Infertility and Adoption - Special Needs Child

Special Needs Child

Children with Special Needs

Learning Disabilities	Speech & Language Disorders
Emotional Disturbances	Spina Bifida
Epilepsy	Traumatic Brain Injury
Attention-Deficit / Hyperactivity Disorder (AD/HD)	Visual Impairments
Autism / PDD	Mental, Emotional, and Behavior Disorders in Children and Adolescents
Deafness and Hearing Loss	It's the Person First.....Then the disability
Down Syndrome	Disabilities That Qualify Children and Youth for Special Education Services under the Individuals with Disabilities Education Act (IDEA)
Mental Retardation	Major Depression in Children & Adolescents
Severe and/or Multiple Disabilities	List of Additional Links
Prematurity and Lung Disease

Learning Disabilities

Definition
The regulations for Public Law (P.L) 101-476, the Individuals with Disabilities Education Act (IDEA), define a learning disability as a "disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or to do mathematical calculations."

The Federal definition further states that learning disabilities include "such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia." According to the law, learning disabilities do not include learning problems that are primarily the result of visual, hearing, or motor disabilities; mental retardation; or environmental, cultural, or economic disadvantage. Definitions of learning disabilities also vary among states.

Having a single term to describe this category of children with disabilities reduces some of the confusion, but there are many conflicting theories about what causes learning disabilities and how many there are. The label "learning disabilities" is all embracing; it describes a syndrome, not a specific child with specific problems. The definition assists in classifying children, not teaching them. Parents and teachers need to concentrate on the individual child. They need to observe both how and how well the child performs, to assess strengths and weaknesses, and develop ways to help each child learn. It is important to remember that there is a high degree of interrelationship and overlapping among the areas of learning. Therefore, children with learning disabilities may exhibit a combination of characteristics.

These problems may mildly, moderately, or severely impair the learning process.

Incidence
Many different estimates of the number of children with learning disabilities have appeared in the literature (ranging from 1% to 30% of the general population). In 1987, the Interagency Committee on Learning Disabilities concluded that 5% to 10% is a reasonable estimate of the percentage of persons affected by learning disabilities. The U.S. Department of Education (1999) reported that slightly less than 5% of all school-aged children received special education services for learning disabilities and that in the 1997-98 school year over 2.7 million children with learning disabilities were served. Differences in estimates perhaps reflect variations in the definition.

Characteristics
Learning disabilities are characterized by a significant difference in the child's achievement in some areas, as compared to his or her overall intelligence.

Students who have learning disabilities may exhibit a wide range of traits, including problems with reading comprehension, spoken language, writing, or reasoning ability. Hyperactivity, inattention, and perceptual coordination problems may also be associated with learning disabilities. Other traits that may be present include a variety of symptoms, such as uneven and unpredictable test performance, perceptual impairments, motor disorders, and behaviors such as impulsiveness, low tolerance for frustration, and problems in handling day-to-day social interactions and situations.

Learning disabilities may occur in the following academic areas:

Spoken language: Delays, disorders, or discrepancies in listening and speaking;
Written language: Difficulties with reading, writing, and spelling;
Arithmetic: Difficulty in performing arithmetic functions or in comprehending basic concepts;
Reasoning: Difficulty in organizing and integrating thoughts; and
Organization skills: Difficulty in organizing all facets of learning.

Educational Implications
Because learning disabilities are manifested in a variety of behavior patterns, the Individual Education Program (IEP) must be designed carefully. A team approach is important for educating the child with a learning disability, beginning with the assessment process and continuing through the development of the IEP. Close collaboration among special class teachers, parents, resource room teachers, regular class teachers, and others will facilitate the overall development of a child with learning disabilities.

Some teachers report that the following strategies have been effective with some students who have learning disabilities:

Capitalize on the student's strengths;
Provide high structure and clear expectations;
Use short sentences and a simple vocabulary;
Provide opportunities for success in a supportive atmosphere to help build self-esteem;
Allow flexibility in classroom procedures (e.g., allowing the use of tape recorders for note-taking and test- taking when students have trouble with written language);
Make use of self-correcting materials, which provide immediate feedback without embarrassment;
Use computers for drill and practice and teaching word processing;
Provide positive reinforcement of appropriate social skills at school and home; and
Recognize that students with learning disabilities can greatly benefit from the gift of time to grow and mature.

Resources
Directory of facilities and services for the learning disabled (17th ed.). (1998). Novato, CA: Academic Therapy. (Telephone: 1- 800-422-7249.)

Journal of Learning Disabilities. Available from Pro-Ed, 8700 Shoal Creek Blvd., Austin TX 78758. [Telephone: (512) 451-3246.]

Lab School of Washington. (1993). Issues of parenting children with learning disabilities (audiotape series of 12 lectures). Washington, DC: Author. (Telephone: (202) 965-6600.)

Mackenzie, L. (1997). The complete learning disabilities directory. Lakeville, CT: GreyHouse. (Telephone: (806) 435-0867. )

Silver, L (1998). The misunderstood child: Understanding and coping with your child's learning disabilities (3rd ed.). New York, NY: Time Books. (Available from Random Books at 1-800-733- 3000.)

Smith, S. (1995). No easy answers (Rev. ed.). New York, NY: Bantam Books. (Telephone: 1-800-323- 9872.)

Organizations
Council for Learning Disabilities (CLD)
P.O. Box 40303 Overland Park, KS 66204
(913) 492-8755
Web: www.cldinternational.org

Division for Learning Disabilities
Council for Exceptional Children
1920 Association Dr.
Reston, VA 22091-1589
(703) 620-3660
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.dldce.org

International Dyslexia Association (formerly the Orton Dyslexia Society)
Chester Building, Suite 382
8600 LaSalle Road
Baltimore, MD 21286-2044
(410) 296-0232 (800) 222-3123 (Toll Free)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.interdys.org

Learning Disabilities Association of America (LDA)
4156 Library Road
Pittsburgh, PA 15234
(412) 341-1515; (888) 300-6710
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.ldanatl.org

National Center for Learning Disabilities
381 Park Avenue South, Suite 1401
New York, NY 10016 (212) 545-7510; (888) 575-7373
Web: www.ndd.org

This publication is copyright free. Readers are encouraged to copy and share it, but please credit NICHCY.
National Information Center for Children and Youth with Disabilities
P.O. Box 1492
Washington, DC 20013-1492
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.nichcy.org
1-800-695-0285 (Voice/TTY)

Emotional Disturbances

Definition
Many terms are used to describe emotional, behavioral, or mental disorders. Currently, students with such conditions are categorized as having a serious emotional disturbance, which is defined under the Individuals with Disabilities Education Act (IDEA) as follows:

"...a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects educational performance

An inability to learn that cannot be explained by intellectual sensory, or health factors;
An inability to build or maintain satisfactory interpersonal relationships with peers and teachers;
Inappropriate types of behavior or feelings under normal circumstances;
A general pervasive mood of unhappiness or depression; or
A tendency to develop physical symptoms or fears associated with personal or school problems. [Code of Federal Regulations, Title 34, 5300.7 (b) (9) ]

As defined by IDEA, serious emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have a serious emotional disturbance.

It is important to know that the Federal government is currently reviewing the way in which serious emotional disturbance is defined and that the definition may be revised.

Incidence
For the 1997-98 school year, 454,363 children and youth with a serious emotional disturbance were provided services in the public schools (Twenty-First Annual Report to Congress, U.S. Department of Education, 1999).

Characteristics
The causes of emotional disturbance have not been adequately determined. Although various factors such as heredity, brain disorder, diet, stress, and family functioning have been suggested as possible causes, research has not shown any of these factors to be the direct cause of behavior problems. Some of the characteristics and behaviors seen in children who have emotional disturbances include:

Hyperactivity (short attention span, impulsiveness);
Aggression/self-injurious behavior (acting out, fighting);
Withdrawal (failure to initiate interaction with others, retreat from exchanges or social interaction, excessive fear or anxiety);
Immaturity (inappropriate crying, temper tantrums, poor coping skills); and
Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings and are sometimes identified as children who have a severe psychosis or schizophrenia.

Many children who do not have emotional disturbances may display some of these same behaviors at various times during their development. However, when children have a serious emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

Educational Implications
The educational programs for children with a serious emotional disturbance need to include attention to mastering academics, developing social skills, and increasing self- awareness, self-control, and self-esteem. Career education (both vocational and academic) is also a major part of secondary education and should be a part of the transition plan included in every adolescent's Individualized Education Program (IEP).

Behavior modification is one of the most widely used approaches to helping children with serious emotional disturbance. However, there are many other techniques that are also successful and may be used in conjunction with behavior modification. Life Space Intervention and Conflict Resolution are two such techniques.

Students eligible for special education services under the category of serious emotional disturbance may have IEPs that include psychological or counseling services. These are important related services which are available under the law and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

There is growing recognition that families, as well as their children, need support, respite care, intensive case management services, and a multi-agency treatment plan. Many communities are working toward providing these wrap-around services, and there are a growing number of agencies and organizations actively involved in establishing support services in the community. Parent support groups are also important, and organizations such as the Federation of Families for Children's Mental Health and the National Alliance for the Mentally Ill (NAMI) have parent representatives and groups in every state. Both of these organizations are listed under the resources section of this fact sheet.

Other Considerations
Families of children with emotional disturbances need help in understanding their children's condition and in learning how to work effectively with them. Help is available from psychiatrists, psychologists or other mental health professionals in public or private mental health settings. Children should be provided services based on their individual needs, and all persons who are involved with these children should be aware of the care they are receiving. It is important to coordinate all services between home, school, and therapeutic community with open communication.

Resources
Adamec, C. (1996). How to live with a mentally ill person: A handbook of day-to-day strategies. New York, NY John Wiley & Sons. (Telephone: 1-800-225-5945.)

Hatfield, A.B. (1991). Coping with mental illness in the family: A family guide (Rev. ed.) Arlington, VA: National Alliance for the Mentally Ill. [Product # 082. Telephone: (800) 950-6264]

Jordan, D. (1996). A guidebook for parents of children with emotional or behavior disorders. Minneapolis, MN: PACER Center. [Telephone: (612) 827-2966.]

Jordan, D. (1995). Honorable intentions: A parent's guide to educational planning for children with emotional or behavioral disorders. Minneapolis, MN: PACER Center. [See telephone number above.]

Koplewicz, H.S. (1996). It's nobody's fault New hope and help for difficult children. New York Random House/Times Books. (Telephone: 1-800-733-3000.)

Wilen, T.E. (1998). Straight talk about psychiatric medications for kids. New York Guilford. telephone: 1-800-365- 7006.)

Organizations
American Academy of Child and Adolescent Psychiatry Public Information Office, 3615 Wisconsin Ave., NW, Washington, DC 20016. Telephone: (202) 966-7300; (800) 333-7636. Web: www.aacap.org

ERIC Clearinghouse on Disabilities and Gifted Education, Council for Exceptional Children, 1920 Association Drive, Reston, VA 22091-1589. Telephone: (800) 328-0272; (703) 264-9449 (TTY).
E-Mail: eri This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: http://ericec.org

Federation of Families for Children's Mental Health, 1021 Prince St., Alexandria, VA 22314-2971.
Telephone: (703) 684-7710. E- Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.ffcmh.org National

Alliance for the Mentally Ill, 200 N. Glebe Road, Suite 1015, Arlington, VA 22203-3754. Telephone: (703) 524-7600; 1- 800-950-6264.
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www.nami.org

National Mental Health Association, 1021 Prince Street Alexandria, VA 22314-2971. Telephone: (703) 684-7722; (800) 969- 6642; (800) 433-5959 (TTY). E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www. nmha.org

Epilepsy

Definition
National Information Center for Children and Youth with Disabilities Epilepsy Definition According to the Epilepsy Foundation of America, epilepsy is a physical condition that occurs when there is a sudden, brief change in how the brain works. When brain cells are not working properly, a person's consciousness, movement, or actions may be altered for a short time. These physical changes are called epileptic seizures. Epilepsy is therefore sometimes called a seizure disorder. Epilepsy affects people in all nations and of all races.

