The State of Education in the U.S.

In a country where four in ten children have significant literacy delays, one would think that education would be a top priority. Unfortunately, neither of the U.S. presidential candidates is seriously focusing on this issue.

According to the 2005-2006 U.S. Department of Education No Child Left Behind testing reports, over one million children in the U.S. have failed all or major parts of the comprehensive criterion referenced tests that are supposed to measure a child’s “response to instruction.” These statistics are not just disappointing; they are unacceptable. And, yet the candidates continue spouting rhetoric about how each one of them can make a change for the better.

In order to make a change for the better, presidential candidates must seriously address the broken educational system in this country (and not just as a footnote in their speeches).

The public school system in America is in tragic need of repair. We have the opportunity to teach all children at their level to succeed. We can teach them not just facts, but how to think, problem-solve and be independent.  We can teach teamwork, respect for differences, and basic American values that we have, perhaps, started to take for granted.

Perhaps we should start by taking a really hard look at a jazzy slogan with little resources to fulfill its promise. What is No Child Left Behind really doing?  Is it leaving no child out of the system of success?  Is it teaching to the child in the way he or she can best learn?  Is it providing related-support services such as occupational, speech, physical and assistive technologies readily?  Are these services being offered in a timely way? Or, are children waiting, in many cases, almost a whole school year before interventions are made available? Has bureaucracy invaded the educational system to the point of hypocrisy?

Has the system of deciding who is eligible for services become so cumbersome that those administering the system, rather than leave no child behind, leave many children out of the educational running for success? 

High-stakes testing has rewritten the public school curriculums—for the worst.  Teachers’ salaries and performance ratings now depend, in many cases, on how well students perform on these tests.  So are we teaching creative thinkers who will invent the next life-saving vaccine, the better computer and the environmentally cleaner car? Or, are we teaching students how to pass a test so that teachers, principals and school districts look good?

I am an occupational therapist working with learning disabled children. By definition, these children are average to above average in cognitive/intelligence, with a “glitch” in one or two areas of learning. They need help and yet they are often denied services, told by their teachers they could do it if they want to and just need to try harder. 

I see kids with IQs that astound me, become angry, shut down, and eventually turn into marginal learners. Denied services by the public schools because they are not “failing,” these kids begin to believe that they cannot succeed and they give up.  Many of these children never finish high school. (Research has shown that children with learning issues are three times more likely not to finish high school than traditional learners). If these kids with learning glitches do finish high school, they often cannot find jobs that can pay the bills.

We are a use and toss society. We cannot afford to use and toss children who learn differently. It would be unconscionable to leave a child behind on a field trip. We are ignoring the fact that everyday is a learning field trip and standardized test results sadly prove that we are leaving too many children behind.

If you don’t think that the educational system is really your problem (you may not have kids or your kids may be grown) think of this: who will be working to pay you your social security?

Therapy and how it works--The FAST Answer

I've been there--Felt that--panic....something is wrong with my child.

I call for help and there seems to be no reassurances and I am left with more questions than I had when I started.

The preschool teacher says that things just "don't seem right" with MaryJane.  She just isn't playing with the other children, she isn't participating in class and she sits by herself.

You look on line and come up with possible reasons.  You find articles, call the author and want an answer--fast.  But all that person does is talk in generalities and you wind up feeling angry.

I think the issue is not understanding the process of therapeutic help.

The person on the other end of the phone is a stranger. He or she does not know you or your child.  They need to meet you and your child.  That is first.  This usually takes place in the form of an evaluation or a screening.

A screening is more superficial than an evaluation, but can reveal a lot of information in the hands of a skilled practitioner.  It should look at sensory, perceptual, fine and gross motor, task and interactive abilities and language.  Depending upon the process it can unitize standardized and/or criterion referenced tests and measures that produce a profile of the child's current functional abilities.

And evaluation is more in depth and looks more closely at the above issues and should involve the comparative  results of 4-7 standardized tests as well as clinical observations.  In some cases characteristics of suggested potential diagnoses can be made.  However, only a medical doctor or PhD psychologist can make those determinations.

