in the services, where the program is provided, the number of hours, days and/or weeks of the program, and the IEP goals/objectives to be addressed. As with any other proposal, parents must be given written prior notice regarding decisions about ESY services.

DISCIPLINE (SUSPENSION / EXPULSON) REQUIRMENTS

When a student with a disability acts out in school or violates a school rule, it is important to investigate whether or not the behavior is related to his/her disability (manifestation of the disability). Behaviors are a manifestation of a child’s disabilities if those behaviors are caused by, or related to, the student’s disabilities or if the disabilities impact the student’s ability to understand the consequences of their behavior. If it is unclear which of the child’s behaviors are a manifestation of their disability, a functional behavioral assessment (FBA) should be conducted.

If the behavior is a manifestation, positive behavioral interventions and other strategies/supports in the IEP and/or placement should be developed. School district discipline policies may also be modified in the IEP, as appropriate, for the student. Therefore, parents should obtain a copy of the school district’s discipline regulations.

Students with disabilities may be suspended, without services, for a total of 10 days in a school year for behaviors which would result in a suspension for a student without educational disabilities, unless the behavior is a manifestation of the student’s disabilities. In that case, the behavior should be addressed through a review of his/her IEP and/or placement, instead of by suspension. If the school district provides services to non-disabled students who are suspended, they must also provide them to students with disabilities.

If a child with a disability has been removed from his/her current placement for more than 10 school days in the same school year, during any additional removals, the child is entitled to receive educational services that enable the child to appropriately progress in the general curriculum and advance towards achieving the goals set out in his/her IEP. The actual services provided will be determined by school personnel in consultation with the child’s special education teacher. After the tenth day of suspension in a school year, a team meeting must be held to conduct a functional behavioral assessment and to develop a positive behavior intervention plan for the child. If the child already has a behavior plan, the team may review and revise it if any team member requests.

In no case may humiliation, unsupervised confinement, abuse, neglect or aversives (denying nutrition, clothing, communication or contact with family) be used.

Requirements for Longer Suspensions or Expulsions

If a child is suspended for more than 10 days at one time, or when there is a pattern of suspensions (for similar behaviors, numbers of days, etc.), totaling more than 10 days in a school year it is considered to be a change in placement. When suspension constitutes a change in placement, in addition to conducting a functional behavioral assessment and developing a behavior intervention plan as part of the child’s IEP, the IEP team and other qualified individuals must hold a manifestation determination meeting. If the behavior is a manifestation of the child’s disability, there would be no further punishment, but the team may revise the IEP or placement to meet the child’s needs and prevent a reoccurrence of the behavior. If the behavior is not related to the child’s disability (no manifestation), the child may be suspended, but would receive services during the suspension.

The following behaviors may result in a longer suspension:

guns or dangerous weapons,
illegal drugs, or
a determination by a hearing officer that the child would pose a significant danger to themselves/others if he/she remained in their current placement.

Any of these situations would result in the child being placed in an interim alternative educational setting for up to 45 calendar days. The setting must be one in which the child can continue to appropriately progress in the general curriculum and advance towards his/her IEP goals, and where the behavioral supports will prevent a recurrence of the behavior. An extension beyond 45 days may be given if the student continues to pose a danger to themselves or others.

While the student is in the interim alternative educational setting, a functional behavioral assessment must be conducted, a behavioral intervention plan developed (or reviewed/revised if one is already in place), and a manifestation determination meeting held. The IEP team then determines if a change in the child’s IEP or placement is needed once the child’s stay at the interim alternative educational setting is completed.

Parents may access procedural safeguards, including an expedited due process hearing, at any time in this process.

Note: The best practice is to conduct a functional behavioral assessment as soon as the IEP team has concerns about a child’s behavior, to avoid suspensions whenever possible.

PROCEDURAL SAFEGUARDS

Procedural safeguards are rights provided to parents and school districts in the special education process. Some procedural safeguards for parents include the right to:

written prior notice before the school district proposes to initiate or change, or refuses to initiate or change, the identification, evaluation, placement of the student, or the provision of a free appropriate public education to the student
have the notice written in understandable language, and provided in the parents’ native language or other mode of communication used by the parent, unless it is clearly not feasible to do so
give or withhold consent for certain activities
examine educational records
obtain independent educational evaluations for the child (which may be presented at a team meeting or due process hearing)
utilize formal and informal dispute resolution mechanisms to resolve disagreements between the parents and school

Often, disputes can be resolved by further meetings or sharing of information between parents and the school district. Parents and schools should try to resolve special education disputes using informal methods as a first step.

When disagreement still exists, the N.H. Department of Education provides neutral conference and mediation as alternatives to due process for resolving disputes regarding the identification, evaluation, placement and provision of a free appropriate public education (FAPE). These options offer both parents and schools an opportunity to present their concerns and reach an agreement that both feel is appropriate for the child.

If agreement cannot be reached through mediation or neutral conference, or if either party wishes to file a due process hearing, then a hearing officer will hear the school and the parents and make a decision regarding the outcome. Both parties must abide by the ruling, unless they file an appeal. Generally, attorneys are involved in due process hearings.

Note: The section in the NH Rules describing due process is still being revised.

When there is a belief that the school or other public agency violated state or federal requirements (example: not following the IEP), a complaint may be filed with the NH Department of Education. The complaint will then be investigated and appropriate steps ordered to remedy any violations found.

A special thanks to all of you who advocated so diligently to maintain the critical protections for children with disabilities in the NH Rules for the Education of Children with Disabilities. Your involvement made all the difference!

Please consider joining the Parent Information Center. Your membership will help support many of PIC’s important activities, which are not funded by any other source. Our membership drive enabled PIC to monitor the status of the NH Rules throughout the revision process, and disseminate accurate and up-to-date information to parents and others.

The Parent Information Center is a private, nonprofit organization that provides information, support and training to parents and professionals regarding special education, parenting, parent/ professional collaboration and other topics. The central office is located in Concord, and serves the entire state of New Hampshire. PIC has satellite offices throughout the state that provide parents with information and referrals in their local communities.

For more information about membership or your rights, call the Parent Information Center. You may also register to attend one of PIC’s FREE workshops on topics such as: the IEP, laws, special education process, effective communication, parent/professional collaboration, functional behavioral assessments, and positive behavioral interventions. PIC also has print materials available on special education law, parent rights, IEP, communication, transition.

Multiple Intelligence

2008-08-03T23:10:00.000-07:00

What is Multiple Intelligence?

Conceived by Howard Gardner, Multiple Intelligences are seven different ways to demonstrate intellectual ability.

What are the types of Multiple Intelligence?

Visual/Spatial Intelligence

ability to perceive the visual. These learners tend to think in pictures and need to create vivid mental images to retain information. They enjoy looking at maps, charts, pictures, videos, and movies.

Their skills include:

puzzle building, reading, writing, understanding charts and graphs, a good sense of direction, sketching, painting, creating visual metaphors and analogies (perhaps through the visual arts), manipulating images, constructing, fixing, designing practical objects, interpreting visual images.

Possible career interests:

navigators, sculptors, visual artists, inventors, architects, interior designers, mechanics, engineers

Verbal/Linguistic Intelligence

ability to use words and language. These learners have highly developed auditory skills and are generally elegant speakers. They think in words rather than pictures.

Their skills include:

listening, speaking, writing, story telling, explaining, teaching, using humor, understanding the syntax and meaning of words, remembering information, convincing someone of their point of view, analyzing language usage.

Possible career interests:

Poet, journalist, writer, teacher, lawyer, politician, translator

Logical/Mathematical Intelligence

ability to use reason, logic and numbers. These learners think conceptually in logical and numerical patterns making connections between pieces of information. Always curious about the world around them, these learner ask lots of questions and like to do experiments.

Their skills include:

problem solving, classifying and categorizing information, working with abstract concepts to figure out the relationship of each to the other, handling long chains of reason to make local progressions, doing controlled experiments, questioning and wondering about natural events, performing complex mathematical calculations, working with geometric shapes

Possible career paths:

Scientists, engineers, computer programmers, researchers, accountants, mathematicians

Bodily/Kinesthetic Intelligence

ability to control body movements and handle objects skillfully. These learners express themselves through movement. They have a good sense of balance and eye-hand co-ordination. (e.g. ball play, balancing beams). Through interacting with the space around them, they are able to remember and process information.