Some people can experience a seizure and not have epilepsy. For example, many young children have convulsions from fevers. These febrile convulsions are one type of seizure. Other types of seizures not classified as epilepsy include those caused by an imbalance of body fluids or chemicals or by alcohol or drug withdrawal. A single seizure does not mean that the person has epilepsy.

Incidence
About two million Americans have epilepsy; of the 125,000 new cases that develop each year, up to 50% are in children and adolescents.

Characteristics
Although the symptoms listed below are not necessarily indicators of epilepsy, it is wise to consult a doctor if you or a member of your family experiences one or more of them:

"Blackouts" or periods of confused memory;
Episodes of staring or unexplained periods of unresponsiveness;
Involuntary movement of arms and legs;
"Fainting spells" with incontinence or followed by excessive fatigue; or
Odd sounds, distorted perceptions, episodic feelings of fear that cannot be explained.

Seizures can be generalized, meaning that all brain cells are involved. One type of generalized seizure consists of a convulsion with a complete loss of consciousness. Another type looks like a brief period of fixed staring.

Seizures are partial when those brain cells not working properly are limited to one part of the brain. Such partial seizures may cause periods of "automatic behavior" and altered consciousness. This is typified by purposeful-looking behavior, such as buttoning or unbuttoning a shirt. Such behavior, however, is unconscious, may be repetitive, and is usually not recalled.

Educational Implications
Students with epilepsy or seizure disorders are eligible for special education and related services under the Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Act (Public Law 94-142). Epilepsy is classified as "other health impaired" and an Individualized Education Program (IEP) would be developed to specify appropriate services. Some students may have additional conditions such as learning disabilities along with the seizure disorders.

Seizures may interfere with the child's ability to learn. If the student has the type of seizure characterized by a brief period of fixed staring, he or she may be missing parts of what the teacher is saying. It is important that the teacher observes and documents these episodes and reports them promptly to parents and to school nurses.

Depending on the type of seizure or how often they occur, some children may need additional assistance to help them keep up with classmates. Assistance can include adaptations in classroom instruction, first aid instruction on seizure management to the student's teachers, and counseling, all of which should be written in the IEP. It is important that the teachers and school staff are informed about the child's condition, possible effects of medication, and what to do in case a seizure occurs at school. Most parents find that a friendly conversation with the teacher(s) at the beginning of the school year is the best way to handle the situation. Even if a child has seizures that are largely controlled by medication, it is still best to notify the school staff about the condition. School personnel and the family should work together to monitor the effectiveness of medication as well as any side effects. If a child's physical or intellectual skills seem to change, it is important to tell the doctor. There may also be associated hearing or perception problems caused by the brain changes. Written observations of both the family and school staff will be helpful in discussions with the child's doctor. Children and youth with epilepsy must also deal with the psychological and social aspects of the condition. These include public misperceptions and fear of seizures, uncertain occurrence, loss of self-control during the seizure episode, and compliance with medications. To help children feel more confident about themselves and accept their epilepsy, the school can assist by providing epilepsy education programs for staff and students, including information on seizure recognition and first aid. Students can benefit the most when both the family and school are working together. There are many materials available for families and teachers so that they can understand how to work most effectively as a team.

Resources
Epilepsy Foundation of America. (n.d.). Epilepsy: Questions and answers about seizure disorders. Landover, MD: Author. (See address below.)

Freeman, J.M., Vining, E., E. Pillas, D.J. (1997). Seizures and epilepsy in childhood: A guide for parents (2nd ed.). Baltimore, MD: Johns Hopkins University Press. [Telephone: 1- 800-537-5487.]

Lechtenberg, R. (1999). Epilepsy and the family: A new guide (2nd ed.). Cambridge, MA: Harvard University Press. Telephone: 1-800-448-2242.)

Organizations
Epilepsy Foundation's National Office
4351 Garden City Drive, Suite 406
Landover, MD 20785
(301) 459-3700; (800) 332-1000 (Toll Free)
(301) 577-0100, for Publications
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.efa.org

National Institute of Neurological Disorders and Stroke (NINDS)
National Institutes of Health
Building 31, Room 8A06
31 Center Drive, MSC2540
Bethesda, MD 20892-2540
(301) 496-5751; (800) 352-9424
Web: www.ninds.nih.gov/

Attention-Deficit / Hyperactivity Disorder (AD/HD)

Mario's Story
Mario is 10 years old. When he was 7, his family learned he had AD/HD. At the time, he was driving everyone crazy. At school, he couldn't stay in his seat or keep quiet. At home, he didn't finish his homework or his chores. He did scary things, too, like climb out of his window onto the roof and run across the street without looking.

Things are much better now. Mario was tested by a trained professional to find out what he does well and what gives him trouble. His parents and teachers came up with ways to help him at school. Mario has trouble sitting still, so now he does some of his work standing up. He's also the student who tidies up the room and washes the chalkboard. His teachers break down his lessons into several parts. Then they have him do each part one at a time. This helps Mario keep his attention on his work.

At home, things have changed, too. Now his parents know why he,s so active. They are careful to praise him when he does something well. They even have a reward program to encourage good behavior. He earns good job points which they post on a wall chart. After earning 10 points he gets to choose something fun he'd like to do. Having a child with AD/HD is still a challenge, but things are looking better.

What is AD/HD?
Attention-Deficit/Hyperactivity Disorder (AD/ HD) is a condition that can make it hard for a person to sit still, control behavior, and pay attention. These difficulties usually begin before the person is 7 years old. However, these behaviors may not be noticed until the child is older. Doctors do not know just what causes AD/HD. However, researchers who study the brain are coming closer to understanding what may cause AD/HD They believe that some people with AD/HD do not have enough of certain chemicals (called neurotrans-mitters) in their brain. These chemicals help the brain control behavior.

Parents and teachers do not cause AD/HD. Still, there are many things that both parents and teachers can do to help a child with AD/HD.

How Common is AD/HD?
As many as 5 out of every 100 children in school may have AD/HD. Boys are three times more likely than girls to have AD/HD.

What Are the Signs of AD/HD?
There are three main signs, or symptoms, of AD/HD. These are:

problems with paying attention,
being very active (called hyperactivity), and
acting before thinking (called impulsivity).

More information about these symptoms is listed in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (1994). Based on these symptoms, three types of AD/HD have been found:

inattentive type, where the person can't seem to get focused or stay focused on a task or activity;
hyperactive-impulsive type, where the person is very active and often acts without thinking; and
combined type, where the person is inattentive, impulsive, and too active.

Inattentive type: Many children with AD/HD have problems paying attention. Children with the inattentive type of AD/HD often:

do not pay close attention to details;
can't stay focused on play or schoolwork;
don't follow through on instructions or finish school work or chores;
can't seem to organize tasks and activities;get distracted easily; and
lose things such as toys, school work and books. (APA, 1994, pp. 83-84)

Hyperactive-impulsive type. Being too active is probably the most visible sign of AD/HD. The hyperactive child is always on the go. (As he or she gets older, the level of activity may go down.) These children also act before thinking (called impulsivity). For example, they may run across the road without looking or climb to the top of very tall trees. They may be surprised to find themselves in a dangerous situation. They may have no idea of how to get out of the situation.

Hyperactivity and impulsivity tend to go together. Children with the hyperactive-impulsive type of AD/HD often may:

fidget and squirm;
get out of their chairs when they're not supposed to;
run around or climb constantly;have trouble playing quietly;
talk too much;
blurt out answers before questions have been completed;
have trouble waiting their turn;
interrupt others when they're talking;
and butt in on the games others are playing. (APA, 1994, p. 84)

Combined type. Children with the combined type of AD/HD have symptoms of both of the types described above. They have problems with paying attention, with hyperactivity, and with controlling their impulses.

Of course, from time to time, all children are inattentive, impulsive, and too active. With children who have AD/HD, these behaviors are the rule, not the exception.

These behaviors can cause a child to have real problems at home, at school, and with friends. As a result, many children with AD/HD will feel anxious, unsure of themselves, and depressed. These feelings are not symptoms of AD/HD. They come from having problems again and again at home and in school.

How Do You Know if a Child Has AD/HD?
When a child shows signs of AD/HD, he or she needs to be evaluated by a trained professional. This person may work for the school system or may be a professional in private practice. A complete evaluation is the only way to know for sure if the child has AD/HD. It is also important to:

rule out other reasons for the child's behavior, and
find out if the child has other disabilities along with AD/HD.

What About Treatment?
There is no quick treatment for AD/HD. However, the symptoms of AD/HD can be managed. It's important that the child's family and teachers:

find out more about AD/HD;
learn how to help the child manage his or her behavior,
create an educational program that fits the child's individual needs; and
provide medication, if parents and the doctor feel this would help the child.

What About School?
School can be hard for children with AD/HD. Success in school often means being able to pay attention and control behavior and impulse. These are the areas where children with AD/HD have trouble.

There are many ways the school can help students with AD/HD. Some students may be eligible to receive special education services under the Individuals with Disabilities Education Act (IDEA). Under the newest amendments to IDEA, passed in 1997, AD/HD is specifically mentioned under the category of "Other Health Impairment" (OHI). We've included the IDEA's definition of OHI below. Other students will not be eligible for services under IDEA. However, they may be eligible for services under a different law, Section 504 of the Rehabilitation Act of 1973. In both cases, the school and the child's parents need to meet and talk about what special help the student needs.

Most students with AD/HD are helped by supports or changes in the classroom (called adaptations). Some common changes that help students with AD/HD are listed in the "Tips for Teachers" below. More information about helpful strategies can be found in NICHCY's publication called Attention-Deficit/Hyperactivity Disorder. The resources listed below will also help families and teachers learn more about ways to help children with AD/HD.

Resources
Alexander-Roberts, C. (1994). ADHD parenting handbook: Practical advice for parents from parents: Proven techniques for raising a hyperactive child without losing your temper. Dallas, TX: Taylor Publishing. [Telephone: 1-800-677-2800.]

Barkley, R. (1995). Taking charge of AD/HD. New York Guilford Press. [Telephone: 1-800-365-7006.]

Dendy, S.A. Z. (1995). Teenagers with ADD: A parent's guide. Bethesda, MD: Woodbine House. [Telephone: 1- 800-843-7323.]

Fowler, M. (1994). Attention-deficit/hyperactivity disorder. NlCHCY Briefing Paper, 1-16. [Telephone: 1-800- 695-0285. Also available on NICHCY's Web site: www.nichcy.org]

Fowler, M. (1999). Maybe you know my kid: A parent's guide to identifying, understanding, and helping your child with ADHD (3rd ed.). New York: Birch Lane Press. [Telephone: 1-800-447- 2665.]

Fowler, M. (1992). CH.A.D.D. educators manual: p children An in-depth look at attention deficit disorders from an educational perspective. Plantation, FL CHA.D.D. Telephone: [1-800-233-4050;]

Wodrich, D.L. (1994). Attention deficit hyperactivity disorder: What every parent wants to know. Baltimore, MD: Paul H. Brookes. [Telephone: 1-800-636-3775.]

Organizations
CHA.D.D. (Children and Adults with Attention Deficit/Hyperactivity Disorder)
8181 Professional Place, Suite 201
Landover, MD 20785
(301) 306-7070
(800) 233-4050
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.chadd.org

National Attention Deficit Disorder Association
P.O. Box 1303
Northbrook IL 60065-1303
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.add.org

IDEA's Definition of "Other Health Impairment"
Many students with ADHD now may qualify for special education services under the "Other Health Impairment" category within the individuals with Disabilities Education Act (IDEA). IDEA defines other health impairment as...

"...having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and adversely affects a child's educational performance."