To put it simply...there just is no FAST ANSWER.

As an occupational therapist for over 36 years I hear the panic in the parent's voice, the fear of knowing and desire to get "it" done.  I wish I could answer you over the phone.  I wish I had those powers. I wish I could tell you that in 3 sessions your child will be OK.  I wish I could with just a few words wipe away your anxiety.  I cannot. And any "professional" that tries to give you those answers and/or assurances without knowing your child should be suspect.

Below is a list of what to expect when you call for therapeutic help:

1. Phone interview
2. Setting an appointment
3. Providing forms to be filled out prior to the first visit (screening or evaluation)
4. The first meeting (screening or evaluation)
5. Your receiving the written report (within 2 weeks of the assessment)  (a written report is essential because insurance companies will ask for as justification for payment, pediatrician will want it, schools may require it for accommodations, etc.)
6. Discussion of the report with the therapist 
7. Initiation of treatment if that is the decision to go forward (Keep in mind there is no formula by which the therapist can determine the length of treatment.  This is not an anti-biotic one takes for 10 days.  This is process that changes neurological functions and that does not happen "overnight".)

What you should expect:

1. Therapist accessibility by phone or email as needed (This is time sensitive and meetings in excess of specific limits may be charged for.)
2. Some therapists allow for parent participation in the treatment sessions.  I think this is a good idea so that there is better carryover at home.
3. The therapist keeping progress notes for sessions
4. Written receipts after each session
5. ICD-9 and CPT codes defined for doctors and insurance companies
6. Verbal progress reports and semi-annual or quarterly written progress notes as needed.
7. Therapist accessibility to needed conferences (be expected to pay for the professional time to do this).
8. As treatment progresses, the parents should be working in concert with the therapist as to the direction of therapy.  Both the family and the therapist should be co-supporting each other.

All this takes TIME.  The length of time depends upon many factors but mainly the receptivity of the child.  If the therapist pushes too hard, the child will resist and tune out.  If the therapist does not challenge the child the child will become disinterested and not engage.  It is a delicate balancing act.

Changes usually happen first in therapy, then at home and then in school and other task demand/out of comfort zone situations. 

The may be no FAST ANSWERS, but with patience there can be many GOOD ANSWERS.

Autistic Teens: the Driving Dilemma

Depending upon where you live in the United States, the decision to let your HFASD (High Functioning Autistic Syndrome Disorder) child drive could rest solely on the shoulders of parents.

If you are lucky enough to live in a state such as Pennsylvania, then all teens applying for a driver’s permit must have a physician sign off on their potential driving abilities.  And if you live in Michigan, Montana or Illinois (for example)  then all teens also need proof having a Graduated Driving License certificate.

That teens are impulsive, at times irrational, and often unpredictable is common knowledge.  These characteristics are often even more pronounced in HFASD children.

In addition, a child with HFASD often has issues with communication, motor regulation, and social skills, all of which are factors that can impact driving skills.  Very few studies have been done on these teens to access their abilities and the potential issues regarding their safety and the safety of others on the road.

It is a statistical fact that the incidence of teen deaths and automobile accidents are closely linked.  Some place automobile crashes as the number one cause of teen deaths.  The Center for Disease Control reports that in 2009 8 teens ages 16-19 died everyday from motor vehicle injuries.  The report goes on the state that per mile driven, “teen drivers ages 16-19 are four times more likely than older drivers to crash”.  Therefore, investigating how teens learn to drive and specifically how HFASD teens learn is a significant safety issue.

Occupational therapists often teach driving to adults who have had injuries that change the way they drive: spinal cord injuries for example.  With the exponential increase of those being diagnosed with Autism, the role of the OT in teaching and assessing driving abilities should be a essential part of therapeutic interventions when addressing the functional capacities of teenagers in treatment.

While not all teens with autism will become drivers, it is important to note that many will.  Patty Huang, MD, a developmental pediatrician at the Children’s Hospital of Philadelphia (CHOP), as devised a list of predictive factors of HFASD teens who will want to and who are most likely to become drivers.  This list includes but is not limited to:

·      At least 17 years old

·      Enrollment in full-time regular education

·      Planning to attend college

·      Having held a paid job outside the home

·      Having a parent who has taught another teen to drive

·      Inclusion of driving-related goals in his or her individualized education plan (IEP)—this is where OT’s can have a lot of input!

