Archives for April 2019

Supporting Differences: When a Child Needs Extra Help

In our last post we looked at developmental milestones and resisted rushing to conclusions about development that doesn’t fit our picture of “normal.”  We also looked at developmental screening tools that help identify situations that might benefit from further assessment. Today, we look assessment and support for children with special needs.

Special needs are often categorized into 4 major types:

  1. Physical, such as muscular dystrophy, multiple sclerosis, chronic asthma, epilepsy
  2. Developmental, like down syndrome, autism, dyslexia, processing disorders
  3. Behavioral/Emotional, such as ADD, bi-polar disorder, oppositional defiance disorder
  4. Sensory Impaired, such as blind, visually impaired, deaf, limited hearing

For young children not yet in Kindergarten, after screening a preschool teacher or doctor can refer a family to Early Intervention for further assessment.  But you don’t need to wait for a referral. Parents can also “self refer”. This means that you do not need a doctor or daycare provider to begin the assessment process.  You can simply call them up and request an appointment.

They will schedule a time for you and your child to visit their offices.  During the visit they will do an assessment and determine if your child would benefit from services.

If they determine that support services will benefit your child, Early Intervention will design an Individualized Family Service Plan (IFSP).  The IFSP outlines the scope of services EI will provide – what they will do and how often they will do it. The IFSP can include transportation to and from the service provider, if needed.  As your child gets older the IFSP will convert to an IEP (Individualized Education Plan) that can carry them through public school to high school graduation.

An IEP (Individualized Education Plan) is a legally binding document that outlines the special education services your child will receive.  The IEP classifies the disability, documents the accommodations needed, and outlines learning environment modifications that will be made by the school.

Each year an IEP meeting is held to assure that parents, teachers, and support specialists review the goals in the IEP, review how the student has progressed toward the goals, and update the goals and supports for the coming year.  Parents have a strong voice in helping craft an individualized plan that assures their child receives the equal education that the law provides.

What exactly is a child with special needs entitled to?  Federal law includes the following:

  1. IDEA (Individuals with Disabilities Education Act)
    1. Students with disabilities must be prepared for further education, employment and independent living
    2. If a child’s strengths, endurance, or stamina cannot keep up with school activities, they qualify for “other health impaired” special education status
  1. Section 504 of the Rehabilitation Act
    1. Prohibits schools from discriminating against children with disabilities
    2. Requires schools to provide accommodations for disabled students
    3. Students with impairments that substantially limit a major life activity can qualify as disabled (including learning and social deficits)
  2. Americans with Disabilities Act (ADA)
    1. Schools must meet the needs of children with psychiatric problems
  3. No Child Left Behind
    1. Schools must uphold achievement standards for children with disabilities

(From:  https://pbwslaw.com/special_needs_children_rights/)

With the supports documented in the IFSP or IEP, the child with special needs is assured a learning environment that is optimized for success.

Parents of special needs children play an important role in the education process – as advocates, watchdog, and cheerleader.

If your child is newly diagnosed, getting involved in online forums and local support groups with other parents can help.  There you can learn what others have found helpful and get input into situations you are experiencing. Support from others can provide encouragement and information as you work with schools and doctors to support your child’s growth and development.

When a child needs extra help, it is important to work together with the school and support specialists, but it is also important to note that parents have a voice in the IEP process.  Your voice matters, so don’t hesitate to go to IEP meetings prepared to ask for what you want. You know your child best and are their best advocate.

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Love and Anger

Today’s blog post is contributed by guest blogger, Esther Schiedel.  We hope you enjoy the read, and we appreciate Esther’s willingness to write for us!

I remember going to a mother’s group back when my firstborn child was around 2 years old and asking “What do I do with my anger?”

Because I got angry sometimes. When I did I yelled, stomped around, said bad words and/or cruel things. Even when my anger was addressed at inanimate objects, this behavior was upsetting to my daughter.

I don’t recall receiving any helpful advice to my question back in that group. Over the years I learned a few things about managing anger—and sometimes was able to put them into practice! I’m still working on it.

Managing anger is hard. Managing anger at young children or even in the presence of young children is even harder.

One thing I tried was ignoring my feelings. I forced myself to stay calm and tried to be accepting and accommodating. Bad idea. I recall an incident with my second daughter who was in the midst of a tantrum. I was trying hard not to scream at her. I said something like “You are upset about having to leave now.” I was trying to be empathetic but she yelled back at me “Why are you so happy?” All my energy had gone into trying to be calm—and that interfered with my being truly empathetic. My calmness made it appear to her that I didn’t understand her feelings at all. And I wasn’t dealing with my own legitimate feelings.

Forced calmness often led to an even stronger outburst later on my part. I call it snapback—I was like a rubber band that got stretched too far and then broke with a snap.

What helped? Awareness about the factors that contributed to my anger. One big one was neglecting my needs in my efforts to be a “good” self-sacrificing mother. Being tired, hungry, stressed, feeling put upon, not having time or opportunities for doing things I enjoyed . . . all those contributed to the likelihood I would get angry and to the force of my anger.

I did get better at taking care of myself. I learned that the self-sacrificing mother ideal is nonsense. Like athletes, mothers need to take excellent care of themselves or they won’t be able to do their

jobs—and the same is true for all parents and people in helping professions. Other things can be sacrificed –not you.