Tips for Parents

Learn about AD/HD. The more you know, the more you can help yourself and your child. See the list of resources and organizations above.
Praise your child when he or she does well. Build your child's abilities. Talk about and encourage his or her strengths and talents.
Be clear, be consistent, be positive. Set clear rules for your child. Tell your child what he or she should do, not just what he shouldn't do. Be clear about what will happen if your child does not follow the rules. Have a reward program for good behavior. Praise your child when he or she shows the behaviors you like.
Learn about strategies for managing your child's behavior. These include valuable techniques such as: charting, having a reward program, ignoring behaviors, natural consequences, logical consequences, and time-out. Using these strategies will lead to more positive behaviors and cut down on problem behaviors. You can read about these techniques in many books. See Resources above.
Talk with your doctor about whether medication will help your child.
Pay attention to your child's mental health (and your own!). Be open to counseling. It can help you deal with the challenges of raising a child with AD/HD. It can help your child deal with frustration, feel better about himself or herself, and learn more about social skills.
Talk to other parents whose children have AD/ HD. Parents can share practical advice and emotional support. Call NICHCY to find out how to find parent groups near you.
Meet with the school and develop an educational plan to address your child's needs. Both you and your child's teachers should get a written copy of this plan.
Keep in touch with your child's teacher. Tell the teacher how your child is doing at home. Ask how your child is doing in school. Offer support.

Tips for Teachers

Learn more about AD/HD. The resources and organizations at the end of this publication will help you identify behavior support strategies and effective ways to support the student educationally. We've listed some strategies below.
Figure out what specific things are hard for the student. For example, one student with AD/HD may have trouble starting a task; while another may have trouble ending one task and starting the next. Each student needs different help.
Post rules, schedules, and assignments. Clear rules and routines will help a student with AD/HD. Have set times for specific tasks. Call attention to changes in the schedule.
Show the student how to use an assignment book and a daily schedule. Also teach study skills and learning strategies, and reinforce these regularly.
Help the student channel his or her physical activity (e.g., let the student do some work standing up or at the board). Provide regularly scheduled breaks.
Make sure directions are given step by step, and that the student is following the directions. Give directions both verbally and in writing. Many students with AD/ HD also benefit from doing the steps as separate tasks.
Let the student do work on a computer.
Work together with the student's parents to create and implement an educational plan tailored to meet the student's needs. Regularly share information about how the student is doing at home and at school.
Have high expectations for the student, but be willing to try new ways of doing things. Be patient. Maximize the student's chances for success.

Thanks to The National Information Center for Children and Youth with Disabilities (NICHCY) for providing this information. NICHCY: 1-800-695-0265

Autism/PDD

Definition
Autism and Pervasive Developmental Disorder-NOS (not otherwise specified) are developmental disabilities that share many of the same characteristics. Usually evident by age three, autism and PDD-NOS are neurological disorders that affect a child's ability to communicate, understand language, play, and relate to others.

In the diagnostic manual used to classify disabilities the DSM-IV (American Psychiatric Association, 1994), "autistic disorder" is listed as a category under the heading of "Pervasive Developmental Disorders." A diagnosis of autistic disorder is made when an individual displays 6 or more of 12 symptoms listed across three major areas: social interaction, communication, and behavior. When children display similar behavior but do not meet the criteria for autistic disorder, they may receive a diagnosis of Pervasive Developmental Disorder-NOS (PDD not otherwise specified). Although the diagnosis is referred to as PDD-NOS, throughout the remainder of this fact sheet, we will refer to the diagnosis as PDD, as it is more commonly known.

Autistic disorder is one of the disabilities specifically defined in the Individuals with Disabilities Education Act (IDEA), the federal legislation under which children and youth with disabilities receive special education and related services. IDEA, which uses the term "autism", defines the disorder as "a developmental disability significantly affecting verbal and nonverbal communication and social interaction, usually evident before age 3 that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences." (In keeping with the IDEA and the way in which this disorder is generally referred to in the field, we will use the term autism throughout the rest of this fact sheet.)

Due to the similarity of behaviors associated with autism and PDD, use of the term pervasive developmental disorder has caused some confusion among parents and professionals. However, the treatment and educational needs are similar for both diagnoses.

Incidence
Autism and PDD occur in approximately 5 to 15 per 10,000 births. These disorders are four times more common in boys than in girls.

The causes of autism and PDD are unknown. Currently, researchers are investigating areas such as neurological damage and biochemical imbalance in the brain. These disorders are not caused by psychological factors.

Characteristics
Some or all of the following characteristics may be observed in mild to severe forms:

Communication problems (e.g., using and understanding language);
Difficulty relating to people, objects, and events;
Unusual play with toys and other objects;
Difficulty with changes in routine or familiar surroundings; and
Repetitive body movements or behavior patterns.

Children with autism or PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak; others have language that often includes repeated phrases or conversations. Persons with more advanced language skills tend to use a small range of topics and have difficulty with abstract concepts. Repetitive play skills, a limited range of interests, and impaired social skills are generally evident as well. Unusual responses to sensory information, for example, loud noises, lights, certain textures of food or fabrics are also common.

Educational Implications
Early diagnosis and appropriate educational programs are very important to children with autism or PDD. PL 105-17, the Individuals with Disabilities Education Act (IDEA), formerly PL 94-142, includes autism as a disability category. From the age of three, children with autism and PDD are eligible for an educational program appropriate to their individual needs. Educational programs for students with autism or PDD focus on improving communication, social, academic, behavioral, and daily living skills. Behavior and communication problems that interfere with learning sometimes require the assistance of a knowledgeable professional in the autism field who develops and helps to implement a plan which can be carried out at home and school.

The classroom environment should be structured so that the program is consistent and predictable. Students with autism or PDD learn better and are less confused when information is presented visually as well as verbally. Interaction with nondisabled peers is also important, for these students provide models of appropriate language, social, and behavioral skills. To overcome frequent problems in generalizing skills learned at school, it is very important to develop programs with parents, so that learning activities, experiences, and approaches can be carried over into the home and community.

With educational programs designed to meet a student's individual needs and specialized adult support services in employment and living arrangements, children and adults with autism or PDD can live and work in the community.

Resources
Harris, S. (1994). Siblings of children with autism: A guide for families. Bethesda, MD: Woodbine House. [Telephone: 1-800- 843-7323.]

Harris, S.L., & Weiss, M.J. (1998). Right from the start: Behavioral intervention for young children with autism: A guide for parents and professionals. Bethesda, MD: Woodbine House. [Telephone: 1-800-843-7323.]

Hart, C.A. (1993). A parent's guide to autism: Answers to the most common questions. New York Pocket Books, Simon & Schuster Co. [Telephone: 1-800-223-2336.]

Journal of Autism and Developmental Disorders. [Available from Plenum Publishing Corporation, 233 Spring Street New York, NY 10013. Telephone: 1-800-221-9369. ]

Maurice, C., Green, G., 5 Luce, S.C. (Eds.). (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Pro-Ed. (Telephone: 1-800-897-3202.)

McClannaham, LE., & Krantz, P.J. (1999). Activity schedules for children with autism: Teaching independent behavior. Bethesda, MD: Woodbine House. [Telephone: 1-800-843-7323.]

Powers, M.D. (Ed.). (1989). Children with autism: A parent's guide. Rockville, MD: Woodbine House. [Telephone: 1-800-843- 7323; (301) 897-3570.]

Schopler, E., 4 Mesibov, G.B. (Eds.). Books avail-able in the "Current Issues in Autism" book series include High-functioning individuals with autism (1992); Preschool issues in autism (1993) ; Behavioral issues in autism (1995); Learning and cognition in autism (1995); and Asperger syndrome or high-functioning autism? (1998). [All are available from Kluwer Academic Publishers at (781) 871-6600.]

Organizations
Autism Hotline
Autism Services Center
P.O. Box 507 Huntington, WV 25710-0507
Telephone: (304) 525-8014

Autism National Committee
635 Ardmore Avenue Ardmore, PA 19003-1831
Web: www.autcom.org

Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814
(301) 657-0881; 1-800-328-8476
Web: www.autism-society.org

Indiana Resource Center for Autism
Indiana Institute on Disability and Community
2853 East 10th Street, Indiana University
Bloomington, IN 47408-2696
(812) 855-6508; (812) 855-9396 (TTY)
Web: www.iidc.indiana.edu/ ~irca

Thanks to The National Information Center for Children and Youth with Disabilities (NICHCY) for providing this information. NICHCY: 1-800-695-0265

Deafness and Hearing Loss

Definition
The Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Act (P.L 94-142), includes "hearing impairment" and "deafness" as two of the categories under which children with disabilities may be eligible for special education and related service programming. While the term hearing impairment is often used generically to describe a wide range of hearing losses, including deafness, the regulations for IDEA define hearing loss and deafness separately.

Hearing impairment is defined by IDEA as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance."

Deafness is defined as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification."

Thus, deafness may be viewed as a condition that prevents an individual from receiving sound in all or most of its forms. In contrast, a child with a hearing loss can generally respond to auditory stimuli, including speech.

Incidence
Hearing loss and deafness affect individuals of all ages and may occur at any time from infancy through old age. The U.S. Department of Education (1999) reports that during the 1997-98 school year, 69,537 students aged 6 to 21 (or 1.3% of all students with disabilities) received special education services under the category of 'hearing impairment.' However, the number of children with hearing loss and deafness is undoubtedly higher, since many of these students may have other disabilities as well and may be served under other categories.

Characteristics

It is useful to know that sound is measured by its loudness or intensity (measured in units called decibels, dB) and its frequency or pitch (measured in units called hertz, Hz). Impairments in hearing occur in either or both areas, and may exist in only one ear or in both ears. Hearing loss is generally described as slight, mild, moderate, severe, or profound, depending upon how well a person can hear the intensities or frequencies most greatly associated with speech. Generally, only children whose hearing loss is greater than 90 decibels (dB) are considered deaf for the purposes of educational placement.

There are four types of hearing loss. Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear (the conduction pathways for sound to reach the inner ear). Conductive hearing losses usually affect all frequencies of hearing evenly and do not result in severe losses. A person with a conductive hearing loss usually is able to use a hearing aid well or can be helped medically or surgically.

Sensorinsural hearing losses result from damage to the delicate sensory hair cells of the inner ear or the nerves which supply it. These hearing losses can range from mild to profound. They often affect the person's ability to hear certain frequencies more than others. Thus, even with amplification to increase the sound level, a person with a sensorineural hearing loss may perceive distorted sounds, sometimes making the successful use of a hearing aid impossible.

A mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the outer or middle and the inner ear. A central hearing loss results from damage or impairment to the nerves or nuclei of the central nervous system, either in the pathways to the brain or in the brain itself.

Educational Implications
Hearing loss or deafness does not affect a person's intellectual capacity or ability to learn. However, children who are either hard of hearing or deaf generally require some form of special education services in order to receive an adequate education. Such services may include:

regular speech, language, and auditory training from a specialist;
amplification systems;
services of an interpreter for those students who use manual communication;
favorable seating in the class to facilitate speechreading
captioned films/videos;
assistance of a notetaker, who takes notes for the student with a hearing loss, so that the student can fully attend to instruction;
instruction for the teacher and peers in alternate communication methods, such as sign language; and
counseling.

Children who are hard of hearing will find it much more difficult than children who have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication. For children who are deaf or have severe hearing losses, early, consistent, and conscious use of visible communication modes (such as sign language, fingerspelling, and Cued Speech) and/or amplification and aural/oral training can help reduce this language delay. By age four or five, most children who are deaf are enrolled in school on a full-day basis and do special work on communication and language development. It is important for teachers and audiologists to work together to teach the child to use his or her residual hearing to the maximum extent possible, even if the preferred means of communication is manual. Since the great majority of deaf children (over 90%) are born to hearing parents, programs should provide instruction for parents on implications of deafness within the family.

People with hearing loss use oral or manual means of communication or a combination of the two. Oral communication includes speech, speechreading and the use of residual hearing. Manual communication involves signs and fingerspelling. Total Communication, as a method of instruction, is a combination of the oral method plus signs and fingerspelling.

Individuals with hearing loss, including those who are deaf, now have many helpful devices available to them. Text telephones (known as TTs, TIYs, or TDDs) enable persons to type phone messages over the telephone network. The Telecommunications Relay Service (TRS) makes it possible for TT users to communicate with virtually anyone (and vice versa) via telephone. The National Institute on Deafness and Other Communication Disorders Information Clearinghouse (telephone: 1-800- 241-1044, voice; 1-800-241-1055, TT) makes available lists of TRS numbers by state.

