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Special education supplement

Supplement to The Jewish Press Periodical Publication

September, 2007 Building Blocks

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Einstein had learning disabilities, too.

Just because a child has trouble in school, it doesn’t mean the child isn’t bright. If your child has been diagnosed with any of the challenges you see here, call now to schedule an appointment with one of our special educators. We still have a few spaces for the 2007-2008 school year. And we’re dedicated to helping you turn your child’s life around.

“Truly one of the Jewish community’s premiere programs serving young children with special needs” Rabbi Martin Schloss, Board of Jewish Education

Say YESS! to children with:

· Learning Disabilities · Auditory/Visual Processing Difculties · Language Delays · Attention Issues

High Schools that have accepted former YESS! students include: North Shore Hebrew Academy • Yeshiva University High School for Boys (MTA) and Girls (Central) • Darchei Torah • Magen David • Tifereth Miriam • Ezra Academy • Kulanu Torah Academy • Sinai Academy, NJ • CHUSH Higher Education Institutions that have accepted former YESS! Students include: Princeton University (Early Decision) • Reishit Yerushalayim, Israel • WITS-Wisconson Institute for Torah Study • Kesser Dovid, Israel • Queensborough Community College

Since 1992

YESS!

Yeshiva Education for Special Students 147-37 70th Road • Flushing, NY 11367 Tel. 718-268-5976 • E-mail: YESS@acninc.net Rabbi Yaakov Lustig, M.S., Director

All your children shall be students of Hashem, and great shall be the peace of your children (Isaiah 54:13) Building Blocks

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INTRODUCTION LETTER FROM THE EDITORS TABLE OF CONTENTS ABA, EI, CPSE, CSE, IEP, MSC, PT, OT, ST, the list goes on and on. The world of special education has turned into a game of alphabet soup. Today, parents, who care for children with special needs require a dictionary just to keep up with the many abbreviations. There is so much out there. But how do parents know where to go, who to turn to for support, what services are important for their child and, more importantly, how to get those services from competent professionals in the field? Professionals, on the other hand, need to learn how to be more sensitive not only to the needs of the child, but the family as a whole.

Perspective is important when trying to understand the complexity that goes along with an individual with special needs. It is perspective that enables a professional to comprehend what it might take for a family to deal with the needs of such a child.

What can a community whose fundamental premise is chessed – (kindness) to others -- as Rabbi Akiva (Jerusalem Talmud Nedarim 9:4) derives from the verse (Leviticus 19:19) “….Ve’ahavta lere’achah kamocha….–….Love your fellow as yourself…”, do to commit itself to bridge the gap for those who are “different? We believe it is our inherent quality as Jews to see the uniqueness and inimitable character that is a part of each and every one of us. Children with special needs are not to be looked upon as being different. Rather, they are extraordinary individuals who are rich in love, intelligence, and character. They might not act as we do or display “appropriate” reactions to everyday situations, but they teach us patience, care, boundless affection for others and an unfettered attitude toward life. We have to acquire the ability to see things from a different perspective and to treat others in the manner that we wish to be treated. Thus it is easier to bridge the gap when we rid ourselves of the malady of indifference by educating our children, families, and community on how to properly apply the teaching Ve’ahavta lere’achah kamocha to include those with special needs.

Over the past 30 years we have come far in technological advances, that enable us to deliver, with greater efficacy treatments to those with special needs. Indeed, better diagnostic tools, safer and more appropriate equipment, and innovative treatment approaches have created an environ-

ment enabling individuals with special needs to reach their maximum potential and “improve the quality of their lives”. Yet, after all is said and done, have we really improved the quality of life for the vast majority of individuals with special needs? Even with a multitude of new agencies, centers, residences, programs, and healthcare professionals available, by what measure have we benefited the special-needs population? We have all heard horror-stories about the treatment of individuals with special needs in the 1970’s and 1980’s. But even today, are we really improving the quality of life for these individuals and their families?

In addressing the vast topic of special education, it was the hope of the editors to create something that goes beyond the scope of what has been previously done. We have toiled tirelessly to give parents, educators, as well as professionals working with children with special needs, the ability to share the insight of professionals from across the spectrum that successfully work with special children. In this special issue you will find articles on the latest equipment and technology, the newest advances and innovative treatment approaches, resources to give parents the tools at their fingertips to find experienced professionals. We also field questions from parents and relate stories of true family situations.

We truly hope that this latest issue is an undertaking that to some degree adds to the quality of life of our precious special needs children, a population that deserves, to the utmost, our attention, respect, and sensitivity.

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Ilene Klass MS, OTR/L Dr. Abe Kopolovich, MS, DPT Helene Wasserman Ilene Klass MS OTR/L, is an occupational therapist who works for New York City Department of Education and Early Intervention, servicing children with a wide range of disabilities. She specializes in sensory integration. She can be reached at ileneklass@aol.com Dr. Abe Kopolovich is currently the Director of Rehab at Therapy-In-Motion, P.C., a full-service state-of-the art outpatient physical therapy office in Brooklyn, New York. He services the Boro Park/Flatbush community with an emphasis on pediatric physical therapy. He can be reached at (718) 435-7000.

Helene Wasserman is a Special Education teacher, works with children with special needs and specializes in ABA. She can be reached at helljar@aol.com.

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® Introduction From The Editors......................................Ilene Klass............................................... 3 Abe Kopolovich, Helene Wasserman Alphabet Soup.......................................................................................................... 4 If Your Child Needs Help..........................Yaakov Kornreich.................................... 5

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When The Truth Sets In............................Chana Mark, Lcsw................................ 6 Medicaid Service Coordination.................Hindy Hecht, Tzivy Ross Reiter.............. 8 Advocating Effectively..............................Michael Inzelbuch, Esq........................... 10 Importance Of Consistency......................Avrohom Adler, Lmsw............................ 11 Every Child A Gem...................................Shari Kenner........................................... 12 Transitions................................................Esther Lustig........................................... 13 Family Forum And Sibs Speak.................Leah David.............................................. 14 Down Syndrome Amongst Us..................Sarah Sanders........................................ 18 I Don’t Mind, Mom....................................Marsha Winokur, Phd.............................. 18 Guardianship............................................Marcie Roth, Esq..................................... 19

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Choosing A School...................................Chaya Shandel Mandel........................... 21 Seit...........................................................Sori Laufer, Ms Ed................................. 22 Inclusion...................................................Naomi Nadata......................................... 24 Victim Or Bully..........................................Rifka Schonfeld....................................... 25 Augmentive Communication....................Megan Petrizio, Ma Ccc-Slp................ 27 Understanding Typical Development............................................Yittie Rimmer, Ms, Otr/L....................... 28 Stages Of Education Ei, Cpse & Cse......................................Kalmen Greenberg, Lmhc...................... 29 Schools Attuned In Practice.....................Dr. Judah Weller...................................... 31 Making Aliyah...........................................Joan Shrensky........................................ 32

® diagnostic Getting A Correct Diagnosis.....................Kalmen Greenberg.................................. 34 Vision Impairment.....................................Alan Purvin.............................................. 34 Spina Bifida..............................................Stephen Glicksman, PhD........................ 36 Juvenile Idiopathic Arthritis.......................Beth S. Gottlieb, Md............................... 37 Cleft Lip And Palate..................................Simeon Blitman, PhD, Ccc.................... 38 Bipolar Disorder........................................Marcia Kesner, Ms, Lpc, Lmhc............. 40 Sensory Processing Disorder...................Malkie Kahn, Ms, Otr/L......................... 41 Autism......................................................Joshua Weinstien.................................... 43 Down Syndrome.......................................Alyssa Kallenos, Pt................................ 44 Andreas Kallenos, Mspt Is Therapy Needed?.................................Ephraim Yablok, Ms, Pt, Dpt................ 46 Eating Disorder.........................................Shoshana Lewin, PsyD........................... 47 Asperger’s Syndrome...............................Dr. Stuart Ibel.......................................... 49

® treatment Interview With Medek Founder, Ramon Cuevas.........................................Perel Grossman...................................... 50 Music Therapy..........................................Toby Williams.......................................... 51 Auditory Processing.................................Penina Bravermann, Ms, Ccc/Slp-A ... 52 Autism......................................................Kreindi Myers, Ms................................... 53 Cognitive Restructuring............................Dr. Michael Foox .................................... 55 Rabbi Reuven Bernstein Pediatric Bracing......................................Ray Marx................................................. 56 Aquatic Therapy.......................................Biana Spektor, Ms, Otr/L...................... 57 Handwriting..............................................Todd Misura, Otr/L................................ 58 Hearing Loss............................................Tziona Bin Nun........................................ 59

® resources General Resource Listing.....................................................................................61-64 Listings By Category............................................................................................64-65 Directory Advertising............................................................................................68-69 Recruitment Advertising.......................................................................................70-71 Index Of Advertisers..................................................................................................70

Supplement Publisher - Moshe Klass Editorial Coordinators - Ilene Klass, Abe Kopolovich, Helene Wasserman Editors - Chumie Friedman, Tova Stulman Resources Editor - Ruthie Abraham Advertising Coordinator - Shaindy Urman

Recruitment Advertising - Marc Weiss Directory Advertising - Chaya Ritterman Design - Jacqueline Broner For questions or comments or to purchase extra copies, email extras@jewishpress.com

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INTRODUCTION The ABC’s of Learning Disabilities While not a comprehensive list, the following are some common abbreviations and terminology in special education and what they mean.

Attention Deficit/Hyperactivity Disorder (ADD/ADHD) - People with AD/HD have difficulty regulating their behavior, concentrating and focusing. People with AD/HD can be over-active, easily distracted or impulsive. Children with AD/ HD often can’t sit still and lose interest quickly. AD/ HD is a disorder of brain function. Most cases are genetic, but some result from brain injury. These conditions often lead to learning and behavior problems at home, school and work. The National Institute of Mental Health has estimated that approximately 3% to 5% of school-aged children have AD/HD.

formation. Symptoms include delays in language development and reading. This is not the same as physical malfunction of the ear.

Autism - Developmental disability that affects communication and social interaction, adversely affecting educational performance, that is generally evident before age 3. Children with autism often engage in repetitive activities and stereotypical movements, resist environmental change or change in daily routines, and have unusual responses to sensory experiences.

Behavior disorder (BD) - See emotional disturbance.

Americans with Disabilities Act of 1990 (ADA) - Legislation enacted to prohibit discrimination based on disability.

Assessment - The process of testing and measuring skills and abilities. Assessments include aptitude tests, achievement tests, and screening tests. Systematic method of obtaining information from tests or other sources; procedures used to determine child’s eligibility, identify the child’s strengths and needs, and services child requires to meet these needs.

Audiology - Related service; includes identification, determination of hearing loss, and referral for habilitation of hearing including physical deficits as well as perceptual and processing deficits.

Auditory Therapy/Retraining - Therapeutic treatment to address difficulty in accurately processing, organizing and discriminating among auditory information. This is not the same as physical malfunction of the ear. Hearing dysfunction necessitating hearing aides or devices does not indicate or correct this condition.

Auditory Processing/Perceptual Disorder - Difficulty in accurately processing, organizing and discriminating among auditory inBuilding Blocks

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receiving, and assumes responsibility to make sure that all of the individual’s needs are being met.

Child find - Requirement that states ensure that all children with disabilities are identified, located and evaluated, and determine which children are receiving special education and related services.

Classroom Assessment - An assessment developed, administered, and scored by a teacher to evaluate individual or classroom student performance.

Committee on Preschool Special Education (CPSE) - A team of individuals for children age 3-5 that arrange evaluations and recommend services for children with disabilities.

Committee on Special Education (CSE) - A team of individuals for school age children that review referrals, arrange evaluations, recommend services for children with disabilities.

Aphasia - A severe language disorder that is presumed to be due to brain injury rather than because of a developmental delay in the normal acquisition of language.

Assistive technology device - Equipment used to maintain or improve the capabilities of a child with a disability. Equipment that enhances the ability of students and employees to be more efficient and successful. For individuals with learning disabilities a typical example would include things such as grammar checkers, an overhead projector used by a teacher, or audiovisual information delivered through a CD-ROM. would be typical examples. A device could be as simple as a modified pencil or as sophisticated as computer equipment.

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Brain Imaging Techniques - Recently developed, noninvasive techniques for studying the activity of living brains. Includes brain electrical activity mapping (BEAML), computerized axial tomography (CAT) and magnetic resonance imaging (MRI).

Brain injury - The physical damage to brain tissue or structure that occurs before, during or after birth that is verified by EEG, MRI, CAT or a similar examination, rather than by observation of performance. When caused by an accident, the damage may be called Traumatic Brain Injury (TBI).

Case manager - A professional who serves as both an advocate for a person with disabilities and liaison with all of the programs and individuals providing services and care, as well as the individual’s family. The case manager coordinates all of the services and treatment the individual is

Competency tests - Tests that measure proficiency in subject areas like math and English.

Some states require that students pass competency tests before graduating.

Composite score - The practice of combining two or more subtest scores to create an average or composite score. For example, a reading performance score may be an average of vocabulary and reading comprehension subtest scores.

Confidential file - File maintained by the school that contains evaluations conducted to determine whether child is handicapped and other information related to special education placement. Parents have a right to inspect the file and have copies of any information contained in it.

Consent - Requirement that the parent be fully informed of all information that relates to any action the school wants to take in connection to the child; parent understands that consent is voluntary and may be revoked at any time.

Criterion-Referenced Tests - The individual’s performance is compared to an objective or performance standard, not to the performance of other students. Tests determine if skills have been mastered and do not compare a child’s performance to that of other children.

Cumulative file - General file maintained by the school; parent has right to inspect the file and have copies of any information contained in it.

Deaf-blindness - IDEA disability category; includes hearing and visual impairments that cause severe communication, developmental and educational problems that adversely affect educational performance.

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INTRODUCTION If Your Child Needs Special Help – An Introduction

By Yaakov Kornreich The prayer of every parent and grandparent is that every new child and grandchild be born to grow up healthy and whole, in both body and mind.

Today, using genetic screening and pre-natal nutrition and care, we can reduce the danger of a baby suffering specific kinds of birth defects. Yet despite these advances, birth defects still affect about 3% of all children born in the United States.

Some common birth defects can be corrected by medical treatment or surgery, but others, such as Down Syndrome, will impair a child’s physical and mental development. A child’s development can also be impacted by complications during birth, injuries causing brain trauma, exposure to toxic substances, or learning disabilities.

According to the United States Department of Education, more than 6 million children in the US under the age of 21 are now receiving some form of special education services. About half of them have been diagnosed with a specific form of learning disability (e.g. dyslexia), 20% suffer from speech or language impairments, another 20% have been diagnosed to have mental retardation or serious emotional disturbances, and the remaining 10% have other impairments or multiple disabilities.

It is important for parents and other family members to understand that having a child with a developmental disability is not a cause for shame, guilt or despair. They are not to blame, and special education, combined with various forms of therapy, can work wonders for these children. Many who are less severely affected can eventually overcome their disabilities and go on to lead normal adult lives. For more severely impacted children, who will remain handicapped by their disabilities for the rest of their lives, special education, therapy and support programs can still make a major difference, significantly improving their quality of life and easing the burden of caring for them on their families.

Over the past 30 years, federal laws have established the right of all children, ages newborn to 21, to receive the most appropriate treatment and special education for their disabilities at government expense, whether or not they are enrolled in public school.

Signs of delay in development in any of these areas- the ability to understand or express themselves using language, physical activities such as crawling, walking, grasping objects or normal activities of daily living, social development, the ability to see or hear, or intellectual development- are all reasons for a parent to have their child undergo a comprehensive screening and diagnosis by a multi-disciplinary team as soon as possible. Thanks to government-funded programs, such professional evaluations are provided at no cost to all parents.

Parents should also know that if their child seems to be developing more slowly than expected, they should not panic. It often takes an expert eval-

It often takes an expert evaluation to tell the difference between the normal variations in the pace of a young child’s development and a learning disability.

It is important for parents and other family members to understand that having a child with a developmental disability is not a cause for shame, guilt or despair. uation to tell the difference between the normal variations in the pace of a young child’s development and a learning disability.

If the child is diagnosed with a developmental disability, the team will develop, in consultation and with the cooperation of the child’s parents, a comprehensive Individualized Education Plan (IEP) for the child, outlining the academic and behavioral goals and the services to be provided.

Early intervention maximizes the chances that special education and treatment will ultimately enable the child to overcome his or her difficulties. There is no need to wait until a child is old enough for school, and no such thing as starting too soon. The government provides full financial support for early intervention (newborn to age 3) and pre-school (ages 3-5) programs. These programs can provide speech therapy, occupational therapy, physical therapy, special education and parent counseling, in accordance with the goals set out in the child’s IEP. According to federal law, the government must provide all children with disabilities or handicaps a “free appropriate public education (FAPE)”

Yaakov Kornreich is an Anglo-Jewish journalist who has written for several Jewish organizations providing services to children with disabilities.

in the “least restrictive environment.” Depending on exactly where the child’s family lives, these programs and services are supervised and funded by a variety of state, county or city agencies and the local school district (CSE), which set their own eligibility requirements. The programs and services can be provided for a child in a school setting, in a playgroup, at a center, or in the child’s home.

The challenge for parents is to find and select the programs and settings that are best for their child. The local school district will provide parents with information on the broad range of available programs serving all children in their area.

Religious families have the legal right to demand that their child receive the assistance they need in an environment that they feel is “culturally appropriate.”

In the New York metropolitan area, they can choose among a broad range of programs operated under religious auspices that, in most cases, can provide all of the services that their child needs.

Parents should guard against allowing their child to be “steered” into a program just because it is the only one offered by a particular agency. Instead, they should get as much information as they can about all the available programs and services of potential interest in their area. They should then be selective, choosing the best combination to meet their child’s specific needs, feeling free to “mix and match” among providers as necessary.

When evaluating competing programs, parents need to do their homework. They should find out how long they have been in operation, ask about in-service training programs and the level of supervision for therapists and teachers, and whether they are using the latest approaches and techniques in the field. A program should be able to work with parents in their native language, helping them to become full partners in the treatment of their child. It should also make every effort to “mainstream” the child with others who do not have disabilities.

There are more options now available than ever before, but in the end, it is up to the parents.

By making the right choices among them, they can make a crucial difference in their child’s future life.

While we pray that we will never need these programs and services for our own children, it is comforting to know that they are available under religious auspices, at government expense, for any child that needs them. n Building Blocks

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® When the Truth Sets In Accepting A Child With Special Needs

By Chana Mark

Avi and Sara drove back in silence. They both knew that this was the beginning of … somethingsomething overwhelming and difficult. They were each busy with their own thoughts about their eldest son, Chaim. They were always thinking about Chaim, but at least now they had a name for what was wrong with him.

Avi thought, Learning disabilities. What does it mean? The doctor told us he isn’t retarded. But what is he? He’s 7 years old and can’t yet read. He can’t do addition in spite of all the tutoring we’ve gotten him. Yet he knew all of his brachos by the time he was three. And he’s so perceptive about people.

Sometimes he has funny ideas but sometimes he’s – well - brilliant. The doctor really seemed to understand him. She said that a learning program could be devised for him – his school has a resource room. How long will he need this?

When I asked her about his future she said that we can’t know, but the state was legally bound to provide him with assistance all through school. Will he eventually catch up?

Yossi, Chaim’s younger brother, is five and he reads beautifully. Yesterday I heard him call Chaim “stupid.” I was in time to stop a fight but – Sara thought, “Chaim, underneath all these difficulties, I know that you are a very bright little boy. All we need to do is give you a little help like the doctor said and then you will be just like everyone else. Sometimes you are just brilliant and this extra help will enable you to use that good mind of yours.

When they got home they found everything peaceful. Bubby and Zaidy had come through, as usual. “Mommy!” cried little Tali as she ran to Sara. Sara swooped her up and gave her a big hug.

At two years old, children were delicious. “What did the doctor have to say?” asked Avi’s father.

“Well, it’s hard to explain –” All the children’s’ heads turned to them. Avi broke off. “Could we talk later?” Sara glanced uneasily at Chaim – then smiled to cover her discomfort. “How’s my big bechor?”

“Okay,” said Chaim.

Chaim knew that his mother was worried about him. Everyone is busy worrying about me because I’m stupid. I can’t be in school like the other kids. I need more teachers than they do. I try to do the same thing the other kids do but they read the words and I can’t. I know that there is something wrong with me.

“Want to come in and help me set the table?”

Chaim didn’t want to set the table. He wanted to go back to play. But he knew that his mother was making him her “big bechor.” Really, she’s ashamed of me.

“Okay, Mommy.” I’d better do it or else she’ll be upset with me.

He’s such a good kid, Sara thought. With a willing attitude like his he’ll be caught up in no time. All he has to do is apply himself.

After the children were in bed the four adults sat down in the living room.

“What did the doctor have to say?” asked Avi’s mother.

Sara looked at Avi. Avi cleared his throat.

“Well, he has learning disabilities. It means (what does it mean?) that he’s good in some areas but behind in others. He can receive special help in the resource room in school. This will help him catch up in reading and in math.”

There was a pause.

“Is he retarded?” asked Avi’s father.

“No! He’s not retarded!”

Avi’s parents sat up and looked with surprise at their gentle, easygoing son.

“I’m sorry, Dad, I guess I’m upset. The truth is – ” Sara broke in. “He’s just a little bit behind kids his age academically, but with a little bit of help he’ll be fine.”

“So this is temporary?” asked Avi’s mother.

“Yes,” said Sara.

“No,” said Avi. They looked at each other impassively, masking the fury each felt towards the other.

Why are you saying such a terrible, doom-laden thing? she wanted to scream.

Why can’t you face facts? he wanted to shout.

This is who he is!

There was an uncomfortable silence. Avi’s parents looked at each other.

“Well,” said Avi’s mother, as she got to her feet. “It’s been a long day for all of us. Maybe we should be running along.”

“We’ll talk some more tomorrow,” said Sara.

She did not know what else to say.

“Take your time,” her mother-in-law said, gently.

Sara felt tears at the back of her eyes. She nodded dumbly.

Avi’s parents drove home in silence. When they entered the house Avi’s father closed the door, shutting out grief and giving them some space to breathe out with each other and to talk things through. Avi’s mother poured tea for them.

“I think they have a lot to sort out right now,” she said.

“Yes they do,” Avi’s father replied slowly.

“And I think they will be sorting it out for quite a long time.”

“I think you’re right.”

Avi’s father sighed. “Sometimes being right is no comfort at all.”

Today, Baruch Hashem, the child with special needs is recognized and provided for. Yet learning the truth and living with it are very painful challenges for parents.

One of the foundations of the parenting function is that the child is ours. He came from

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Chana Mark, L.C.S.W. is a psychotherapist with a private practice in Suffern, N.Y. She sees adults, couples, adolescents and children. She completed an Interdisciplinary Training Fellowship at the Westchester Institute for Human Development (at Westchester County Medical Center) and has extensive experience working with children with disabilities and their families.