Occupational therapy, while common with the elementary school aged child, is less so with the high school teen.  The OT’s role in the IEP Plan would be to assess and set the driving related goals.

Research supports that teens that have participated in Graduated Drivers Licensing (GDL) programs are 38%-40% less likely to have accidents than teens that were taught by family members or by other individuals.  With a GLD rights and privileges for operating a vehicle are slowly gradually graduated into a program that eventually leads to fully independent driving.

It is during that period that the occupational therapist can work on increasing rate of motor response speed, visual scanning, peripheral visual awareness, midline issues (turning the steering wheel with both hands), integrating the concept of attention concerns (radio/tape player/friends, etc.) and reciprocal motor movements both upper and lower extremities.

Creating a pre-driving competency checklist may be helpful for starting such a program in your state.  Be sure add specific laws that are essential for the driver to know, process and understand.

Dr. Vanessa M. Dazio, OTD, OTR has a checklist for aging drivers that I slightly altered for the teen driver. You can read more from Dr. Dazio at: http://www.safeaging.com/information/SkillsDriving

Driving is multi-tasking taken to an “art form”.  Driving engages the total person: physically, mentally and emotionally.  Being able to not only be aware of yourself, but everything around you requires practice as well a patience while learning to coordinate multiple tasks with multiple skills. 

Suggested Checklist for the Teen Driver:

Physical Skills

·      Focus constantly on the task of driving even in the presence of minor distractions

·      Twist and turn body quickly (to see motorists or pedestrians coming from the far right and far 
left

·      Move the head and neck side to side, up and down, back and forth and use visual scanning techniques


·      Good joint range of motion and coordination are needed to: 
hold, control and turn wheel
 reach and manipulate knobs/buttons/controls
use turn signals and wipers
 adjust mirrors
 quickly move the foot from the accelerator to the brake

Visual Skills

•       Good distance vision for checking intersections, highway changes, signs
determine distances needed for merging into lanes, making turns, lane changing look at highway and even weather conditions
look for other approaching cars
observe and scan far ahead for potential safety threats or hazards
observe road conditions
watch for pedestrians

•       Close vision is needed to: Judge the closeness of other cars, pedestrians, walkways distinguish curbs, ramps, roadways, etc.
distinguish details
read road signs, maps, inside car features

•       Fluid peripheral vision is needed to see a moving object (like a person stepping off a curb) Hearing is used to detect:

•       Determine closeness of approaching cars (by the sound of tires and engines)
inside car sounds for "empty gas tank" or "check oil".
odd engine sounds suggesting maintenance problems
outside sounds of life: such as children playing, distracted pedestrians
outside warning sounds such as car horns, trains, ambulances, sirens, screams threatening weather conditions, etc.

•       Touch: The awareness of touch is needed to gage how hard to tap the brakes or press the accelerator. It is also important to be aware of gripping the steering wheel.  Fluid use of palmar and pincer grasp with and without associated reaching.

Mental/emotional Skills

•       The brain is "Central Control". It directs the body to do everything when driving. Driving requires a clear and alert mind. The new driver should not have the radio/tape player or other auditory distractor on when driving

•       Quickly and correctly choose the best options in constantly changing situations quickly and correctly react to prevent or reduce accidents or injuries.  To be able to 
quickly make the best decisions given the set of circumstances
 quickly recall and apply driving rules and regulations at all times.

Teens, inclusive of those with HFASD, and the desire to drive are most probably inevitable.  The current statistical rate of teen automobile fatalities does not have to be.  OT’s can make an impact here and the sooner the better!!

Additional references:

·      Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2010). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). [Cited 2010 Oct 18].

·      NHTSA[2009]. Fatality Analysis Reporting System (FARS), 2009. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis.

·      Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and Economic Burden of Injuries in the United States. New York: Oxford University Press; 2006.