Resources
Luterman, D.M. (1991). When your child is deaf: A guide for parents. Parkton, MD: York Press. (Telephone: 1-800-962-2763.)

Medwid, D.J., & Weston, D.C. (1995). Kid-friendly parenting with deaf and hard of hearing children: A treasury of fun activities toward better behavior. Washington, DC: Gallaudet University Press. (Telephone: 1-800-621-2736; (888) 630-9347 (V/ TTY). Web: http://gupress.gallaudet.edu)

Ogden, P.W. (1996). The silent garden: Raising your deaf child (Rev. ed.). Washington, DC: Gallaudet University Press. (See telephone above.)

Schwartz, S. (Ed.). (1996). Choices in deafness: A parents' guide to communication options (2nd ed.). Bethesda, MD: Woodbine Hose. (Telephone: 1-800-843-7323.)

Tucker, B.P. (1997). IDEA advocacy for children who are deaf or hard of hearing: A question and anser book for parents and professionals. San Diego, CA: Singular. (Telephone: 1-800-521-8545.)

Organizations
Alexander Graham Bell Association for the Deaf, Inc.
3417 Volta Place, NW
Washington, DC 20007
(202) 337-5220 (Voice/TT)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www.agbell.org

American Society for Deaf Children
P.O. Box 3355
Gettysburg, PA 17325
1-800-942-2732 (Voice/TTY); (717) 334-7922 (T/TTY)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www.deafchildren.org

American Speech-Language Hearing Association
10801 Rockville Pike
Rockville, MD 20852
(301) 897-5700 (Voice/TT); 1-800-638-8255 (Helpline)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www.asha.org

Laurent Clerc National Deaf Education Center and Clearinghouse, KDES PAS-6, Gallaudet University
800 Florida avenue N.E.
Washington. DC 20002-3695
(202) 651-5051 (Voice); (202) 651-5052 (TT)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: http://clerccenter.gallaudet.edu/infotogo/index.html

National Institute on Deafness and Other Communication Disorders Clearinghouse
One Communication Avenue
Bethesda, MD 20892-3456
1-800-241-1044 (Voice); 1-800-241-1055 (TT)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www.nih.gov/nidcd/

Self Help for Hard of Hearing People (SHHH)
7910 Woodmont Avenue, Suite 1200
Bethesda, MD 20814
(301) 657-2248 (Voice); (301) 657-2249 (TT)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www.shhh.org

This information is copyright free. Readers are encouraged to copy and share it, but please credit NICHCY.
National Information Center for Children and Youth with Disabilities
P.O. Box 1492
Washington, DC 20013-1492
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.nichcy.org
1-800-695-0285 (Voice/TTY)

Down Syndrome

Definition
Down syndrome is the most common and readily identifiable chromosomal condition associated with mental retardation. It is caused by a chromosomal abnormality: for some unexplained reason, an accident in cell development results in 47 instead of the usual 46 chromosomes. This extra chromosome changes the orderly development of the body and brain. In most cases, the diagnosis of Down syndrome is made according to results from a chromosome test administered shortly afterbirth.

Incidence
Approximately 4,000 children with Down syndrome are born in the U.S. each year, or about 1 in every 800 to 1,000 live births. Although parents of any age may have a child with Down syndrome, the incidence is higher for women over 35. Most common forms of the syndrome do not usually occur more than once in a family.

Characteristics
There are over 50 clinical signs of Down syndrome, but it is rare to find all or even most of them in one person. Some common characteristics include:

Poor muscle tone;
Slanting eyes with folds of skin at the inner corners (called epicanthal folds);
Hyperflexibility (excessive ability to extend the joints);
Short, broad hands with a single crease across the palm on one or both hands;
Broad feet with short toes;
Flat bridge of the nose;
Short, low-set ears;
Short neck;
Small head;
Small oral cavity; and/or
Short, high-pitched cries in infancy.

Individuals with Down syndrome are usually smaller than their nondisabled peers, and their physical as well as intellectual development is slower.

Besides having a distinct physical appearance, children with Down syndrome frequently have specific health-related problems. A lowered resistance to infection makes these children more prone to respiratory problems. Visual problems such as crossed eyes and far- or nearsightedness are higher in individuals with Down syndrome, as are mild to moderate hearing loss and speech difficulty.

Approximately one third of babies born with Down syndrome have heart defects, most of which are now successfully correctable. Some individuals are born with gastrointestinal tract problems that can be surgically corrected.

Some people with Down syndrome also may have a condition known as Atlantoaxial Instability, a misalignment of the top two vertebrae of the neck. This condition makes these individuals more prone to injury if they participate in activities which overextend or flex the neck. Parents are urged to have their child examined by a physician to determine whether or not their child should be restricted from sports and activities which place stress on the neck Although this misalignment is a potentially serious condition, proper diagnosis can help prevent serious injury.

Children with Down syndrome may have a tendency to become obese as they grow older. Besides having negative social implications, this weight gain threatens these individuals' health and longevity. A supervised diet and exercise program may help reduce this problem.

Educational and Employment Implications
Shortly after a diagnosis of Down syndrome is confirmed, parents should be encouraged to enroll their child in an infant development/early intervention program. These programs offer parents special instruction in teaching their child language, cognitive, self-help, and social skills, and specific exercises for gross and fine motor development. Research has shown that stimulation during early developmental stages improves the child's chances of developing to his or her fullest potential. Continuing education, positive public attitudes, and a stimulating home environment have also been found to promote the child's overall development.

Just as in the normal population, there is a wide variation in mental abilities, behavior, and developmental progress in individuals with Down syndrome. Their level of retardation may range from mild to severe, with the majority functioning in the mild to moderate range. Due to these individual differences, it is impossible to predict future achievements of children with Down syndrome.

Because of the range of ability in children with Down syndrome, it is important for families and all members of the school's education team to place few limitations on potential capabilities. It maybe effective to emphasize concrete concepts rather than abstract ideas. Teaching tasks in a step- by-step manner with frequent reinforcement and consistent feedback has proven successful. Improved public acceptance of persons with disabilities, along with increased opportunities for adults with disabilities to live and work independently in the community, have expanded goals for individuals with Down syndrome. Independent Living Centers, group-shared and supervised apartments, and support services in the community have proven to be important resources for persons with disabilities.

Resources
Cunningham, C. (1996). Understanding Down syndrome: An introduction for parents. Cambridge,MA: Brookline. (Telephone: 1-800-666-2665.)

Pueschel, S.M. (Ed.). (1995). A parent's guide to Down syndrome: Toward a brighter future. Baltimore, MD: Paul H. Brookes. (Telephone: 1-600-638-3775.)

Uhruh, J.F. (1994). Down syndrome: Successful parenting of children with Down syndrome. Eugene, OR: Fern Ridge Press. (Telephone: (503) 485-8243.)

Woodbine House (at 1-800-843-7323) publishes a series of books on Down syndrome, including:

Differences in common: Straight talk about mental retardation, Down syndrome, and life
Communication skills in children with Down syndrome: A guide for parents
Medical and surgical care for children with Down syndrome: A guide for parents
Babies with Down syndrome: A new parent's guide
Teaching reading to children with Down Syndrome
Gross motor skills in children with Down Syndrome
Fine motor skills in children with Down syndrome

Organizations
National Down Syndrome Congress
7000 Peachtree-Dunwoody Road N.E.
Lake Ridge.400 Office Park Building 5, Suite 100 Atlanta, GA 30328
(770) 604-9500; 1-800-232-6372 (Toll Free)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: www.ndsccenter.org

National Down Syndrome Society
666 Broadway, 8th floor New York, NY 10012-2317

(212)460-9330; 1-800-221-4602 (Toll Free)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web: ndss.org

The Arc (formerly the Association for Retarded Citizens of the United States)
1010 Wayne Avenue, Suite 650
Silver Springs, MD 20910
(301) 565-3842 E-mail: info@thearcorg Web: www.thearcorg
For publications: www.TheArcPub.com

The month of October is National Down Syndrome Awareness Month...hence the Buddy Walks that take place all over.

Here is a copy of the Bush proclamation setting the month of October as National DS month!

Proclamation 6361 - National Down Syndrome Awareness Month October 21, 1991 By the President of the United States of America

A Proclamation

Down Syndrome is one of the most common congenital causes of mental retardation.

According to the Department of Health and Human Services, it affects approximately 4,000 babies in the United States each year. At one time in our history, people with Down Syndrome were stigmatized or, all too frequently, committed to institutions. Now they are benefiting from important advances in research, education, and health care.

Today we know that many individuals with Down Syndrome are both determined and able to lead active, productive lives. Thanks to early intervention and main-streaming, as well as improved treatment of physical health problems related to Down Syndrome, thousands are doing just that.

In recent years, more and more parents have been able to obtain the information and support that they need to cope with the unique challenges of rearing a child with Down Syndrome. Through special classes and mainstream programs in schools, more and more young people with this developmental disability are joining in the exciting process of learning and discovery. Many are also working to achieve their fullest potential through vocational training and independent living programs.

Their achievements, underscored by recent television appearances of actors with Down Syndrome, are helping to dispel old myths and misconceptions about the disorder. Much of this progress has been made possible by the vision and hard work of concerned researchers, physicians, educators, and parents, including members of private voluntary organizations such as the National Down Syndrome Congress and the National Down Syndrome Society. Working together with government agencies, these Americans have helped to affirm the God-given abilities and worth of persons with Down Syndrome.

This month, we express our admiration and our support for their efforts. To help promote greater understanding of Down Syndrome, the Congress, by Senate Joint Resolution 131, has designated the month of October as "National Down Syndrome Awareness Month" and has authorized and requested the President to issue a proclamation in observance of this month.

Now, Therefore, I, George Bush, President of the United States of America, do hereby proclaim the month of October as National Down Syndrome Awareness Month. I invite all Americans to observe this month with appropriate programs and activities. In Witness Whereof, I have hereunto set my hand this twenty-first day of October, in the year of our Lord nineteen hundred and ninety-one, and of the Independence of the United States of America the two hundred and sixteenth. George Bush [Filed with the Office of the Federal Register, 4:25 p.m., October 21, 1991] Note: This proclamation was published in the Federal Register on October 23.

http://www.ndss.org/eventsconferences/buddywalk/buddywalk.html

Mental Retardation

Definition
People with mental retardation are those who develop at a below average rate and experience difficulty in learning and social adjustment. The regulations for the Individuals with Disabilities Education Act (IDEA) provide the following technical definition for mental retardation:
"Mental retardation means significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a child's educational performance."

"General intellectual functioning" typically is measured by an intelligence test. Persons with mental retardation usually score 70 or below on such tests. Adaptive behavior refers to a person's adjustment to everyday life. Difficulties may occur in learning, communication, social, academic, vocational, and independent living skills.

Mental retardation is not a disease nor should it be confused with mental illness. Children with mental retardation become adults; they do not remain "eternal children." They do learn, but slowly and with difficulty.

Probably the greatest number of children with mental retardation have chromosome abnormalities. Other biological factors include (but are not limited to): asphyxia (lack of oxygen); blood incompatibilities between the mother and fetus; and maternal infections, such as rubella or herpes. Certain drugs have also been linked to problems in fetal development.

Incidence
Some studies suggest that approximately 1% of the general population has mental retardation (when both intelligence and adaptive behavior measures are used). According to data reported to the U.S. Department of Education by the states, in the 1997-98 school year, 603,111 students ages 6-21 were classified as having mental retardation and were provided services by the public schools. This figure does not include students reported as having multiple disabilities or those in non-categorical special education preschool programs who may also have mental retardation.

Characteristics
Many authorities agree that people with mental retardation develop in the same way as people without mental retardation, but at a slower rate. Others suggest that persons with mental retardation have difficulties in particular areas of basic thinking and learning such as attention, perception, or memory. Depending on the extent of the impairment 'mild, moderate, severe, or profound' individuals with mental retardation will develop differently in academic, social, and vocational skills.

Educational Implications
Persons with mental retardation have the capacity to learn, to develop, and to grow. The great majority of these citizens can become productive and full participants in society.