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There are five elements in the process of acceptance The five elements or stages of mourning were first codified by Elizabeth Kubler-Ross in her book, On Death and Dying. The focus of her studies was on people who had learned that they had a terminal illness.

However her findings have application to the mourning of other losses as well.

Denial When we receive information that is too overwhelming or painful to bear our first reaction is to deny its reality or its severity.

We see that Sara was having great difficulty accepting that her beloved bechor was deficient in a way that might be permanent.

As a defense, denial is called “the first and the worst.” As the first stage of mourning, it is a natural reaction. However, parents who will never allow the truth to sink in will do their child and themselves a great disservice.

Anger Anger is our response when external reality does not fulfill our expectations.

Both Avi and Sara were angry at the situation, and they took it out on each other.

Sometimes parents get angry with the doctor, deriding him or her in their minds (or to her face). Really, anger is a way we have of making ourselves feel strong and in control, to cover over unbearable feelings of sadness and helplessness.

Bargaining We are beginning to let the awful truth in, but not completely. Maybe it’s just temporary. “He just needs tutoring for six months.” Maybe it isn’t so bad. “It will take longer, but eventually he’ll be just like everybody else.”

Sadness or Depression Avi is a little farther along than Sara in accepting the truth, and his sadness and depression are more evident. He is even resigned to the worst. “That’s the way he is.”

Chaim’s future may not be so bleak, but Avi cannot see this yet. Sara is also very sad.

Her mother-in-law’s gentle acceptance is enough to trigger it.

Acceptance Avi’s parents have accepted the situation and are aware that their children will need more time to do the same.

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FAMILY Truth Sets In continued from previous page us and certainly it is our responsibility to provide for him as well as we can so that he will develop into a physically and emotionally healthy adult.

But more than this, the goal that we strive for, the all-encompassing hope, is that he will take in our values and learn from our experience as well as his own. We hope that he will live those values, passing them on to his children and contributing to society.

When a child rejects our wisdom and our values we feel – rightly or wrongly – that we have failed as parents.

What if we are faced with the real possibility that a child of ours cannot take in our wisdom or our values, or can do so only in a limited way?

What if he cannot go on to marry or contribute to society? When this happens we feel wounded in our parenting capacity. We cannot say of such a child that he is “different.” He is delayed or deficient in those capabilities that are required for successful living.

This blow to our parenting facility is experienced as a loss. Each loss must be mourned before it can be healed and this mourning process follows a natural course. We must give ourselves time.

Children with disabilities know that they are not simply “different.” They know that they are deficient in areas and activities that other children their age perform without effort. When the adults around them sugar coat the truth, it causes them

Today, Baruch Hashem, the child with special needs is recognized and provided for.

Yet learning the truth and living with it are very painful challenges for parents. to feel anxious and isolated. Anxious, because they are always afraid that they will not perform as expected. They may feel shame by thinking they are disappointing to the people they love and depend on. Isolated, because they feel alone in these difficulties and because no one seems to understand them. What they need from us, as parents, is skilled help and lots of encouragement. It should be our

goal to enable them to experience success. The experience of success builds self-confidence and self-confidence builds motivation. When we can enable children with disabilities to feel motivated to meet their challenges there is real hope that they can go on to succeed.

As parents, being able to fully accept the reality of raising a child with disabilities takes time.

Once we accept it fully and willingly, we are the people who can provide what he needs, support him through his struggles, validate his success and watch him flourish. Isn’t this what nachas is all about?

As parents watch their child move forward, helping, encouraging, filling in gaps, the months and years roll by. Other children in the family move forward, develop friendships and other relationships, and proceed to become more autonomous. The child with disabilities moves forward as well, but his limitations – well – limit him. He feels sad about this and we feel sad too. This enduring sorrow is part of what we must learn to accept and help him to accept as well.

Part of this enduring sorrow for the child is a basic element in his concept of himself: that he is damaged. Note for the psychotherapist: It is the view of this writer that the child’s experience of being damaged is the most crucial aspect to be addressed. Because it endures always he will not “grow out of it.” Painful though it is, it must be brought to the surface and worked through so that it too can be accepted. n

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FAMILY Making The Most Out Of Medicaid Service Coordination

By Hindy Hecht and Tzivi Reiter The day-to-day responsibility of caring for a child with developmental disabilities can be overwhelming. Parents devote their time and energy to ensure their child is given the appropriate education, enrichment and stimulation to realize his potential. Yet at the same time they have many other responsibilities, including caring for their other children, running their household, maintaining employment and meeting financial obligations, leaving them paradoxically with little time to research and investigate the services available to lighten their load.

This is why the role of the Medicaid Service Coordinator [MSC] is so essential. The MSC program provides parents with a personal researcher, investigator, life coach and advocate.

The Medicaid Service Coordinator has the perspective to step back and help families objectively view their situation, needs and life goals.

The job of an MSC is to not only identify gaps in service, but to help the family envision the goals that they would like their child to achieve and to develop a plan of action toward the realization of these goals.

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Identifying & Working On Goals For some families, goals are immediate and short-term. One mother of a child with autism and severe behavior challenges described her goal as the following: “I would just like to be able to go out for a cup of coffee with my husband. I have not been able to do that for 7 years.” Her MSC helped identify respite and recreation programs for her son, enabling her to have free time after school and on Sundays.

Other goals are more long-term and far-reaching. One mother described her goal of wishing to maintain her physically disabled daughter in her home as she continued to grow. Yet carrying her up and down the stairs to her bedroom was becoming prohibitive. Her MSC helped obtain the funding for an elevator to be installed, so that she could continue to care for her daughter in her own home.

Another parent described a goal of seeing her daughter “make a true friend” and “eventually be mainstreamed with her peers.” Her MSC researched and identified a social skills training program for her daughter, and additionally arranged for her to attend a program with typically developing peers for her to interact with.

Still another parent described her goal for

Summer Camp Along with overseeing programming for the school year, MSCs are highly involved in summer planning.

Helping families to identify appropriate camping programs, the MSC presents the family with available options for summer opportunities. The MSC assists the family in completing applications, and makes referrals for obtaining any necessary updated testing and medical paperwork. Once the child has been accepted into a camp program, many families are faced with a significant financial obligation. MSCs often help obtain 12 month IEPs (individualized education plan) to ensure the child’s enrollment and reimbursement in an appropriate camp setting. In this instance, while the child may have part of his camp tuition covered by the Department of Education, the parent is often left to cover a considerable portion of the camp bill. MSCs research reimbursement programs being offered by various agencies, and submit applications to available funding sources. Typical grants for camp reimbursement range from $200-$1500, and are based on financial need.

Mr. Cohen, a single father, found himself in an untenable situation. Approaching Chaya, his MSC, he reminded her that he would be unable to stay home with Chaim during the summer. When his MSC suggested a camp program, Mr. Cohen exclaimed that there was no way that he could cover another expense from his current salary. Understanding the desperate nature of Mr. Cohen’s situation, Chaya applied for an eight-week camp program for Chaim, and advocated to the camp director for a scholarship, explaining the extenuating circumstances of the family. As a result, the camp reduced Chaim’s tuition by half. With her work not yet complete, Chaya applied to seven agencies that were offering camp reimbursement programs that summer. Three weeks later, Chaya met with Mr. Cohen, offering him eight weeks of camp plans for Chaim – fully paid for!

Tzivy Reiter, LCSW is Assistant Director at Ohel Bais Ezra and has worked at Ohel for the past 12 years.

Hindy Hecht has a Masters in Human Behavior and Organization Psychology and has been with Ohel for 12 years. To contact either author or to learn more about Ohel Children’s Home and Family Services, please call 718.851.6300 or visit www.ohelfamily.org Building Blocks

September 2007

her son with multiple and debilitating disabilities as wishing that he would “truly live,” as opposed to having what she believed was just a “mere existence.” The MSC together with his family created a service plan to achieve this which included intensive residential habilitation to enhance his skills, enhanced socialization opportunities through volunteer and recreation programs, the procurement of a more technologically advanced augmentative device which increased his ability to communicate, & the development of a specialized therapeutic residential program for his long-term placement.

Knowing What To Ask Yet despite the fact that there are countless resources at the disposal of families through MSC, many families do not make the most out of this vital service. Individualized Service Plan [ISP] meetings are held at least annually with the individual’s MSC and their family, yet goals are often redundant and families do not always realize what is at their disposal. The following is a general guideline of the type of goods, services and programs that MSC can offer many families, so they can work toward achieving both their short-term and longterm life goals.

Recreation & Respite Programs There are a myriad of programs available to children which provide socialization and recreational opportunities that parents are often unaware of, providing much-needed respite. Some of these programs specialize in services for children with high needs including children who have autism, are nonambulatory, or have severe behavioral challenges. MSCs research suitable programs, and work together with parents to obtain the necessary documentation to secure enrollment. Referrals can be made to after-school, Sunday, Shabbaton, B’nos and school holiday programs.

In addition, MSCs frequently refer children to in-home respite programs to provide additional relief to families. Typical in-home respite provides 1:1 care by a trained counselor to a child with a disability in his home for several hours per week. Eligibility for this service typically entails an updated psychological report with a confirmed diagnosis of developmental disability.

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FAMILY Environmental Modifications (e-mods)

Financial Grants/ Reimbursement

Families that would like to continue caring for their disabled children at home, yet require assistance in the physical environment to do so, are eligible for modifications that are fully funded by OMRDD. Examples of environmental modifications that have been obtained by MSC include adaptive strollers, communication devices, wheelchair lifts, adaptive high chairs, ramps, bath chairs, gates, vehicle modifications & elevators.

Families with children with disabilities often have expenses that are above and beyond the norm, including fees for specialized therapies and doctor visits. MSCs at times are able to successfully access funding for some of these costs. Expenses that MSCs can often obtain partial reimbursement for include gym memberships, specialized therapies & doctor visits. Supporting documentation and a doctor or therapist’s note is needed to qualify. In addition, many MSC’s go above and beyond in advocating to local merchants and stores for the discount or donation of necessary items for families they represent, and have successfully procured a variety of items including household furniture, computers, and a Sukkah.

Referrals Families with children with disabilities can often benefit from additional services including parenting groups, support groups, psychoeducation and therapy. MSCs research and make referrals for available services, including resources through OMRDD and the general community. The MSC researches the individual’s insurance coverage, specific medical needs and necessary accommodations, as well as availability for appointments, and makes referrals to the most appropriate facility. Family Education Training programs & In-Home Behavior Modification Programs are two frequently used Medicaid Waiver services for families of children with disabilities.

Accessing Entitlements

In order to secure e-mods, the MSC needs to identify the need with the family, secure a therapist or doctor’s letter justifying this need and obtain 3 bids for the cost.

This information is submitted to OMRDD. In addition, in certain locations such as Long Island, building materials must be approved by the local DDSO. In order to be eligible to receive e-mods, the individual must be receiving Medicaid Waiver as well as Medicaid Service Coordination.

Housing When appropriate, MSCs will often discuss housing options for the child they are working with. Future planning is an integral component of the MSC function. The MSC will work with the family and the individual, assessing if their current residential setting meets their needs, and work towards the eventuality of considering residential placement outside the family home. MSCs will assist families in identifying agencies which provide residential services, and assist families in selecting the type of placement which will best meet their needs. Helping with the application process, the MSC will often accompany the family to the potential site, assisting the family in assessing the appropriateness of the proposed setting.

In raising a child with a developmental disability, parents are faced with the task of applying for and updating governmental benefits and entitlements. A confusing and time-consuming task, the MSC assists the family in the process. MSCs submit for Medicaid Recertification, ensuring that the child has continuous coverage. The MSC guides the family, helping to secure all available governmental resources available to a child with a disability, including Medicaid, Medicaid Waiver, Food Stamps, and Department of Education Services. One family that required out of state Medicaid coverage for their child’s upcoming surgery was helped to obtain it by their MSC. In addition, MSC’s routinely access many other resources including Access A Ride & Reduced Fare Metrocards.

Life Coach As the child matures, the MSC takes on the role of a life coach. Discussing dreams both large and small, the MSC helps the child identify his life goals, and develops a plan to achieve these goals. Goals may be small – learning how to swim, play piano, or visit Disney World; or far-reaching – wanting to move out of the family home, live on his own with friends, or date. As they work together to identify life dreams, the MSC helps the individual to develop a realistic plan leading to the attainment of these goals.

Asked by her MSC what her biggest dream in life was, 17-year-old Devorah responded “I’d like to move in to an apartment with my friends Rachel and Shani.” Exploring this dream with Devorah, her MSC discussed the many aspects of what this dream entailed. Devorah described her desire to follow in the footsteps of her older siblings, reaching the age where she would be grown up enough to be on her own, living in the community, holding a job, and hosting friends in her home. Together with her MSC, Devorah identified the small goals that she could begin to work on immediately, toward the attainment of her ultimate goal in the future.

When an MSC is working comprehensively in partnership with families, it can provide exceptional support, concrete assistance and relief. In the words of one mother, “ I know that I have someone in my corner. It makes facing the trials & tribulations that come with being the parent of a handicapped child that much easier to bear.”

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FAMILY

® Advocating Effectively For Your Child

By Michael I. Inzelbuch, Esq. Responsible child advocacy is one of the hallmarks of the Individuals with Disabilities Education Improvement Act (“IDEIA”), the Federal legislation that governs much of special education in the United States. However, despite specializing in this detail oriented area of law for some ten years (primarily as an attorney representing the interests of children), until this day I am still amazed by the number of parents who elect not to take an active and constructive role in the process which develops a child’s educational program and, more importantly, establishes the foundation for his/her future. It is my fervent hope that this article will persuade those parents who, to date, have not actively participated and will provide parents with some knowledge so they can effectively advocate for their child (see sidebar about parents rights).

When speaking of their child’s needs, parents should focus and stress what is “special” and “unique” about their child, the truly “individualized” needs, and not argue or demand only “the best” the “optimum.” This may sound like an attempt to minimize the advocacy efforts of parents, but in fact represents what much of the legal decisions in this area of the law dictates. In addition, if a parent requests “the best” for his/her child, although it may be based on the noblest of intentions, I have often seen school districts summarily dismiss such requests based on school official’s knowledge of the aforementioned legal standard. I have also seen school districts misuse parental demands as wishful thinking, often wrongly characterizing the parents as being in denial and somehow thinking that more services or the best program will somehow make little David or Rachel better. Avoid this at all costs!!! Stress your child’s needs in terms of what is needed for him/her to progress and what is appropriate for him/her to acquire knowledge and benefit at his individualized level and based on his/her unique needs.

It is also important to remember that for the benefit of obtaining the most for your child, one should attempt to be cooperative rather than hostile, demanding or highly emotional (although I know that this is easier said than done). Parents, or actually the child, lose when parents come to meetings (sometimes with alleged advocates who often are advancing other issues other than your child or even attorneys not skilled in this area of the law) when they appear to dictate their personal wishes to school officials, rather than trying to participate in what is intended to be a collaborative process as to the child’s individualized educational needs. School districts may take similar dictator-like positions by deciding where a child will attend school or what goals and objectives will be utilized before meeting the child or actively listening to the parents. This tramples upon the requirements of IDEIA, and such self-serving actions should be challenged.

WHAT CAN I DO FOR MY CHILD? Learn everything you possible can about your child’s diagnosis, abilities and needs. Many

books and magazines exist at the library or Jewish book stores which provide readily understandable information. Become familiar with the rules and regulations that apply to your child’s program.

Request copies of these from your local school district or from your State Department of Education.

(They are required to process this information and provide it to you upon your request.)

Seek out other parents and established organizations whose goal is to help parents.

For the benefit of obtaining the most for your child, one should attempt to be cooperative rather than hostile, demanding or highly emotional.

Parents Rights Recently, the United States Supreme Court affirmed this integral right of parents. Specifically, the Supreme Court, in part, stated that the goal of IDEIA is to ensure that all children with disabilities have available to them a free and appropriate public education (“FAPE”). The Court went to great lengths to remind the school district in question that the parents serve as a member of the Team that develops the IEP, that parental concerns must be considered by the IEP Team, and in certain instances, require the IEP to be revised to address certain information provided by the parents. [Winkleman v. Parna School District, 550 U.S. 2007 decided in May 2007.]

Attend ALL meetings concerning your child despite the slight inconvenience this may cause at all costs such as the annual IEP meeting but also parent conferences, evaluation planning meetings, and meetings where evaluations are discussed.

Keep a copy of all your child’s records such as report cards, IEP’s, evaluations, progress reports, teacher’s notes, work samples and projects.

This will allow you to monitor your child’s progress, or lack thereof, in a precise data driven format so your concerns and requests can be taken seriously and acted upon. (I can not tell you how many cases where I have prevailed on behalf of a child that was largely due to the parents keeping detailed information/documentation in their possession.)

Ask Questions. Share Information. Do not attend meetings and simply accept what is being told to you about your child. Ask specific questions about your child’s progress and your child’s needs such as what your child was able to do in September and what he/she can now do in May/June. This will allow you to monitor progress in a meticulous fashion. Also, share information about recent evaluations you may have completed privately or your recent experiences with your child, for example on a summer trip. (After all the whole purpose of special education is for your child to take the skills and information he/ she obtained and apply this in the “real world”). This will allow the individuals who are responsible to work

Michael I. Inzelbuch, Esq., is an attorney licensed in the states of New Jersey and New York who has assisted hundreds of parents and their children obtain individualized and appropriate educational services. Mr. Inzelbuch can be reached at michaelinz@aol. com or 732-905-0325.

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with your child on a daily basis to better understand his/her needs and preferences.

WHAT CAN I DO TO PREPARE BEFORE A MEETING? Visit your child’s program before the meeting so you can meet the staff beforehand and, more importantly, see what your child’s schedule and learning environment is. [It is, of course, understood that the choice of time must be mutually convenient to both you and the school district and can not serve to disrupt the program.]

Think of questions or concerns you may have and write them down prior to the meeting. This will allow you to listen to the professionals at the meeting without losing focus as to your concerns for your child and what educational services you are seeking.

Talk to your child. If appropriate, talk with your child about his/her feelings about school such as what he is learning, other children in the class, the specific services he is receiving and what he/she likes most and least. This will allow you to possibly identify areas that need to be reviewed or focused on at the meeting and also may allow you to verify the frequency and duration of services your child is set to receive per his/her IEP/Service Plan (Non Public students in New Jersey receive educational services through a Service Plan as opposed to an IEP). Allow your child to express his/her frustrations, his/her disappointment, his/her preferences.

By visiting your child’s program, planning in advance of the meeting and talking to your child, you will better know your child’s needs, strengths and weaknesses.

WHAT CAN I DO AT THE MEETING? Listen. Allow the professions such as his/ her teacher(s), therapist(s) and Case Manager to discuss your child’s needs and progress.

Bring a friend or knowledgeable advocate to the meeting so he/she can take notes so as to allow you to concentrate on what is being said and so your opinions can be expressed in a calm demeanor.

Tell the team of professionals of which you are one (parents, not coincidentally, are listed as the first member of what comprises the IEP Team) of the concerns you have in specific terms. Do not express these concerns in less than specific or general terms such as “I want David to read” or “Rachel will walk” as everyone involved would like to see this occur and because this provides no specific guidance as to what you are seeking for your child.

Better possible ways to express your concerns would be “David will be able to read five (5) word sentences by June” or “Rachel will walk unassisted under certain prescribed situations.”

Work collaboratively and closely with the professionals who work with your child. This should be done in a positive, non-threatening and partnership-like manner so as to allow your child to obtain the benefit of the resources available. Get to know these people – communicate with them on the phone, at school events, volunteer in the classroom and/or through a written communication log.

It is my hope that the above information will allow parents to make informed decisions when advocating for our future- the children. n

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FAMILY The Importance of Consistency

By Avrohom Adler, LMSW Consistency, Consistency, Consistency. This is one of the most important words to keep in mind when raising or educating a child with special needs. While every child needs consistency with parents or between school and parents, this is especially important for children with special needs. The parents and school should be “on the same page” whether dealing with educational or behavioral needs. In New York State, the Individualized Education Plan (IEP) is used to work with each child’s special educational, social and behavioral needs. This document is generated through a meeting in which Board of Education professionals and family members discuss the child’s needs and come to some agreement on the most effective ways to work with the child.

It is of utmost importance for the family to be involved in this process and to advocate for their child all along the way. When the child comes home from school, parents should reinforce what the child has learned during the day. Likewise, what is being done in the home should be reinforced at school. For example, if the school

is using a particular item for positive reinforcement and when the child comes home that item is automatically given to the child, the item loses its reinforcement value. A very basic example of positive reinforcement is if you give a child candy after he/she takes a bath (assuming he/she has refused to be bathed), after a while he/she will associate the bath with something positive. This usually makes bath time easier. If the child re-

Every child needs to hear from their parents and teachers that they are loved and valued. ceives candy throughout the day, at bath time it will be harder to use candy as reinforcement since its value to the child has decreased.

Using food as reinforcement—although often the easiest approach yielding the quickest results—for a variety of reasons should not be used

Avrohom Adler, LMSW, Clinical Program Director at Mishkon a program of the Jewish Board of Family and Children’s Services.

Mishkon provides residences, therapeutic day services, and other programs for developmentally disabled people and their families. For more information, call (718) 851-7100.

as the sole reinforcement for behavior. First, the foods that children enjoy and are therefore motivated by are generally not of a healthy nature.

Second, as time goes by it is difficult to wean the child off the reinforcement. The most important reason, however, is that in the long term, using encouraging phrases such as “good job” or “you did great” will do more for the child’s self-esteem than any food can. Every child needs to hear from their parents and teachers that they are loved and valued, and using these terms will solidify that idea for the child. Though not a new idea, consistency is a very important concept to keep in mind when raising and educating a child with special needs. n

“Different Talmidim have different needs and have to be treated differently. That’s P’TACH.” -RABBI YISROEL REISMAN

Every child can learn in a nurturing environment from caring teachers specially trained to recognize and manage learning differences in children.

They build upon children’s strengths and teach them to overcome their weaknesses – students go on to college, careers and marriage.

P’TACH, the leading provider of special education in the Orthodox Jewish Community, offers: • DOCUMENTED SUCCESS – students go on to college, careers and marriage • SCHOLARSHIPS – $1.5 million already awarded • 31 YEARS EXPERIENCE delivering high quality special education • 24 PROGRAMS in the New York Metro area, nationwide, in Canada and Israel • HIGHLY TRAINED EDUCATORS experts in the Schools Attuned® method of teaching • STUDENT TO TEACHER RATIO OF 4:1 • SMALL CLASSROOMS for maximum attention to each student • PRIDE AND SELF CONFIDENCE for students and nachas for parents

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By Shari Kenner

FAMILY

® Every Child A Gem

Long ago, in a province far away, a large clay sculpture was being transported when it started pouring. This caused a crack to appear in the clay, through which a glowing spot could be seen. Upon further examination it became evident that once the outer layer was removed, the whole sculpture was in fact really made of pure, shining gold, radiating beautifully for all to see. * People who have developmental disabilities are like this sculpture–beneath their ordinary and sometimes imperfect exteriors, their shining souls glow, trying to break free and fly. It is our job, pleasure and honor to attempt to help them spread their wings and soar.