Their skills include:

dancing, physical co-ordination, sports, hands on experimentation, using body language, crafts, acting, miming, using their hands to create or build, expressing emotions through the body

Possible career paths:

Athletes, physical education teachers, dancers, actors, firefighters, artisans

Musical/Rhythmic Intelligence

ability to produce and appreciate music. These musically inclined learners think in sounds, rhythms and patterns. They immediately respond to music either appreciating or criticizing what they hear. Many of these learners are extremely sensitive to environmental sounds (e.g. crickets, bells, dripping taps).

Their skills include:

singing, whistling, playing musical instruments, recognizing tonal patterns, composing music, remembering melodies, understanding the structure and rhythm of music

Possible career paths:

musician, disc jockey, singer, composer

Interpersonal Intelligence

ability to relate and understand others. These learners try to see things from other people's point of view in order to understand how they think and feel. They often have an uncanny ability to sense feelings, intentions and motivations. They are great organizers, although they sometimes resort to manipulation. Generally they try to maintain peace in group settings and encourage co-operation.They use both verbal (e.g. speaking) and non-verbal language (e.g. eye contact, body language) to open communication channels with others.

Their skills include:

seeing things from other perspectives (dual-perspective), listening, using empathy, understanding other people's moods and feelings, counseling, co-operating with groups, noticing people's moods, motivations and intentions, communicating both verbally and non-verbally, building trust, peaceful conflict resolution, establishing positive relations with other people.

Possible Career Paths:

Counselor, salesperson, politician, business person

Intrapersonal Intelligence

ability to self-reflect and be aware of one's inner state of being. These learners try to understand their inner feelings, dreams, relationships with others, and strengths and weaknesses.

Their Skills include:

Recognizing their own strengths and weaknesses, reflecting and analyzing themselves, awareness of their inner feelings, desires and dreams, evaluating their thinking patterns, reasoning with themselves, understanding their role in relationship to others

Possible Career Paths:

Researchers, theorists, philosophers

Psychological Theories of SPED

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20th (early decades of the century), behaviorism gained popularity as a guiding psychological theory. Behaviorism reigned as the dominant model in psychology, largely due to the creation of conditioning theories as scientific models of human behavior, and their successful application in the workplace and in fields such as advertising and military science.

Fields of research

Qualitative psychological research and Quantitative psychological research.

Abnormal psychology

Abnormal psychology is the study of abnormal behavior in order to describe, predict, explain, and change abnormal patterns of functioning.

Cognitive psychology

The nature of thought is another core interest in psychology. Cognitive psychology studies cognition, the mental processes underlying behavior.

Comparative psychology

Comparative psychology refers to the study of the behavior and mental life of animals other than human beings. It is related to disciplines outside of psychology that study animal behavior, such as ethology.

Social psychology

Social psychology is the study of the nature and causes of human social behavior, with an emphasis on how people think towards each other and how they relate to each other.

Quantitative psychology

Quantitative psychology involves the application of mathematical and statistical modeling in psychological research, and the development of statistical methods for analyzing and explaining behavioral data.

Psychometrics is the field of psychology concerned with the theory and technique of psychological measurement, which includes the measurement of knowledge, abilities, attitudes, and personality traits

Sociological Theories of SPED

2008-08-03T18:57:00.000-07:00

¡ Sociology (from Latin socious”companion and suffix –logy “the study of from Greek logos “knowledge )is scientific or systematic study of society including patterns of social relationships, interaction and culture. Areas studied in sociology can range from analysis of brief contact s between anonymous individuals on the street to the study of global social interaction, numerous fields within the discipline concentrated on how and why people are organized in society either as individuals or as members of associations, groups and institutions.

¡ Sociological Theories

¡ Sociological theories are complex theoretical frameworks that sociologist use to explain and analyze variously how social action. Social processes and social structures work. Sociological theories are sometimes called social theories though the later term generally refers to interdisciplinary theory .In seeking to understand society, sociologist use both sociological theory and interdisciplinary social theories to organize social research.

¡ . Structural Functionalism

¡ Structural functionalist believe that society leans toward equilibrium and social order. They see society like a human body, in which institutions such as education are like important organs that keep the society /body healthy and well. Social health means the same social order and is guaranteed when nearly everyone accepts the general moral values of their society. Hence structural functionalist believe the aim of key institutions, such as education is to socialize children and teenagers. Socialisation is the process by which the new generation learns the knowledge, attitudes and values that they will need as productive citizens. Although this aim is stated in formal curriculum it is mainly achieved through he hidden curriculum, a subtler, but nonetheless powerful, indocrination of the norms and values of the wider society. Students learn these values because their behavior at school is regulated until they gradually internalize and accept them. Education must however perform another function .as various jobs become vacant. They must be filled with the appropriate people. Therefore the other purpose of education is to sort and ranks individuals for placement in the labor market. Those with high achievement will be trained for the most important jobs and in reward, be given the highest incomes. Those who achieved the least, will be given the least demanding jobs, and hence the least income.

¡ According to Sennet and Cobb however,”to believe that ability alone decides who is rewarded is to be deceived “megham agrees sating that large numbers of capable students from the working class backgrounds fail to achieve satisfactory standards in school and therefore e fail to obtain the status they deserve, Jacob believes this is because the middle class cultural experiences that are provided at school may be contrary to the experiences working-class children receive at home .In other words, working class children are not adequately prepared to cope at school. They are therefore “cooled out” from school with the least qualifications, hence they get the least desirable jobs and so remain working class. Argent confirms this cycle, arguing that schooling supports continuity, which in turn support social order. Talcott Parsons believe d that this process, whereby some students were identified and labeled educational failures “was a necessary activity which one part of the social system ,education ,performed for the whole yet the structural functionalist perspective maintains that this social order ,this continuity is what most people desire. The weakness of this perspective thus becomes evident .Why would the working class wish to stay working class? Such an inconsistency demonstrates that another perspective may be useful.

¡ Conflict Theory

¡ The conflict theory contrary to their her structural functionalist perspective. Believes that society is full of vying social groups with different aspirations, different access to life chances and gains different social rewards. Relation in society, in this view is mainly based on exploitation, oppression, domination and subordination. This is a more cynical picture of society than the previous idea that most people accept continuing inequality. Some conflict theorist believe education is controlled by the state which is controlled by the powerful and its purpose is to reproduce existing inequalities, as well as legitimize “acceptable ideas which actually work to reinforce the privileged position of the dominant group. Education achieves its purpose by maintaining the status quo.where lower-class children becomes lower class adults and middle class children become middle and upper –class adults. This cycle occurs because the dominant group has, overtime closely aligned education with middle class values and aims, thus alienating people of the other classes. Many teachers assume that students will have particular middle class experiences at home, and for some children this assumption isn’t necessarily true. Some children are expected to help their parents after school and carry considerable domestic responsibilities in their often –single parent home. The demands of this domestic labor often make it difficult for them to find time to do all their homework and thus affect their academic performance.

¡ Ethno methodology:

¡

¡ Examines how people make sense out of social life in the process of living it as if each was as researcher engaged in enquiry.

¡ Feminist theory

¡

¡ Focuses on how male dominance of society has shaped social life.

¡ Interpretative sociology

¡

¡ This theoretical perspective, based in the work of Max Weber, proposes social, economic and historical research can never be fully empirical or descriptive, as one must always approach it wit conceptual apparatus.

¡ Social phenomenology

¡

¡ The social phenomenology of Alfred Schultz influenced the development of the social constructivism and ethnomethology.

¡ Social positivism

¡

¡ Social positivist believes that social process es should be studied in terms of cause and effect using scientific method.

¡ Symbolic interactionism

¡

¡ Examines how shared meanings and social patterns are developed in the course of social interactions.

¡ Dramaturgical perspective

¡ A specialized symbolic interactionism paradigm developed by Irving Goff man seeing life as a performance

¡ Rational choice theory –Models social behavior as the interaction of utility maximizing individuals..