Appropriate educational services that begin in infancy and continue throughout the developmental period and beyond will enable children with mental retardation to develop to their fullest potential.

As with all education, modifying instruction to meet individual needs is the starting point for successful learning. Throughout their child's education, parents should be an integral part of the planning and teaching team.

In teaching persons with mental retardation, it is important to:

Use concrete materials that are interesting, age- appropriate, and relevant to the students;
Present information and instructions in small, sequential steps and review each step frequently;
Provide prompt and consistent feedback;
Teach these children, whenever possible, in the same school they would attend if they did not have mental retardation;
Teach tasks or skills that students will use frequently, in such a way that students can apply the tasks or skills in settings outside of school; and
Remember that tasks that many people learn without instruction may need to be structured, or broken down into small steps or segments, with each step being carefully taught.

Children and adults with mental retardation need the same basic services that all people need for normal development. These include education, vocational preparation, health services, recreational opportunities, and many more. In addition, many persons with mental retardation need specialized services for special needs. Such services include diagnostic and evaluation centers; special early education opportunities, beginning with infant stimulation programs and continuing through preschool; and educational programs that include age- appropriate activities, functional academics, transition training, and opportunities for independent living and competitive employment to the maximum extent possible.

Resources
Arc. (1998). Introduction to mental retardation (Rev. ed.). Silver Spring, MD: Author. [Telephone: (301) 565-3842.]

Smith, R. (Ed.). (1993). Children with mental retardation: A parents' guide. Bethesda, MD: Woodbine House. [Telephone: 1- 800-843-7323; (301) 897-3570.]

Trainer, M. (1991). Differences in common: Straight talk on mental retardation, Down syndrome, and life. Rockville, MD: Woodbine House. [Telephone: 1-800-843-7323; (301) 897-3570.]

Organizations
The Arc (formerly the Association for Retarded Citizens of the United States)
1010 Wayne Avenue, Suite 650
Silver Spring, MD 20910
(301) 565-3842
E-mail: info@thearcorg
Web: www.thearc.org
For publications: www.TheArcPub.com

American Association on Mental Retardation (AAMR)
444 N. Capitol Street N.W., Suite 846
Washington, D.C. 20001
1-800-424-3688 (Toll-free, outside of DC); (202) 387-1968
Web: www.aamr.org

National Down Syndrome Congress
7000 Peachtree-Dunwoody Road N.E.
Lake Ridge 400 Office Park Building 5, Suite 100
Atlanta, GA 30328
(770) 604-9500; 1-800-232-6372 (Toll Free)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.ndsccenter.org

National Down Syndrome Society
666 Broadway, Suite 810
New York, NY 10012
1-800-221-4602 (Toll-free); (212) 460-9330
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: ndss.org

Severe and/or Multiple Disabilities

Definition
People with severe disabilities are those who traditionally have been labeled as having severe or profound mental retardation. These people require ongoing extensive support in more than one major life activity in order to participate in integrated community settings and enjoy the quality of life available to people with fewer or no disabilities; they frequently have additional disabilities, including movement difficulties, sensory losses and behavior problems.

Incidence
In the 1997-98 school year, the states reported to the U.S. Department of Education that they were providing services to 106,758 students with multiple disabilities (Twenty-first Annual Report to Congress, 1999).

Characteristics
People with severe or multiple disabilities may exhibit a wide range of characteristics, depending on the combination and severity of disabilities, and the person's age. There are, however, some traits they may share, including:

Limited speech or communication;
Difficulty in basic physical mobility;
Tendency to forget skills through disuse;
Trouble generalizing skills from one situation to another; and
A need for support in major life activities, e.g., domestic, leisure, community use, vocational.

Medical Implications
A variety of medical problems may accompany severe disabilities. Examples include seizures, cerebral palsy, sensory loss, hydrocephalus, and scoliosis. These conditions should be considered when establishing services. A multidisciplinary team consisting of the student's parents, educational specialists and medical specialists in the areas in which the individual demonstrates problems should work together to plan and coordinate necessary services.

Educational Implications
In the past, students with severe and/or multiple disabilities were routinely excluded from public schools. Since the implementation of Public Law 94-142 (the Education of the Handicapped Act, now called the Individuals with Disabilities Education Act, or IDEA), public schools now serve large numbers of students with severe and/or multiple disabilities. Educational programming is likely to begin as early as infancy. At that time, as well as later on, the primary focus is upon increasing the child's independence.

In order to be effective, educational programs need to incorporate a variety of components to meet the considerable needs of individuals with severe and/or multiple disabilities. Programs should access needs in four major areas: domestic, leisure/recreational, community and vocational. These assessments enable the identification of functional objectives (objectives which will result in the learner's increased skill and independence in dealing with the routine activities of his/her life). Instruction should include: Expression of choice; communication; functional skill development; and age-appropriate social skills training.

Related services are of great importance, and the multidisciplinary approach is crucial. Appropriate people such as speech and language therapists, physical and occupational therapists, and medical specialists need to work closely with classroom teachers and parents. Because of problems with skill generalization, related services are best offered during the natural routine in the school and community rather than removing a student from class for isolated therapy.

Frequently, classroom arrangements must take into consideration students' needs for medications special diets, or special equipment. Adaptive aids and equipment enable students to increase their range of functioning. For example, in recent years computers have become effective communication devices. Other aides include: wheelchairs, typewriters, headsticks (head gear), clamps, modified handles on cups and silverware, and communication boards. Computerized communication equipment and specially built vocational equipment also play important roles in adapting working environments for people with serious movement limitations.

Integration with nondisabled peers is another important component of the educational setting. Attending the same school and participating in the same activities as their nondisabled peers is crucial to the development of social skills and friendships for people with severe disabilities. Integration also benefits nondisabled peers and professionals through positive attitude change.

Beginning as early as the elementary school years, community- based instruction is an important characteristic of educational programming. In order to increase the student's ability to generalize (transfer) skills to appropriate situations, this type of instruction takes place in the actual setting where the skills will be used. As students grow older, increasing time is spent in the community; high school students may spend as much as 90 percent of their day there. Programs should draw on existing adult services in the community, including group homes, vocational programs and recreational settings.

In light of the current Vocational Rehabilitation Act and the practice of supported employment, schools are now using school- to-work transition planning and working toward job placement in integrated, competitive settings rather than sheltered employment and day activity centers.

Resources
Downing, J.E. (1996). Including students with severe and multiple disabilities in typical classrooms: Practical strategies for teachers. Baltimore, MD: Paul H. Brookes. (Telephone: 1-800-638-3775.)

Orelove, F., l Sobsey, D. (1996). Educating children with multiple disabilities: A transdisciplinary approach (2nd ed.). Baltimore, MD: Paul H. Brookes.

Rainforth, B York, J., A Macdonald, C. (1992). Collaborative teams for students with severe disabilities: Integrating therapy and educational services. Baltimore, MD: Paul H. Brookes. (Telephone: 1-800-638-3775.)

TASH Newsletter. Monthly newsletter from TASH. See contact information below.

Organizations
TASH (formerly the Association for Persons with Severe Handicaps)
29 W. Susquehanna Avenue, Suite 210
Baltimore, MD 21204
(410) 828-8274; (410) 828-1306 (TTY)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.tash.org

National Rehabilitation Information Center (NARIC)
1010 Wayne Avenue, Suite 800
Silver Spring, MD 20910-5632
1-800-346-2742 (Toll-free); (301) 562-2400 (301) 495-5626 (TTY)
Web: www.naric.com

The Arc (formerly the Association for Retarded Citizens of the United States)
1010 Wayne Avenue, Suite 650
Silver Spring, MD 20910
(301) 565-3842
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.thearc.org
For publications: www.TheArcPub.com
United Cerebral PalsyAssociations, Inc.
1660 L Street NW, Suite 700
Washington, DC 20036
1-800-872-5827 (Toll-free) (202) 776-0406; (202) 973-7197 (TTY)
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.ucpa.org

Prematurity & Lung Disease

http://www.fertilethoughts.net/rsv.html: An online video "A Helping Hand for Parents of Children at Risk for Respiratory Syncytial Virus (RSV) Infections" brought to you courtesy of The RSV Protection Program^TM

Speech & Language Disorders

Definition
Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

Incidence
More than one million of the students served in the public schools' special education programs in the 1997-98 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech/ language problems secondary to other conditions such as deafness. Language disorders maybe related to other disabilities such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders (including speech, language, and hearing disorders) affect one of every 10 people in the United States.

Characteristics
A child's communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders maybe problems with the way sounds are formed, called articulation or phonological disorders, or they maybe difficulties with the pitch, volume, or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say "see" when they mean "ski" or they may have trouble using other sounds like "l" or "r." Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary, and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Educational Implications
Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate timely intervention. While many speech and language patterns can be called baby talk and are part of a young child's normal development, they can become problems if they are not outgrown as expected. In this way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language, and related skills is often affected.

Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child's teacher about the most effective ways to facilitate the child' s communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home.

Technology can help children whose physical conditions make communication difficult.

The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and, as students get older, the understanding and use of language becomes more complex. Communication skills are at the heart of the education experience. Speech and/or language therapy may continue throughout a student's school year either in the form of direct therapy or on a consultant basis. The speech-language pathologist may assist vocational teachers and counselors in establishing communication goals related to the work experiences of students and suggest strategies that are effective for the important transition from school to employment and adult life.

Communication has many components. All serve to increase the way people learn about the world around them, utilize knowledge and skills, and interact with colleagues, family, and friends.

Resources
Berkowitz, S. (1994). The cleft palate story: A primer for parents of children with cleft lip and palate. Chicago, IL Quintessence. (Telephone: 1-800-621-0387.)

Cleft Palate Foundation. (1997). For parents of newborn babies with cleft lip/cleft palate. Chapel Hill, NC: Author. (Telephone: 1-800-242-5338. Also available online at: www.cleft.com/cpf/cpffrm.html)

Eisenson, J. (1997). Is my child's speech normal? (2nd ed.). Austin TX: Pro-Ed. (Telephone: 1-800-897-3202.)

Hamaguchi, P. M. (1995). Childhood speech, language, 4 listening problems: What every parent should know. New York, NY: John Wiley & Sons, Inc. (Telephone: 1-800-225-5945.)

Organizations
Alliance for Technology Access
2175 E. Francisco Blvd., Suite L
San Rafael, CA 94901
(415) 455-4575; (800) 455-7970
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.ataccess.org

Cleft Palate Foundation
104 South Estes Drive, Suite 204
Chapel Hill, NC 27514
(919) 933-9044; (800) 242-5338
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.cleft.com

American Speech-Language-Hearing Association (ASHA)
10801 Rockville Pike
Rockville, MD 20852
(301) 897-5700 (V/TTY); (800) 638-8255
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.asha.org

Learning Disabilities Association of America (LDA)
4156 Library Road Pittsburgh, PA 15234
(412) 341-1515; (412) 341-8077; (888) 300-6710
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Web: www.ldanatl.org

Easter Seals' National Office
230 West Monroe Street, Suite 1800
Chicago, IL 60606-4802
(312) 726-6200; (312) 726-4258 (TTY) (800) 221-6827
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.easter-seals.org

Scottish Rite Foundation Southern Jurisdiction, U.S.A., Inc.
1733 Sixteenth Street, N.W.
Washington, DC 20009-3199
(202) 232-3579

Trace Research and Development Center
University of Wisconsin - Madison
S-151 Waisman Center
1500 Highland Avenue Madison, WI 53705-2280
(608) 262-6966; (608) 263-5408 (TTY)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: trace.wisc.edu/

Spina Bifida

Definition
Spina Bifida means cleft spine, which is an incomplete closure in the spinal column. In general, the three types of spina bifida (from mild to severe) are:

Spina Bifida Occulta: There is an opening in one or more of the vertebrae (bones) of the spinal column without apparent damage to the spinal cord.
Meningocele: The meninges, or protective covering around the spinal cord, has pushed out through the opening in the vertebrae in a sac called the "meningocele." However, the spinal cord remains intact. This form can be repaired with little or no damage to the nerve pathways.
Myelomeningocele: This is the most severe form of spina bifida, in which a portion of the spinal cord itself protrudes through the back In some cases, sacs are covered with skin; in others, tissue and nerves are exposed. Generally, people use the terms "spina bifida" and "myelomeningocele" interchangeably.