·      Insurance Institute for Highway Safety (IIHS). Fatality facts: teenagers 2008. Arlington (VA): The Institute; 2009 [cited 2009 Nov 3]. 

·      Chen L, Baker SP, Braver ER, Li G. Carrying passengers as a risk factor for crashes fatal to 16- and 17-year old drivers. JAMA 2000;283(12):1578–82.

·      Jonah BA, Dawson NE. Youth and risk: age differences in risky driving, risk perception, and risk utility. Alcohol, Drugs and Driving 1987;3:13–29.

·      Simons-Morton B, Lerner N, Singer J. The observed effects of teenage passengers on the risky driving behavior of teenage drivers. Accident Analysis and Prevention

·      National Highway Traffic Safety Administration (NHTSA), Dept. of Transportation (US). Washington (DC): NHTSA; 2000a [cited 2009 Nov 6].  

·      National Highway Traffic Safety Administration (NHTSA), Dept. of Transportation (US). Washington (DC): NHTSA; 2008b [cited 2009 Nov 6 ].

·      Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2007 [Online]. (2009). National Center for Chronic Disease Prevention and Health Promotion (producer). [Cited 2009 Nov 6 ].

Keeping “it” a secret!! Dumping the Guilt!! Helping our families

No parent wants their child labeled, made fun of by peers, or ostracized in any way.  But when does “protection” go too far?  When is “keeping the secret” more harmful than helpful?

Being an occupational therapist is a commitment to life-long learning.  So in my 35+ years of practice I had not encountered a child with XXX Syndrome until December 2011.  I had to get a handle on what it was, prognosis, treatment and life consequences. 

I have chosen this scenario because it was new to me, and perhaps is to my readers as well.

So what is it? It is a chromosomal variation that puts an extra X chromosome in each cell of the human female.  It is not inherited and is caused by an error in cell division in utero.  Generally speaking, these children are usually within normal IQ but may be lower than their genetic siblings, have speech delays and/or poor language skills, and have delayed motor skills with specific coordination and generalized clumsiness.  There are also some slight physical differences but nothing too pronounced that would set them remarkably apart from their peers.

So here I am working with a parent who wants “all of this kept quiet’; not allowed to share with the teachers or the head of school, I am in a therapeutic communication no-man’s land. 

During the evaluation, when trying to help the mother feel less anxious, I said “as one parent to another, our children are who they are and what they are we cannot take blame or credit”.  At this she promptly replied, “oh but it is my fault, it was my egg that did not split right, this is all my fault”.  Stunned and incredibly saddened all I could do is take her hand.

How many parents are in this situation?  How many parents live the with misplaced burden of blame (about their children)?  How often do we (as therapists, teachers, etc.) get so caught up helping the child that we miss what is going on inside the parent that lives daily with these overwhelming feelings? 

As parents, and particularly moms, we (myself included) are in charge of “making it right”, “fixing it” and “kissing away the hurts”.  When hurts just cannot be made right or kissed away, when the diagnosis is devastating, when the earth starts moving under their feet, parents become our patients too.

How your chosen professional deals with you and your family is as important as making sure that your  child is achieving developmental gains.

Sometimes the health situation is something parents cannot “just get over”; it is a seismic life shift that impacts them, their child, and their other children.  Below is a list of ideas that my be helpful for the family and that can easily be incorporated into OT sessions and/or therapy.

1.     Including siblings during some of the therapy sessions

2.     Cooking cookies during a session with siblings and then having a “party/snack” together—letting the child in TX be the “leader”

3.     Helping families structure homework or quiet time (if not homework, drawing, reading, etc.)

4.     Talk about it, and then talk some more, there is no monster in the closet it is a fact that just is—keeping it natural makes it OK.

5.     If needed suggest a support group for the parents/family if there is not one, contact a psychologist or a counselor and with respecting privacy, ask for resources

6.     Former client’s families that have been through similar situations are often a great resource for both information and support.

7.     Encourage the parents to share confidentially with the school, so that accommodations and modifications can be offered and learning stresses decreased.

8.     Celebrate each other:  make a “WOW Board” and each week each person in the family gets to post at least one thing that they are really proud of.