A Vermont man, Wilson “Snowflake” Bentley, spent thousands of hours photographing snowflakes.

He said no two are alike, and described them as “tiny miracles of beauty,” and “gems from G-d’s own laboratory.” Each of our clients is a special gift to this world, a gem from on high, with their own individual strengths, talents, needs and desires. While they may not always be able to express themselves clearly, they each have a unique world inside them, put on this earth by Hashem, waiting to be uncovered.

Some are put into a state of bliss by music.

Others create art, and some love dressing up. Their friends and family are the light of their lives. They are interested in everything from cars to checkers, to books on how things are made. Many are amazed at the simple things around them, intuiting that those are what are truly important in life. Blessed by their family’s love of Yiddishkeit, they recognize Torah is, above all, the essence of our lives. Some daven from the siddur, others just talk to Hashem from the heart in their own way. They observe mitzvahs joyfully. Some dream of Israel. Recently, when a group participated in an organized trip to Israel, they were smiling and bubbling over with enthusiasm for weeks.

Even the most “limited” among them love to dance and sing to Jewish music, their faces aglow, looking like I imagine the tzaddikim of old did when they were closest to G-d.

We work from a person-centered perspective.

Who is this individual before us? What is impor-

tant to him in his life? How can we help him fulfill his deepest dreams? Each one has dreams, even the quietest and most withdrawn. Through observing and talking with people with developmental disabilities, their families, and caregivers, we try to peek inside their souls and discover who they are and what they crave. For Hashem made them, and like us they have individual neshamas, yearning to be who they are deep down.

They are not “broken,” and we do not have to “fix” them…

They are not “broken,” and we do not have to “fix” them, as the old “medical model” of “treatment” used to suggest. We need to see them, feel them, and help them connect with those things and people that they love. We must strive to learn their language, see how they view their world. They constitute a whole range of levels of functioning, each different, but then again, don’t we?

While traditional therapies are still important, we’ve seen that, when people with developmental disabilities spend time fulfilling their dreams, big or small, they will often be happier and behave more appropriately than they would after only being exposed to traditional treatment modalities and medications. Just as we spend our days doing things that we feel are important, that we enjoy, and that have meaning to us, so too our developmentally disabled friends, children and neighbors should spend their

Shari Kenner is a social worker who has been a service coordinator at HASC Center for the past 11 years. She has worked in the field of developmental disabilities for 21 years.

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days indulging their interests and preferences.

When I hear others speak about “those people” who are “disabled”, I sometimes wonder if it is perhaps us, not them, who are the ones that are really “dis-abled.” We are taught to think that life is about the pursuit of knowledge and formal education. However, I’ve learned that what life is really about is spirit, or what is inside someone’s soul; what they put into the world, how they make others feel. I’ve watched the joy, the purity, the ecstatic look on their faces, as well as the directness and realness of all their other emotions, and have come to understand that they are connected to the essence of life in a far deeper way than I, and many of us, will ever be. Because they often do not possess sophisticated cognitive insightfulness, they usually cannot intellectualize away their feelings. They feel life as it is on the deepest levels – they experience true emotion and exhibit pure spirit.

We may not always like their direct way of expressing those feelings, perhaps they are the ones who have something to teach us about what is really important in life and not the other way around.

When Yehuda approached Yosef in Egypt in Parshas Vayigash after having not seen him for a long time (and perhaps never really having seen the real him), some of the commentaries say ‘vayigash Yehuda’ means that this time Yehuda looked beyond Yosef ’s obvious appearance to see who Yosef essentially was. He approached Yosef on the deepest levels possible. Yehuda, I believe, had a great deal to teach us about how to view those around us, including the “disabled” among us.

There was once a religious enclave in the woods that sadly was no longer getting any members. Afraid they were going to die out, they asked a wise rabbi living nearby what they could do. He said he could not help them, but that they should know that one of their present members was destined for greatness. This surprised them, but as they began thinking about it, each wondered if one of the others among them, despite their imperfections, could be that person. They began treating each other very well. People around their community started to feel this warmth and love, and slowly some began joining their enclave to study. Neighbors started spending time near them. Their love and acceptance turned into a powerful light, shining brightly for all to see. * n *Both anecdotes from “Chicken Soup for the Soul”

ple” pereally bout owpirit, into hed s, as ther are way they ghtheir els – pirit. sing have tant

FAMILY Transitions, In Every Sense Of The Word

By Esther Lustig In genetics, a transition is defined as a point mutation occurring within the DNA sequence. Variations and mutations of DNA sequences affect how humans develop diseases and respond to drugs, chemicals, and other pathogens. These transitions are caused by copying errors in the genetic material during cell division, or reproduction. Interestingly enough, a transition is also defined as the period during childbirth immediately preceding the baby’s entrance into the world, the joyous moment when a woman transitions from wife,

pt in or a the gash ond espest al to lud-

Making decisions leading to transitions for a developmentally disabled child is often agonizing and painful.

the emed a said now d for gan othould very feel oinendance r all n

daughter, and sister to mother. This beautiful moment can be compared to a transition as defined in music, a lovely and harmonious passing from one key to another. However, musicians are equally aware of another sort of transition, that of a sudden and unprepared modulation or shift in key. Sometimes, when enough transitions occur concurrently, a woman’s most joyous moment can become just such a sudden and unprepared shift.

Often, the instant a woman becomes the mother of a developmentally disabled child she is thrown into a new and unfamiliar world. In this instant, all of the hopes and dreams that she spent nine months creating for the new life she has just brought into the world feel as if they have been shattered. Instead of walking around with the bright confidence of a new parent, mothers of developmentally disabled children feel unsure, lost, and alone. Social service agencies exist as the experienced guide, lighting the way for newcomers by helping them onto the right path and ensuring that they are never alone. These agencies are here to bring mothers out of the daunting place they have been thrust into by leading them through the jarring transition they are faced with.

This transition however, is only the first of many facing the parent of a

developmentally disabled child.

Any parent can attest to the fact that each and every child experiences numerous transitions throughout their life. Toilet training, entering the first grade, going to sleep away camp for the first time, becoming bar mitzvah, and graduating high school are only a few of the transitions that mark a child’s growth and maturity. The difficulties faced by parents of so-called “typical” children during these transitional moments are often dwarfed by those of parents of developmentally disabled children. Making decisions leading to transitions for a developmentally disabled child is often agonizing and painful. For instance, choosing a school that is right for your developmentally disabled child can be a process spanning months and deciding what path your child should take after they have grown out of that school can be even more challenging. However, parents of developmentally disabled children most often express that the greatest transitional challenge they experience is that of placement of their child in an Individual Residential Alternative, or a group home.

On a molecular level, a transition occurs when an excited electron moves from one energy level to another. This transition will be accompanied by a gain or loss of energy. This change of resting location for the electron is much like the transition a developmentally disabled child makes from their parent’s home to a group home. For the parents of a developmentally disabled child, this transition is accompanied first by a loss of energy, but then by a great gain. The decision of whether or not to place one’s child is draining. The pain and anguish associated with choosing to allow your child to leave your home can sometimes be overwhelming.

Again, parents feel uncertain as they are faced with a new process, that of placement, which they are unfamiliar with. Giving up the child you have put so much time and effort into caring for is terrifying. Knowing if they are happy, safe, and warm at all times seems like an impossibility. A mother’s energy is lost to worrying and deciding. The social service agencies, which manage group homes, can help a parent understand that they are not giving up the child they love so much, but rather experiencing a transition with this child.

Group homes help a parent find a

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By Mrs. Leah David As I sat down to write the opening for this new section in Building Blocks, I felt hopelessly inadequate to the task. After all, what do I know about special needs? My daughter has good old simple dyslexia - issues with reading and language.

Some of you may be familiar with the steps I took to deal with her issues; I opened an Orton-Gillingham school for my daughter, Gittel Bracha. Baruch Hashem after three years of special schooling, she is doing well is attending a mainstream Bais Yaakov.

So, what do I really know about the suffering that parents feel when they are faced with real serious issues? Maybe not a lot, but I do know that we al have something to share and that we call gain from each other’s experiences. It is our hope that the Family Forum be a place for that sharing, gaining, venting and maybe gathering a little strength to help us continue living life one day at a time.

I once read the following: “Just for today I will try to live through this day only, and not tackle all my problems at once. I can do something for twelve hours that would appall me if I felt that I had to keep it up for a lifetime. Just for today I will be happy. This assumes to be true what Abraham Lincoln said, that ‘Most folks are as happy as they make up their minds to be.’ Just for today I will be unafraid. Especially I will not be afraid to enjoy what is beautiful, and to believe that as I give to the world, so the world will give to me.”

So for today dear readers, be grateful for what Hashem has given you and look only on your side of the street.

It is our privilege to share with you some letters from readers who want to share a little of themselves. This first letter, a mother’s story brought tears to my eyes.

The Blessing of Our Naama Bracha The road is a long one. It begins with

Transitioning continued from previous page more improved role in their child’s life and this new role is accompanied by a great gain of energy. Parents no longer have to worry about the day to day difficulties associated with raising a developmentally disabled child. They are now given the opportunity to enjoy special moments with their child by visiting them as often as they choose, taking them out to dinner or on a trip, or bringing them home for Shabbat every so often. Knowing that her child is well taken care of, a mother who was so previously consumed with doing everything she could for her developmentally disabled son or daughter can now focus her attention on the other important loved ones in her life.

Group homes allow each of their occupants to function at their most productive level by helping them to develop social skills, ensuring community inclusion,

FAMILY

® Family Forum so many uncertainties and, quite honestly, many of them never go away. I am probably in a different place than most. I am the mother of a baby diagnosed with cerebral palsy when she was nine months old. I had little idea of what that even meant. Spastic quadriplegia was an unfamiliar term to me. It was 37 years ago that we surmised something was not right about this beautiful little girl. The doctors were hesitant to tell us what was wrong and when they finally did, they strongly suggested we not keep her at home. We, as her parents, could not fathom placing our child in an institution or with a foster family. Naama Bracha, our special daughter, deserved to be with us, the parents who had given birth to her with such excitement and awe, and the brother and sisters who treated her as normally as they could.

We had not a clue what really lay ahead for us. We decided that we would “wing it”. We would do what we felt would be appropriate for her and for the others in the family. We would shower her with love. We would take her on all of our family outings, despite people suggesting to us that having her around would perhaps affect our other children negatively. We would bring her to shul, where her father was the Rav. Every Shabbos she greeted the baalabatim in her own fashion – a big smile and a waving of her hand to come over and say hello. We watched as elderly men overcame their inhibitions once they got to know her and came anxiously over to speak with her and share with her about their families each week.

We watched as friends of our children warmed to the idea that maybe Naama wasn’t as different as they had heard from their parents. We pained and pleasured at the way that our parents interacted with this very special grandchild. She was so handicapped but so able to share and communi-

In life, as in literature, journalism, and all other forms of writing, transitions are challenging. encouraging independence, and maximizing quality of life. By allowing their own child to achieve a maximum quality of life in a place they are loved and cared for, a parent can also begin to achieve a maximum quality of life for themselves.

In writing, transitions refer to the words and phrases that authors use to connect their ideas and ensure that their work flows and is easy and enjoyable to read. For beginning writers, transitioning is one of the most difficult aspects of the

Esther Lustig is a Licensed Clinical Social Worker and the Executive Director of Human Care Services for Families and Children.

She maintains a private practice and is available as a consultant to other agencies.

Building Blocks

September 2007

cate in her own way. Her grandparents spent hours sitting with her and talking to her and telling her stories. Upon their passing she would point to the sky when she would be asked where they had gone.

I want somehow for everyone to know that those of us who have older special needs children were once in the position of those who are now beginning to face challenges.

Perhaps it is easier today – perhaps the services are greater – perhaps the community is more accepting - but I have learned that the responsibility of such a child no matter their age is always there. As I often tell my husband – it never goes away. One can say that it is the same with a married child, but obviously it is not. A married child leans on their partner when it comes to sharing and dreaming. A 37year-old daughter with cerebral palsy is her parents’ responsibility forever and ever.

It became even more evident to us recently when our beautiful Naama was diagnosed with breast cancer. Yes, our Naama who has literally “never hurt a fly” was suddenly faced with the greatest challenge of her life. It has certainly been one of the most devastating situations that we have ever been dealt. Perhaps this was even more upsetting than the original diagnosis 37 years ago. Where is the justice in such a reality? Yet, in the past two months since we have been faced with this new challenge, we realized that Naama has contributed so much to the world. She has had such an impact on so many that we are overwhelmed with gratitude to Hashem for the chizuk we have received from many people all over the world. Friends of our children, from years ago called and wrote to tell us of the impact Naama has had on their lives. Counselors and friends from HASC and Yachad are constantly in touch with tefillos and warm

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art to master. This difficulty applies not only to writers. In life, as in literature, journalism, and all other forms of writing, transitions are challenging. Transitions and changes take time. They can demand massive amounts of emotional effort.

Sometimes transitions are so difficult, they leave a person feeling as if they are drowning. It is at these moments that people need a life preserver, something or someone to help them out of the churning waters. With the right support, transitions can be smoothly overcome. They do not have to be made alone and without help. Together, the challenge of transitions can be conquered and a brighter future can be found. n

TIPS FROM PARENTS Never feel guilty or embarrassed about asking for help.

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FAMILY Family Forum continued from previous page thoughts. People who have not seen Naama for years have been writing to tell us how she affected their families, many making the effort to come and visit.

Baruch Hashem since her surgery Naama is doing remarkably well (much better than her mother). What we realized more than anything is how much she has accomplished in her life. She has sensitized and brought out the very best in so many. My message to all parents of children with special needs is that Hashem has blessed us with this hardship. Trust me, there were many days when I wondered how this could happen and thought how unfair it seemed. Yet now, all things having been said, I see the purpose that our Naama has fulfilled. Her contribution to society is far greater than most. Everyone is allowed and has reason to feel burdened, sad and overwhelmed but remember that Hashem didn’t intend that the world should be perfect. . After my recent experience I am beginning to absolutely believe that perhaps perfection is these beautiful special children. When you have a quiet moment, please daven for our Naama Bracha….

Signed, Nina Glick, Mother I spoke with Nina before press time and her Naama Bracha is doing better. I am sure you all join me in wishing her a refuah sheilama. *** Who said being a parent is easy? Our next letter is from a mother of three special needs children.

She has 6-year-old twin girls and a 5-year-old boy.

Three Special Stars I have 6-year-old twin girls. Susan is Down syndrome and Rebecca is Cerebral Palsy.

My son Michael is 5 years old. He is very healthy, but has language learning and processing issues.

All three children are in Special Education programs.

My journey started when I was 5 months pregnant with my twins. The doctor did a sonogram and told us, that twin B would be born with a blockage in the intestines and would need surgery right after birth. The doctor also told me that one out of every four babies that have this problem can be Down syndrome. My husband and I tried to put that thought away. We prayed to Hashem and hoped that our babies would be born normal and healthy. Our prayers were not answered in the way we wanted, our girls born prematurely at 29 weeks, were small but strong. The doctor’s felt that they would do well and that we had nothing to worry about. This hope was short lived. At two weeks the Doctor said that Susan was showing sign of Down syndrome. Tests were

done and the worst was confirmed. Our with Tamye R. She conveyed beautiful baby girl was not perfect. She had hope and trust. I knew from Down syndrome. They told us to be strong her letter that her life was hecand said that our other daughter, Rebecca’s tic, yet she volunteered to take calls from people twin was a healthy, happy baby. But they who needed help, advice and chizuk. Thank you, were very wrong!

Tamye R, for being a great role model.

When I found out about Rebecca the twins were about one month old. They were *** both still in the hospital. My husband and I were first getting used to idea of having one It is hard enough for adults to understand special baby. I remember calling the hospi- their feelings, imagine what it is like for a 7-year tal to check on my “girls” when a nurse told old who has to compete with a 5-year old speme to come quick, my baby was bleeding in cial needs brother. Well, Zahava sent us a few the brain and something was wrong. I burst words to let us know how she feels. Thank you, into tears and rushed to the hospital. To this Zahava. day I am not 100% sure what that nurse told me. When I got there the doctors told we that Zahava’s Story the worst scenario would be that she is CeI’m Zahava, and I will tell you how I feel rebral Palsy. I cried for three days. I cried having a brother who needs help. His name so hard that I got sick. They wouldn’t let me is Yehuda. Sometimes I feel left out when take my baby home. my brother gets all the attention. My brother When we finally got the babies home our is 5, and I’m 7, and he goes to bed after me. lives were filled with appointments, evalu- Sometimes he cries because he wants someations, and therapies. We went to eye doc- thing that I’m eating but he can’t have betors, neurologists, cardiologists and pedia- cause he is allergic. Once he went to the hostricians. They came out physically healthy, pital for a long time. My parents were at the but we all knew the truth. I had two special hospital. My aunt was watching me. When needs children. my father and mother came home I was so All in all life is very hectic. We have our so happy to see them. Sometimes Yehuda is twins with their disabilities and a wonderful son mean and sometimes he is nice. But I still with his learning issues. All three children are in like him even though he is mean sometimes. different Special Education programs. I do a lot Continued on page 17 of running around and spend many hours on the phone taking care of their needs. I meet School Age Program on a consistent basis 6220 14th Ave. , Brooklyn, NY 11219 with various members Providing special education, functional of their support teams. academic instruction and vocational I also go to support training for boys and girls ages 5-21 groups where I give and get information � NYS licensed teachers & therapists � Separate boys & girls classes that can help others. � Hot Kosher/Cholov Yisroel lunch In the beginning � ADL and Functional Life Skills curriculum my husband had a � Warm, supportive environment hard time dealing with the disabilities but now he is dealing with it a lot better.

Baruch Hashem all our children are progressing and I thank Hashem for that. I believe that Hashem is watching over our children and me.

If anyone needs help or chizuk you can reach me at 347-2871566. I am a grateful mother of three beautiful children. I thank Hashem every day for Funded and regulated by the New York State Department of Education this special gift. in conjunction with the NYC Department of Education and local school districts (CSE).

Sincerely, Services are provided at no cost to families for children who meet eligibility guidelines: Tamye R, Registration Now Open - Limited Space Available Brooklyn, NY

HASC

I recently spoke

For Information Call: 718 331-1624 Building Blocks

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FAMILY Sibs Speak ^

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Welcome to SIBS SPEAK, the best place for kids to share some of their thoughts and feelings about their brothers and sisters who have special needs. Growing up in a traditional family comes with day-to-day challenges and many ups and down. Growing up in a home with a special needs SIB makes the road even harder. Today we will hear from 7 children who took the time to answer our 6 SIB SPEAKS questions.

Let’s meet:

1-Shimi is 12 and has a 5 year old brother with Down syndrome 2-Sharon is 6 and has a 2 year old sister with a hearing impairment 3-Sarah is 15 and has a 13 year old sister with Cerebral Palsy 4-Laurie is 7 and has a 4-year-old brother who has Asperser’s Syndrome 5-Reuven is 11 and has a six year old brother with a genetic disorder 6-Susan is 19 and has a 10-year-old sister with Down syndrome 7-Faigy is 11 and has a three-year-old brother with Autism Here are the questions that we asked all of the SIBS, Match the color to read the answers 1) The thing I like best about my sibling with a disability is

2) The thing I wish I could change about my sibling is

Shimi- I love teaching him sports, like how to kick or catch a ball.

Shimi- I wish that people wouldn’t stare at him and point when we go places, and that they would realize that he is really a great kid.

Sharon- I like how she sings the ABC song, and mixes up all the letters.

Sarah- I used to love pushing her in her wheelchair, and riding on the back of it.

Laurie- I love the funny way he reads books.

Reuven- I love going to the carnival for special kids like him every year.

Susan- I love the way she shows constant affection for others and me. Everyone loves my sister.

Faigy- I love the funny way he calls my name.

Sharon- I don’t like that she gets to play with Malky (her sister’s speech therapist) and I don’t.

Sarah- I wish she would be able to come to my sleep away camp instead of going to a camp for kids with disabilities. I hate being apart for the whole summer.

Laurie- I wish he wouldn’t take away my toys and hide them.

Reuven- I would like him to be like other six year olds.

Susan- Not a thing.

Faigy- That he didn’t scream and cry so much.

4) The thing I have gained most about having a sibling with a disability is

5) Sometimes I get angry because

Shimi- To be sensitive to other peoples feelings, because I see how upset I get when other people say stupid things about my brother.

Shimi- Even though I know that he doesn’t mean it, it really makes me mad when he touches and destroys my things.

Laurie-That little brothers are cute.

Sharon- My mommy always takes her special places and leaves me home.

Susan- I know how much of a difference good therapists can make in the life of a child with special needs. My sister helped me realize that I want to become a therapist so that I can help other kids like her.

Sarah- Because it was my sister that had to be born with a disability. I only have one sister, why does she have to have CP?

Faigy- We get to go to Israel every year to get a special brocha for my brother.

Reuven- He always gets his way when we fight.

Well now you have it, a look at how 7 SIBS view their SIBS… Do you have a SIB? Do you have any funny or sad stories you want to share. Our mailbox is always open. Send your mail to ldavidny@earthlink.net. Thanks for sharing!

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Laurie- He talks and plays all night and doesn’t let me go to sleep.

3) The funniest statement or story about my sibling is Shimi- When my brother learned to sing the ABC song, he used to sing the letters “L M N O P” as “elephant-O-P.” It was so funny, wherever we went we would have him sing it to everyone. He was so cute.

Sharon- I think my sister is funny when she sings songs in her funny voice.

Sarah- A couple of years ago, my sister was trying to go from her wheelchair to her bed and she fell on the floor. She was laughing so hard that she made me laugh hard too. When I tried to help her up, I was laughing so much that I fell right into her lap. We both sat there giggling for a long time. My brother came to see what happened and he said “crazy girls, always laughing.”

Laurie- When he gets very happy, he makes very funny faces.

Reuven- My brother’s favorite Uncle Moishy video song is the cholent song.

One day when my mother was cooking cholent for Shabbos, he yelled wait, went over to the cabinet and pulled out jellybeans, just like Uncle Moishy.

Susan- One year my sister’s class put on a play. When she finished her lines, she turned to my mother and me asking, “Did I do a good job?” The whole audience burst out laughing.

Faigy- My brother loves to play with water and bubbles. One day we came into the bathroom and found the sink on with water and bubbles all over the floor. My brother was splashing away in the mess.

6) What I have learned from my special sibling is Shimi- The thing I have learned from my brother is that if you try hard enough at something, you will be able to do it.