Incidence
Approximately 40% of all Americans may have spina bifida occulta, but because they experience little or no symptoms, very few of them ever know that they have it The other two types of spina bifida, meningocele and myelomeningocele, are known collectively as "spina bifida manifesta," and occur in approximately one out of every thousand births. Of these infants bern with "spina bifida manifesta," about 4% have the meningocele form, while about 96% have myelomeningocele form.

Characteristics
The effects of myelomeningocele, the most serious form of spina bifida, may include muscle weakness or paralysis below the area of the spine where the incomplete closure (or cleft) occurs, loss of sensation below the cleft, and loss of bowel and bladder control. In addition, fluid may build up and cause an accumulation of fluid in the brain (a condition known as hydrocephalus). A large percentage (70%-90%) of children born with myelomeningocele have hydrocephalus. Hydrocephalus is controlled by a surgical procedure called "shunting," which relieves the fluid buildup in the brain. If a drain (shunt) is not implanted, the pressure buildup can cause brain damage, seizures, or blindness. Hydrocephalus may occur without spina bifida, but the two conditions often occur together.

Educational Implications
Although spina bifida is relatively common, until recently most children born with a myelomeningocele died shortly after birth. Now that surgery to drain spinal fluid and protect children against hydrocephalus can be performed in the first 48 hours of life, children with myelomeningocele are much more likely to live. Quite often, however, they must have a series of operations throughout their childhood. School programs should be flexible to accommodate these special needs.

Many children with myelomeningocele need training to learn to manage their bowel and bladder functions, Some require catheterization, or the insertion of a tube to permit passage of urine.

The courts have held that clean, intermittent catheterization is necessary to help the child benefit from and have access to special education and related services. A successful bladder management program can be incorporated into the regular school day. Many children learn to catheterize themselves at a very early age.

In some cases, children with spina bifida who also have a history of hydrocephalus experience learning problems. They may have difficulty with paying attention, expressing or understanding language, and grasping reading and math. Early intervention with children who experience learning problems can help considerably to prepare them for school.

Mainstreaming, or successful integration of a child with spina bifida into a school attended by nondisabled young people, sometimes requires changes in school equipment or the curriculum. Although student placement should be in the least restrictive environment the day-to-day school pattern also should be as 'normal as possible. In adapting the school setting for the child with spina bifida, architectural factors should be considered. Section 504 of the Rehabilitation Act of 1973 requires that programs receiving federal funds make their facilities accessible. This can occur through structural changes (for example, adding elevators or ramps) or through schedule or location changes (for example, offering a course on the ground floor).

Children with myelomeningocele need to learn mobility skills, and often require the aid of crutches, braces, or wheelchairs. It is important that all members of the school team and the parents understand the child's physical capabilities and limitations. Physical disabilities like spina bifida can have profound effects on a child's emotional and social development. To promote personal growth, families and teachers should encourage W children, within the limits of safety and health, to be independent and to participate in activities with their nondisabled classmates.

Resources
Lutkenhoff, M. (Ed.). (1999). Spina bifida: A parent's guide. Bethesda, MD: Woodbine. (Telephone: 1-800-843-7323.)

Lutkenhoff M., & Oppenheimer, S. (1996). SPINAbilities: A young person's guide to spina bifida. Bethesda, MD: Woodbine. (Telephone: 1- 800-843-7323.)

McLone, D. (1998). An introduction to spina bifida. Washington, DC: Spina Bifida Association of America. (See address below.)

Sandler, A. (1997). Living with spina bifida: A guide for families and professionals. Chapel Hill, NC: University of North Carolina Press. (Telephone: 1-800-848-6224.)

Spina Bifida Assoication of America. (n.d.). Publications list. Washington, DC: Author. (See address below. Also available online at: www.sbaa.org/html/sbaa_pubs.html)

Organizations
Spina Bifida Association of America
4590 MacArthur Boulevard, Suite 250
Washington, DC 20007
(202) 944-3285 1-800-621-3141 (Toll Free)
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Web: www.sbaa.org

March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue White Plains, NY 10605
(914) 428-7100
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.modimes.org

Easter Seals' National Office
230 West Monroe Street, Suite 1800
Chicago, IL 60606
(312) 726-6200 1-800-221-6827; (312) 726-6200 (312) 726-4258 (TTY)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.easter-seals.org

National Rehabilitation Information Center (NARIC)
1010 Wayne Avenue, Suite 800
Silver Spring, MD 20910-5632
(301) 562-2400; (301) 495-5626 (TTY) 1-800-346-2742 (Toll Free)
Web: www.naric.com

Traumatic Brain Injury

Susan's Story
Susan was 7 years old when she was hit by a car while riding her bike. She broke her arm and leg. She also hit her head very hard. The doctors say she sustained a traumatic brain injury. When she came home from the hospital, she needed lots of help, but now she looks fine.

In fact, that's part of the problem, especially at school. Her friends and teachers think her brain has healed because her broken bones have. But there are changes in Susan that are hard to understand. It takes Susan longer to do things. She has trouble remembering things. She can't always find the words she wants to use. Reading is hard for her now. It's going to take time before people really understand the changes they see in her.

What is TBI?
A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. (The exact definition TBI, according to special education law, is given in the box on the right.) This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:

thinking and reasoning,
understanding words,
remembering things,
paying attention,
solving problems,
thinking abstractly,
talking,
behaving,
walking and other physical activities,
seeing and/or hearing, and
learning.

The term TBI is not used for a person who is born with a brain injury. It also is not used for brain injuries that happen during birth.

IDEA's Definition of TBI
The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities. IDEA defines traumatic brain injury as... "...an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open or dosed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning abstract thinking judgment; problem-solving sensory, perceptual, and motor abilities; psycho-social behavior, physical functions; information processing and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma." 34 Code of Federal Regulations circa 300.7(c)(12)

How Common is TBI?
More than one million children receive brain injuries each year. More than 30,000 of these children have lifelong disabilities as a result of the brain injury.

What Are the Signs of TBI?
The signs of brain injury can be very different depending on where the brain is injured and how severely. Children with TBI may have one or more difficulties, including:

Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely pa d on one side of the body, or both sides.
Difficulties with thinking: Because the brain has been injured, it is common that the person's ability to use the brain changes. For example, children with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.
Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.
A child with TBI may not have all of the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it's hard to predict how m individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education.

It's also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student's difficulty comes from the earlier injury.

What About School?
Although TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or mental retardation. As a result, they don't receive the type of educational help and support they really need.

When children with TBI return to school, their educational and emotional needs are often very different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child's family, friends, and teachers also recall what the child was like before the injury. These other people in the child's life may have trouble changing or adjusting their expectations of the child.

Therefore, it is extremely important to plan carefully for the child's return to school. Parents will want to find out ahead of time about special education services at the school. This information is usually available from the school's principal or special education teacher. The school will need to evaluate the child thoroughly. This evaluation will let the school and parents know what the student's educational needs are. The school and parents will then develop an Individualized Education Program (IEP) that addresses those educational needs.

It's important to remember that the IEP is a flexible plan. It can be changed as the parents, the school, and the student learn more about what the student needs at school.

Tips for Parents

Learn about TBI. The more you know, the more you can help yourself and your child. See the list of resources and organizations at the end of this publication.
Work with the medical team to understand your child's injury and treatment plan. Don't be shy about asking questions. Tell them what you know or think Make suggestions.
Keep track of your child's treatment A 3-ring binder or a box can help you store this history. As your child recovers, you may meet with many doctors, nurses, and others. Write down what they say. Put any paperwork they give you in the notebook or throw it in the box You can't remember all this! Also, if you need to share any of this paperwork with someone else, make a copy. Don't give away your original!
Talk to other parents whose children have TBI. There are parent groups all over the U.S. Parents can share practical advice and emotional support. Call NICHCY (1-800- 695-0285) to find out how to find parent groups near you.
If your child was in school before the injury, plan for his or her return to school. Get in touch with the school. Ask the principal about special education services. Have the medical team share information with the school.
When your child returns to school, ask the school to test your child as soon as possible to identify his or her special education needs. Meet with the school and help develop a plan for your child called an Individualized Education Program (IEP).
Keep in touch with your child's teacher. Tell the teacher about how your child is doing at home. Ask how your child is doing in school.

Tips for Teachers

Find out as much as you can about the child's injury and his or her present needs. Find out more about TBI. See the list of resources and organizations at the end of this publication.
Give the student more time to finish schoolwork and tests.
Give directions one step at a time. For tasks with many steps, it helps to give the student written directions.
Show the student how to perform new tasks. Give examples to go with new ideas and concepts.
Have consistent routines. This helps the student know what to expect. If the routine is going to change, let the student know ahead of time.
Check to make sure that the student has actually learned the new skill. Give the student lots of opportunities to practice the new skill.
Show the student how to use an assignment book and a daily schedule. This helps the student get organized.
Realize that the student may get tired quickly. Let the student rest as needed.
Reduce distractions.
Keep in touch with the student's parents. Share information about how the student is doing at home and at school.
Be flexible about expectations. Be patient. Maximize the student's chances for success.

Resources
DeBoskey, D.S. (Ed.). (1996). Coming home: A discharge manual for famines of persons with a brain injury. Houston, TX: HDI. (Telephone: (800) 321-7037; (713) 526-6900.)

DePompei, R., Blosser; J., Savage, R, & Lash, M. (1998). Special education: IEP checklist for a student with a brain injury. Wolfeboro, NH: L&A Publishing/ Training. (Telephone: (919) 562-0015. Web: http://www. lapublishing.com)

DePompei, R, A Cluett.B. (1998). All about me! Wolfeboro, NH: L&A Publishing/Training. (For use by elementary school children with TBI. Available from L&A, at the phone number above.)

Glang,A., Singer, G.H.S., &Todis, B. (1997). Students with acquired brain injury: The school's response. Baltimore, MD: Paul H. Brookes. (Telephone: 1-800-638-3775.)

Lash, M. (1998). Resource guide: Children and adolescents with brain injuries. Wolfeboro, NH: L&A Publishing/ Training. (See phone number above.)

Lash, M., Wolcott, G., & Pearson, S. (1995). Signs and strategies for educating students with brain injuries: A practical guide for teachers and schools. Houston, TX: HDI. (Telephone: (800) 321-7037; (713) 526-6900.)

Savage, R. (1995). An educator's manual: What educators need to know about student with TBI (3rd ed.). Houston, TX HDI. (See phone number above.)

Snyder, H. (1998). Elvin the elephant who forgets. Wolfeboro, NH: L&A Publishing/Training. (A 16-page picture book for children. Available from L&A at the phone number above.)

Ylvisaker, M. (1998). Collaborative brain injury intervention: Positive everyday routines. San Diego, CA: Singular Publishers. (Telephone: (800) 521-8545.)

Organizations
Brain Injury Association (formerly the National Head Injury Foundation)
105 North Alfred Street
Alexandria, VA 22314.
Telephone: (800) 444-6443 (Family Helpline); (703) 236-6000.
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web site http://www.biausa.org

Emergency Medical Services for Children National Resole Center
111 Michigan Avenue N.W.
Washington, DC 20010-2979
Telephone: (202) 884-4927

Epilepsy Foundation National Office
4351 Garden City Drive, Suite 500
Landover, MD 20785
Telephone: 301459-3700; (800) 332-1000; (800) 332-2070 (TTY)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web site: http://www.efa.org

Family Caregiver Alliance
690 Market Street, Suite 601
San Francisco, CA 94104
Telephone: (415) 434-3388; (800) 245-6686 (CA only).
Web site: http://www.caregiver.org

Family Voices
P.O. Box 769
Algodones, NM 87001
Telephone (505) 867-2368
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web site: http://www.familyvoices.org

Head Injury Hotline
212 Pioneer Building
Seattle, WA 98104
Telephone: (206) 621-8558
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web site: http://www.headinjury.com

Visual Impairments

Definition
The terms partially sighted, low vision, legally blind, and totally blind are used in the educational context to describe students with visual impairments. These terms are defined as follows:

"Partially sighted" indicates some type of visual problem has resulted in a need for special education;
"Low vision" generally refers to a severe visual impairment, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting, the size of print, and, sometimes, braille;
"Legally blind" indicates that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its widest point); and
Totally blind students, who learn via braille or other non-visual media.