Expressive Language Disorder (ELD)

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Expressive Language Disorder
 a communication disorder identified by developmental delays and difficulties in the ability to produce speech.
www.childrensnyp.org/mschony/1182342521479.html
 An impairment in expressive language development.
www.mhrt.qld.gov.au/GlossaryMHRT.htm
 Expressive language disorder (DSM 315.31) is a communication disorder which is characterised by having a limited vocabulary and grasp of grammar. ...
en.wikipedia.org/wiki/Expressive language disorder
DESCRIPTION
Expressive language disorder is generally a childhood disorder. There are two types of ELD.
 The developmental type- does not have a known cause and generally appears at that time a child is learning to talk.
 The Acquired type- is caused by damage to the brain. It occurs suddenly after events such as stroke or traumatic head injury. And it can occur at any age.
CAUSES
 There is no known cause of developmental expressive language disorder. Research is ongoing to determine which biological or environmental factors may be the cause.
 Acquired expressive language disorder is caused by damage to the brain. Damage can be sustained during a stroke, or as the result of traumatic head injury, seizures, or other medical conditions. The way in which acquired expressive language disorder manifests itself in a specific person depends on which parts of the brain are immured and how badly they are damaged.
SYMPTOMS
 ELD- is characterized by a child having difficulty expressing himself/herself using speech. The signs and symptoms vary drastically from child to child. The child does not have problems with the pronunciation or words, as occurs in phonological disorder. The child does not have problems putting sentences together coherently, using proper grammar, recalling the appropriate word to use, or other similar problems. A child with ELD is not able to communicate thoughts, needs, or wants at the same level or with the same complexity as his or her peers. The child often has a smaller vocabulary than his/her peers.
- they have the same ability to understand speech as their peers, and have the same level of intelligence. Therefore, a child with this disorder may understand words that he/she cannot use in sentences. The child may understand complex spoken sentences and be able to carry out intricate instructions.

 Some children do not properly use pronouns, or leave out functional words such as “is” or “the”. Other children cannot recall words that they want to use in the sentence and substitute general words such as “thing” or “stuff”. Some children cannot organize their sentences so that the sentences are easy to understand. These children do comprehend the material they are trying to express they just cannot create the appropriate sentences with which to express their thoughts.
DEMOGRAPHICS
 Is a relatively common childhood disorder. Language delays occur in 10-15% of children under age three, and in 3-7% of school-age children. ELD is more common in boys than in girls. Studies suggest that developmental ELD occurs two to five times more often in boys as girls. The developmental form of the disorder is far more common than acquired type.
DIAGNOSIS
 Children must be performing below their peers at tasks that require communication in the form of speech. This can be hard to determine because it must be shown that an individual understands the material , but cannot express that comprehension. Therefore, non-verbal tests must be used in addition to tests that require spoken answers. Hearing should also be evaluated, because children who do not hear well may have problems putting together sentences similar to children with expressive language disorder. In children who are mildly hearing impaired, the problem can often be resolved by using hearing aids to enhance the child’s hearing. Also, children who speak a language other than English in the home should be tested in that language if possible. The child’s ability to communicate in English may be the problem, not the child’s ability to communicate in general.

The Diagnostic and Statistical of Manual of Mental Disorders.

- The first is that the child communicates using speech at a level that is less developed than expected for his/her intelligence and ability to understand spoken language. This problem with communication using speech must create difficulties for the child in everyday life or in achieving goals. The child must understand what is being said at a level that is age-appropriate, or at a developmental level consistent with the child’s. Otherwise the diagnoses should be mixed receptive expressive language disorder. If the child has mental retardation, poor hearing, or other problems, the difficulties with speech must be greater than is generally associated with the handicaps that the child has.
TREATMENT
 There are two types of treatment used for expressive language disorder. The first involves the child working one-on-one with speech therapist on a regular schedule and practicing speech and communication skills. The second type of treatment involves the child’s parents and teachers working together to incorporate spoken language that the child needs into everyday activities and play. Both of these kinds of treatment can be effective, and are often used together.
PROGNOSIS
 The developmental form of ELD generally has a good prognosis. Most children develop normal or nearly normal language skills by high school. In some cases, minor problems with expressive language disorder has a prognosis that depends on the nature and location of the brain injury. Some people get their language skills back over days and months. For others, it takes years, and some people never fully recover expressive language function.
PREVENTION
 There is no known way to prevent developmental expressive language disorder. Because acquired language disorder is caused by damage to the brain, anything that would help to prevent brain damage may help to prevent that type of the disorder. This can include such things ranging from the lowering cholesterol in order to prevent stroke to wearing a bicycle helmet to prevent traumatic brain injury.

An Introduction to Biomedical Ethics

2008-08-03T15:51:00.000-07:00

Ethical Theories

Ethical theories represent the grand ideas on which guiding principles are based. They attempt to be coherent and systematic, striving to answer the fundamental practical ethical questions:

What ought I do?

How ought I live?

Generally ethical principles stem from ethical theories, and when defending a particular action, ethicists normally appeal to these principles, not the underlying theory. Ethical traditions stretch back to earliest recorded history. Separate bodies of ethics, often not encompassing a true theory but rather a general system, were developed in India and China, and within the Jewish, Christian, Islamic, and Buddhist and Hindu religions. All of these theories represent altruistic, rather than egoistic, attitudes towards mankind. Some of the most commonly cited ethical theories include the following:

Natural Law

The system of natural law, often attributed to Aristotle, posits that man should live life according to an inherent human nature. It can be contrasted with man-made, or judicial, law, but they are similar in that both may change over time, despite the frequent claim that natural law is immutable, often tying it to particular religious beliefs.

Deontology

Deontology holds that the most important aspects of our lives are governed by certain unbreakable moral rules. Deontologists hold that these rules may not be broken, even if breaking them may improve an outcome. In other words, they may do the "right" thing, even though the consequences of that action may not be "good." The famous philosopher, Immanuel Kant is often identified with this theory. One example of a list of "unbreakable" rules is the Ten Commandments.

Utilitarianism

One of the more functional and commonly used theories, utilitarianism, sometimes called consequentialism or teleology, basically promotes good or valued ends, rather than using the right means. This theory instructs adherents to work for those outcomes that will give the most advantage to the majority of those affected in the most impartial way possible. (Simplistically, this theory advocates achieving the greatest good for the greatest number of people.) It is often advocated as the basis for broad social policies.

Virtue Theory

The virtue theory asks what a "good person" would do in specific real-life situations. This recently revived theory stems from the character traits discussed by Aristotle, Plato, and Thomas Aquinas. They discuss such timeless and cross-cultural virtues as courage, temperance, wisdom, justice, faith, and charity.

Values And Principles

Where Learned?

Values are the standards by which we judge human behavior. They are, in other words, moral rules, promoting those things thought of as good and minimizing or avoiding those things thought of as bad. We usually learn these values at an early age, from observing behavior and through secular (including professional) and religious education. Societal institutions incorporate and promulgate values often attempting to make old values rigid, even in a changing society. In a pluralistic society, clinicians often treat subjects having multiple and differing value systems, and they must be sensitive to others’ beliefs and traditions.

Ethical values stem from ethical principles. Ethical principles are action guides derived from ethical theories. Each of these principles consists of various moral rules, which are our learned values. For example, the values of dealing honestly with patients; fully informing patients before procedures, therapy, or being involved in research; and respecting the patient’s personal values are all subsumed under the principle of autonomy or respect for persons.

Although each person is entitled (and perhaps even required) to have a personal system of values, there are certain values that have become generally accepted by the medical community, courts, legislatures, and society at large. A respect for patients (often described as patient autonomy) has been considered so fundamental that it is often given overriding importance. Although some groups disagree about each of the generally accepted values, this dissension has not affected their application to medical care.

Assessing Patient Values

A key to making ethical decisions at the bedside is to know what the patient’s values are. In patients too young or incompetent to express their values, it may be necessary for physicians to make general assumptions about what the normal person would want in a specific situation or to rely on surrogate decision making. With patients who are able to communicate, however, care must be taken to discover what their own uncoerced values really are.