Keep sharing with the family all the wonderful things their child can do. Shine “light” on the achievements.  If they haven’t shared the child’s issues with grandparents, or a close trusted extended family member or friend, encourage them to do so.  Sharing this information allow the parent to not be alone and creates for them a caring community of support.

So, shhh no more, and shoo away the guilt—my daughter (now 34 years old) wrote a song when she was in 7^th grade; the refrain was:  “Kids don’t come with instruction books, and they don’t come with guarantees, I’d like to thank you Mom and Dad for taking care of me”. 

So, remember Mom and Dad, take care of your child and YOURSELF too!!.

Back to School Coping Skills and Frequently Asked Questions

BACK TO SCHOOL COPING SKILLS

How to spot academic issues early.

Is your child is some way “different” from his/her peers and does that difference bother you?  If you have a "feeling" seek an assessment or screening by a registered occupational therapist. HOW  your child does something can be even MORE important than what they are doing!

How to request services.

Simply go into the principal’s office and ask…it is your RIGHT to ask for services.  There is a process, but you can initiate it.

What to ask for and when if you think your child is having concerns.

You can ask for a psycho-educational evaluation.  In fact parents have a lot of power, it is just that the schools are often not very forthcoming about this.

Keep in mind that reports from the  "Student Support Team" are not a legal document. It is basically a "promise" that your child will be given "consideration as to possible needs".

Only an IEP or a 504 Form bind the school to specific actions.

What is the difference between and Occupational Therapy Evaluation and Psychological Evaluation?

A psychological gives an IQ score and assess what the child has learned. An OT evaluation looks at the way a child learns: visual/sensory/motor processing.

Handwriting matters--the answer why it does.

Handwriting is graphic motor skill that uses every sensory/motor pathway in the brain. WSJ article 2011: “Handwriting Trains the Brain”. The WIN™ Write Incredibly NOW™ Program is sensory based and non-repetitive as so many of the standard programs are.  (WIN™ is a registered trademark of Children's Special Services, LLC.  The WIN™ Program is available through YourTHERAPYSource.com).

Homework strategies  AVOID power struggles

“Homework Box” it organizes the “monster” and cleans out the book-bag!~~Ideas from "Learning Re-Enabled" , Elsevier/Mosby Books

Behavior--it's not just about the kids.

Think how are YOU responding to the ups and downs of your child’s school day?  Parents of kids grade 3 and up beware!—relationships turn on a dime—remember to let your kids work things out—coach from a distance.

If you feel your child is "not working up to his potential".

Keep in mind that what you see 1-1 when you are working with your child may be VERY different than what he can do in a class of 20+ children.  The pressures are different.  But if you feel that the teacher is letting your child "slide by" then you may want to think about the following.

Start a "MY BEST" portfolio.  In it DO NOT put HOMEWORK or previous class assignments. Put a drawing and/or a poem, a picture that shows a special interest.  Let your child work on this over time.  Let him (her) know that you want to show the teacher how wonderful they are.

And HIS optimum at school under peer and teacher stress may not be what you see when you are with him at home. But this is the goal he can reach for because it is not a teacher expectation, but something he is already capable of.

Sometimes you need to talk to the teacher--how to handle that.

Go with something written down, think this through at home first. Speak slowly and respectfully, ASK Questions. Do not go in like gang-busters.  But if you do not talk to the teacher first, the principal will not talk to you unless you do.  (State procedures--in most states)

And sometimes the teacher and/or the principal IS NOT RIGHT. Be tactful but clear. (No, his IEP does say...."...."helium and nitrogen do not make a compound"....."You did get a note today. I handed it to you about....."

Report card responses--the child and you.

The Homework Box (see "Learning Re-Enabled")  should take the surprises out and prevent Report Card Shock.  But teachers have email now and you can set up at the start of the year that you want to know immediately if your child is not keeping up, not turning assignments, etc., RIGHT AWAY!!

Most of all this is a temporary marriage between you, your child and the school so hone your negotiating skills, all of life is always give and take and keep your focus on where you want your child to be at the END of this school year.

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