Visual impairment is the consequence of a functional loss of vision, rather than the eye disorder itself. Eye disorders which can lead to visual impairments can include retinal degeneration, albinism, cataracts, glaucoma, muscular problems that result in visual disturbances, corneal disorders, diabetic retinopathy, congenital disorders, and infection.

Incidence
The rate at which visual impairments occur in individuals under the age of 18 is 12.2 per 1,000. Severe visual impairments (legally or totally blind) occur at a rate of .06 per 1,000.

Characteristics
The effect of visual problems on a child's development depends on the severity, type of loss, age at which the condition appears, and overall functioning level of the child. Many children who have multiple disabilities may also have visual impairments resulting in motor, cognitive, and/or social developmental delays.

A young child with visual impairments has little reason to explore interesting objects in the environment and, thus, may miss opportunities to have experiences and to learn. This lack of exploration may continue until learning becomes motivating or until intervention begins.

Because the child cannot see parents or peers, he or she maybe unable to imitate social behavior or understand nonverbal cues. Visual disabilities can create obstacles to a growing child's independence.

Educational Implications
Children with visual impairments should be assessed early to benefit from early intervention programs, when applicable. Technology in the form of computers and low-vision optical and video aids enable many partially sighted, low vision, and blind children to participate in regular class activities. Large print materials, books on tape, and braille books are available.

Students with visual impairments may need additional help with special equipment and modifications in the regular curriculum to emphasize listening skills, communication, orientation and mobility, vocation/career options, and daily living skills. Students with low vision or those who are legally blind may need help in using their residual vision more efficiently and in working with special aids and materials. Students who have visual impairments combined with other types of disabilities have a greater need for an interdisciplinary approach and may require greater emphasis on self care and daily living skills.

Resources
American Foundation for the Blind. (1997). AFB directory of services for blind and visually impaired persons in the United States and Canada (25th ed.). New York, NY: Author. (Telephone: 1- 800-232-3044.)

American Foundation for the Blind. (n.d.). Accessing education services for students with visual impairments: A guide for parents. Available on-line at: www.afb.org/ edserv.html

Holbrook, M.C. (Ed.). (1996). Children with visual impairments: A parents' guide. Bethesda, MD: Woodbine. [Telephone: 1-800-843-7323; (301) 897-3570.]

Scott, E., Jan, J., 5 Freeman, R. (1995). Can't your child see? (2nd ed.). Austin, TX: Pro-Ed. [Telephone: (512) 451-3246. ]

Organizations
American Council of the Blind Parents
c/o American Council of the Blind
1155 15th St. N.W., Suite 720
Washington, D. C. 20005
(202) 467-5081; (800) 424-8666
Web: www.acb.org

American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001
(800) 232-5463 (Toll Free Hotline)
For publications, call (800) 232-3044
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.afb.org

Blind Children's Center
4120 Marathon Street
Los Angeles, CA 90029-0159
(323) 664-2153; (800) 222-3566
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.blindchildrenscenter.org

National Association for Parents of the Visually Impaired, Inc.
P.O. Box 317
Watertown, MA 02472-0317
(617) 972-7441; (800) 562-6265
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.spedex.com/napvi

National Association for Visually Handicapped
22 West 21st Street, 6th Floor
New York, NY 10010
(212) 889-3141
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.navh.org

National Braille Association, Inc (NBA)
3 Townline Circle
Rochester, NY 14623
(716) 427-8260
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

National Braille Press
88 St. Stephen Street
Boston, MA 02115
(617) 266-6160, (1-800) 548-7323
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.nbp.org

National Eye Institute, National Institutes of Health
U.S. Department of Health & Human Services
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.nei.nih.gov

National Federation of the Blind, Parents Division
1800 Johnson Street
Baltimore, MD 21230
(410) 659-9314
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web; www.nfb.org

National Library Service for the Blind and Physically Handicapped
Library of Congress
1291 Taylor Street, N.W.
Washington, D.C. 20542
(202) 707-5100; (800) 424-8567; (202) 707-0744 (TTY)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Web:
www.locgov/nls

Prevent Blindness America
500 E. Remington Road
Schaumburg, IL 60173
(847) 843-2020; (800) 221-3004 (Toll Free)
E-Mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Web: www.preventblindness.org

The Foundation Fighting Blindness (formerly the National Retinitis Pigmentosa Foundation)
Executive Plaza One, Suite 800
11350 McCormick Road
Hunt Valley, MD 21031-1014
(888) 394-3937; (800) 683-5551 (TTY) (410) 785-1414; (410) 785-9687 (TTY)
Web: www.blindness.org

It's the Person First.....Then the disability

If you saw a person in a wheelchair unable to get up the stairs into a building, would you say "There is a handicapped person unable to find a ramp"? Or would you say "There is a person with a disability who is handicapped by an inaccessible building"?

What is the proper way to speak to or about someone who has a disability?

Consider how you would introduce someone Jane Does - who doesn't have a disability. You would give her name, where she lives, what she does or what she is interested in, she likes swimming or eating Mexican food, or watching Robert Redford movies.

Why say it differently for a person with disabilities? Every person is made up of many characteristics - mental as well as physical - and few want to be identified only by their ability to play tennis or by their love for fried onions or by the mole that's n their face. Those are just parts of us.

In speaking or writing, remember that children or adults with disabilities are like everyone else - except they happen to have a disability. Therefore, here are a few tips for improving your language related to disabilities and handicaps.

Speak of the person first, then the disability.
Emphasize abilities, not limitations.
Do not label people as part of a disability group - don't say "the disabled", say "people with disabilities."
Don't give excessive praise or attention to a person with a disability; don't patronize them.
Choice and independence are important; let the person do or speak for him/herself as much as possible; if addressing an adult, say "Bill" instead of "Billy".
A disability is a functional limitation that interferes with a person's ability to walk, hear, talk, learn, etc.; use handicap to describe a situation or barrier imposed by society, the environment or oneself.

SAY....	INSTEAD OF.....
Child with a disability	disabled or handicapped child
Person with cerebral palsy	palsied or C.P., or spastic
Person who has....	Afflicted, suffers from, victim
Without speech, nonverbal	mute, or dumb
Developmental delay	slow
Emotional disorder, or Mental illness	crazy or insane
Deaf or hearing impaired & communicates with sign	deaf and dumb
Uses a wheelchair	confined to a wheelchair
Person with retardation	retarded
Person with epilepsy	epileptic
With Down syndrome	mongoloid
Has a learning disability	is learning disabled
Nondisabled	normal, healthy
Has a physical disability	birth defect
Congenital disability	disease (unless it is a disease)
Seizures	fits
Cleft lip	hare lip
Mobility impaired	lame
Medically involved, or has chronic illness	sickly
paralyzed	invalid or paralytic
has hemiplegia (paralysis of both arms and legs)	quadriplegic
has quadriplegia (paralysis of both arms and legs)	quadriplegic
has paraplegia (loss of function in lower body only)	paraplegic
of short stature	dwarf or midget

What else can you do? If you see or hear reporters use incorrect terminology (even to save space in a headline or time on the air), call them up or send them this page so they can be aware of the appropriate words to use. Tell them it matters to you and people with disabilities.

Disabilities That Qualify Children and Youth for Special Education Services under the Individuals with Disabilities Education Act (IDEA)

The Education of the Handicapped Act, Public Law (P.L.) 94-142, was passed by Congress in 1975 and amended by P.L. 99-457 in 1986 to ensure that children with disabilities would have a free, appropriate public education available to them which would meet their unique needs. It was again amended in 1990, and the name was changed to the Individuals with Disabilities Education Act, or IDEA. The most recent reauthorization was in June 1997.

IDEA defines "children with disabilities" as having any of following types of disabilities: autism, deaf-blindness, hearing impairments (including deafness), mental retardation, multiple disabilities, orthopedic impairments, other health impairments, serious emotional disturbance, specific learning disabilities, speech or language impairments, traumatic brain injury, and visual impairments (including blindness). These terms are defined in the regulations for IDEA, as described below.

Autism
A developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects educational performance.
Deafness
A hearing impairment which is so severe that a child is impaired in processing linguistic information through hearing, with or without amplification, which adversely affects educational performance.
Deaf-Blindness
Simultaneous hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational problems that a child cannot be accommodated in special education programs solely for children with deafness or children with blindness.
Hearing Impairment
An impairment in hearing, whether permanent or fluctuating, which adversely affects a child's educational performance but which is not included under the definition of "deafness."
Mental Retardation
Significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period, which adversely affects a child's educational performance.
Multiple Disabilities
Simultaneous impairments (such as mental retardation/blindness, mental retardation/orthopedic impairment, etc.), the combination of which causes such severe educational problems that the child cannot be accommodated in a special education program solely for one of the impairments. The term does not include children with deaf-blindness.
Orthopedic Impairment
A severe orthopedic impairment which adversely affects a child's educational performance. The term includes impairments caused by a congenital anomaly (e.g., clubfoot, absence of some limb, etc.), impairments caused by disease (e.g. poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns which cause contractures).
Other Health Impairment
Having limited strength, vitality, or alertness, due to chronic or acute health problems such as a heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, or diabetes, which adversely affects a child's educational performance. According to the Office of Special Education and Rehabilitative Services' clarification statement of September 16, 1991, eligible children with ADD may also be classified under "other health impairment."
Serious Emotional Disturbance
- A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects educational performance:
  1. an inability to learn which cannot be explained by intellectual, sensory, or health factors;
  2. an inability to build or maintain satisfactory interpersonal relationships with peers and teachers;
  3. inappropriate types of behavior or feelings under normal circumstances;
  4. a general pervasive mood of unhappiness or depression; or
  5. a tendency to develop physical symptoms or fears associated with personal or school problems.
- The term includes children who have schizophrenia. The term does not include children who are socially maladjusted, unless it is determined chat they have a serious emotional disturbance.
Specific Learning Disability
A disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. The term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include children who have learning problems which are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage.
Speech or Language Impairment
A communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment, which adversely affects a child’s educational performance.
Traumatic Brain Injury
An acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, which adversely affects educational performance. The term does not include brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma.
Visual Impairment, Including Blindness
A visual impairment which, even with correction, adversely affects a child’s educational performance. The term includes both children with partial sight and those with blindness.

Services for Infants, Toddlers, and Preschoolers with Disabilities
Service for infants, toddlers, and preschoolers with disabilities are also made available through the IDEA. The Preschool Program extends educational rights to children age three to five, including all definitions and requirements. In the 1997 amendments to the IDEA, Congress made an important distinction for preschoolers: States are not required to label 3-5 year-olds in order to serve these children.

Through the IDEA's Early Intervention Program, infants and toddlers with disabilities receive services. This program is directed to the needs of children, from birth to their third birthday, who need early intervention services because they: (1) are experiencing developmental delays in one or more of the following areas: cognitive, physical, language and speech, psychosocial, or self-help skills; (2) have a physical or mental condition that has a high probability of resulting in delay, such as Down syndrome, cerebral palsy, etc.; or (3) at the state's discretion, are at risk medically or environmentally for substantial developmental delays if early intervention is not provided. In addition, under this program the infant or toddler's family may receive services that are needed to help them assist in the development of their child. State definitions of eligibility under this program vary; many states are still in the process of developing their early intervention programs. Therefore,' depending on the state, services may be fully available or still in the process of developing. Under the old IDEA, passed in 1990, the Early Intervention Program was called Part H. Under the 1997 reauthorization will be called Part C, beginning July 1, 1998.

For Additional Information
If you feel that any of the above statements accurately describes your child, we encourage you to find out more about special education and related services available in your child's public school district. Many parents have found the NICHCY publication entitled "Questions Often Asked About Special Education Services" helpful. For children birth through 5 years, ask for the free publication "A Parents' Guide to Accessing Programs for Infants, Toddlers, and Preschoolers with Disabilities."