A typical ethically dangerous scenario is with a patient who refuses lifesaving medical intervention "on religious grounds." Typically, the spouse is at the bedside, does most of the talking, and may be influencing the patient’s decision. In those cases, it is incumbent on the clinician to question the patient alone to assess his or her real values.

What is gene testing? How does it work?

Gene tests (also called DNA-based tests), the newest and most sophisticated of the techniques used to test for genetic disorders, involve direct examination of the DNA molecule itself. Other genetic tests include biochemical tests for such gene products as enzymes and other proteins and for microscopic examination of stained or fluorescent chromosomes. Genetic tests are used for several reasons, including:

carrier screening, which involves identifying unaffected individuals who carry one copy of a gene for a disease that requires two copies for the disease to be expressed
preimplantation genetic diagnosis (see the side bar, Screening Embryos for Disease)
prenatal diagnostic testing
newborn screening
presymptomatic testing for predicting adult-onset disorders such as Huntington's disease
presymptomatic testing for estimating the risk of developing adult-onset cancers and Alzheimer's disease
confirmational diagnosis of a symptomatic individual
forensic/identity testing

In gene tests, scientists scan a patient's DNA sample for mutated sequences. A DNA sample can be obtained from any tissue, including blood. For some types of gene tests, researchers design short pieces of DNA called probes, whose sequences are complementary to the mutated sequences. These probes will seek their complement among the three billion base pairs of an individual's genome. If the mutated sequence is present in the patient's genome, the probe will bind to it and flag the mutation. Another type of DNA testing involves comparing the sequence of DNA bases in a patient's gene to a normal version of the gene. Cost of testing can range from hundreds to thousands of dollars, depending on the sizes of the genes and the numbers of mutations tested.

What are some of the pros and cons of gene testing?

Gene testing already has dramatically improved lives. Some tests are used to clarify a diagnosis and direct a physician toward appropriate treatments, while others allow families to avoid having children with devastating diseases or identify people at high risk for conditions that may be preventable. Aggressive monitoring for and removal of colon growths in those inheriting a gene for familial adenomatous polyposis, for example, has saved many lives. On the horizon is a gene test that will provide doctors with a simple diagnostic test for a common iron-storage disease, transforming it from a usually fatal condition to a treatable one.

Commercialized gene tests for adult-onset disorders such as Alzheimer's disease and some cancers are the subject of most of the debate over gene testing. These tests are targeted to healthy (presymptomatic) people who are identified as being at high risk because of a strong family medical history for the disorder. The tests give only a probability for developing the disorder. One of the most serious limitations of these susceptibility tests is the difficulty in interpreting a positive result because some people who carry a disease-associated mutation never develop the disease. Scientists believe that these mutations may work together with other, unknown mutations or with environmental factors to cause disease.

A limitation of all medical testing is the possibility for laboratory errors. These might be due to sample misidentification, contamination of the chemicals used for testing, or other factors.

Many in the medical establishment feel that uncertainties surrounding test interpretation, the current lack of available medical options for these diseases, the tests' potential for provoking anxiety, and risks for discrimination and social stigmatization could outweigh the benefits of testing.

For what diseases are gene tests available?

Currently, more than 1000 genetic tests are available from testing laboratories. Some gene tests available in the past few years from clinical genetics laboratories appear below. Test names and a description of the diseases or symptoms are in parentheses. Susceptibility tests, noted by an asterisk, provide only an estimated risk for developing the disorder. Contact GeneTests for comprehensive information on test availability and genetic testing facilities.

Some Currently Available DNA-Based Gene Tests

Alpha-1-antitrypsin deficiency (AAT; emphysema and liver disease)
Amyotrophic lateral sclerosis (ALS; Lou Gehrig's Disease; progressive motor function loss leading to paralysis and death)
Alzheimer's disease* (APOE; late-onset variety of senile dementia)
Ataxia telangiectasia (AT; progressive brain disorder resulting in loss of muscle control and cancers)
Gaucher disease (GD; enlarged liver and spleen, bone degeneration)
Inherited breast and ovarian cancer* (BRCA 1 and 2; early-onset tumors of breasts and ovaries)
Hereditary nonpolyposis colon cancer* (CA; early-onset tumors of colon and sometimes other organs)
Central Core Disease (CCD; mild to severe muscle weakness)
Charcot-Marie-Tooth (CMT; loss of feeling in ends of limbs)
Congenital adrenal hyperplasia (CAH; hormone deficiency; ambiguous genitalia and male pseudohermaphroditism)
Cystic fibrosis (CF; disease of lung and pancreas resulting in thick mucous accumulations and chronic infections)
Duchenne muscular dystrophy/Becker muscular dystrophy (DMD; severe to mild muscle wasting, deterioration, weakness)
Dystonia (DYT; muscle rigidity, repetitive twisting movements)
Emanuel Syndrome (severe mental retardation, abnormal development of the head, heart and kidney problems)
Fanconi anemia, group C (FA; anemia, leukemia, skeletal deformities)
Factor V-Leiden (FVL; blood-clotting disorder)
Fragile X syndrome (FRAX; leading cause of inherited mental retardation)
Galactosemia (GALT; metabolic disorder affects ability to metabolize galactose)
Hemophilia A and B (HEMA and HEMB; bleeding disorders)
Hereditary Hemochromatosis (HFE; excess iron storage disorder)
Huntington's disease (HD; usually midlife onset; progressive, lethal, degenerative neurological disease)
Marfan Syndrome (FBN1; connective tissue disorder; tissues of ligaments, blood vessel walls, cartilage, heart valves and other structures abnormally weak)
Mucopolysaccharidosis (MPS; deficiency of enzymes needed to break down long chain sugars called glycosaminoglycans; corneal clouding, joint stiffness, heart disease, mental retardation)
Myotonic dystrophy (MD; progressive muscle weakness; most common form of adult muscular dystrophy)
Neurofibromatosis type 1 (NF1; multiple benign nervous system tumors that can be disfiguring; cancers)
Phenylketonuria (PKU; progressive mental retardation due to missing enzyme; correctable by diet)
Polycystic Kidney Disease (PKD1, PKD2; cysts in the kidneys and other organs)
Adult Polycystic Kidney Disease (APKD; kidney failure and liver disease)
Prader Willi/Angelman syndromes (PW/A; decreased motor skills, cognitive impairment, early death)
Sickle cell disease (SS; blood cell disorder; chronic pain and infections)
Spinocerebellar ataxia, type 1 (SCA1; involuntary muscle movements, reflex disorders, explosive speech)
Spinal muscular atrophy (SMA; severe, usually lethal progressive muscle-wasting disorder in children)
Tay-Sachs Disease (TS; fatal neurological disease of early childhood; seizures, paralysis)
Thalassemias (THAL; anemias - reduced red blood cell levels)
Timothy Syndrome (CACNA1C; characterized by severe cardiac arrhythmia, webbing of the fingers and toes called syndactyly, autism)

Is genetic testing regulated?

Currently in the United States, no regulations are in place for evaluating the accuracy and reliability of genetic testing. Most genetic tests developed by laboratories are categorized as services, which the Food and Drug Administration (FDA) does not regulate. Only a few states have established some regulatory guidelines. This lack of government oversight is particularly troublesome in light of the fact that a handful of companies have started marketing test kits directly to the public. Some of these companies make dubious claims about how the kits not only test for disease but also serve as tools for customizing medicine, vitamins, and foods to each individual's genetic makeup. Another fear is that individuals who purchase such kits will not seek out genetic counseling to help them interpret results and make the best possible decisions regarding their personal welfare. More information on these questionable test kits is available from Dubious Genetic Testing, an online report provided by Quackwatch. For a brief overview of the current regulatory environment for genetic testing, see the Oversight of Genetic Testing, a Genetics Brief from the National Conference of State Legislatures.

Does insurance cover genetic testing?