Sarah- That I should be very grateful that I could walk and do things easily, and not have to struggle so hard to do a simple thing like taking a bath.

Laurie- To smile a lot because he is always smiling.

Rueven- That Hashem makes us all different, but he loves each one of us.

Susan- I get extremely angry with adults when they whisper, point and say stupid things about my sister. I expect it from kids, but adults should know better.

Susan- That all human beings have something special about them that make them different from others, some differences are just more obvious than others.

Faigy- I am trying to do my homework and he is screaming or ruining my stuff.

Faigy-If you cry, scream and bang your head, you can get your own way.

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FAMILY Family Forum continued from page 15 Ellen L of Brooklyn NY had a hard time being the protector of her little brother. Now Ellen is 43 and her successful baby brother is 41. When they were kids, Special Education was in its infancy. Even the professionals didn’t always have the tools necessary to help children overcome what we commonly call the ADD or ADHD issues. Let’s hear what Ellen has to say.

Dear Readers, These days more people are willing to speak openly about their family members who have disabilities. When I was a child (I am now 43) people were somewhat secretive about these situations. I am glad that people are more willing to speak up and that others are more tolerant.

My younger brother was in special-education classes for many years; he was fully, and finally, mainstreamed when he was in ninth grade. We were all proud of him and relieved that society would be more ac-

cepting of him. Today he is married, has two children, and a good job.

But I do remember the slings and arrows he had to face. I tried to be protective of him in many situations, but at times I did resent him and his problems.

I felt vulnerable because he was vulnerable.

A particular incident stands out in my mind. I was about 8 or 9, my brother 6 or 7.

We were friendly with two boys who lived on our block. Their mother was a bit of a loose cannon. One time she got mad at my brother and she called him a “retard.” He was not retarded; he was and is very bright.

This was a terrible thing for this woman to say, and for her to say with venom. She set a bad example for her children, and she hurt the relationship and us between her boys and us.

I realize that my brother and I are fortunate that he has outgrown many of his problems. We are both sensitive to the burdens and the joys that a child’s disability can have on a family, as well as the child in question. Today this “ retard” has an MBA

in Business; he’s a financial wiz, the father of two healthy boys and a dedicated husband. Good job brother…. I love you.

-Ellen L. I am sure that there are many people out there who have stories to share. Please take some time to jot them down and send them to us, so we can share them in other special editions of The Jewish Press. You never know how your story or thought can affect someone else.

Don’t forget to spend 15 minutes reading to your kids tonight, listen to their krias Shema and then give them all a great big kiss. Good night, Gittel Bracha, mommy loves you! n Supplementary Reading The Sibling Slam Book: What It’s Really Like To Have A Brother Or Sister With Special Needs by Don Meyer – (This book was the inspiration for the Sibs Speak) Living With a Brother or Sister With Special Needs: A Book for Sibs by Donald J. Meyer and Patricia Vadasy

Leah David BS, MS is the Executive Director of Ohr HaLimud, now starting it’s fifth year, located at 1681 42nd Street, at the Machon High School Hilda Birn Campus, which offers various multi-sensory programs that utilize the scientifically based Orton- Gillingham Approach to the teaching of reading, writing and spelling. Programs at Ohr HaLimud include a Bais Yaakov for girls’ ages 7-14 that features an Orton-Gillingham, multi-sensory, language arts enriched program that customizes its curriculum for each girl. The school also features an after school and Sunday Orton-Gillingham tutoring program and offers teacher training in this Approach. Mrs. David is available to discuss your children’s specific needs and can be reached at 718-972-0170 or by e-mail at ldavidny@earthlink.net A checklist for signs of Dyslexia is available and can be requested by calling the school.

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FAMILY

Down Syndrome Amongst Us

By Sarah Sander

I always thank the Ribono Shel Olam that my son was born in 1989 and not in 1969 or earlier. This is a new world for individuals with Down syndrome.

The medical care, the education, and the social evolvement over the past two decades are remarkable. Down syndrome no longer poses the challenge it did decades ago. Early Intervention Programs address the Down syndrome baby’s needs shortly after birth. At an early stage the child’s low muscle tone is treated by physical therapy, fine motor skills are enhanced by occupational therapy, and deficits in oral motor development/feeding issues are aided by skilled speech/language/oral motor therapists.

The best advice that one can give to the new parents is NO ADVICE. They should be given support, love, understanding, and told that whatever help they need, they will get.

A special education teacher complements the team by engaging the child in educational and stimulating activities. If a child has some specific issues that the above-listed team cannot address, additional professionals are consulted and added to the team.

Children with Down syndrome have tremendous potential. It sounds funny to say it, but though my son is mentally retarded, he is brilliant. I don’t understand the dynamics of the human brain, and I have a hard time separating the retardation from the brilliance, but they are both there. The child with

Down Syndrome at a glance The human body is composed of billions of cells. Each cell has 23 pairs of chromosomes, which maps out the genetic makeup of the human being.

Trisomy 21, the most common form of Down syndrome(DS), affects the 21st pair of chromosomes in every single cell of the human body. Trisomy 21 is NOT hereditary; the medical world calls it ‘a fluke, an accident, a mistake.’ We call it ‘bashert.”

Another form of Down syndrome is called a ‘translocation’; that does have some hereditary components and it is advisable for families affected by Translocation Down syndrome to consult with a genetics counselor.

®

Down syndrome can learn and does learn, when taught properly. The intellectual capacity of an individual with Down syndrome far exceeds the general population’s expectations.

If social skills are properly instilled, individuals with Down syndrome are social darlings. Their derech eretz, simchas ha’chayim, and love of their social peers are unique.

Children with Down syndrome impact their families in ways that are difficult to describe, because words cannot do justice to something so spiritual, far-reaching, and just plain ‘gevaldig!’

Were somebody to give me the option of obtaining a magic potion to make Down syndrome disappear, I would surely decline giving it to my son, Moishey.

Our Moishey’s qualities are BECAUSE of his Down syndrome, and they make him so unique, adorable, lovable, wonderful, funny, and endearing to all family and friends. Who wants all these special qualities to go away?

Down syndrome is a challenge, but a very manageable one. Today’s government programs help parents of children with DS from the moment they are born. A child with DS is less of an expense to the family than a ‘normal’ child. There are school programs, respite programs, summer programs, etc. for the individual with Down syndrome. For the adult with Down syndrome there are beautiful, functional group homes where the individual learns to live independently, under supervision, with peers of his kind. The new possibility is that adults with Down syndrome can get married, of course, with the supervision of parents or counselors.

Down syndrome used to be considered something that ‘happened only to older couples.’ Statistics have changed that misconception; more and more young women are giving birth to babies with Down syndrome, oftentimes as first-time mothers.

In the frum community, with young adults marrying at a young age, some new parents are not quite 20 years of age when their ‘special’ baby is born.

Attitude is the number one factor in overcoming the initial shock after diagnosis. Grandparents, family and friends play a MAJOR role in how the parents will deal with their new challenge. The best advice that one can give to the new parents is NO ADVICE. They should be given support, love, understanding, and told that whatever help they need, they will get. It is highly inappropriate to attempt to convey advice that would impact the family for life. The new parents should be allowed to mourn and grieve and they should be offered only support and encouragement.

Life with a child with Down syndrome is a ‘zchiyuh’; it is a treat. It is a gift that one needs to have ‘S’yata D’shmaya’ to be able to see and enjoy. n

Sarah Sanders is the mother of six children, including Moishey, their second child, who is 16 years old and has Down syndrome.

Mrs. Sanders along with her husband opened the first yeshiva for boys with Down syndrome, “Yeshiva Bonim Lamokom” and is located in the mainstream yeshiva of Torah Vodaath in Brooklyn. She also publishes a magazine titled Down Syndrome Among Us. To contact Down Syndrome Amongst Us, email downsyndrome@earthlink.net.

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I Don’t Mind, Mom, I’ll Help Him

By Marsha Winokur, PhD This article reflects on the challenges a family faces with having a special needs child, Brad, and the effect this has on his sibling, Danielle.

13-year-old Danielle has always been very willing to help her parents care for her older brother Brad, who was born with cerebral palsy and always required a great deal of attention. Danielle has grown up knowing that the primary focus of the family is taking care of Brad. From a very early age, Danielle was the helper. With few complaints and a smile on her face, she missed soccer games and ballet classes in order to accompany her mother to Brad’s doctors’ appointments or when they were unable to leave Brad alone.

When asked, Danielle always reassured her parents that it was “fine.”

Danielle was so afraid that any negative feelings would be a betrayal to her family that she tried to keep those feelings hidden.

Danielle had always been a good student and a good friend. Her teachers were proud of her hard-working style and felt that she was an integral part of the school community. For the first time this year, her parents received some concerned phone calls about Danielle’s functioning in school.

Not only were they concerned about grades that were significantly lower than they had been in 6th grade, but there was also a general attitude that seemed less outgoing and more reserved. Was the transition from 6th to 7th grade somewhat overwhelming to Danielle, or was there something more going on?

Danielle was clearly a wonderfully generous child whose family’s values had been very well internalized. The sacrifices that all members of a family make when one member needs special attention are well-known, but what needs to be considered are the individual styles of the “other children” in the family. As we have seen in some families, children become angry and overtly competitive. In other families, children often feel that things are “unfair.” Probably a very popular response of parents is that “life is not fair,” and this is certainly true for siblings during a period of resentment.

Danielle’s teacher was attuned to the shifts in

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I Don’t Mind continued from previous page her general responsiveness and decided to address this with Danielle and then speak with her parents.

It became clear that Danielle was totally unaware of the “resentment” part of her internal experience. Love, responsibility, duty, and “being a good girl” were much more comfortable feelings for her.

Although initially embarrassed by her teacher’s invitation to this conversation, Danielle was relieved to know that somebody had noticed that she was having a hard time. In her conversations with her teacher and parents, she was able to realize the combination of love and resentment that she was experiencing. What she also realized was how guilty her resentment made her feel. She was so afraid that any negative feeling would be a betrayal to her family that she tried to keep those feelings hidden. As Danielle discovered that she didn’t have to keep all of her mixed feelings to herself, she realized that she could allow herself to have visions for her own future without having to worry about whether she would still be a good sister. n Marsha Winokur, PhD, is the Founding Director of Learning Resource Network, a program of the Jewish Board of Family and Children’s Services. The Learning Resource Network offers a wide range of consultation and support services to help parents concerned with child development and learning issues. If you first step ad 7/27/07 9:42 Page have any questions of concerns about your child,AM please feel free to contact us at (212) 632-4499 or email lrn@jbfcs.org.

FAMILY Protecting Your Loved One Through a Guardianship

By Marcie G. Roth, Esq. When you have a child or family member with a disability that prevents them from fully participating in the management of their finances, healthcare decisions or other things we all generally do every day, there are steps you can take to ensure that he or she is well cared for now, and even after you are gone. Guardianship is a key tool that can help you address and manage the issues that your loved one will face. New York State offers a great deal of flexibility in how guardianships can be structured to meet the individual’s needs, as well as the needs of that person’s family. In this article we will explore the two principal paths to guardianship, along with the benefits and drawbacks of each approach.

Why Consider a Guardianship?

A guardianship is a very effective way to safeguard the person, rights, property – and even the preferences – of a family member who has a disability that prevents them from effectively communicating their wishes on their own. This can be useful as primary caregivers age, to ensure that the family member is still cared for properly. It can also be useful 1 as the family member with the disability becomes a legal adult. Imagine, for example, that a family mem-

ber is enrolled in a day program and changes in the program or its staff suddenly make it less congenial for the family member. Another example is when a child ages out of his or her educational facility and needs to move to a suitable adult residence. In both cases, chances are good that your family member will not be able to effectively advocate for himself or herself. Unless you have the standing of a legal guardian, you might not be able to do so, either.

What Does a Guardian Do? The law recognizes two types of guardians – one of an individual’s person and one of an individual’s property. A guardian of someone’s person makes essential basic decisions, such as where that person will live, which doctors he or she will see, what medical treatments will be administered and what day programs or supervised work experiences he or she might participate in. A guardian of someone’s property oversees investment and allocation of their assets within the guidelines laid down by the court that awarded the guardianship. Sometimes these guardians are the same person, but they can be different; particularly when the person with a disability has substantial assets, it can be important to have a professional with fiduciary and investment expertise

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2935 Ave S (off Nostrand) Brooklyn, N.Y. 11229 2555 Nostrand Ave (Bet K&L) Brooklyn, N.Y. 11210 Call 718-336-9500 Fax 718-645-9300 Building Blocks

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Guardianship

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continued from previous page as guardian of his or her property.

How Do I Obtain a Guardianship?

Because a guardianship involves legally altering a person’s rights over themselves and their property, all types of guardianship require some sort of court order. Note that courts are very careful when awarding guardianships; they do not wish to take rights away from a person unless it is clear that person cannot make decisions for himself or herself nor do they allow a guardian to compel an individual to seek treatment to which he or she is resistant. For this reason, guardianship is rarely – if ever – granted over someone whose disability is purely physical in nature or who suffers from an eating disorder or mental illness.

New York State law has established two paths to obtain a guardianship for a person with a disability.

The first path to guardianship, established by Section 17-A of the New York Surrogate’s Court Procedure Act, is through the Surrogate’s Court.

This option is available for individuals who are diagnosed as developmentally disabled or mentally retarded before they reach the age of twenty-two.

In either situation the impairment is permanent in

FAMILY

®

Guardianship is a key tool that can help you address and manage the issues that your loved one will face.

nature or likely to continue indefinitely. This type of guardianship can be obtained by completing papers which can be obtained from the local Surrogate’s Court. The Surrogate may dispense with a personal appearance by the disabled person. The procedure is fairly straightforward and it is possible to obtain a 17-A guardianship without legal representation. The costs are comparatively low. However, the court typically directs a very conservative investment strategy, often limited to governmentguaranteed instruments, and retains the right to review and approve any allocation of assets and expenditures. The court may also retain the right to review other decisions concerning the subject’s life, so there will be subsequent applications to the court. A Section 17-A guardianship can be the right choice if the individual with the disability does not have any substantial assets and the goal is simply to protect his or her person.

An Article 81 guardianship is granted by the

Marcie G. Roth is a partner at the pioneering elder law firm, Freedman Fish & Grimaldi LLP. Her practice is focused on planning for persons with disabilities, elder law and estate planning. She can be reached at mroth@ffglaw.com.

county Supreme Court after a very involved process that includes a formal written petition and at least one full courtroom hearing at which the person to be subject to guardianship must be present. Originally designed for those who have lost capacity, Article 81 guardianships incorporate comprehensive protections for the allegedly incapacitated person. Although both courts require an annual accounting of the assets, once an Article 81 guardianship is obtained the guardian has more freedom to direct asset allocation, subject only to the prudent investor law. In addition, a properly constructed Section 81 petition can invest the guardian with specific powers and authorities to make the subject’s life easier. You will need to work with an attorney – preferably one with experience in this area, so your petition is properly thought through the first time. You will also need to be prepared to invest significant time and money in this process, but it can pay off in the long run.

Conclusion Guardianship can be an important tool in protecting your loved one’s quality of life. For most families, though, it is only a beginning. Talk to an attorney with expertise in this area, meet with someone at a social service agency or confer with a social worker you trust to see if a guardianship makes sense for your family member. At the same time, you will also want to consider setting up a special needs trust to protect your family member’s assets while preserving his or her eligibility for various government-sponsored programs. n

BOARD OF JEWISH EDUCATION OF GREATER NEW YORK

Department of Special Education Jewish Parent Advocate Coalition Presents

P ARENT E MPOWERMENT C ONFERENCE ON S PECIAL N EEDS AND R ESOURCE F AIR T UESDAY, O CTOBER 3 0 , 2 0 0 7

9:30 AM - 3:00 PM A t t h e B oa r d of J ew i s h E d uc a t i on 5 2 0 8th Av enue , 15 th Flo o r , NYC (BETWEEN 36TH & 37TH STREETS)

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THE FOLLOWING WORKSHOPS :

Accessing Transition Services; Travel Training; Stress Management; Guardianship, Wills & Trust; and Legal Issues Concerning Transition Services

ALL DAY RESOURCE FAIR FREE ADMISSION! For more information please call

Stacey Frank at 646-472-5338 or Phyllis Miller at 646-472-5341 Building Blocks

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education Choosing An Appropriate School For Your Child

By Chaya Shandel Mandel Choosing an appropriate school for your child might seem to be a daunting task. In order to assist parents in this process, I would like to share some information. Once an evaluation is completed, and an IEP is composed by the CSE and the parent, the process of placement begins.

All parents want the best for their children, the best school, the best teacher, the best therapy and the best programming! Unfortunately, for children with disabilities the law provides only for an ‘appropriate education’. Public schools are open for all children who live in New York City, and not all public schools have the appropriate classes in proximity to the child’s residence.

Parents are required to first exhaust the myriad of programs offered in the public sector that the CSE believe would meet the child’s IEP. This process has led parents to seek placement at private special education schools. There are publicly funded private schools (NPS) and there are private schools that have a set tuition rate. If you send your child to a private school, you will need to pay the tuition and then begin a legal process to be reimbursed.

Non-public schools are licensed by the NY State Education Department (NYSED) to provide education and services to children with disabilities.

The NYSED regulates the criteria for these schools which includes • Licensed, certified teachers • Student-teacher ratios • Number of classrooms and total number of students the school can accommodate • Handicapping conditions the schools is licensed to accept • Therapy services the school must provide • A tuition rate (payable by the NYSED) Once an NPS agrees to accept an approved child, funding is paid directly from the State to the school. When an NPS accepts a child, they also accept the IEP requirements. Parents need to be aware that in certain circumstances, a child’s IEP can be amended in order to qualify for a school.

In seeking a school for your child, several issues should be considered: • What classroom ratios are available?

• What is the philosophy of the school?

What seems to be happening in the classroom: • Are there obvious signs of literacy on the walls?

• What is the noise level in the classroom?

All parents want the best for their children, the best school, the best teacher, the best therapy and the best programming!

• Is the class environment conducive to sensory concerns?

• Is the classroom organized?

Do the children in the class look similar to your child in behaviors and educational needs?

• How are behaviors handled?

• How does the staff interact with the students?

• Does the teacher seem in control of the class?

• Does the staff seem enthusiastic when interacting with the students?

• Does the staff give the impression of being professional?

PTA conferences • Is there a school social worker?

• Does the school provide workshops for parents?

• How can you request conferences with therapists, teachers, administration?

• Is there a PTA? Does the school want parents involved?

• Is there an afterschool program?

If you are requesting an NPS or a private school, and the Department of Education agrees, they will issue a “Nickerson Letter.” Nickerson letters are produced the last two weeks in August.

This letter entitles you to choose a school of your choice. If the school of your choice has a vacancy in an appropriate class, they will create a P-2. A P-2 is the classroom ratio, and therapies they will be able to provide. The parent must sign and then the school forwards the P-2 to the CSE. The CSE will then convene, rewrite the IEP to reflect the new school and therapies able to be provided. When the new IEP is completed and sent to the school, the Office of Pupil Transportation is notified and within 5-10 school days bussing is provided.

I hope this information will be helpful in the search for the correct school for your child. n supplementary reading A Parents Guide to Special Education in New York City and the Metropolitan Area, by Laurie Dubos and Jana Fromer.

What other settings in the school were you able to observe (bathrooms, therapy rooms, cafeteria, play areas, etc.)?

• How accessible is the school to barrier free students and parents?

• How do children transition from one space to another?

• Where are the bathrooms located in proximity to the classrooms?

• Is there a registered nurse on staff at all times, for the medical and medication needs of your child?

• Are the therapies your child needs available at the school?

• Are sensory diets part of the program?

• Other information regarding school policies: • Communication systems between parents and staff

Chaya Shandel Mandel has been at HASC for 24 years. She has taught every age from birth thru 21,began the EI classroom at HASC in 1991, served on the evaluation team, and is presently the Program Director at HASC’s Boro Park school age site located at 6220 14th Avenue. tel 718-331-1624.

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education

®

SEITAn Eye Opener

By Sori Laufer

“You’re writing an article about SEIT? Do you mean to say you really believe in it?” This was the response received from an experienced and dedicated teacher when she heard about the preparation of this essay. Sadly, there are some teachers, parents and others involved in the education of our preschoolers who have this somewhat doubtful or even negative perception of SEIT services. This may be the result of personal experiences with particular circumstances, hearsay, misconception of the tools, methods and goals of these services or general misinformation. In this essay, we seek to generally describe the areas SEIT addresses, its methods and goals, and ways to avoid its potential shortcomings and maximize its benefits.

fied teachers work one on one with children who exhibit social, emotional, or academic issues.

For these children, a SEIT teacher can change their preschool experience from challenging and unpleasant to a rewarding, wonderful one where growth and overcoming difficulties takes place on a daily basis. With the proper support, the shy, withdrawn youngster can learn to interact with her peers and truly blossom. The child with weak academic ability can be taught the classroom curriculum with material broken down to tailor his/ her needs.

S.E.I.T. Success Stories Malky (all names have been changed) was a child who spent her days alone, even at the tender age of 4½. At every point in the school day, Malky was always by herself. During free play, lunch, or What is S.E.I.T.? outdoor play, Malky never mixed with her peers.

S.E.I.T. (Special Education Itinerant Teach- Although the look in her eyes spoke of a longing er) is a special education program funded by the to be a part of the social fabric of her class, Malky New York State Education Department that ser- lacked the social skills to succeed socially in her vices preschoolers ranging in age from three to classroom. After being approved for several hours five. For preschool children with varying degrees of SEIT per week, Malky received the encourageof weakness, SEIT services have literally opened ment, support, and knowledge of skills to become a whole network of opportunity for success. Certi- more socially adept in the classroom.

Shimon was a child who was unable to remain attentive to an activity for any length of time. It made no difference whether Shimon was at a group lesson, at a free play center or on a class trip to a hands-on museum geared for chilThe Beacon Elementary School Program, dren. Shortly after belocated in Flatbush, New York, specializes in coming involved in an acserving students with a broad range of special tivity, he’d lose focus and needs. Our nurturing staff is dedicated to become unable to gain creating a learning environment in which each from, enjoy or apprecistudent can reach their full potential. Small ate the activity. Although student-teacher ratios allow for each student’s individual learning styles and needs to be met. Shimon’s skills were not significantly delayed in The Beacon School offers its students: general, Shimon was los· A comprehensive dual curriculum program ing out on so many learncombining general and Judaic studies. ing experiences in his environment each and every · Social and life skills development day because of his inabil· Enrichment Activities – art, music, ity to remain on task. Adtechnology, physical education, and ditionally, Shimon’s lack interactive eld trips to enhance the curriculum and reinforce of focus caused him to classroom instruction. exhibit some behavioral · Additionally, related services such as speech/language and issues. He was unable to occupational therapy are available on site on an as needed basis. remain seated at a tenminute lesson because of The Beacon Elementary School his inattentiveness to the is a division of the material. Often, he would National Jewish Council for Disabilities, disturb the children near an agency of the Orthodox Union. him in an attempt to keep

The Beacon School **Now Accepting New Applications** Primary Grades K-3

We welcome the opportunity to further discuss our program with you.