The Special Education Director for your child's school district, Child Find Coordinator, or the principal of your child's school should bc able to answer specific questions you may have about obtaining special education and related services for your child. In addition, the Federally funded Parent Training and Information Programs across the country are excellent sources of information. For a listing of information sources in your state, NICHCY has a State Resource Sheet for each state and U.S. Territory; this sheet includes the address of the Parent Training and Information Program.

Mental, Emotional, and Behavior Disorders in Children and Adolescents

In this fact sheet, "Mental Health Problems" for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention-deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders, among others. Mental health problems affect one in every five young people at any given time. "Serious Emotional Disturbances" for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community. Serious emotional disturbances affect 1 in every 10 young people at any given time.

Mental, Emotional, and Behavior Problems are Real
Young people can have mental, emotional, and behavior problems that real, painful, and costly. These problems, often called "disorders," are a source of stress for the child as well as the family, school, community, and larger society.

The number of families who are affected by mental, emotional, and behavior disorders in young people is staggering. It is estimated that as many as one in five children or adolescents may have a mental health problem that can be identified and treated. At least 1 in 10 - or as many as 6 million young people - may have a "serious emotional disturbance." This term refers to a mental health problem that severely disrupts a person' s ability to function socially, academically, and emotionally.

Mental health disorders in children and adolescents are caused by biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury. Many factors in a young person's environment can affect his or her mental health, such as exposure to violence, extreme stress, and loss of an important person.

Caring families and communities working together can help children and adolescents with mental disorders. A broad range of services often is necessary to meet the needs of these young people and families.

The Disorders
Following are descriptions of some of the mental, emotional, and behavior problems that can occur during childhood and adolescence. All of these disorders can have a serious impact on a child's overall health. Some disorders are more common than others, and conditions, can range from mild to severe. Often, a child has more than one disorder.

Anxiety disorders are among the most common of childhood disorders. They affect an estimated 8 to 10 of every 1000 children and adolescents. These young people experience excessive fear, worry, or uneasiness that interferes with their daily lives. Anxiety disorders include:

phobia - an unrealistic and overwhelming fear of some object or situation;
generalized anxiety disorder - a pattern of excessive, unrealistic worry not attributable to any recent experience;
panic disorder - terrifying panic attacks that include physical symptoms such as rapid heartbeat and dizziness;
obsessive-compulsive disorder - being trapped in a pattern of repeated thoughts and behaviors such as counting or handwashing; and
post-traumatic stress disorder - a pattern of flashbacks and other symptoms that occurs in children who have experienced a psychologically distressing event such as physical or sexual abuse, being a victim or witness of violence, or exposure to some other traumatic event such as a bombing or hurricane.

Major depression is recognized more and more in young people. Years ago, many people believed that major depression did not occur in childhood. But we now know that the disorder can occur at any age. Studies show that up to 6 out of every 100 children may have depression. The disorder is marked by changes in:

emotion - the child often feels sad, cries, looks tearful, feels worthless;
motivation - schoolwork declines, the child shows no interest in play;
physical well-being - there may be changes in appetite or sleep patterns and vague physical complaints;
and thoughts - the child believes that he or she is ugly, that he or she is unable to do anything right, or that the world or life is hopeless.

Some adolescents or even elementary school children with depression may not place any value on their own lives, which may lead to suicide.

Bipolar disorder (manic-depressive illness) in children and adolescents is marked by exaggerated mood swings between extreme lows (depression) and highs (excitedness or manic phases). Periods of moderate mood cur in between. During a manic phase, the child or adolescent may talk nonstop, need very little sleep, and show unusually poor judgment. Bipolar mood swings can recur throughout life. Adults with bipolar disorder, as common as 1 in 100 adults, often experienced their first symptoms during teenage years.

Attention-deficit/hyperactivity disorder occurs in up to 5 of every 100 children. A young person with attention-deficit/hyperactivity disorder is unable to focus attention and is often impulsive and easily distracted. Most children with this disorder have great difficulty remaining still, taking turns, and keeping quiet. Symptoms must be evident in at least two settings (for instance, at home and at school) for attention-deficit/ hyperactivity disorder to be diagnosed.

Learning disorders affect the ability of children and adolescents to receive or express information. These problems can show up as difficulties with spoken and written language, coordination, attention, or self-control. Such difficulties can make it harder for a child to learn to read, write, or do math. Approximately 5 of every 100 children in public schools are identified as having a learning disorder.

Conduct Disorder causes children and adolescents to act out their feelings or impulses toward others in destructive ways. Young people with conduct disorder repeatedly violate the basic rights of others and the rules of society. The offenses that these children and adolescents commit often get more serious over time. Examples include lying, theft, aggression, truancy, firesetting, and vandalism. Children and adolescents with conduct disorder usually have little care or concern for others. Current research has yielded varying estimates of the number of young people with this disorder; most estimates range from 4 to 10 of every 1000 children and adolescents.

Eating disorders can be life threatening. A young person with anorexia nervosa, for example, cannot be persuaded to maintain a minimally normal body weight. This child or adolescent is intensely afraid of gaining weight and doesn't believe that he or she is underweight. Anorexia affects 1 in every 100 to 200 adolescent girls and a much smaller number of boys.

Youngsters with bulimia nervosa feel compelled to binge (eat huge amounts of food at a time). Afterward, to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Reported rates vary from 1 to 3 out of 100 young people.

Autism spectrum disorder or autism appears before a child's third birthday. Children with autism have problems interacting and communicating with others. They behave inappropriately, often repeating behaviors for long periods. For example, some children bang their heads, rock, or spin objects. The impairments range from mild to severe. Children with autistic disorder may have a very limited awareness of others and are at increased risk for other mental disorders. Studies suggest that autism spectrum disorder affects 7 to 14 of every 10,000 children.

Schizophrenia can be a devastating mental disorder. Young people with schizophrenia have psychotic periods when they may have hallucinations (sense things that do not exist, such as hearing voices), withdraw from others, and lose contact with reality. Other symptoms include delusional or disordered thoughts and an inability to experience pleasure. Schizophrenia is even more rare than autism in children under 12, but occurs in about 3 out of every 1000 adolescents.

Treatment, Support Services, and Research: Sources of Hope
Many of the symptoms and much of the distress associated with childhood and adolescent mental, emotional, and behavior problems may be alleviated with timely and appropriate treatment and support services.

A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.

Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a "system of care." A system of care is designed to improve the child's ability to function in all areas of life - at home, at school, and in the community. For a fact sheet on systems of care, call 1.800.789.2647. In a "System of Care," local organizations work in teams - with families as critical partners - to provide a full range of services to children and adolescents with serious emotional disturbances. The team strives to meet the unique needs of each young person and his or her family in or near their home. These services should also address and respect the culture and ethnicity of the people they serve.

Researchers are working to produce new knowledge and understanding about mental, emotional, and behavior disorders. Studies are also exploring ways to prevent and treat mental, emotional, and behavior problems, including the range of services that may be required.

Many of these studies are funded by Federal agencies within the Department of Health and Human Services, which include:

the National Institutes of Health:
- the National Institute of Mental Health
- the National Institute of Child Health and Human Development
- the National Institute for Drug Abuse
- the National Institute on Alcoholism and Alcohol Abuse.
the Substance Abuse and Mental Health Services Administration:
- the Center for Mental Health Services
- the Center for Substance Abuse Prevention

Major Depression in Children and Adolescents

This is one of a series of fact sheets on the mental, emotional, and behavior disorders that can appear in childhood or adolescence. The Center for Mental Health Services extends appreciation to the National Institute of Mental Health, National Institutes of Health, for contributing to the preparation of this fact sheet. Any questions or comments about its contents may be directed to the CMHS National Mental Health Services Knowledge Exchange Network (KEN) (301)443-2792.

What Is Depression?
Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person's behavior, thoughts, feelings, and body. Major depression in children and adolescents is serious; it is more than "the blues." Depression can lead to school failure, alcohol or other drug use, and even suicide.

What Are the Signs of Depression? Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self- esteem. Signs of depression often include:

sadness that won't go away;
hopelessness;
loss of interest in usual activities;
changes in eating or sleeping habits;
missed school or poor school performance;
aches and pains that don't get better with treatment; and
thoughts about death or suicide.

Some young children with this disorder may pretend to be sick, be overactive, cling to their parents and refuse to go to school, or worry that their parents may die. Older children and adolescents with depression may sulk, refuse to participate in family and social activities, get into trouble at school, use alcohol or other drugs, or stop paying attention to their appearance. They may also become negative, restless, grouchy, aggressive, or feel that no one understands them. Adolescents with major depression are likely to identify themselves as depressed before their parents suspect a problem. The same may be true for children.

How Common is Depression?
Recent studies show that, at any given time, as many as 1 in every 33 children may have depression. The rate of depression among adolescents is closer to that of depression in adults, and may be as high as one in eight.

Having a family history of depression, particularly a parent who had depression at an early age, increases the chances that a child or adolescent may develop depression. Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next 5 years. This young person is also at risk for other mental health problems.

What Help Is Available for a Young Person with Depression?
While several types of antidepressant medications can be effective to treat adults with depression, these medications may not be as effective in treating children and adolescents. Additional research is needed to determining whether antidepressants are useful in helping young people. Researchers also are concerned about potential severe side effects of these medications.

Some success has been reported recently with a drug called fluoxetine (Prozac). Fluoxetine seems to have fewer side effects than other antidepressant medications. However, care must be used in prescribing and monitoring all medication.

Many health care providers use different types of psychotherapy to help children and adolescents with depression. The National Institute of Mental Health has made it a priority to evaluate the effectiveness of individual psychotherapy, family psychotherapy, and group therapy. A specific type of psychotherapy, cognitive- behavioral therapy, is particularly helpful in children and adolescents with depression.

A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan'' developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.

Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a "system of care." A system of care is designed to improve the child's ability to function in all areas of life - at home, at school, and in the community. In a "System of Care," local organizations work in teams - with families as critical partners - to provide a full range of services to children and adolescents with serious emotional disturbances. The team strives to meet the unique needs of each young person and his or her family in or near their home. These services should also address and respect the culture and ethnicity of the people they serve. (For more information on systems of care, call 1.800.789.2647.)

What Can Parents Do?
If parents or other important adults in a child's or teenager's life suspect a problem with depression, they should:

Make careful notes about the behaviors that concern them. Note how long the behaviors have been going on, how often they occur, and how severe they seem.
Get an appointment with a mental health professional or the child's doctor for evaluation and diagnosis.
Get accurate information from libraries, hotlines, or other sources.
Ask questions about treatments and services - talk to other families in their community
Find family network organizations.

It is important for people who are not satisfied with the mental health care they are receiving to discuss their concerns with the provider, to ask for information, and/or to seek help from other sources. Important Messages About Children's and Adolescents' Mental Health:

Every child's mental health is important.
Many children have mental health problems.
These problems are real and painful and can be severe.
Mental health problems can be recognized and treated - Caring families and communities working together can help.
Information is available - for free publications, references, and referrals to local and national resources and organizations - call 1.800.789. 2647; TTY 301.443.9006; or go to www.mentalhealth.org.

Information provided by: U.S. Department of Health and Human Services, 5600 Fishers Lane, Room 13-103, Rockville, MD 20857, Telephone (301)443-2792.

How to Have a Baby - Overcoming Infertility
By Dr. Malpani
Updated for the new Millennium !

Infertility Myths & Facts

Introduction to In Vitro Fertilization

Medications For Infertility

Infertility Counseling and Support

Male Factor Infertility

About Fertile Thoughts
FertileThoughts is designed to help and support anyone and everyone with their family-building challenges. This includes infertile couples/individuals and couples/individuals seeking adoption, couples and single parents going through pregnancy or surrogacy, and couples and single parents going through the various stages of parenthood. The site, conceived in 1995-6 and produced during 1996-7, was created with one purpose in mind: providing support for the site's visitors. From its inception FertileThoughts was and still is a labor of love.

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