In most cases, an individual will have to contact his or her insurance provider to see if genetic tests, which cost between $200 and $3000, are covered. Usually insurance companies do not cover genetic tests, those that do will have access to the results. Insured persons would need to decide whether they would want the insurance company to have this information. States have a patchwork of genetic-information nondiscrimination laws, none of them comprehensive. Existing state laws differ in coverage, protections afforded, and enforcement schemes. The National Conference of State Legislatures provides a listing of current legislation regarding genetic information and health insurance. The recent marketing of genetic test kits directly to consumers, may lead to an increase in demand for insurance coverage. See the Genetics and Health Insurance (PDF) policy brief from the National Conference of State Legislatures for more information.

What is gene therapy?

Genes, which are carried on chromosomes, are the basic physical and functional units of heredity. Genes are specific sequences of bases that encode instructions on how to make proteins. Although genes get a lot of attention, it’s the proteins that perform most life functions and even make up the majority of cellular structures. When genes are altered so that the encoded proteins are unable to carry out their normal functions, genetic disorders can result.

Gene therapy is a technique for correcting defective genes responsible for disease development. Researchers may use one of several approaches for correcting faulty genes:

A normal gene may be inserted into a nonspecific location within the genome to replace a nonfunctional gene. This approach is most common.
An abnormal gene could be swapped for a normal gene through homologous recombination.
The abnormal gene could be repaired through selective reverse mutation, which returns the gene to its normal function.
The regulation (the degree to which a gene is turned on or off) of a particular gene could be altered.

How does gene therapy work?

In most gene therapy studies, a "normal" gene is inserted into the genome to replace an "abnormal," disease-causing gene. A carrier molecule called a vector must be used to deliver the therapeutic gene to the patient's target cells. Currently, the most common vector is a virus that has been genetically altered to carry normal human DNA. Viruses have evolved a way of encapsulating and delivering their genes to human cells in a pathogenic manner. Scientists have tried to take advantage of this capability and manipulate the virus genome to remove disease-causing genes and insert therapeutic genes.

Target cells such as the patient's liver or lung cells are infected with the viral vector. The vector then unloads its genetic material containing the therapeutic human gene into the target cell. The generation of a functional protein product from the therapeutic gene restores the target cell to a normal state. See a diagram depicting this process.

Some of the different types of viruses used as gene therapy vectors:

Retroviruses - A class of viruses that can create double-stranded DNA copies of their RNA genomes. These copies of its genome can be integrated into the chromosomes of host cells. Human immunodeficiency virus (HIV) is a retrovirus.
Adenoviruses - A class of viruses with double-stranded DNA genomes that cause respiratory, intestinal, and eye infections in humans. The virus that causes the common cold is an adenovirus.
Adeno-associated viruses - A class of small, single-stranded DNA viruses that can insert their genetic material at a specific site on chromosome 19.
Herpes simplex viruses - A class of double-stranded DNA viruses that infect a particular cell type, neurons. Herpes simplex virus type 1 is a common human pathogen that causes cold sores.

Besides virus-mediated gene-delivery systems, there are several nonviral options for gene delivery. The simplest method is the direct introduction of therapeutic DNA into target cells. This approach is limited in its application because it can be used only with certain tissues and requires large amounts of DNA.

Another nonviral approach involves the creation of an artificial lipid sphere with an aqueous core. This liposome, which carries the therapeutic DNA, is capable of passing the DNA through the target cell's membrane.

Therapeutic DNA also can get inside target cells by chemically linking the DNA to a molecule that will bind to special cell receptors. Once bound to these receptors, the therapeutic DNA constructs are engulfed by the cell membrane and passed into the interior of the target cell. This delivery system tends to be less effective than other options.

Researchers also are experimenting with introducing a 47th (artificial human) chromosome into target cells. This chromosome would exist autonomously alongside the standard 46 --not affecting their workings or causing any mutations. It would be a large vector capable of carrying substantial amounts of genetic code, and scientists anticipate that, because of its construction and autonomy, the body's immune systems would not attack it. A problem with this potential method is the difficulty in delivering such a large molecule to the nucleus of a target cell.

What is the current status of gene therapy research?

The Food and Drug Administration (FDA) has not yet approved any human gene therapy product for sale. Current gene therapy is experimental and has not proven very successful in clinical trials. Little progress has been made since the first gene therapy clinical trial began in 1990. In 1999, gene therapy suffered a major setback with the death of 18-year-old Jesse Gelsinger. Jesse was participating in a gene therapy trial for ornithine transcarboxylase deficiency (OTCD). He died from multiple organ failures 4 days after starting the treatment. His death is believed to have been triggered by a severe immune response to the adenovirus carrier.

Another major blow came in January 2003, when the FDA placed a temporary halt on all gene therapy trials using retroviral vectors in blood stem cells. FDA took this action after it learned that a second child treated in a French gene therapy trial had developed a leukemia-like condition. Both this child and another who had developed a similar condition in August 2002 had been successfully treated by gene therapy for X-linked severe combined immunodeficiency disease (X-SCID), also known as "bubble baby syndrome."

FDA's Biological Response Modifiers Advisory Committee (BRMAC) met at the end of February 2003 to discuss possible measures that could allow a number of retroviral gene therapy trials for treatment of life-threatening diseases to proceed with appropriate safeguards. In April of 2003 the FDA eased the ban on gene therapy trials using retroviral vectors in blood stem cells.

What factors have kept gene therapy from becoming an effective treatment for genetic disease?

Short-lived nature of gene therapy - Before gene therapy can become a permanent cure for any condition, the therapeutic DNA introduced into target cells must remain functional and the cells containing the therapeutic DNA must be long-lived and stable. Problems with integrating therapeutic DNA into the genome and the rapidly dividing nature of many cells prevent gene therapy from achieving any long-term benefits. Patients will have to undergo multiple rounds of gene therapy.
Immune response - Anytime a foreign object is introduced into human tissues, the immune system is designed to attack the invader. The risk of stimulating the immune system in a way that reduces gene therapy effectiveness is always a potential risk. Furthermore, the immune system's enhanced response to invaders it has seen before makes it difficult for gene therapy to be repeated in patients.
Problems with viral vectors - Viruses, while the carrier of choice in most gene therapy studies, present a variety of potential problems to the patient --toxicity, immune and inflammatory responses, and gene control and targeting issues. In addition, there is always the fear that the viral vector, once inside the patient, may recover its ability to cause disease.
Multigene disorders - Conditions or disorders that arise from mutations in a single gene are the best candidates for gene therapy. Unfortunately, some the most commonly occurring disorders, such as heart disease, high blood pressure, Alzheimer's disease, arthritis, and diabetes, are caused by the combined effects of variations in many genes. Multigene or multifactorial disorders such as these would be especially difficult to treat effectively using gene therapy. For more information on different types of genetic disease, see Genetic Disease Information.

What are some recent developments in gene therapy research?

· Results of world's first gene therapy for inherited blindness show sight improvement. 28 April 2008. UK researchers from the UCL Institute of Ophthalmology and Moorfields Eye Hospital NIHR Biomedical Research Centre have announced results from the world’s first clinical trial to test a revolutionary gene therapy treatment for a type of inherited blindness. The results, published today in the New England Journal of Medicine, show that the experimental treatment is safe and can improve sight. The findings are a landmark for gene therapy technology and could have a significant impact on future treatments for eye disease. Read Press Release.

Previous information on this trial (May 1, 2007): A team of British doctors from Moorfields Eye Hospital and University College in London conduct first human gene therapy trials to treat Leber's congenital amaurosis, a type of inherited childhood blindness caused by a single abnormal gene. The procedure has already been successful at restoring vision for dogs. This is the first trial to use gene therapy in an operation to treat blindness in humans. See Doctors Test Gene Therapy to Treat Blindness at www.reuters.com.