An important part of self-care is paying attention to feelings. Feelings can serve as warning lights reminding us that some need we have requires attention. Anger is a secondary emotion—we feel scared or frustrated or hurt and then we get angry. Karen Young from HeySigmund.com writes that anger “exists to block other more difficult emotions from rising to the surface.” Our mind is trying to protect us from those feelings we don’t know how to handle. For many of us recognizing emotions may need to be learned and may require professional help—and that’s okay.

Even with the best self-care parents will get angry. And that anger should be acknowledged –in ways that don’t hurt or scare others. In order to do that successfully we first need to recognize the physical signs that indicate we are getting angry. If we’ve never thought about anger in this way, identifying what led up to an outburst (or to a cold simmer, or a stone-faced withdrawal) may take some reflection. Authors Susan Beekman and Jeanne Holmes [Battles, Hassles, Tantrums & Tears] recommend looking back at a recent incident and remembering where, what, and particularly when you started to lose it.

A lot of times parents tell their children, “use your words,“  but words may not be adequate to manage the physical sensations of anger. (Not to mention that the words that come to mind may be ones you don’t want your children repeating.)

Taking deep breaths, briefly walking away, and counting to ten are some things that can help us calm down enough to use appropriate words. Doing something physical but safe—my son recommends hurling ice-cubes into the shower stall—is another approach.

Then simply saying “I’m angry” is a good place to start. Describing what triggered your anger in non-accusatory language can be helpful as well: “When we are late for an appointment, I get frustrated because I like to be on time.”

Nancy Samalin, author of Love and Anger (yes, I stole that title) also suggests: Avoid physical force and threats; Keep it short and to the point; Put it in writing; Focus on the essentials.

And finally, apologize for any hurtful words or actions. This can be a good time to reflect on what triggered you and make plans for handling future situations.

 

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What’s “Normal”? Tracking Developmental Milestones

When every baby is different, how do you know if your baby is meeting developmental milestones?   As parents, we observe, compare, and worry when we see other children doing things our child isn’t yet attempting.  How do we know what is normal?

As we watch and wonder, descriptions of typical child development can help.  But lists and charts provide only a framework for understanding. Not all children will meet all milestones at the ‘typical’ age‘.  You know your child best.

My son was born with a condition that limits his vision. We adopted him when he was 13 months old.  Since we knew babies typically start to walk around 12 months, we worried when he didn’t walk until he was well over 18 months old.  Was it his vision keeping him from this milestone? Was it adoption trauma? Was there something we should be doing?

Pediatricians and daycare centers routinely ask parents to complete developmental screening questionnaires to help monitor a child’s developmental progress.  Done regularly, these tools provide a picture of your unique child’s development over time.

If you have concerns consulting your pediatrician or preschool teacher is a great way to begin the conversation about normal development and your child’s individual personality.  They will likely invite you to complete one of the many different tools that screen for growth and development.

These are typically not assessment tools, but rather help screen for indicators that suggest the child would benefit from closer monitoring or early intervention services.

There are a number of different screening tools available:

ASQ (Ages & Stages Questionnaire): Many doctors and pre-schools use the Ages and Stages Questionnaire (ASQ) to screen children between the ages of 15 months and 48 months.  ASQ is not an assessment tool but it can help determine if a child needs further assessment or support. https://agesandstages.com/about-asq/for-parents/

CDC checklist:  The CDC checklist provides lists of typical behaviors from birth through kindergarten.  In addition, they offer parenting tips for interacting with your child at each stage of development.  https://www.cdc.gov/ncbddd/actearly/pdf/checklists/all_checklists.pdf

M-CHAT (Modified Checklist for Autism in Toddlers): The M-CHAT, like the ASQ, is a screening tool and not an assessment.  The American Academy of Pediatrics recommends that children be screened for autism at 18 and 24 months. It cannot diagnose but it helps identify children who should be evaluated further. https://www.healthychildren.org/English/health-issues/conditions/Autism/Pages/How-Doctors-Screen-for-Autism.aspx

Completed questionnaires document your child’s growth and development, helping you and your support team of doctors and caregivers know what is normal for your child.  They also provide indicators when further assessment and support would be helpful to you and your child.

My son did eventually move from crawling to walking.  The delay was normal for him. But his unique circumstances meant that we also sought help from early intervention to equip him with the tools he would need to help him walk safely with limited vision.

Screening tools help us answer the question “Is this normal?”.  But they also provide a path toward further support when warranted.

 

Sidebar

10 Physical, Social, Emotional & Cognitive Milestones from healthychildren.org:

  • By 2 months: Tries to look at his or her parent and pays attention to faces.
  • By 4 months: Copies facial movements, such as smiling or frowning, and responds to affection.
  • By 6 months: Likes to look at himself or herself in the mirror and brings objects to mouth.
  • By 9 months: Has favorite toys and picks up small items between the thumb and forefinger.
  • Around 12 months: Puts out arm or leg to help with dressing and follows simple directions.
  • At 18 months: Explores alone if a parent is nearby and points to a body part when asked.
  • By 2 years: Gets excited to see other children and begins sorting shapes and colors.
  • By 3 years: Is able to dress himself or herself and completes puzzles with three or four pieces.
  • By 4 years: Is able to tell the difference between real and make-believe and predicts what is going to happen next in a book.
  • By 5 years: Wants to be like his or her friends and is able to draw a person with six body parts.

(https://www.healthychildren.org/English/family-life/health-management/Pages/Milestones-Matter.aspx)

 

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