For further information, please contact:

(212) 613-8229 Building Blocks

September 2007

himself occupied. At a Lego activity, while his peers were building elaborate cities, he would be unable to build for more than several moments, after which he would either destroy parts of his peers’ structures or stroll aimlessly around the classroom.

SEIT services helped Shimon gradually lengthen the amount of time that he was able to focus using stimulating activities initially done in a one-on-one setting with lots of positive reinforcement. Over time, the activity times were lengthened and the activities were more varied. The results were soon seen in the classroom. Incentive programs were run in the classroom and Shimon now had the skills to be successful at obtaining the rewards.

Leah was the epitome of disorganization, which made functioning in a classroom nearly impossible. This stemmed from spatial issues, which made it particularly challenging for Leah to assess

Will my child feel stigmatized? where she was in space and therefore in which space she belonged. Leah was never seated in a conventional manner, which caused her supplies, lunch or paint to be on the floor, on her clothes and on her chair. She could not line up with her class appropriately as she was always being found on the wrong side of the stairs and significantly lagging behind. As a very intelligent verbal child, Leah had a sense that she was unable to keep up with the group and her peers certainly sensed it as well. SEIT services made such a significant change in Leah’s classroom performance; it was hard for her parents and teachers to believe. Leah’s issues did not disappear and she still struggled with her weaknesses in various areas, yet the improvement that she exhibited was remarkable. Now, while Leah colored, she learned to sit with her feet on the ground, so she was finally able to keep her crayons on the table and develop age appropriate coloring skills, such as remaining within the line or following a paper and pencil exercise given by the teacher. On a school trip, it was hardly necessary to remind Leah to keep in line while enjoying the outing alongside her peers.

SEIT therapists use their knowledge and experience to design a program that works best to remediate the particular needs of each child.

Although results are not always immediately apparent, persistent and diligent work by qualified personnel help children reach critical milestones which impact a child’s long term schooling in a significant and positive way.

Are children who receive S.E.I.T. services stigmatized?

When considering applying for therapy in general and SEIT services specifically, there is often the parent’s unvoiced concern, “Will my child feel stigmatized, disadvantaged or like an underachiever?”

The opposite result has actually been wit-

Continued on next page

Sori Laufer, MS Ed, is an Agency Representative at A HelpingHand, LLC. A Helping Hand provides special education support to preschool students in the mainstream environment. For more information, please call (718) 435-7464.

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EDUCATION PARENT DOS AND DONâ&#x20AC;&#x2122;TS Do make sure to speak to your SEIT provider periodically Do not keep your SEIT provider on the phone unnecessarily.

Do observe a SEIT session, if services are taking place outside of the classroom. (â&#x20AC;&#x153;I heard that youâ&#x20AC;&#x2122;re working fabulously with my child. Iâ&#x20AC;&#x2122;d love to see it in actionâ&#x20AC;?.)

Do make sure that the amount of SEIT hours is appropriate to address your childâ&#x20AC;&#x2122;s needs (Yes, too many hours will also detrimentally effect the quality of the services.)

Do let SEIT provider know when your child will be out.

TEACHER DOS AND DONâ&#x20AC;&#x2122;TS Do sign session notes at the time the session takes place.

Do maintain open communication with therapist about present goals and progress being made.

Do keep a formal businesslike relationship with therapists.

SEIT continued from previous page nessed in countless instances. The children receiving SEIT services outside of the classroom often become a celebrity of sorts. Leaving the classroom with a SEIT is perceived as a treat and privilege that many children vie for. They feel special and they sense that their needs are being addressed.

Whenever possible, SEIT services take place within the classroom (â&#x20AC;&#x153;least restrictive environmentâ&#x20AC;?).

In this setting, children are not always aware of which childâ&#x20AC;&#x2122;s needs are being addressed as providers work with their student in small group settings where speciďŹ c skill areas can be targeted without isolating their student. In those situations, the child feels fortunate to be working with the provider.

Where Does S.E.I.T. take place?

Unlike other therapists (speech, OT, PT) that do much of their work outside of the classroom, SEIT therapists work on their childâ&#x20AC;&#x2122;s needs inside the classroom to the greatest degree possible. However, when goals and objectives require a one-on-one environment to be worked on without the distraction of the classroom, SEIT sessions will take place outside of the classroom. When the child is ready to generalize and incorporate newly learned skills, the therapist will assist the child in the classroom. Skills that can be taught in the classroom setting will be worked on within the classroom environment.

.2&/( &)- 1&/1&2&-32 $()+%1&- "-% "%.+&2$&-32 6)3( +&"1-)-' "-% /(72)$"+ %)2"#)+)3)&2 )- &%4$"3).-"+ ,"33&12 "-% 1&+"3&% +)3)'"3).-

8 "-% &&3)-'2 8 &5)&6 .-24+3"3).8 )2$)/+)-"17 "33&12 8 4/&1)-3&-%&-3 &"1)-'2 8 "13&1 4-%)-' 4)3).- &),#412&,&-3

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Key Factors of S.E.I.T. There are several key factors that contribute to the success of SEIT services.

Therapist Integrity Therapists who conduct themselves with a strong sense of personal integrity are a critical component to achieving the desired results.

While this holds true for any job responsibility, it is even more relevant for SEIT. Providers who are honest about ďŹ lling the time slots assigned to them and truly expend efforts to help their students achieve optimum results (investing in effort and equipment, as necessary) will see results in their work.

Scheduling Additionally, because SEIT services are done within the classroom framework it is integral that the services be scheduled for times at which they can be most effective. Social issues are best tackled at free play; group focusing may need to worked on during the classroom lesson, etc.

Credentials/Experience The underlying factor that determines the ultimate effectiveness of SEIT services is the expertise of the SEIT provider. High quality undergraduate and graduate studies combined with background experience will produce enhanced results for the child being serviced with help from Above. n

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education

® A Glorious Crown:

The Legacy Of Inclusion

By Naomi Nadata

Dressed in their Shabbos best for this special occasion, the children’s eyes glittered with excitement, while their parents waited expectantly.

Most of the children had never been able to successfully participate in the davening, even though most had started their schooling in a mainstream yeshiva. Others had attended public school special education classes. Recognizing and reading hebrew had only been a distant dream. Now, however, they were about to begin their tefilah party in this special yeshiva class for children with learning disabilities. The Rebbe said, “Let’s begin!” and the sing-song words of the tefilos filled the classroom with the children’s sweet, innocent voices.

The children read the birchos hashachar. When they reached “Oter Yisrael b’tifarah,” “You crown Israel with glory,” each child placed a gold crown upon his head. The joy felt by the children and parents was palpable. I then realized that if every Jewish child could experience this wonderful feeling and connection to Hashem and Klal Yisrael, we may not lose so many precious neshamot.

It’s time to be honest with ourselves- today’s yeshiva system sets standards and expectations that can only be met by a percentage of its students.

What happens to the child with a disability who may learn differently from the majority of the students? What happens to the weak student when he or she can’t fit the mold? All our children are precious gems waiting to be polished and shined to their potential. Yet many children are unable to experience success and develop both their abilities and self-esteem in the mainstream yeshiva classrooms. How can they feel important and valued in the academically driven yeshiva world?

It’s time to bring about a change in our scholastic expectations and look honestly at the gifts that Hashem has given to each child. Many years ago, I had a student in my yeshiva resource room who was failing most of his classes. Yosef* felt small and insignificant, and he soon became depressed. His teachers urged him to try harder, complete more homework, and do better. The words alone were empty. None of his teachers offered him the tools to develop the skills or confidence to succeed. When I personally worked with Yosef, I discovered that he was a talented artist and musician. I gave him art books and a guitar, and I let him know that I believed in him.

Yet I still couldn’t effect a change for Yosef in the classroom. No matter how hard I tried, I couldn’t close the academic gap quickly enough to stop the reprimands, disappointments and pain. The story does not end well. Today, Joe is married and works in the music profession; he is not observant and his children have no connection to the frum world. The outcome could have been different if

Yosef ’s teachers had modified his academic goals, and Yosef had been given an opportunity to develop and share his artistic and musical abilities.

The blessings that Yaakov Aveinu gave to each of his sons emphasize that we are members of a diverse and multi-talented family, and that not everyone is destined to become talmidei chachamim.

It’s time to change our attitudes and reactions to children who may appear different in one way or another. If we remember that every human being is equal in the eyes of Hashem, and that our role in this world is to emulate Hashem, we can make the extra effort to recognize and highlight the positive in every child. How can this be achieved? Take the time to identify each child’s capabilities and call upon the child to “help” his

or her peers and teachers. It’s as simple as saying, “Leah, you are so organized that I want you to be in charge of keeping my book shelves neat” or, “Uri, please lead the benching, you have such a powerful voice.” While it may only take a moment to come up with a compliment and encourage a child, the effect can make a huge difference in a child’s self image.

It’s time to foster a feeling of achdus and increase our tolerance, understanding and appreciation for each other. Too many adults don’t stop to think about the impact of their personal reactions upon those around them. Some parents are hesitant to allow their children to play with other children who don’t have ideal social and academic skills. Their children pick up these attitudes and tease the weaker students whenever adults are not around. It is especially difficult for the child who is a bystander to step up and defend the taunted child. I remember the horror experienced by a

Naomi Nadata has been the Program Director of CAHAL, a special education program for children with learning disabilities, since its inception fifteen years ago. A former resource room coordinator at Yeshiva Tifereth Moshe and HANC, she has her Masters in Learning Disabilities from New York University and her Certificate as School Administrator / Supervisor from Queens College. Mrs. Nadata can be reached at 516 295-3666 or cahal@cahal.org.

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September 2007

Today’s yeshiva system sets standards and expectations that can only be met by a percentage of its students. It’s time to foster a feeling of achdus and increase our tolerance, understanding and appreciation for each other. special education student after she was sent to join a mainstream class going on a school trip. Morah Klein had gladly agreed to have Tova included with her class, but she had forgotten to add Tova’s name to the list of participating students. Another teacher took attendance as the children boarded

the bus. When Tova stepped up to join the others she was told that her name was not on the list, and she had to leave. Mustering every bit of courage that she had, Tova stammered, “But they told me I could come.” The teacher held her ground, not bothering to investigate the situation. The other children snickered as Tova was sent back into the school building. Of course, the teacher was just following protocol and did not consider the lasting impression she made on all the children.

Dina was turned away from yeshiva after first grade. Sent to public school, she refused to join her family for meals on chagim, saying that she no longer belonged. In fifth grade, Dina returned to yeshiva joining our special education class. Today, Dina is married and working as a special education morah in our program helping others overcome their challenges and stay connected to Yiddishkeit.

We can crown our children with confidence and joy, or we can destroy them with our tunnel vision and insensitivity. What legacy do you want to leave for the next generation? n *Names have been changed.

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education The Special Ed Child And The Class Bully Making The Connection

By Rifka Schonfeld Bullying- it may be a common problem for children both in school or at camp, but it’s still heartbreaking every time I see it happen. Take Naftoli, for instance. Naftoli refuses to go to yeshiva. He lays in bed, complaining of an imaginary stomachache. His mother, of course, knows what the real problem is. Naftoli can’t bear to face Chesky, a classmate who is making her son miserable. Ever since the school year began, he’s been teasing and taunting Naftoli at any given opportunity. And while Naftoli handled it bravely for as long as he could, his resistance finally wore down.

He refuses to face his tormentor again.

What makes kids bully their peers and how do we deal with the situation when it affects our children? These are questions that parents ask me quite often, and believe me when I say I truly sympathize with their plight. It’s sad to hear how heartless and cruel some children can be to others.

It’s also sad to see how profoundly it affects the selfesteem of the victim/child.

Researchers have long ago discovered a very

“boys use more physical aggression and direct bullying” whereas girl bullies resort to “name calling and social exclusion.” real connection between the special ed child and the bully syndrome. They’ve found that both the bully and his victim are often underachieving students with possible self-esteem issues who are more susceptible than others to these negative social interactions. As is so often the case, one negative experience leads to another and a child who is struggling academically will often be struggling with a range of other issues as well A number of studies have been conducted on the dynamics of bullying and its effect on the children involved. Some of the results may be surprising. In a recent study held at the University of Zurich (by Sonja Perren and Rainer Hornung),

it was discovered that there is a connection between bullying or victim-of-bullying behavior and negative family relationships. This means that children involved in bullying are more likely to have ‘issues’ at home. The study cites “insecure family attachment or overprotective parenting styles” as possible risk factors.” Other family issues associated with bullying are “lack of warmth or closeness at home, a focus on power and high aggression, and the use of physical disciplining.” (Parents, take heart. These studies are meant only to point out certain trends. Just because your child is a victim of bullying, it doesn’t mean that you’re running a dysfunctional household.)

Another study, conducted by Rene Veenstra and associates in the Netherlands, indicates that boys are “overrepresented” in the role of bully in contrast to girls (which means that there are more male bullies than female bullies.) However, both boys and girls are equally represented as victims.

The study also states that, when they’re bullying, “boys use more physical aggression and direct bullying” whereas girl bullies resort to “name calling and social exclusion.” They conclude that “Hitting and threatening are types of bullying which are common to boys in particular. Gossiping and the taking of personal belongings are common for girls.”

Either way, it makes for unpleasant circumstances. What’s a parent to do? One important

Continued on next page

Special Education Preschool Accepting Referrals for September 2007 Our services are available for children ages 3-5 years who are experiencing developmental delays.

We offer: Centerbased Classrooms Special Education Itinerant Teachers (ABA Trained Available) Related Service Providers (Speech, OT, PT and Counseling) Address: 460 Grand Street New York, NY 10002 Email: jane@comprehensivekids.org Tel: 212.539.0259 • Fax: 212.677.4853 Employment opportunities available for NYS certied/licensed Special Education Teachers and Therapists (preschool experience required).

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helped. Thereâ&#x20AC;&#x2122;s something about their dress, their demeanor, their academic performance, or their behavior that is drawing out this negative atten-

Our society has conditioned us to consider the â&#x20AC;&#x2DC;wimpâ&#x20AC;&#x2122; or the â&#x20AC;&#x2DC;nebâ&#x20AC;&#x2122; as the lowest common denominator on the social stratosphere. Weâ&#x20AC;&#x2122;ll do

tion. A professional educator or social worker can work with them, drawing out reserves of self confidence, raising academic achievement, or building self esteem so that they are better equipped to face the world. An educator who is familiar with the dynamics of todayâ&#x20AC;&#x2122;s generation can make an independent evaluation of what exactly is going wrong. We all know that itâ&#x20AC;&#x2122;s not fair to be superficial when judging others, but the truth is that a new O6U<R9 hairstyle, better groom8 th[OY @E, ing, losing a few pounds, A(R 9 ! a new wardrobe, or better grades can also do wonders in helping children $ 7KHUDSHXWLF +LJK 6FKRRO 3URJUDP IRU *LUOV WL +L K 6 K O 3 blend in better with the #FQNGUEGPEG KU QHVGP HTCWIJV O +PFKXKFWCN )TQWR 6JGTCR[ rest of their peers.

YKVJ VWTOQKN CPZKGV[ CPIGT CPF O 5GNH #YCTGPGUU 5GNH 'UVGGO Now letâ&#x20AC;&#x2122;s analyze EQPHWUKQP &GXGNQRKPI C WPKSWG 9QTMUJQRU KFGPVKV[ YJKNG EQOKPI VQ VGTOU the bully himself. Letâ&#x20AC;&#x2122;s O &KRNQOC 5VWF[ %QWTUG .GCFKPI YKVJ UQOGVKOGU FKHHKEWNV CPF not let him off the hook RCKPHWN EKTEWOUVCPEGU ECP NGCF VQ C )'& too easily. Heâ&#x20AC;&#x2122;s got â&#x20AC;&#x2DC;issuesâ&#x20AC;&#x2122; VGGPCIGTU VQ UGGM VJG EQORCP[ O ,GYKUJ %QWTUGU YKVJ C 4GHTGUJKPI QH QVJGTU KP UKOKNCT UKVWCVKQPU too. Too many of us tend 1WVNQQM 6QQ QHVGP VJKU YKNN OGCP LQKPKPI C to smile or shrug when O 'PTKEJOGPV %QWTUGU KP VJG #TVU UQEKGV[ QH [QWPI RGQRNG RTQOQVKPI we are confronted with a O 8QECVKQPCN 6TCKPKPI CNN UQTVU QH UGNH FGUVTWEVKXG bully in our class or in our DGJCXKQTU 6JKU ECP NGCF VQ DGKPI O %JCNNGPIKPI 'PVGTVCKPKPI 5CHG TGLGEVGF D[ VJG EQOOWPKV[ HTKGPFU 6TKRU 6JTQWIJQWV 'TGV\ ;KUTCGN family. After all, we think CPF UQOGVKOGU HCOKN[ C HCEVQT O %QOHQTVCDNG &QTOKVQT[ (CEKNKVKGU to ourselves, these kids are YJKEJ ITGCVN[ EQORQWPFU VJG going to be okay, arenâ&#x20AC;&#x2122;t GZRGTKGPEG QH EQPHWUKQP CPF RCKP 'PFQTUGF D[ NGCFKPI )GFQNKO they? They are outgoing /CP[ QH QWT VGGPU HGGN GORV[ /GEJCPEJKO CPF RTQHGUUKQPCNU KP and assertive. They even CPF FGURQPFGPV CPF YJCV VJG[ 'TGV\ ;KUTQGN CPF VJG 7PKVGF 5VCVGU QHVGP [GCTP HQT OQUV KU C JCXGP QH have a certain aura of 6\QHKCJ JCU C UWEEGUUHWN VTCEM CEEGRVCPEG VJCV YKNN GPEQWTCIG â&#x20AC;&#x2DC;powerâ&#x20AC;&#x2122; and â&#x20AC;&#x2DC;authority,â&#x20AC;&#x2122; TGEQTF CPF KU PQY CEEGRVKPI VJGKT ITQYVJ KP C PWTVWTKPI CPF which may serve them CRRNKECVKQPU HQT VJG EQOKPI [GCT NQXKPI GPXKTQPOGPV well when they are older.

6\QHKCJ NQECVGF KP UCHG UEGPKE Tzofiah, located in safe, scenic ´7]RILDK LV D OLIHVDYHU IRU Iâ&#x20AC;&#x2122;ve seen parents look 4COCV $GKV 5JGOGUJ +UTCGN KU C Ramat Beit Shemesh, Israel, is a JLUOV ZKR KDYH JRWWHQ LQWR upon their bully/children VJGTCRGWVKE RTQITCO ECVGTKPI therapeutic program catering to VHOI GHVWUXFWLYH EHKDYLRUV Âľ with a sense of pride. BeVQ VJG PGGFU QH year [GCT old the needs of the 16-18 QNF #OGTKECP %CPCFKCP CPF American, Canadian, Australian, lieve me when I tell you 5DEEL $EUDKDP - 7ZHUVNL 0' South African and British young $TKVKUJ [QWPI YQOGP HTQO thereâ&#x20AC;&#x2122;s nothing here to be TGNKIKQWU DCEMITQWPFU women from religious backgrounds. proud of.

anything, even raise a child to be a bully if we have to, to avoid this. The Torah, of course, teaches us a completely different set of values. The character traits that we should truly aspire to are â&#x20AC;&#x2DC;ehrlichkeitâ&#x20AC;&#x2122; and â&#x20AC;&#x2DC;aidelkeitâ&#x20AC;&#x2122; and a quiet finesse. We have to teach our children and our talmidim that we respect the youngster with outstanding derech eretz, even if he is a little quiet and reserved. We have to look to him as a role model for other children.

If youâ&#x20AC;&#x2122;re still not convinced, consider the latest scientific studies. They point out that our friend, the bully, may be looking forward to some serious â&#x20AC;&#x2DC;issuesâ&#x20AC;&#x2122; of his own somewhere down the road. A teen who bullies his peers may very well be struggling with his schoolwork. Bullies are more likely than others to be involved in a variety of delinquent behaviors including crime, violence, harassment, threatening, excessive anger, etc.

They may be temporarily popular while theyâ&#x20AC;&#x2122;re in school, (after all, everyone wants the bully to be their friend), but have difficulty maintaining relationships with others as an adult. Finally, bullies were found to have higher levels of aggression and lower levels of academic performance than most of their peers.

Just as the parents of the victim should seek guidance from professionals, so should the bullyâ&#x20AC;&#x2122;s parents. Chances are thereâ&#x20AC;&#x2122;s some underlying reason for the childâ&#x20AC;&#x2122;s aggressive and abusive behavior. Are there serious academic issues? Is there a self-esteem issue that is being masked by playing â&#x20AC;&#x2DC;tough?â&#x20AC;&#x2122; These questions should be evaluated and the causes should be established.

Reach out for help now, while the children are still relatively young and the problems are easier to deal with. And remember. Just as Naftoli is suffering, you can be sure that Chesky is suffering in some way as well. We should work on â&#x20AC;&#x2DC;savingâ&#x20AC;&#x2122; the bully from himself just as we try to save the victim from the bully. n

Class Bully continued from previous page first step to take is to see the teacher. Experienced mechanchim and mechanchos have seen the syndrome so often they can probably write their own studies on bullying behavior. Thatâ&#x20AC;&#x2122;s why theyâ&#x20AC;&#x2122;re also your first line of defense. If your child, like Naftoli, is exhibiting the classic symptoms of a bully victim, especially if he is also academically challenged, donâ&#x20AC;&#x2122;t be embarrassed. Intervene on his or her behalf. Make an appointment to meet with the Rebbe, the morah, or the Menahel. They are on your side. Theyâ&#x20AC;&#x2122;ve seen this syndrome so often, they usually will know how to handle it. They have the power to effectively isolate the bully or at least to keep watch over him so as to minimize his powers. They can make subtle changes in the classroom patterns (change of seat, of chavrusa, of recess partners, etc) that can be very helpful. They can enlist the aid of other students to help reduce the effectiveness of the bullyâ&#x20AC;&#x2122;s taunts.

Donâ&#x20AC;&#x2122;t think that calling the teacher is a sign of weakness or caving in. The teacher is your ally, and you need all the allies you can get to fight the bully in this battle.

Some children are singled out by one particular bully for no apparent reason. Other children are consistently designated as the victim, whether they are in camp, in school, at the local pirchei group, or in any social situation. These children need to be

For more information and registration, call

972-2-999-8096 or email us at: (QT OQTG KPHQTOCVKQP CPF TGIKUVTCVKQP ECNN info@tzofiah.org â&#x20AC;˘ www.tzofiah.org

Contributions welcome! Checks made out to

QT GOCKN WU CV KPHQ"V\QHKCJ QTI American Friends of Tzofiah 874 East 9th St.,YYY V\QHKCJ QTI Brooklyn, NY 11230

Building Blocks

September 2007

Mrs. Schonfeld is the Principal in a Brooklyn school, and runs the widely acclaimed educational program, S.O.S. (Strategies For Optimum Student Success) in English and Hebrew on all grade levels.