A combination of two tumor suppressing genes delivered in lipid-based nanoparticles drastically reduces the number and size of human lung cancer tumors in mice during trials conducted by researchers from The University of Texas M. D. Anderson Cancer Center and the University of Texas Southwestern Medical Center. See Dual Gene Therapy Suppresses Lung Cancer in Preclinical Test at www.newswise.com (January 11, 2007).
Researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, successfully reengineer immune cells, called lymphocytes, to target and attack cancer cells in patients with advanced metastatic melanoma. This is the first time that gene therapy is used to successfully treat cancer in humans. See New Method of Gene Therapy Alters Immune Cells for Treatment of Advanced Melanoma at www.cancer.gov (August 30, 2006).
Gene therapy is effectively used to treat two adult patients for a disease affecting nonlymphocytic white blood cells called myeloid cells. Myeloid disorders are common and include a variety of bone marrow failure syndromes, such as acute myeloid leukemia. The study is the first to show that gene therapy can cure diseases of the myeloid system. See Gene Therapy Appears to Cure Myeloid Blood Diseases In Groundbreaking International Study at www.cincinnatichildrens.org (March 31, 2006).
Gene Therapy cures deafness in guinea pigs. Each animal had been deafened by destruction of the hair cells in the cochlea that translate sound vibrations into nerve signals. A gene, called Atoh1, which stimulates the hair cells' growth, was delivered to the cochlea by an adenovirus. The genes triggered re-growth of the hair cells and many of the animals regained up to 80% of their original hearing thresholds. This study, which many pave the way to human trials of the gene, is the first to show that gene therapy can repair deafness in animals. See Gene Therapy is First Deafness 'Cure' at NewScientist.com (February 11, 2005).
University of California, Los Angeles, research team gets genes into the brain using liposomes coated in a polymer call polyethylene glycol (PEG). The transfer of genes into the brain is a significant achievement because viral vectors are too big to get across the "blood-brain barrier." This method has potential for treating Parkinson's disease. See Undercover Genes Slip into the Brain at NewScientist.com (March 20, 2003).
RNA interference or gene silencing may be a new way to treat Huntington's. Short pieces of double-stranded RNA (short, interfering RNAs or siRNAs) are used by cells to degrade RNA of a particular sequence. If a siRNA is designed to match the RNA copied from a faulty gene, then the abnormal protein product of that gene will not be produced. See Gene Therapy May Switch off Huntington's at NewScientist.com (March 13, 2003).
New gene therapy approach repairs errors in messenger RNA derived from defective genes. Technique has potential to treat the blood disorder thalassaemia, cystic fibrosis, and some cancers. See Subtle Gene Therapy Tackles Blood Disorder at NewScientist.com (October 11, 2002).
Gene therapy for treating children with X-SCID (sever combined immunodeficiency) or the "bubble boy" disease is stopped in France when the treatment causes leukemia in one of the patients. See 'Miracle' Gene Therapy Trial Halted at NewScientist.com (October 3, 2002).
Researchers at Case Western Reserve University and Copernicus Therapeutics are able to create tiny liposomes 25 nanometers across that can carry therapeutic DNA through pores in the nuclear membrane. See DNA Nanoballs Boost Gene Therapy at NewScientist.com (May 12, 2002).
Sickle cell is successfully treated in mice. See Murine Gene Therapy Corrects Symptoms of Sickle Cell Disease from March 18, 2002, issue of The Scientist.

What are some of the ethical considerations for using gene therapy?

--Some Questions to Consider...

What is normal and what is a disability or disorder, and who decides?
Are disabilities diseases? Do they need to be cured or prevented?
Does searching for a cure demean the lives of individuals presently affected by disabilities?
Is somatic gene therapy (which is done in the adult cells of persons known to have the disease) more or less ethical than germline gene therapy (which is done in egg and sperm cells and prevents the trait from being passed on to further generations)? In cases of somatic gene therapy, the procedure may have to be repeated in future generations.
Preliminary attempts at gene therapy are exorbitantly expensive. Who will have access to these therapies? Who will pay for their use?

What are genetic counselors?

Genetic counselors are health professionals with specialized graduate degrees and experience in the areas of medical genetics and counseling. Most enter the field from a variety of disciplines, including biology, genetics, nursing, psychology, public health, and social work.

Genetic counselors work as members of a healthcare team, providing information and support to families who have members with birth defects or genetic disorders and to families who may be at risk for a variety of inherited conditions. They identify families at risk, investigate the problem present in the family, interpret information about the disorder, analyze inheritance patterns and risks of recurrence, and review available options with the family.

Genetic counselors also provide supportive counseling to families, serve as patient advocates, and refer individuals and families to community or state support services. They serve as educators and resource people for other healthcare professionals and for the general public. Some counselors also work in administrative capacities. Many engage in research activities related to the field of medical genetics and genetic counseling.

Societal Concerns Arising from the New Genetics

Fairness in the use of genetic information by insurers, employers, courts, schools, adoption agencies, and the military, among others.

Who should have access to personal genetic information, and how will it be used?

For more on this topic, see the Privacy and Legislation page in this ELSI suite.

Privacy and confidentiality of genetic information.

Who owns and controls genetic information?

For more on this topic, see the Privacy and Legislation page in this ELSI suite.

Psychological impact and stigmatization due to an individual's genetic differences.

How does personal genetic information affect an individual and society's perceptions of that individual?
How does genomic information affect members of minority communities?

For more on this topic, see the Minorities, Race, and Genetics and Genetic Anthropology, Ancestry, and Ancient Human Migration pages in this ELSI suite.

Reproductive issues including adequate informed consent for complex and potentially controversial procedures, use of genetic information in reproductive decision making, and reproductive rights.

Do healthcare personnel properly counsel parents about the risks and limitations of genetic technology?
How reliable and useful is fetal genetic testing?
What are the larger societal issues raised by new reproductive technologies?

For more on this topic, see the Gene Testing page in this ELSI suite.

Clinical issues including the education of doctors and other health service providers, patients, and the general public in genetic capabilities, scientific limitations, and social risks; and implementation of standards and quality-control measures in testing procedures.

How will genetic tests be evaluated and regulated for accuracy, reliability, and utility? (Currently, there is little regulation at the federal level.)
How do we prepare healthcare professionals for the new genetics?
How do we prepare the public to make informed choices?
How do we as a society balance current scientific limitations and social risk with long-term benefits?

For more on this topic, see the Gene Testing and Gene Therapy pages in this ELSI suite.

Uncertainties associated with gene tests for susceptibilities and complex conditions (e.g., heart disease) linked to multiple genes and gene-environment interactions.

Should testing be performed when no treatment is available?
Should parents have the right to have their minor children tested for adult-onset diseases?
Are genetic tests reliable and interpretable by the medical community?

For more on this topic, see the Gene Testing and Gene Therapy pages in this ELSI suite.

Conceptual and philosophical implications regarding human responsibility, free will vs genetic determinism, and concepts of health and disease.

Do people's genes make them behave in a particular way?
Can people always control their behavior?
What is considered acceptable diversity?
Where is the line between medical treatment and enhancement?

For more on this topic, see the Behavioral Genetics page in this ELSI suite.

Health and environmental issues concerning genetically modified foods (GM) and microbes.

Are GM foods and other products safe to humans and the environment?
How will these technologies affect developing nations' dependence on the West?

For more on this topic, see the Genetically Modified Foods page in this ELSI suite.

Commercialization of products including property rights (patents, copyrights, and trade secrets) and accessibility of data and materials.

Who owns genes and other pieces of DNA?
Will patenting DNA sequences limit their accessibility and development into useful products?

Increasing Attention

2008-07-27T19:52:00.001-07:00

Many children with learning disabilities, including crossover children, are unable to sustain attention appropriately. Attention has three major roles in the learning process:

1. It allows us to focus on a particular problem for an extended period.
2. It helps us retrieve inactive memory elements when they are needed for current problem solving.
3. It allows us to shift the focus and content of our attention when it is required.

The inability to maintain sufficient control over these three attention processes is the essence of attention deficit.

The Diagnostic and Statistical Manual of the American Psychiatric Association lists the following characteristics of ADHD. Children may be diagnosed as inattentive, as hyperactive-impulsive, or as a combination of both. Children must exhibit six or more of the criteria for more than a six-month period.
Inattentiveness (Exhibits six or more)

* Failure to pay close attention to details; careless mistakes in schoolwork.
* Difficulty sustaining attention while working or playing.
* Does not listen even when spoken to directly.
* Does not follow instructions or complete assigned tasks.
* Has difficulty organizing tasks and activities.
* Avoids or dislikes tasks requiring sustained mental effort.
* Often loses materials and books.
* Is easily distracted by extraneous stimuli.
* Is often forgetful in daily activities.

Hyperactivity (Exhibits six or more combined with impulsivity)

* Fidgets with hands or feet or squirms in seat.
* May leave seat in classroom when it is inappropriate.
* May run or climb excessively or in inappropriate situations.
* May have difficulty in playing quietly.
* Is often "on the go."
* Often talks excessively.

Impulsivity

* Blurts out answers before questions have been completed.
* Has difficulty awaiting turn.
* Interrupts or intrudes on others.

One has only to observe a child with ADHD for a few minutes in a classroom before it becomes obvious that the setting makes it difficult for the child to stay on task. The following are helpful strategies to assist an inattentive, hyperactive, or impulsive student:

* Use carrels or individual workplaces. When the use of the "office" is handled appropriately, it can become rewarding rather than punishing.
* Use a secret sign between teacher and child to signal that the child should consider moving to the carrel. The development of an "It's our secret way to help you" system will reinforce the positive aspects of the experience.
* Allow the child to walk to a designated spot, stretch to "get the kinks out," and return to working at his or her seat. This "movement" corner can be a small space designated by a piece of carpet or by tape on the floor.

Teaching Students with ADD

2008-07-27T19:49:00.000-07:00

You will probably find that most of your students with attention deficit disorder tend to benefit from some type of instructional modification, which is the cornerstone of helping students with attention deficit disorder succeed in the classroom. When modification is used, students are not penalized for not knowing how to learn.

There are many ways you can modify your lessons. Target those aspects of the learning setting that can be most troublesome for the student:

Lesson presentation
Physical arrangement of the classroom
Work assignments

Lesson Presentation

Use the principles of effective instruction when delivering lessons. Make sure that students are successful and challenged. Model cognitive strategies such as "think aloud" techniques, which help students verbalize the thought processes they should engage in to complete the task. Cooperative groupings can also be used effectively. Finally, give praise and feedback immediately and consistently.

Suggestions for maintaining student involvement in the lesson include the following:

Keep lesson objectives clear
Deliver the lesson at a brisk pace
Encourage collaboration among students
Use meaningful materials and manipulatives
Prompt for student answers after allowing at least five seconds of wait time
Have the students recite in unison
Vary the tone of your voice and model enthusiasm

There are additional ways you can accommodate the student's learning characteristics and needs when designing your lessons. For example, if the student has a short attention span, you might accommodate this learning characteristic by modifying the length of the material. The following are examples of additional accommodations:

Break up long presentations by "chunking" content. At the end of each chunk, have the student respond in some way.
Provide the student with additional time to finish an assignment or test.
Break down assignments into "mini-assignments," and build in reinforcement as the child finishes each part. So as not to overwhelm the student, consider passing out longer assignments in segments.
Reduce the number of practice items that the student must complete. For instance, allow the student to stop once he or she has demonstrated mastery.

Holding students' interest and attention is not always an easy task. Don't hesitate to experiment with a variety of approaches – and ask your colleagues for ideas.

Physical Arrangement of the Classroom

To help a student who is easily distracted focus on the task at hand, you may need to reduce competing stimuli in the environment or directly cue the student's attention. The goal here is not to create a dull environment, but rather to find ways to focus the student's attention. The following are examples of things you can do:

Seat the student away from high-traffic and noisy areas such as the pencil sharpener, window, hallway, and materials table. Make a study carrel available.
Define the work space for the child. For example, when children are to sit on the floor, use carpet squares to help define each child's space.
Reduce the amount of materials present during work time by having the student put away unnecessary items. Have a special place for tools, materials, and books.

Work Assignments

Because many students with attention deficit disorder are inefficient learners, it is a good idea to spend some time helping them develop learning strategies. Organizational strategies are a must for students with attention deficit disorder. Help them get into the habit of making reminders for themselves of what they need to do, using such strategies as assignment sheets, daily schedules, and "to do" lists.

A teacher in Suffield, Connecticut designed a daily check-sheet for students to keep track of assignments, grades, and targeted behaviors. Here's how it works:

The first column lists all of the student's classes. Next to it is a column for the student's grades. The next column features criteria (e.g., Is on time for class, Came prepared with appropriate materials, Participates in instruction and discussion, Completes homework). A space is left for the student to write in homework assignments. At the end of the day, the student reviews the check-sheet and uses the data on it to determine what to take home for study purposes.
Parents are expected to review and sign the check-sheet daily. Daily check-sheets like the one just described enable you to maintain an active record of student progress. These check-sheets also assist the student by clarifying expectations and highlighting successes.

Teach older students how to take notes from both oral presentations and textbooks. Help the student by listing the main ideas or concepts in advance. Some teachers have found it helpful to give their students a template graphic organizer to use when outlining and taking notes.

Other tactics that teachers have used to help students focus in on the task at hand include the following:

Use color coding or highlighting to help focus attention on critical information contained in assignments.
Give clear directions both orally and visually. Whenever possible, provide the student with a model of what he or she should be doing.
Set up consistent routines for making the transition between lessons, getting and putting away materials, and requesting assistance. Teach these routines and reward students for following them.