As a reading and â&#x20AC;&#x153;Kriyahâ&#x20AC;? specialist, she has successfully set up reading labs in many schools and Yeshivos. She also offers teacher training and educational consulting services, and specializes in teaching social skills to the socially inept child. She can be reached at (718) 376-5545.

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education Augmentative Communication

By Megan Petrizio M.A. CCC-SLP Speech pathologists work with a variety of populations, ranging from preschoolers who have difficulties using speech and language to adults whose abilities are impaired following a stroke or brain injury. They often work with students with autism spectrum disorder, who typically demonstrate limited expressive and receptive language skills and commonly require attention in the areas of oral motor functions (such as strengthening and awareness of the mouth, tongue, lips and jaw), feeding, and social skills.

This is a population where a speech pathologist is critical in the evaluation and treatment of students in order to find successful communication methods. Many students with autistic spectrum disorder are able to speak. Others have difficulties in this area and consider using other modes of communication such as sign language, picture exchange systems, or another area of the field that is gaining more recognition- Augmentative/Alternative Communication (AAC). Over the years, this has become a consistently growing method of functional communication for children with autism

A common misconception regarding speech pathologists working with students with autism is that they are responsible for the production of speech sounds only as a method of communication. Although this is a focus of therapy, when working with the autistic population, this is not necessarily the only focus. Speech pathologists do work on eliciting productions of sounds and words for everyday communication, but we are also responsible for exploring all areas of communication to find the most effective mode for a child.

There are times when a speech pathologist sees a child who is not able to make certain productions of words using speech, but can point to pictures and objects to communicate his or her wants and needs. In these instances, speech pathologists may implement Augmentative Communication. Augmentative and Alternative Communication methods are different strategies that assist people with severe communication disabilities to participate more fully in society.

Within Augmentative and Alternative Communication, there are low technology forms like sign language, gestures, or Picture Exchange Systems (PECS). In these cases, speech pathologists

Megan Petrizio has bachelor and master degrees in speech pathology and audiology. She received her New York State and California State license in the field and her clinical and rehabilitative sciences credential, and has researched the evaluation and treatments of individuals with Autism Spectrum Disorder. She currently works at Reach for the Stars Learning Center in Brooklyn, NY.

may teach the students sign language, or how to exchange pictures with teachers or peers in order to achieve successful communication and participation in the classroom and home environments. Some students using low technology forms of Augmentative Communication use devices that take the form of a button with a recorded message that students activate to have a voice in different activities of school and home. Once students demonstrate success in the area of low technology, often speech language pathologists provide them with high technology methods such as visual display screens. These forms of high technology devices appear like flat screen computers with a touch screen for students to activate in order to relate their want and needs.

Research is now suggesting that students with au-

Continued on next page

Building Blocks

September 2007

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education

® Understanding Typical Child Development

By Yittie Rimmer

We live in a wonderful age in which all types of remedial services are offered and can be accessed. Yet the downside of knowing what deficits, disorders or disabilities exist raises an internal radar when a child appears to not follow exactly what other children around his/her age are doing. The tendency is for parents to start to panic and to assume the worst for their child. The purpose of this article is to help parents understand the normal developmental ranges, and to make appropriate decisions for their children based on these ranges.

In our haste to pinpoint possible delays and deficits in children, we often overlook the normal range that development should take place in. Part of the problem may relate to socioeconomic factors. Basic cost of living expenses, such as mortgages, private school tuition, cost of summer camp, higher property taxes, higher water, gas, electric and telephone bills, not to mention a rise in the cost of food, creates a need for two income households in order to survive. This in turn creates a cycle of sending children out to stimulating environments at a younger age to save in house child care costs.

These playgroups are hopefully taught by a warm, well meaning, and stimulating individual, who may not necessarily have formal training in normal early childhood development other than a background in being a wonderful early childhood teacher for a number of years. Children are grouped together according to the year they were born in. This creates a serious disadvantage for the children and their parents, as comparisons start forming. Many wellmeaning teachers do not realize that every month to a young child, from birth to six years of age makes a difference, as well as gender, and birth order. In addition, in an effort to prove how wonderful they are, many teachers often choose to over teach young children, pumping them full of information to impress the parents, and unwittingly creating an environment of great expectations, more than the average child should be expected to handle.

When it comes to developmental skills, there is a natural inborn course in which these skills will be

Augmentative Communication continued from previous page tism spectrum disorder are experiencing increased success using these forms of high technology devices to increase their attention, communication and participation in the classroom.

Overall, speech pathologists are responsible for selecting the appropriate communication methods for students with autism and planning for its implementation. Ideally, a speech pathologist working with methods such as Augmentative/ Alternative Communication methods works closely with teachers and other allied health professionals such as occupational therapists or behavior therapists to ensure that students are following their communication strategies in the classroom.

In partnership with parents, speech pathologists educate the student and those working with him or her regarding how to use a device. Speech paBuilding Blocks

September 2007

achieved. Just as we would never seriously expect a three month old to perform the same as a nine month old, we must bear in mind that a child who is 3 years and three months will also not perform the same as a child who is 3 years and nine months. However, after the age of six, the developmental gap closes. As a child grows, it is specific skills related to knowledge that makes experience important, (think of math where you can only learn calculus after learning something like addition), rather than the achievement of the skill itself. With developmental skills, once a typical developing child achieves a developmental skill, they can perform it on par to anyone else who has achieved the same skill, regardless of age and experience. For example, once a child learns to walk, they can walk

When it comes to developmental skills, there is a natural inborn course in which these skills will be achieved. together with an adult, even if the adult has learned to walk 50 years ago. In many cases, the child may be walking all over the place, and it is the adult who is too tired to keep up! Another example is the six years old child who learns to ride a two-wheeler, and can ride just as fast as a 46-year old adult, despite the adult having 40 years more of cycling experience.

Therefore, when comparing developmental skills in children, we must first take into account their age, (by month as well as year), in order to determine if they are exhibiting a delay in a certain area, (the child has passed the age range of the expected skill and has not achieved it), or rather just an immaturity, (the child falls within the range expected but has not completed the skill yet).

A few years ago, a mother requested that I intercede with her child’s nursery school teacher to discuss ways that the teacher can help the child, who had mild sensory integration dysfunction, in the school setting. The teacher requested that I teach this child, who was exactly three years and thologists may also provide consultation services to determine if a device is a good fit for a student with autism. Utilizing these devices, students with autism often engage in fewer challenging behaviors and increase their participation in their classrooms and families.

With consistent consultation and team work, implementing these methods of Augmentative and Alternative Communication can provide students with autism with more independence and active voices in our communities. To the child with autism spectrum disorder, these methods are often their opportunity for a voice when they are unable to make one on their own. It is ultimately the opportunity to communicate successfully and to become communicatively competent in their lives. Now, with the increasing awareness and implementation of Augmentative and Alternative Communication (AAC) as a method of communication, students with autism are achieving our dreams for them to become happy, contributing members of our society as a whole. n

one month old at the time of the call, toileting hygiene. After all, she reasoned, occupational therapist’s work with activity of daily living skills, such as hygiene and toileting. When I calmly explained that it is unreasonable to expect this particular skill from a 3-year old child since it usually appears around 4 ½ to almost 5 years, the teacher became agitated.

“Well, what am I supposed to do with her when she goes to the bathroom and needs help?” she asked.

“Why don’t you ask your assistant to help her out?” I replied.

“I need my assistant to do all the cutting preparation for the arts and crafts.” she answered.

“Besides, I toilet trained my own children by the age of two, and taught them how to clean themselves up afterwards. They were all able to do it, why can’t she?”

I complimented her that her children were obviously “Einsteins” in this area, but realistically the brain bladder connection is only fully established at 2 ½. We need to work realistically with normal childhood development. This particular skill was not age appropriate, should not be expected, and I refused to pre-teach a skill to an otherwise normally developing child. Her choice was either to buy disposable gloves and deal with it, or to consider teaching an older age where the skill has already been achieved and would not present as a problem.

While this particular story of an unrealistic early childhood expectation stands out, there are so many others that boggle the mind. From the parents who insist that their 1 ½ year old should be toilet trained, (from 2 years, 6 months to 3 years is the age range when you can expect the child will be ready to learn how to be toilet trained), to the teachers who insist preschoolers write words, (from 5 years, 2 months to 5 years 10 months is the age range when you can expect the child to be ready to print simple words, copying models). From the adults who expect nursery age children to color in the lines, (from 5 years, 2 months to 5 years 10 months is the age range when you can expect a child to be able to color within an outline) to the ones who insist that young children who are unable to sit quietly during a 45 minute circle time should be medicated for hyperactivity. (The actual expected age ranges for this skill is that the ability to sit still for one minute occurs between 3 years of age to 3 years, four months. From 3 years, 6 months to 3 years, 10 months you can expect the child to be able to sit in circle time quietly for 5 minutes. From 4 years, 4 months to 4 years, 8 months you can expect the child to be able to sit in circle time quietly for 10 minutes. By 6 years of age, the child is capable of staying in their seat, or standing in line without moving for 75% of the activity).

These are all examples of unrealistic expectations.

For a basic guideline from an occupational therapy perspective, see www.jewishpress.com. n Yittie Rimmer is an occupational therapist who is in private practice.

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education EI, CPSE, CSEThe Alphabet Jumble

By Kalman Greenberg Every parent who has looked into getting services for their child has heard the following acronyms: EI, CPSE, and CSE. Government agencies love to use acronyms, and this article will define them and describe the process for getting services for each area. According to federal law, a child must have a developmental delay in one or more of the following areas: cognitive (intellectual) development, physical development (includes vision and hearing), language development, social or emotional development, and adaptive development. If a parent feels that there is an issue with any of these areas, their child can be evaluated for services. Where to go for an evaluation depends upon the child’s age.

EI EI-Early Intervention, ages birth – 3 years. The New York State Department of Health contracts with agencies to provide therapeutic and educational services to babies and toddlers who require additional support. These services may include: Kalman Greenberg is a Certified School Psychologist at HASC & Adjunct Professor, at Touro College.

Speech therapy - Language, communication and feeding issues.

Physical therapy - Gross motor issues, such as crawling and walking.

Occupational therapy - Fine motor issues such as grasping, cutting, dressing and sensory issues.

Counseling - Psychological counseling for emotional and behavioral issues.

Hearing - Activities and exercises to address hearing deficits.

Vision - Assist children to function with visual deficits.

Special education teacher (SEIT) - Educational services in the home or in a center based program.

The process to receive these services as applicable is complicated. Parents can call the agency of their choice (this magazine has a listing), which can help you with the process. Typically, a social worker or case worker will speak to you about the concerns you or your doctor may have. An evaluation will then be scheduled and depending on your concerns, will consist of psychological, speech, occupational, physical and educational evaluations. These evaluations should be conducted in the language that is spoken in your home, including Yiddish, Hebrew,

PREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTINPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREHOTLINE • SUPPORT GROUPS • REFERRALS VENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREConfidential Hotline 10am - 10pm I N T E R N A T I O N A L VENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREVENTIONPREBe our partner! Please send your tax deductible donation to: VENTIONPREVENTIONPREVENTIONPREVENTIONPRE2566 Nostrand Avenue • Brooklyn, NY 11210 VENTIONPREVENTIONPREVENTIONPREVENTIONPRE-

and Russian. Copies of the evaluation reports will be given to you by the agency. Based on the results of these evaluations, recommendations for services may be made. Be aware that the state requires a certain level of delay before therapies can be recommended. Even if a delay is found, if it does not meet the criteria given by the state it will be very difficult to have services approved. The child will also need to be given a physical and a blood test for lead by your pediatrician.

An IFSP meeting is then scheduled with an agency representative or service coordinator, a representative from NY Health Department (EIOD), and the parents. The IFSP, or Individualized Family Service Plan, is a legal document describing how the child’s and family’s needs will be met. It describes the child’s level of functioning, the needs of the parent and family, and what services, if any, will be provided.

After the meeting, follow-up meetings or reviews will be conducted to discuss the child’s progress and what changes might be needed. The parent may be provided an EI service coordinator who will answer your questions and help with the process. At age 3, the child “ages out” of EI and depending on their needs can receive services from CPSE.

Continued on next page

Parenting: Hang in Hold on Hug tight

718-758-0400

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education

®

Alphabet Jumble continued from previous page CPSE CPSE - Committee on Preschool Special Education, ages 3-5. This is a New York City Department of Education agency that contracts out services for child ages 3 to 5 years of age. Parents whose children age out of EI or request services for the first time must be evaluated for CPSE. The parent makes a written request to the local region office (a service coordinator can help you with this). Once the request has been made, the child must be evaluated in a timely fashion. A list of agencies that have contracts with the city will be mailed to you. Your child will then be evaluated by the agency you have chosen. The evaluation process consists of an interview by a social worker, a psychological and educational evaluation, a classroom observation if applicable, and additional evaluations as needed. These may include a speech/ language evaluation (often includes an audiological

evaluation as well), physical therapy and occupational therapy evaluations. After the evaluation, a copy of the evaluations and their recommendations will be sent to you and to the city.

While the evaluators may make recommendations, only an administrator from the Department of Education can approve it. This decision is made at the IEP meeting. The Individualized Education Program describes the child’s medical, educational and therapeutic needs and the services that will be provided by the city. At this meeting there will be a representative from the city, the parent(s), a representative of the evaluation agency, and perhaps a parent representative from the city. If it is decided that the child requires services, a contracted agency will provide those services in either a school or a therapy center. Home-based services are typically not provided. A special education classroom placement may also be recommended at no cost to the parent. The child’s progress is discussed annually, at the annual review, and any changes to the therapies provided will be discussed then. This process continues until the child turns five, and if deemed

appropriate the child will be evaluated for CSE. CSE CSE- The Committee for Special Education, ages 5-21 (or graduation from high school). This committee is responsible for school age children who require therapeutic or educational services. The process is very similar to a CPSE evaluation and meeting.

An IEP is also developed and services are provided.

However, therapists are paid at a lower rate than EI, and there is a correspondingly smaller pool of therapists providing these services. There are, however, agencies providing services to the larger yeshivas, and children placed in special education classrooms are provided services at their site.

Each of these agencies has their own regulations that can be confusing to parents. It is therefore recommended that parents seek the assistance of a service coordinator if you qualify, and that copies of all written communication and a telephone log should be kept. Remember, parents are the primary advocates for their child, and if you feel that necessary services are not being given, appeals can be made. n

Stages of Development Social Skills

Daily Living

Gross Motor

Fine Motor

Language

0-6 months

Social smile.

Recognizes mother.

Reacts to method of nutrition.

Uses pacifier or thumb for comfort.

Lifts head when lying on their stomach.

Turns over when lying on their stomach.

Looks at faces and toys and reaches for them

Spontaneous social vocalizations (sounds).

Responds to coos, voices.

EI

6-9 months

May reach out to familiar people.

Pushes or turns head away from things they don’t like.

Puts small cracker in mouth.

Roll over when lying on back.

Sits up without support.

Picks up objects with thumb and fingers.

Turns and looks when hears name.

EI

Transfers toys from hand to another.

Wider range of vocalizations- sounds like they are speaking their own language.

9-12 months

Social games- peek-a-boo

Holds out limbs during dressing.

Drinks from cup with help.

Crawls on hands and knees.

Walks around furniture while holding on.

Holds cup with 2 hands.

Mama, dada.

Understands “no”, “stop”

12-18 months

Has a “blankie” or favorite stuffed animal.

Says ”hi” or waves.

Gives kisses or hugs familiar people.

Uses a spoon (with spilling).

Wants to do things by themselves.

Stands by themselves.

Walks- “Toddles” Runs, but may fall.

Creeps up stairs.

Picks up toys without falling.

Stacks 2 blocks.

Scribbles.

Turns pages in a book 2-3 at a time.

Identifies things using 1-2 EI words.

Asks for food or drinks.

18-24 months

Empathy- comforts other children.

NO is heard often when told to stop.

Eats with spoon and fork with little spillage.

Takes off open coat.

Throw, kicks a ball.

Runs well.

Uses stairs-may hold on to banister.

Builds towers of 4 or more blocks.

Turns pages of book one at a time.

Uses at least 10 words.

Follows two part instructions.

EI

24-30 months

Plays with other children.

May “help” with common chores

Washes hands.

Climbs on play equipment.

Uses knob to open door.

Uses 2-3 word phrases.

EI

30-36 months

Pretend play

Dresses themselves with help.

Uses both feet on each step to go up and down stairs.

Draws vertical lines Uses safety scissors.

Uses one hand consistently.

Is more easily understood.

Ask or answer simple questions.

EI

3-31/2 years old

Helps other children- gives Toilet trained directions. May be bossy. Washes face by themselves.

Uses alternate feet to walk up and down steps.

Rides a tricycle using pedals.

Balances on one foot

Draws a complete circle.

Has a more appropriate grasp when using a pencil.

Can identify four primary colors and parts of body.

Uses 3 word sentences, plus “and”, “or”, “but.”

CPSE

31/24 years old

Cooperative play.

Dresses without help, (not including fasteners).

Hops on one foot without falling.

Throw ball over their head.

Cuts a paper in two.

Can count 5 items when asked.

Answer simple “Who”, “what”, “where” questions.

CPSE

4-5 years

Follow simple rules of a game

Buttons clothing (may skip buttons) .

Using swing by pumping legs.

Skips.

Draws recognizable pictures.

Follow 3 step instructions.

Identify 5 or more letters.

CPSE

Building Blocks

September 2007

EI

SE

SE

SE

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education All Kinds Of Minds

Yeshivas And Day Schools Using “Schools Attuned”

By Dr. Judah Weller

help, particularly when he’s already doing his best are methods designed to help a child work around or has done his best to no avail. Similarly, punish- a particular problem. Imagine asking a student The “All Kinds of Minds” Institute, founded ing him for an inability to complete a particular with average to strong organizational and creative

by Dr. Mel Levine, has as its mission to help stu- task in a particular way is ineffective. Yet these skills but poor handwriting skills to draft an essay dents who struggle with learning, and measurably types of responses to those highly vulnerable kids by hand. The result, more than likely, will be frusimprove their success in school and life by provid- are common. Having insight into the specific na- trating and disappointing for everyone involved. ing programs that integrate educational, scientif- ture of the breakdown is critical to creating the Allowing that student to use a keyboard, in effect ic, and clinical expertise. Their primary goal is to appropriate set of solutions to remedy or work “bypassing” the motor problem will, more than educate teachers, parents, educational specialists, around the particular situation. Does this kid have likely, lead to success. a memory problem? And what about his memory The kinds of dysfunctions that affect a sixseems to be causing the problem? year old are profoundly different from those that We must look carefully at each of the func- impair the progress of an eighth grader. For extions of the brain that affects the ways a student ample, just think about how differently an inabillearns as well as performs in school—functions ity to summarize a chapter, take notes, or manage such as memory, language, and attention, neu- one’s time would impact a high school student romotor functions, social cognition, and higher versus a second grader. Essentially, this means order cognition. The human brain is like a com- that it’s quite possible to experience a learning plex orchestra, with many different instruments problem during one school year while succeeding playing many roles. Finding precisely where the earlier or later on. It also means that sooner or breakdown is occurring when a student is falling later most kids will encounter a learning situation behind begins with the teacher, parents, clini- for which they are not optimally wired. cians and the student himself working together We also know that as adults we’re allowed, if to create a neurodevelopmental profile—a kind not encouraged, to practice our brain’s specialties. of balance sheet that accounts for the student’s Yet we expect school-aged kids to be rather good strengths and weaknesses. Once this is identi- at everything. This expectation can have traumatfied, a highly individualized plan can be develContinued on next page oped. When students are having difficulty National Association of with a particular acaYeshiva Day Schools Serving Special Children demic skill, the task of A Division of Yachad/NJCD parents, teachers, and clinicians is to pinpoint Educating the Whole Child: the areas of difficulty, to specify the weak Academic and Psycho-Social Elements of Education Telling a student sub-skills, and to create Tuesday, November 6, 2007 a plan for strengthen“you can do better” 8:00 a.m.-4:30 p.m. ing strengths and areas doesn’t help… in need of improveKushner Academy, Livingston, NJ ment. psychologists, pediatricians, and students about Every plan starts Keynote Speaker: differences in learning, so that children who are with “demystification,” DR. SANDRA REIF struggling in school because of the way their a process that teaches “Managing ADD/ADHD brains are “wired” are no longer misunderstood. the student all about The following is a summary of the programs his or her strengths and in the Classroom” goals and philosophies that has been utilized by weaknesses. This emHighlighted Speakers include: school systems across the country. powering and respectDr. Joel Dickstein, Rabbi Rafael Feuerstein, Dr. Jeffrey Lichtman, Too many kids struggle and fail needlessly ful process makes kids Dr. Jay Lucker, Dr. David Pelcovitz, and Dr. John Winer. simply because the way in which they learn is part of the solution, incompatible with the way they’re being taught. helps them to feel betWorkshop topics include: Autism, Auditory Processing, Visual Disorders and Reading, Schools are filled with kids who give up on them- ter about themselves Management of Students with Emotional Disorders, selves, are convinced they’re “losers,” and con- as well as appreciate Diagnostic Procedures for Teaching Limudei Kodesh, Midot through Art, clude that they’re just dumb. It’s painful for the individual differences Reading and Math Fundamentals, Graphic Facilitation, Career Development … student, teacher, and parent who may be unaware in general. It also sets that the “wiring” of that child’s brain simply is the stage for introducFee: $120 per educator Lunch Included not in synch with the demands and expectations ing bypass strategies or Special Rates for Schools of the situations at hand. direct interventions.

Special travel subsidy available Telling a student “you can do better” doesn’t Bypass strategies For further information, and to register, contact Batya Jacob at Dr. Judah Weller is the Educational Director of P’TACH. P’TACH has adapted the Schools Attuned 212-613-8127/551-404-4447 or jacobb@ou.org ® program for Jewish educators. Since 2002 it has been instrumental in training over 700 Jewish www.njcd.org/schoolprograms educators, mostly regular classroom teachers and rabbeim. Dr. Weller, has himself facilitated over 20 groups of 25 Jewish educators in this intensive 5 day (35 hour) “Jewish Day Schools Attuned” program. P’TACH is beginning its third decade of providing mainstream special education programs that follow the All Kinds of Minds philosophy.

NJCD is a division of the Orthodox Union.

This conference is co-sponsored by the Keren Keshet Foundation.