NCLB

2008-07-27T19:40:00.000-07:00

The debate that has emerged over the No Child Left Behind Act of 2001 (NCLB) and its effect on students
with disabilities involves three different viewpoints: (1) stay the course and tough it out; (2) keep these
students in the accountability system but give them different tests and hold them to different standards; or
(3) take the students out of the NCLB accountability system because it is unreasonable and unfair to them.
As the evolution of accountability for education programs for students with disabilities has slowly inched
its way from accountability for process and procedure to accountability for educational performance,
NCLB has presented an unprecedented dilemma for special education programs.
For its first 22 years, special education as we know it today was a prescriptive, federally driven program;
procedural compliance was the rule. Concern for access and protections, which was the momentum
behind the original 1975 statute, dominated special education accountability. Educators griped about this,
but grudgingly attempted to comply with the complicated and ever-growing maze of requirements.
This direction began to change as the movement to raise standards took hold in the mid-1990s.
Policymakers were confronted with the proposition that if they were to raise standards and improve
results, they could not choose which students would be affected; it would have to be all students.
At the same time, organizations such as the Education Trust published research that exposed enormous
achievement gaps between certain subgroups of students and the general student population.
Policymakers, and some researchers, began to question why these groups were so far behind.
The subgroup that has recently caused the most consternation is the special education population. Why
are educators so conflicted over academic expectations for this group of students?
One reason is that, historically, expectations for this population were shaped during a time when the
students in special education were a homogeneous group. This group has become increasingly diverse in
type of disability, with a growing percentage of school enrollment being classified as needing special
education services. The driving force behind the landmark 1975 legislation had been parents of children
with mental retardation or multiple disabilities, while the population receiving special education in 1995
was primarily identified as learning disabled, emotionally disturbed, and speech impaired. The population
had changed significantly, and expectations did not keep pace.
In 1997, with the reauthorization of IDEA, special education accountability crossed the magic line from
process to educational performance. Most educators cheered this moment. Finally, access to the general
education curriculum was a primary focus for these students. Accountability systems were to include
them, and reports on their performance were to be as routine as all other reports on student performance.
After all these years, students with disabilities had finally been recognized as a group who, in many cases,
could and should be able to meet standards. As the 1997 reauthorization stated, special education should
become a service rather than a place where students are sent.
2
States and local districts began to show progress in performance for students receiving special education
services. This was an exciting time for those of us involved at the state and local levels. Then along came
NCLB, and how quickly the attitudes of some educators changed.
The policies and adequate yearly progress provisions designed to implement NCLB have created
dilemmas regarding accountability that even the most ardent supporters of the effort to help students with
disabilities meet high standards are finding troublesome. AYP has supplanted IEP as the acronym most
used in discussions among special educators.
The problem as we see it is not with the intent of the AYP provision but with the design of its
implementation for this population. To begin with, the idea of setting a hard-and-fast percentage of
students who could be considered for an alternative assessment is flawed. In the ideal world that might be
desirable, but in the real world, a uniform percentage cannot be expected to be right for each district and
every state.
Another problem is the requirement that AYP rules be applied in the same way to special education
students as to the general education population. The fact is that only recently have many of these students
been exposed to the full general education curriculum on a regular basis. Moreover, special education
services are still undergoing realignment as the expectation to have more effective instructional strategies
and programs in place grows nationwide.
And now, as AYP results are reported, educators have been sounding the alarm that it is the special
education students who are causing their schools to be considered in need of improvement, and “that’s not
fair to the schools.” This reaction could place the onus for achievement on the special education students,
and we could end up with a scenario in which school administrators say that they have a good school but
the special education students are holding them back from meeting their annual progress goals.
It appears that NCLB has exposed an issue concerning the expectations of educators that was hidden
below the surface of the IDEA requirements. While it was acceptable to begin to account for the
educational performance of these students, it is less acceptable to be held accountable for continuous
improvement for these results.
Finally, the issue of “highly qualified teachers” has raised a concern among those responsible for
implementing NCLB. Some educators feel it is unrealistic to expect special education teachers also to be
qualified to teach academic subjects. The concern is that this will drive even more teachers out of the field
or result in students being placed inappropriately in general education classrooms in order to be taught by
“qualified” teachers.
Are these perhaps the wrong concerns? Shouldn’t we be more concerned about the student who may be
capable of mastering a curriculum based on high standards but who, by virtue of being classified as
needing special education services, is being taught by a teacher who does not have the knowledge to
teach, for example, biology? We all know there are special education students in this situation today,
although perhaps not as many as in the past. But particularly in many large and poor districts, this is still
the case for a significant number of students.
There are strategies that can be put in place to address these challenges and make good on the intentions
of the legislation to ensure that special education services are provided within the context of high-quality
instruction. We must avoid the possibility of students with disabilities once again being set aside from the
world of high expectations and rigorous curricula that must be available to all students if they are to be
competitive, independent, and capable of participating fully in this complex world in which we live.
3
Here’s what we recommend.
1. Get rid of caps on how many students’ scores can be counted on alternative assessments and
instead use percentages as a trigger to review how states are using the assessments. It is important
to ensure that no student who has the potential to succeed in the general education curriculum be
denied that opportunity. At the same time, it is reasonable to allow the state to show why the
percentage of students it has taking alternative assessments is appropriate.
2. Do not remove students with disabilities from accountability systems or rush to rely on tests that
are less demanding as quick solutions to the AYP problem. Doing so would be a terrible mistake
and would set special education back 25 years. If these students are removed from the
accountability system, their performance will be ignored again. The opportunity NCLB provides
to parents to have information on the progress their children are making as a result of special
education services will be lost. After all, we want all students to make adequate yearly progress,
and we want the many students receiving special education services who are academically
capable, given the right opportunities and supports, to have every chance to reach higher
standards.
We know that the performance gap between general education and special education is huge.
Many students with disabilities are way behind their age-mates. For some students, this is due to
the nature of their disability. We must not lose sight of this. However, much of the gap is due to
the inadequate curriculum that special education programs have offered and to the lack of
expectation or opportunity for these students to succeed at higher levels.
Let’s reconsider our options for measuring AYP for this group of academically capable special
education students. It would be reasonable to devise a continuous improvement approach. What if
we measured growth using a different scale from the standard AYP approach, not as a pilot but as
national policy, and held states and districts accountable for a somewhat less ambitious schedule
of progress? This suggestion would allow time to study those districts that are ahead of the curve
in terms of progress — and they do exist — and apply what we learned from them to the broader
set of districts.
Policy adjustments could be made along the way, recognizing that there must be dramatic
improvement over time but that we are entering a whole new world of expectations for the
services being provided to this group. This approach would also give those responsible for
developing and implementing state assessments more time to consider new and more desirable
ways to deal with the issue of testing the relatively small group of students that don’t seem to fit
into the alternate assessments states have designed under IDEA or the general state assessments
required for most students.
3. Let’s devise a workable approach to ensuring that many more students with disabilities receive
instruction from teachers qualified to teach subject matter courses, so that the students have a
legitimate opportunity to meet academic standards. Few teachers have the knowledge to teach
multiple academic subjects at the middle and high school levels. Therefore, we need new
approaches to offering special education services to the many students with disabilities potentially
capable of meeting higher standards in these settings. While access to the general education
curriculum has resulted in significant change in instructional delivery models in many districts,
data tells us that many large urban districts and districts that lack resources still rely heavily on
the more traditional “full-time special class” models.
4
There is no reason why teachers of the future can’t receive pre-service education that both
prepares them to teach diverse learners and allows them to have mastery of an academic subject.
Many teacher preparation programs are already moving in this direction. There is no reason why
teachers in schools today can’t combine their skills and knowledge as a faculty and be organized
to provide high-quality academic instruction to all students. Thousands of local districts have
restructured their instructional approaches to do this. Federal policies should allow for this change
to take place within sensible timelines and permit states and districts to develop innovative
strategies to ensure that it happens.
Special education and NCLB can co-exist, and students with disabilities can benefit from a law that
clearly has placed the spotlight on the significant achievement gap that exists between certain groups of
students in this country. We cannot retreat to a position that continues the tradition of low expectations for
students receiving special education services. On the other hand, we cannot expect dramatic improvement
in educational performance from many of these students until instructional programs are realigned to give
them the supports and opportunities that will allow them to succeed. A steady path to increased
expectations and insistence on continuous improvement in educational performance define the prudent
way to proceed.

SWU SPED

IDEA DISCIPLINE RULES ENSURE CONTINUED SCHOOLING FOR VIOLENT STUDENTS

SPED Acronyms

What’s Special in a Diploma?

'Eugenic Abortion’: With Pre-Natal Testing, 9 in 10 Down Syndrome Babies Aborted

SEMINAR: Faces of Autism

How to Download from Youtube?

SWU DSPED 08 List of Requirements

Hearing Impairment

Loudness, frequency, and discrimination deficiencies

Types and causes of hearing impairment

Conductive

Sensorineural hearing loss

Long-term exposure to environmental noise

Genetic

Disease or illness

Medications

Physical trauma

Categories of hearing impairment

Types

Quantification of hearing loss

Age of onset of hearing impairment

Pre-lingual deafness

Post-lingual hearing impairment

Hard-of-hearing

Unilateral hearing loss

Social impact

Pre-lingual impairment

Post-lingual impairment

Medical treatments

Approaches

Views of treatments

Gene therapy

Adaptations to hearing impairment

Resources

Obsessive-Compulsive Disorder

Diagnostic criteria

Symptoms and prevalence

Contamination

Performing tasks

Intrusive thoughts and fears

Violent or aggressive thoughts

Inappropriate sexual thoughts

Related conditions

Related disorders

Causes

Psychological

Biological

Demographics and other statistics

Treatment

Behavioral therapy

Medication

Alternative Drug Treatments

Psychosurgery

Transcranial magnetic stimulation

Neuropsychiatry

Components of SPED

Steps In The Special Education Process

IDENTIFICATION - (CHILD FIND)

REFERRAL

DISPOSITION OF REFERRAL(How the concerns raised in the referral will be resolved)

EVALUATION

Evaluation requirements include the following;

INDEPENDENT EDUCATIONAL EVALUATION

RE-EVALUATION

DETERMINATION OF ELIGIBILITY

DEVELOPMENT OF THE INDIVIDUALIZED EDUCATION PROGRAM (IEP)

PLACEMENT

MONITORING

DISCIPLINE (SUSPENSION / EXPULSON) REQUIRMENTS

PROCEDURAL SAFEGUARDS

Multiple Intelligence

Psychological Theories of SPED

Qualitative psychological research and Quantitative psychological research.

Abnormal psychology

Abnormal psychology is the study of abnormal behavior in order to describe, predict, explain, and change abnormal patterns of functioning.

Cognitive psychology

The nature of thought is another core interest in psychology. Cognitive psychology studies cognition, the mental processes underlying behavior.

Comparative psychology

Comparative psychology refers to the study of the behavior and mental life of animals other than human beings. It is related to disciplines outside of psychology that study animal behavior, such as ethology.

DISPOSITION OF REFERRAL
(How the concerns raised in the referral will be resolved)