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education

® Making Aliyah With A Child With Special Needs

By Joan Shrensky

Many families are afraid to make Aliyah- not for financial reasons, security concerns or job security; they can deal with those issues. Why, then, are they so hesitant? Because Hashem has presented these families with a special test – He has given each of them a special child (or in some cases – children). Hashem gives each of us only what we have the ability to handle in life, and these families want to make sure they make the right decision for their child. Therefore questions arise as to the availability and quality of education for children with special needs in Israel and, in the long run, the quality of life.

Of course, every child and every situation is unique, and specific answers can only be made on an individual basis. Answers are affected by the types of disabilities and personalities each child may have, where someone wants to settle, knowledge of Hebrew and sometimes financial situations. But on the other hand, there are certain general facts that all persons who wish to make Aliyah with a child with special needs should be aware of.

With regard to schools, in every town and city there are different numbers and kinds of educational frameworks, and each framework has its own individual characteristics. However, for children with special needs, there are basically three choices of schooling in Israel: 1) special education 2) a self-contained classroom (sometimes with occasional inclusion in a regular class), or 3) enroll-

All Kinds Of Minds continued from previous page ic effects on students. It is critical, therefore, in an effort to preserve and protect these kids’ minds, Supplementary Reading A description of EI from the NY State Dept. of Health. http://www.health.state.ny.us/community/infants_ children/early_intervention/ Parent Guide to EI http://www.health.state.ny.us/community/infants_ children/early_intervention/parents_guide/index.htm IEP Guide from the Education Dept. http://www.ed.gov/parents/needs/speced/iepguide/ index.html Preschool to School Age Guide http://schools.nyc.gov/NR/rdonlyres/69D786299B1B-4247-A23B-C09B581AFAB1/15127/ PreSchooltoSchoolAge102406ENGLISH.pdf Guide to Parent Rights http://schools.nyc.gov/NR/rdonlyres/69D786299B1B-4247-A23B-C09B581AFAB1/7096/ ParentsRightsLetterEnglishSept05.pdf CSE Contacts http://schools.nyc.gov/Parents/Essentials/ Special+Education/contacts.htm

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Hashem gives each of us only what we have the ability to handle in life, and these families want to make sure they make the right decision for their child. ment in a regular classroom in a regular school (with supplemental remedial services provided by the government and/or the parents). By law, you may choose whatever framework you want, but the government is not required to provide support services if your choice does not correspond to their recommendation. Parents of any child who needs special education or special services (therapies, tutors, private aide, etc.) will need to schedule a “Vaadat Hasama” hearing (a placement committee geared towards special education) or a “Vaadat Shiluv” hearing (a placement committee that coordinates inclusion) in the city they plan to live in. If a child needs a “Vaadat Hasama” hearing, this is from the age of three for nursery school. At the “Vaadat Hasama,” the child’s psycho-educational evaluation, along with any reports provided by therapists and teachers, is discussed by a team of professionals along with the parents. Together, everyone decides which educational framework is best for the child. Then, that we adopt a developmental perspective when evaluating a student’s strengths and weaknesses.

Helping kids get better and better at what they are good at makes a lot of sense. After all, in the adult world, it’s the strength of your strengths and not the weakness of your weaknesses that really counts.

Similarly, taking advantage of a student’s special interests can both motivate as well as help through or around a learning impasse. For example, reading about something that excites you can help enhance reading skills. The same can be said for writing, remembering information, and for concentrating. We must not only recognize these strategies as practical, but apply them widely in an effort to help kids achieve their potential.

Given the complexity of both learning processes and individual differences in learning, no single discipline or profession could or should be expected to have all the answers.

Taking a multidisciplinary and multi-perspective approach to interpreting and working with children has a far greater likelihood of achieving positive results.

Pessimism is one of the worst complications of a disappointing school performance. Far too many kids have been told or feel that because of their learning difficulties, they “will never amount to anything.” These prophecies can come true if

if inclusion is chosen or agreed upon, necessary services are also decided upon.

The placement recommendation made by the committee is not only based upon what would constitute the “best educational framework” for the child. It also takes into consideration available schools and resources in the city at the time of the meeting! If a parent is knowledgeable, and is a good advocate, he or she can sometimes find the “perfect” school in a nearby town, and convince the committee to approve bussing the child to that school and transferring the funds for the child’s schooling to the other municipality. In short, it isn’t a simple process, and the possibilities are very numerous and diverse. The first thing a family should do is decide where they want to live.

Then, decide how important inclusion is for their child. Inclusion in Israel, as it applies to the “least restrictive environment” has been mandated for a number of years, but its enforcement is fairly recent. It is slowly being more accepted, but an advocate is often needed to help the parents and child realize their right to an inclusive education (again, this varies in different communities). If the family chooses special education, depending on where you live, you often will not have as much of a choice regarding which school your child will be placed in. The special education facilities in some communities are few. In some cities, such as Jerusalem, the choices are many. If one knows of a school that meets the needs of their child, placement in that school can be requested. One

Continued on next page

Pessimism is one of the worst complications of a disappointing school performance. Far too many kids have been told or feel that because of their learning difficulties, they “will never amount to anything.” said enough times, and aggressive counteraction is certainly warranted. We believe that parents, teachers, and clinicians must devote considerable time and effort to helping kids see the possibilities for themselves in the future.

Interestingly, when we asked a group of parents and students to name what they felt was the key benefit to our approach, the overwhelming majority echoed “it gave us hope.”

Optimism is central to our mission. All kids need to gaze ahead with excitement and a positive outlook. All kids deserve a hopeful vision of the future. n

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education Making Aliyah continued from previous page can also request schools which meet the religious requirements of the family. If the parents want inclusive education, they can choose from almost any school which agrees to accept the child, in the area they will be living. Then, they schedule the appropriate “Vaada,” and argue their case for inclusion and appropriate services.

One can schedule a “Vaada” before having moved to Israel – registration for each year begins in March of the previous year – but a future home address needs to be provided and all the child’s test results and educational recommendations will have to be forwarded to the committee (translated) as well as copies of passports. This is something an advocate can take care of for the family. Inclusion is successful here, but it demands a lot of involvement on the part of the parents, and sometimes parents have to provide some of the funds for services they know their child needs, but which the government won’t or can’t provide.

If the child goes into special education, he/she will be placed in the most appropriate school setting which exists in or near that locality, and should receive all the basic therapies they require. Inclusion is harder to coordinate and manage (thus

one’s children are placed in the correct educational setting, little or no knowledge of “the system,” lack of sufficient Hebrew competency, adjustment issues, etc. are some of the issues which some families face. On the other hand, there are support systems and people who can serve as support and advocates for the family and with proper preparation, the Aliyah process can and does run smoothly. n

Aliyah can be a daunting experience for any family, but for one which has a child with special needs, it can seem overwhelming. far, in Israel), but can be much more tailored to a child’s educational needs and religious/social/ educational values.

Aliyah can be a daunting experience for any family, but for one which has a child with special needs, it can seem overwhelming. Making sure

Joan Shrensky is the founder and director of Mercaz Harmony, the International Center for Inclusion, in Yerushalayim. Mercaz Harmony has served as an advocate for inclusion since its inception in 1985 and provides Pre-Aliyah and Consultation Services (both in Israel and abroad) for families with children with special needs. For more information, please visit www.mercazharmony.org.

TIPS FROM PARENTS My ten year old daughter couldn’t remember what items she needed to pack in her book bag for school the next day. I made a checklist on half of an index card with check boxes by each item. Then I laminated it and poked a hole.

I attached the checklist and a wipe erase marker to her book bag. She was able to check off the items as she packed them and erase it for use the next day.

What a life saver.

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diagnostic

® The Importance Of

A Correct Diagnosis

By Kalman Greenberg

point you in the right direction and give you questions to ask the doctor.

Parents often ask me “Why does my child need Parents should question the professional that exa diagnosis?” “Why do I want my child to have amines their child. What experience do you have treata label?” There is a valid basis for their concern. ing children like my son/daughter? Do you work with Studies have shown that children who are labeled other professionals? What treatments do you typically often function at the level at which they are larecommend? Many parents are nervous about askbeled. This “self-fulfilling prophesy” is well ing these questions to their doctors. However, Correct documented in research. However, there is a parents are not only entitled to ask, but should. critical reason why children need a diagnosis, Diagnosis Before anyone buys a car, the buyer asks many and that reason is services. In order to receive questions before handing over their money. A services- educational, therapeutic or medicaldiagnosis has much greater implications for treatthe city and state agencies require a diagnosis. The ment and educational placement. Another question type and level of services a child receives is depen- that should be asked, before a diagnosis is made, is if dant on their diagnosis. other tests are recommended? There are many factors “Who can provide my child with a diagnosis?” that can affect a child’s level of functioning and behavThat depends on the issue involved. Strictly medical ior. Biological factors- health, hearing and vision are issues such as cerebral palsy, traumatic brain injury, very common. Recently, an ophthalmologist related and others can be diagnosed by your pediatrician. the story of a young man he treated. The child had That diagnosis would be a valid start to receive ser- behavioral difficulties in school. However, upon exvices. However, if a parent wished to know the exact amining the child, he discovered that the child needed ramifications of the disorder, it is highly recommend- glasses. The child could not see what his teachers were ed that they take their child to a specialist with experi- writing on the board, and would act out in class. With ence with that specific disorder. Psychological disor- his new glasses, these behaviors disappeared. ders are more confusing. Any licensed psychologist, Parents and professionals need to remember psychiatrist, mental health counselor, or any medical that they are working with a child, not a disorder. doctor is permitted to make that diagnosis if they feel Every child is unique. The diagnosis that a child is they are knowledgeable of the disorder. Every profes- given should be used as a guide for possible treatsional has a different perspective on how they view ment, not to describe who the child is. Therefore, symptoms and the treatments they use. parents should act as advocates for their child and Where can parents get recommendations from remind their doctors that they should look at the other doctors? Ask people whom they would recom- unique characteristics and needs of the child. At mend. Ask your primary care physician and ask par- the same time, it is important that the professional ents of children with similar issues. Your school can be given all the information that he or she asks for. also be an excellent resource for finding information Minimizing or omitting information can affect a about the professional that can help treat your child. child’s diagnosis and treatment. The perils of an The teacher and your child’s therapists can further incorrect diagnosis are great and will adversely afKalman Greenberg, is a Certified School Psychologist at HASC & Adjunct Professor, Touro College.

Visual Impairment

By Allen Purvin

anomalies (abnormal structural eye development), diseases (any illness), and trauma (injury). Some The term “visually impaired” usually refers to children have a congenital visual impairment, a person who has some degree of vision loss. This meaning they are born visually impaired. Other can range from a minimal loss requiring glasses children develop or manifest a visual impairor minor accommodations to total blindness ment later in life. Though the diseases and with an inability to distinguish between light anomalies that may cause a visual impairVisual and dark. Depending on the severity of the Impairment ment vary, some are more prevalent than vision loss, a person may also be “legally others. Among the more common ones in blind.” Legal blindness refers to an individual children are: amblyopia, strabismus, nyswith a visual acuity of 20/200 or less in the bettagmus, refractive (acuity) disorders, aniridia, ter eye, with best correction. “20/200” means that coloboma, achromatopsia, albinism retinopathy of what a normally sighted individual can see at 200 prematurity, optic nerve atrophy, microphthalmia, feet, the visually impaired person needs to be 20 and Stragardt’s disease. (Specific information confeet away from to see the same thing. Another way cerning these can be found at some of the websites to be “legally blind” is to have a limited visual field listed or through an internet search). of 20° or less.

If you are concerned that your child may There are various causes of visual impair- have a visual impairment, there are some signs and ments. These fall into three broad categories: symptoms to look for. It is important to note that Building Blocks

September 2007

In order to receive services – educational, therapeutic or medical – the city and state agencies require a diagnosis.

fect the health and well-being of the child.

Most children receive services from New York State Early Intervention, Committee of Preschool Special Education, or Special Educational school age programs. These services require a finding of an issue that significantly affects a child’s learning.

Other issues are treated by the health insurance the child possesses. It is therefore important to remember that the earlier a child goes for an evaluation, the earlier they can receive services and treatment.

Early treatment is essential. The brains of young children are extremely plastic and are very adaptable. Deficits that are disastrous later in life can be treated, accommodated and dealt with in young children. These include issues dealing with speech, motorical functioning, and social skills.

Parents are the most important people in their children’s lives. They not only provide food, clothing, shelter, and love, they also act as their advocates.

Work with your doctor and other professionals and help coordinate the care your child receives. If the doctor finds your questions problematic, then it may be time to find another doctor. A child’s diagnosis is important, but it is the parents who will be the determining factor for their child’s progress. Be involved and act cooperatively with your child’s doctors and therapists and progress will follow. n a child exhibiting these signs does not necessarily indicate that he or she has a visual impairment.

These are just some behaviors exhibited by some children who are visually impaired: • Photosensitivity (unusually sensitive to light) • Poor handwriting • Complaints of headaches/eyes hurting • Loses place when reading • Visual fatigue • Difficulty navigating his/her environment • Holding reading material close to face • Reading difficulties are one of the most common indicators of a visual impairment. However, determining whether the reading difficulty is due to a vision issue or a learning issue can be a challenge.

Though not necessarily definitive, one method of differentiating between the two is to give your child a reading passage approximately two years below her current reading level. Alternatively, have her identify the letters, numbers or symbols instead of reading the words or phrases (i.e., c-a-t instead of cat). If the child can read the material, it may sug-

Continued on next page

V

diagnostic Visual Impairment continued from previous page gest a learning difficulty. If the child cannot read the material, it is likely a pre-access issue and the cause may be visual.

If you are concerned that your child has a visual impairment, the most important thing to do is to get your child tested. Either an ophthalmologist or an optometrist is qualified to examine her eyes.

An ophthalmologist is a medical doctor (M.D.) with specialized training in the eye. An optometrist is a doctor of optometry, (O.D.) who has attended four years of graduate school.

Based upon the eye exam, an educational vision evaluation may be warranted. In New York State, a child does not need to be legally blind to receive a vision evaluation or vision services. A vision evaluation is performed by a certified Teacher of the Visually Impaired (TVI). (This is different than vision therapy, which tends to be more medically based). All children are different, and two children with the same visual diagnosis may actually function very differently. Therefore, the purpose of the vision evaluation is to determine the child’s visual functioning level within school (for school-aged children) or home (for early intervention children) and areas that may require remediation or assistance. The vision

All children are different, and two children with the same visual diagnosis may actually function very differently. teacher may recommend an orientation and mobility evaluation performed by a Certified Orientation and Mobility Specialist (COMS). A COMS helps people who are blind and visually impaired to use

Allen Purvin has his BS in Special Education in Severe Disabilities, his MS in Special Education for the Blind and Visual Impairment and is certified in Orientation and Mobility. He has been working as a teacher of the visually impaired for over 7 years. He can be reached at 718-591-6183 or allenpurvin@gmail.com.

PERSEVERANCE Turns Dreams INTO REALITY

a cane (if necessary), cross streets and travel independently, safely and efficiently.

If vision education services are warranted, the child will need an Individualized Education Plan (IEP) or a 504 plan. These will delineate the amount and length of service, goals, and any classroom and testing modifications. Though the particular needs will vary depending on the individual child, there are some accommodations that are fairly common.

Typical classroom accommodations include preferential seating (usually front and center, although not always), use of large print books and materials, books on CD or in an electronic format, special paper and writing implements, a slant board and a copy of board notes. Typical testing modifications include large print tests and answer sheets, separate locations, and extended time.

There is a mistaken impression among some that with the advent of different reading technologies, Braille is no longer necessary. While technology has definitely provided more options for people who are blind, Braille is still a vital skill for a person who cannot consistently access print or for those with some forms of degenerative eye conditions.

Listening to books on tape or CD is an auditory skill, not a literacy skill. Reading is required on state reading comprehension tests, not listening.

Also, within a frum context, books on tape or CD are not accessible on Shabbos or Yom Tov. There are various technologies available to

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diagnostic

Spina Bifida

By Stephen Glicksman, Ph.D.

good idea to have this condition surgically repaired because, as the child grows, Spina Bifida Occulta Spina Bifida is a neural tube defect present at could cause a variety of challenges including back birth that can cause lifelong physical and cognitive pain, sensory issues, scoliosis, and leg and foot probchallenges. A neural tube defect is a birth defect ef- lems. It has been estimated that 40% of Americans fecting the brain and spinal cord. In the case of Spina have Spina Bifida Occulta without even knowing it, Bifida, the problem results from the failure of as symptoms are either non-existent or so mild the spinal cord to “close” properly during the that they can be explained in other ways (i.e.

Spina first month of a mother’s pregnancy. In othback pain is just thought of as “due to a bad Bifida er words, instead of the spinal cord being a back”). straight line down the back, people with Spina A more significant form of Spina Bifida Bifida have a protrusion of their spinal chords is known as “Meningocele.” Meningocele ocwhere the defect occurs. How significant this protru- curs when the meninges, which is another protective sion is defines the severity of the Spina Bifida. covering around the spinal column itself, actually pushes through the opening in the underdeveloped vertebrae. This form, too, can be surgically repaired with little or no damage to the spinal column.

The final form of Spina Bifida is called “Myelomeningocele”. This is the most severe form of Spina Bifida in which a child is born with part of the spinal column actually protruding through the skin.

Sometimes, this protrusion is covered by its own layer of skin and looks simply like a large red protuberance on the back of a newborn baby. Other times, however, there is no layer of skin covering the protuberance, and nerves and tissue of the spinal column itself is exposed. This form of Spina Bifida is the most serious form, and can result in lifelong disabilities including muscle weakness, loss of sensation, paralysis, and loss of bowel and bladder control. Many children with this form of Spina Bifida also develop an allergy to latex (the material commonly used to make balloons and surgical gloves, so both medical visits and birthday parties need to be “latex free”). In addition, It has been estimated that 70% to 90% of people born with myelomeningo40% of Americans have cele also have a condition known as Hydrocephalus, Spina Bifida Occulta without which literally means “fluid on the brain.” Children with hydrocephalus have a buildup of spinal fluid in even knowing it. their brains which can cause brain damage if not addressed. Usually, hydrocephalus can be addressed by Your backbone, the spine (the bone the doctor surgically implanting a “shunt” (a “drain” placed in checks to see if you have scoliosis), is actually made the brain to help get rid of the excess fluid). Without up of a chain of little bones called vertebrae. The ver- this procedure, hydrocephalus can lead to brain damtebrae themselves form a tube (the neural tube) that age, seizures, blindness, or worse. protects the “spinal column” (a collection of nerves Today, many people use the terms “myelomeninthat begins in your brain and goes does your back). gocele” and “Spina Bifida” interchangeably. There The spinal column is the pathway on which mes- was a time when people born with myelomeningocele sages get sent from the brain to the rest of your body. died shortly after birth. With new surgical techniques So, simply put, when you want to move your leg, the and medical care, the vast majority of children born brain sends that message through the spinal column with myelomeningocele survive, and can grow to lead to your leg. When you want to clap your hands, the full and productive lives with the help of braces or brain sends that message through the spinal column to wheelchairs, corrective surgeries, early intervention your arms and hands. If for some reason, the neural and ongoing therapies, bowel and bladder managetube doesn’t fully develop, the spinal column remains ment assistance, and, if necessary, special education unprotected. That, in a nutshell, is Spina Bifida. (learning difficulties are particularly common for those The mildest form of Spina Bifida is known as children who also have hydrocephalus).

Spina Bifida Occulta. In this case, there is an openAlthough relatively rare, Spina Bifida is one of ing in one or more of the bones that make up the the most common conditions present at birth that spine, but the spinal column itself is not affected. can lead to lifelong physical and cognitive challengOften, a patch of hair or a dimple on the back are es, occurring in approximately seven out of every the only signs to alert a good pediatrician that any- 10,000 live births in the United States. At the same thing is unusual. Once discovered, however, it is a time, however, it may also be one of the most preDr. Stephen Glicksman is a Developmental Psychologist at Jumpstart Early Intervention, a division of Women’s League Community Residences. If you have any additional questions about Spina Bifida, child development, or Early Intervention services, he can be contacted at Jumpstart Early Intervention, 718-853-9700.

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Supplementary Reading Living with Spina Bifida: A Guide for Families and Professionals

by Adrian, M.D. Sandler The Official Parent’s Sourcebook on Spina Bifida: A Revised and Updated Directory for the Internet Age

by Icon Health Publications Children With Spina Bifida: A Parent’s Guide (The Special Needs Collection) (Paperback) by Marlene Lutkenhoff www.sbaa.org www.waisman.wisc.edu/~rowley/sb-kids/

ventable. The United States Public Health Service recommends that all women capable of becoming pregnant consume 0.4 milligrams of Folic Acid every day. Folic Acid is a B vitamin found in foods such as leafy green vegetables, fruits and fruit juices, and many vitamin enriched breakfast cereals and breads. Most daily multivitamins for women also contain the recommended daily dose of Folic Acid.

While taking folic acid is not a guaranteed way to avoid Spina Bifida, it is believed to reduce the risk of neural tube defects by at least 70%.

For more information of Spina Bifida and neural tube defects, a great place to start is the National Resource Center of the Spina Bifida Association of America. They can be contacted at 800-621-3141 or via email at sbaa@sbaa.org. n

Visual Impairment continued from previous page assist a person who is visually impaired. Handheld magnifiers are small portable devices that are placed on or above the page and enlarge the image; they come in various magnification levels. CCTV’s (closed circuit televisions) can greatly enlarge the magnification o an image (the image and pixels within the picture can be seen across the room) in full color, black on white, reversed polarity (white on black) or various color combinations. For the computer, there are a number of screen magnification programs (most computers also come with internal computer magnification options) and voice out-put software available.

The advent of technology has greatly increased the ease with which a visually impaired person can function. Most things that a sighted person can do can be done by a person who is blind or visually impaired; they are just sometimes done differently. n Some information for this article was obtained from Foundations of Low Vision by Anne L Corn and Alan J. Koenig.

Supplementary reading www.afb.org American Foundation for the Blind www.lighthouse.org/ Lighthouse International www.abvi-goodwill.org/ The Association for the Blind and Visually Impaired www.spedex.com/napvi/ National Association of Parents of Children with Visual Impairments http://jgb.org/ - Jewish Guild for the Blind www.jewishbraille.org/ - Jewish Braille Institure (Braille and large print materials) www.computersciences.org/ - Computer Assistive Devices http://www.maxiaids.com/ - MaxiAids http://www.independentliving.com/ - Independent Living Aids

diagnostic

Juvenile Arthritis

By Beth S. Gottlieb, MD Chronic arthritis affects almost 300,000 children in the United States. There are many different forms of chronic arthritis affecting children, the most common of which is juvenile idiopathic arthritis (JIA). JIA is the newer term replacing the old name “juvenile rheumatoid arthritis.” This name change helps to distinguish chronic arthritis in children from adult rheumatoid arthritis. There are multiple differences between arthritis in childhood and adulthood.

The recognition that JIA is not like “adult rheumatoid arthritis in smaller people” prompted the development of the field of pediatric rheumatology. Pediatric rheumatologists are pediatricians who complete three additional years of specialty Juvenile Idiopathic Arthritis

It is important to treat arthritis and not allow it to continue even when it is not causing much pain. training in rheumatologic diseases of children. Pediatric rheumatologists are experts in the diagnosis and treatment of children specifically and always consider other aspects of childhood, such as normal growth and development and need to consider the different ways that children’s bodies handle medications.

The first step in diagnosing JIA is recognizing that children get arthritis. Joint swelling should not be automatically attributed to injury. Arthritis is inflammation in a joint. It is diagnosed based on a physical examination. The physician finds fluid in a joint usually accompanied by warmth, tenderness, pain on motion and/or limitation of motion.

The majority of children who develop arthritis have a short duration of arthritis called acute or transient arthritis. It resolves itself within six weeks

Prompt diagnosis and treatment results in better function. and will not recur. Acute arthritis may occur following infections.

Arthritis that continues in at least one joint for six or more weeks, without another cause results in the diagnosis of JIA. It is important to understand that there is no diagnostic test for JIA. Neither blood testing, x-rays nor MRI studies can diagnose JIA and these tests are often unnecessary. Arthritis is an autoimmune reaction, where the body’s own defenses- the immune system- attacks its own joints. There is no evidence that any environmental exposure, food, vitamin deficiency or allergy causes arthritis. It has now been found that individuals who develop chronic arthritis have a genetic predisposition to arthritis.

There are multiple subtypes of childhood arthritis that differ in their course and outcome. One form of JIA is accompanied by daily fevers and a characteristic rash, as well as multiple abnormalities in blood tests. The other forms of arthritis differ by the number of joints affected and the pattern of joints involved. Children usually have what is termed “asymptomatic arthritis” suggesting that they do not complain of pain despite significant swelling in their joints. Unfortunately, this results in arthritis that has been present for quite a length of time by the time it becomes apparent to others.

Subtle evidence of arthritis may include stiffness or awkward movements in the morning. For example, a child who suddenly asks to be carried out of bed in the morning or who limps in the morning may be experiencing morning stiffness from arthritis.

A parent may also notice that the child does not move a limb fully, resulting in a joint that does not bend or straighten completely. Parents may also note that a child is having difficulty keeping up physically with his/her peers or siblings.

An important consideration in following and treating children with arthritis is monitoring for an associated complication involving eyesight. Children with JIA can develop iritis/uveitis, which is an

Beth S. Gottlieb, MD, MS is the chief of Pediatric Reumatology at Schneider Children’s Hospital, North Shore-Long Island Jewish Health System, and the principal investigator, Long-Term JRA Outcome Study (the largest study of patients with JIA in North America).

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inflammation in the eye. This inflammation does not have symptoms early on and in fact can be present for a long time before the child will complain of visual difficulties. Left untreated, this condition can result in permanent eye damage including blindness. Children diagnosed with JIA must have frequent examinations by an ophthalmologist (preferably a pediatric ophthalmologist) in order to check for this inflammation. If the inflammation is, in fact, discovered, the condition can be treated with eye drops.

It is important to treat arthritis and not allow it to continue even when it is not causing much pain, since the arthritis can result in joint damage. Without adequate treatment, continued inflammation in a joint will cause the surrounding muscles to tighten and weaken. Surrounding bone will develop osteoporosis and the cartilage and bone will slowly be eaten away. Over time, this severe damage will result in pain, difficulty moving and can require surgical treatment such as joint replacement.

Fortunately, children diagnosed with JIA have the advantage of multiple new medications that have been found to be effective and safe for children. Treatment begins with medications such as ibuprofen (Motrin ® and Advil ®), naproxen, etc.

For widespread arthritis there are multiple other medications that may be added and are chosen based on the child and the pattern of arthritis. It is unusual not to be able to control the arthritis given the variety of medications now available.

Physical and/or occupational therapy must be remembered as an important component of arthritis treatment. Optimizing joint movement and regaining/maintaining muscle strength is vital to the overall health of the joint. The goal of treatment is to allow a child to be active and enjoy his/her childhood as do children without arthritis.

Studies in JIA show that prompt diagnosis and treatment results in better function. For many children arthritis will resolve and the child will have a long-lasting remission. Children with arthritis should be encouraged to be active and pursue all activities. Both parents and children should be active participants in the management of juvenile arthritis. Working with a pediatric rheumatologist and health care team is the best way to successfully treat children with arthritis. n Supplementary Reading www.arthritis.org – The Arthritis Foundation website – for help in finding your local chapter of the Arthritis Foundation who can provide additional resources and support. There is also a link to the Juvenile Arthritis Alliance www.rheumatology.org - the website for the American College of Rheumatology www.niams.nih.gov/hi/topics/juvenile_arthritis/juvarthr. htm - information sheets about juvenile arthritis The Official Patient’s Sourcebook on Juvenile Rheumatoid Arthritis: A Revised and Updated Directory for the Internet Age by Icon Health Publications Living With Juvenile Rheumatoid Arthritis (Living Well Chronic Conditions) by Susan Heinrichs Gray and Serge Bloch

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diagnostic

Cleft Lip And Palate: Causes And Treatments

By Simeon Blitman, Ph.D., CCC Imagine Chaya, who is expecting her first child and meets her husband at the doctor’s office for her second trimester checkup. After testing is completed, the couple is informed that their child to be will have a cleft lip and/or palate. Chaya and her husband have never heard of this condition and are uncertain as to where to turn. The young couple is informed by friends and family that their child may have speech and feeding issues, and they will need to consult many specialists to fully understand the surgical and rehabilitation options necessary to correct the problem. The feeling of uncertainty exhibited by Chaya and her husband are common to expecting parents worldwide when they are informed about the diagnosis of cleft lip and/or palate.

Cleft lip and palate is when a baby is born with an opening on their lip and palate (roof of mouth). In addition, there is a type of cleft of the palate called submucous cleft palate which may not be easily discernable at birth. The submucous cleft cannot be seen just by looking at the palate because the skin lining of the palate is intact, but

Cleft lip and palate is when a baby is born with an opening on their lip and palate (roof of mouth). the muscles above the lining are separated. The submucous cleft palate is usually diagnosed by a pediatric otolaryngologist using a nasal endoscope when a parent complains that their child’s speech sounds nasal. Cleft lip and palate occur because of incomplete lip and palate development during the first three months of pregnancy. Scientific research has reported many different causes for cleft development. However, it is commonly agreed that alterations of genes, chromosomes and environment during pregnancy can be the primary causes of clefts in newborn babies. It is important to understand which of the above listed factors caused the cleft because the particular factor may have a more generalized effect on the growth of the fetus. This means that certain factors such as

Cleft Lip and Palate

chromosomal disorders may cause other problems besides clefts (i.e., irregularities with the head, face, jaw and heart in addition to behavior and learning issues) which if diagnosed correctly may help with fixing the other medical and behavioral issues associated with that particular disorder. Therefore, it is crucial to seek out a physician who specializes in the area of craniofacial disorders for an accurate diagnosis. Once the child born with a cleft is diagnosed appropriately, surgery and speech therapy should be scheduled.

A primary concern of parents with children born with cleft lip and/or palate is when surgery will take place and what surgical options are available. For the most part, cleft lip and palate are repaired within the first year of life. However, the submucous cleft is usually repaired after four years of age. There are several surgical procedures that can be used. The type of procedure used will depend on the type of cleft (partial cleft/complete cleft/submucous cleft) as well as the surgeon’s experience using a particular procedure. It is recommended that parents concerned with cleft palate issues, consult a speech pathologist, otolaryngolo-

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DIAGNOSTIC

the hypernasality and improves speech clarity. However, it is possible that after therapy some hypernasality may persist, which would require additional surgery to the palate. Usually, the speech pathologist will recommend a follow up visit with the craniofacial surgeon post therapy to see if the palate is working appropriately to decide if any further recommendations will be necessary.

Parents of children who exhibit nasal speech may want to first contact their pediatrician to see if the problem is temporary such as cold/allergies. However, if the problem is chronic and you suspect compensatory articulation movements, you may want to contact an otolaryngologist and speech pathologist to evaluate the problem. Parents should not conclude that their child has a cleft of the palate because they sound nasal. In fact, compensatory articulation movements can occur when children have histories of dental abnormalities (malocclusion), fluctuating hearing loss, or adeniod hypertrophy. In these cases, a brief period of speech therapy is sufficient to fix the problem. n

Cleft Lip And Palate continued from previous page gist, or medical referral service to help them find the best surgeon to repair the cleft and/or palate.

Although cleft surgery may improve the speech intelligibility for many children, there are children that still sound nasal (hypernasal) post surgery and will require speech therapy.

Children who present with increased nasality post cleft repair may be using inappropriate compensatory movements of their tongues and vocal cords during speech that cause air to be directed to their nose while the palate is working properly. These compensatory movements are being made because initially there was an open palate, which caused the children to make these inappropriate approximations that continue as a habit with a functional palate. These compensatory movements do not sound like typical speech sound distortions. For example, to produce the sound /s/, children with compensatory movements may move their tongues toward the back of their mouth, which sounds like a snorting sound.

Another example would be to produce the sound /k/, children with compensatory articulation movements may slam their vocal cords together

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A primary concern of parents with children born with cleft lip and/palate is when surgery will take place and what surgical options are available. which sounds like throat clearing. For many patients, undergoing a period of speech therapy to eliminate the compensatory errors eliminates

Dr. Simeon Blitman is the director of Blitman Speech-Language Pathology Services in Brooklyn, NY. He has been an adjunct lecturer at Brooklyn College for the past fourteen years, and has lectured at Teachers College Columbia University and NYU. Dr. Blitman provided evaluation and treatment for children and adults presenting with articulation, voice, swallowing, fluency, language, cleft palate and neurogenic based disorders. He can be reached at 718 972-1100.

SUPPLEMENTARY READING Your Cleft-Affected Child: The Complete Book of Information, Resources, and Hope (Hardcover) by Carrie Gruman-Trinkner A Parent’s Guide to Cleft Lip and Palate (University of Minnesota Guides to Birth and Childhood Disorders) (Hardcover) by Karlind T. Moller, Clark D. Starr, Sylvia A. Johnson

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diagnostic

Bipolar Disorder

By Marcia Kesner, MS, LPC, LMHC

and a reduced need for sleep. It’s also very common for someone to act impulsively during a manic epiBuzz Aldrin, astronaut; Art Buchwald, writ- sode, and engage in behaviors that are risky or that er and humorist; Dick Cavett, writer and media they will likely later regret, like spending sprees. The personality; singer Rosemary Clooney; Ralph symptoms of a depressive episode often include an Waldo Emerson, author and poet; William overwhelming feeling of emptiness or sadness, a Faulkner, writer; John Keats, poet; Patrick lack of energy, a loss of interest in things, trouBipolar J. Kennedy, Congressional Representable concentrating, changes in normal sleep or Disorder tive; composer Wolfgang Amadeus Moappetite, and/or thoughts of dying or suicide. zart; artists Edvard Munch and Vincent A mixed episode includes symptoms that are Van Gogh; author Kurt Vonnegut; Virginia both manic and depressive.

Woolf, poet and novelist; countless other famous and notable personalities.

What causes Bi-polar Illness?

What do these seemingly very different, creThe symptoms of Bi-polar Disorder are thought ative, energetic, bright and passionate individuals to be caused by an imbalance of key chemicals in the from different eras all have in common? Each of brain. The brain is made up of billions of nerve cells these personalities has been diagnosed with Bi- that move a constant stream of information from one polar Disorder during their lifetime. to the other. To keep the information flowing, the cells release chemicals known as “neurotransmitters.”

Two key neurotransmitters that are needed for brain function are dopamine and serotonin, which both play a crucial role in emotional health.

Many scientists believe that when the levels of these neurotransmitters aren’t quite right, it may result in Bi-polar Disorder. For instance, too much dopamine in certain parts of the brain can cause symptoms such as delusions, while too little dopamine in other parts of the brain can cause symptoms such as a lack of emotion and energy. Bi-polar Disorder involves cycles of mania and depression.

Signs and symptoms It may be helpful to think of the various mood of depression include states in Bi-polar Illness as a spectrum or continudiscrete periods of: ous range. At one end is severe depression, which shades into moderate depression; then come mild Persistent sad, anxious, or empty mood. and brief mood disturbances that many people call Feelings of hopelessness or pessimism. “the blues,” then normal mood, then hypomania Feelings of guilt, worthlessness, or (a mild form of mania),then finally mania. helplessness.

Recognition of the various mood states is esLoss of interest or pleasure in ordinary sential so that the person who has Bi-polar Illness activities. can obtain effective treatment and avoid the harmDecreased energy, a feeling of fatigue or of being “slowed down”. ful consequences of the illness which may include Difficulty concentrating, remembering, destruction of personal relationships, loss of emmaking decisions. ployment, and suicide. Bi-polar Illness is often not Restlessness or irritability. recognized by the patient, relatives, friends, or even Sleep disturbances. physicians. An early sign of manic-depressive illness Loss of appetite and weight, or weight gain. may be hypomania--a state in which the person Chronic pain or other persistent bodily shows a high level of energy, excessive moodiness or symptoms that are not caused by physical irritability and impulsive or reckless behavior. Hydisease. pomania may feel good to the person who experiThoughts of death or suicide; suicide attempts. ences it. Thus even when family and friends learn to recognize the mood swings the individual often Bipolar disorder, formerly called Manic-Depres- will deny that anything is wrong. In its early stages sive Illness, is a condition that currently affects more Bi-polar Disorder may masquerade as a problem than two million Americans. People who have this ill- other than a treatable illness. For example, it may ness tend to experience extreme mood swings, along first appear as alcohol or drug abuse, or poor school with other specific symptoms and behaviors. These or work performance. If left untreated, Bi-polar Illmood swings or “episodes” can take three forms: man- ness tends to worsen and the person experiences epic episodes, depressive episodes, or “mixed” episodes. isodes of full-fledged mania and clinical depression.

The symptoms of a manic episode often inTreatment clude elevated mood (feeling extremely happy), being Almost all people with Bi-polar Illness, even extremely irritable and anxious, talking too fast and those with the most severe forms, can obtain subtoo much, and having an unusual increase in energy stantial stabilization of their mood swings. Although Marcia Kesner, MS, LPC, LMHC is a psychotherapist in private practice with offices in Brooklyn and Rockland County. She serves on the Executive Board of Nefesh International and is an Adjunct Professor in the Ferkauf Graduate School of Psychology at Albert Einstein College of Medicine. She can be reached at (718) 391-4608 or (212) 887-0916.

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September 2007

Signs and symptoms of mania include discrete periods of: Increased energy, activity, restlessness, racing thoughts, and rapid talking.

Excessive “high” or euphoric feelings.

Extreme irritability and distractibility.

Decreased need for sleep.

Unrealistic beliefs in one’s abilities and powers.

Uncharacteristically poor judgment.

A sustained period of behavior that is different than usual.

Abuse of drugs, particularly cocaine, alcohol, and sleeping medications.

Provocative, intrusive, or aggressive behavior.

Denial that anything is wrong.

there is currently no cure for Bi-polar Disorder, medicine can play a key role in helping to manage symptoms and extreme mood swings. It can help make the behaviors more even and predictable.

Many people act very agitated, uncooperative, and aggressive during acute manic episodes, which can be frightening for them and those around them.

Medicine can help get these behaviors back under control. Once that’s achieved, the physician may recommend continuing medicine (along with psychotherapy and support from family and friends) to maintain stability. Unfortunately, taking medicine as prescribed and staying on it can be difficult, for many people think they don’t need medicine when their symptoms improve. It’s important to understand that the patient must continue to take prescribed medicine during those times, until consultation with a physician. It is advisable to keep a journal or chart of moods, symptoms and life events that can help the doctor and therapist understand how to best tailor treatment. As an adjunct to medications, psychotherapy is often helpful in providing support, education, skill training and guidance to the person with Bi-polar Illness and their family. n

Th

Supplementary Reading Parenting a Bipolar Child: What to Do & Why by Gianni L. Faedda and Nancy B. Austin The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder by Demitri Md Papolos and Janice Papolos The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by David J. Miklowitz The Bipolar Workbook: Tools for Controlling Your Mood Swings by Monica Ramirez Basco Survival Strategies for Parenting Children with Bipolar Disorder by George T. Lynn www.managingbipolar.com www.geodon.com, www.dsballiance.org www.bipolar.com

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diagnostic Sensory Processing

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Helping Children With Sensory Processing Disorders

By Malkie Kahn MS OTR/L, Reviewed by Naomi Wholberg OTR/L, Malky Grunfeld MS OTR/L and Rachel Avigdor MS OTR/L The buzz word among teachers and parents in today’s society is “Sensory Integration,” better known as “sensory processing disorder (SPD).” Lately, when something doesn’t seem right with a child/student, it is described as a sensory integrative problem.

What is sensory integration?

What can a parent and/or teacher do to help their child/student?

Dr. Lucy Jane Miller, founder of the SPD Foundation, is one of the leading researchers in the field of sensory processing. According to Dr. Miller, “Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects developing children. Children with SPD misinterpret everyday sensory information, such as touch, sound, and movement. Depending on which type of SPD a child has, the child may

feel overwhelmed with information, he may seek out intense sensory experiences, or he might have other symptoms. This can lead to behavioral problems, difficulties with coordination, and other issues.”

“Sensory processing” refers to our ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response. For Having sensory preferences does not mean most people, this process we have a sensory processing disorder. is automatic. When we hear someone talking to us or a bird chirping, our brains interpret the sound as speech or an Sensory Processing Disorder (SPD), however, animal sound. We can then respond to the in- don’t experience this process in the same way. formation appropriately. Children who have a Continued on next page

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® Sensory Processing continued from previous page SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional, motor, and other responses (www.spdnetwork. org).

We must remember that everyone has some “sensory issues.” As we mature, we learn how to adapt our environment to meet our sensory needs. Some people like it hot, while others like it cold. While reading or studying, some need a quiet environment, and others need background noise. Some people are very sensitive to various fabrics, while others are not. As adults we can use cognition, language, and movement to get through situations that are difficult or uncomfortable for us. Children with SPD do not always know how to get the input they need or how to avoid the sensations they dislike. Therefore, they may need assistance to learn how to deal with these situations.

Having sensory preferences does not mean we have a sensory processing disorder! In order to define a child as having a sensory processing disorder, the child must present with multiple sensory symptoms in one or several areas. Before treating a child, the OT will assess whether or not the sensory difficulties are affecting the child’s day to day functioning. If the sensory issues are not that severe and are not affecting the child’s daily functions, then often it is just part of the child’s personal preferences.

What Can Parents/Teacher do?

What can one do as a teacher or parent to help the children with SPD feel more comfortable in the home and school environments? An occupational therapist may create a sensory diet for the child. Sensory diets are activities (doses of sensory input) that are specifically designed for a child based on his/her individual need. A sensory diet provides the child with beneficial sensory input at frequent intervals throughout the day. This enables the child to participate more fully in the activities that comprise their daily schedule. Implementation of the sensory diet should span all aspects of the child’s day, particularly those involving the school and home environments (www.henryot.com).

To the right is a general list of suggestions for teachers and parents. Please keep in mind that some may not be appropriate for your student/child. You must carefully observe your child’s reactions and adjust tasks based on their responses.

Supplementry reading Sensational Kids by Dr. Lucy Miller The Out of Sync Child –revised addition, by Carol Kranowitz.

Malkie Kahn, is a graduate of Long Island University. She currently works for HASC and Omni Childhood Center, and does early intervention homecare for various agencies.

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diagnostic

As occupational therapists, we understand the complexity of the children that we evaluate and treat. No two children are the same and each needs to be viewed as an individual. We take the behaviors we observe and make recommendations to help the child succeed at home and in school. Understandably, there are other important issues that have to be taken into consideration, i.e. sleep and nutrition patterns. n

For the classroom teacher (some of these suggestions are also helpful for the home during homework time) For a student that is easily distracted: Look at the student when sitting at their desk. Does his/her feet touch the ground? It will be harder for the student to concentrate if his/her feet are not grounded. In addition, does the student have to reach up because the desk is too high or reach down for the desk is also too low? The desk height can also have an effect on the child’s concentration.

The child should not be placed near the door or the window of the classroom as these are generally noisier seats. They should sit close to the teacher where they can be easily re-directed when needed.

Tips for Parents Ideas for incorporating sensory input into the child’s daily routines: Be consistent with routines. Children need predictability. Letting him/her know in advance of upcoming appointments, schedule changes (within a reasonable time), etc.

Bath time: Scrub using a washcloth or sponge, using only deep touch pressure (many children find light touch noxious). A towel rub down following the bath and deep pressure massage using lotion can be used to calm the nervous system.

Hugs and more hugs! The deep touch pressure from hugs helps organize a child’s sensory system.

Grocery shopping: Allow your child to push the cart (as long as the weight is within reason). Let them help with carrying the bags and putting away the groceries. Heavy muscle work and deep pressure activities aid in increasing sensory organization in the body.

Household chores: Allow the child to vacuum, sweep/mop the floor, move furniture, shovel the snow, and/or carry/push or pull the laundry basket.

Let them assist with meal preparation.

Activities that are resistive give feedback to the joints of the body and are organizing.

Provide children with after school/ weekend sensory activities: Bowling, swimming, races, bike riding, horseback riding, paddle boating, rowing, roller blading, gymnastics, ballet, jumping rope, push ups, basketball, soccer, rock climbing, running, and climbing on playground equipment.

Test time should be kept completely quiet.

A sign should be posted outside the classroom so the child won’t be interrupted by outside individuals. Teachers should try to check the lighting in the classroom as certain florescent bulbs flicker or make humming noises that may be distracting.

Noise level during recess can be overstimulating to some children. Classroom music should be kept to a minimum as to not over-stimulate the child.

Observe the classroom setup. Are the decorations on the walls visually overstimulating? Are there many objects hanging from the ceiling? The wall/board that the teacher wants the child to focus on should be free of extraneous visual distractions.

The student that appears to be fidgety and is constantly moving: Allow the child to have frequent “breaks” such as bringing papers to/from the office or other simple errands. Provide the child with a 10 second stretch before each new activity.

Chewing gum, erasers, pen caps, etc. helps many stay organized and focused during looking and listening tasks.

Fidget toys/small manipulatives in the hands often allow for longer and better concentration and help prep the hands for improved quality and endurance during written work. For example, rubber bands, paper clips, silly putty, koosh ball, latex squeezy toys, etc.

A swivel disc on a chair or seat cushion may allow for the child to receive natural body movements and rhythm in order to focus on more relevant tasks in the classroom. (This has been shown to be most effective for a child with mild sensory needs when attention difficulties are interfering with participation in class).

For the disorganized student: Routines are important. Provide a system to keep classroom materials organized.

Keep an activity schedule or calendar posted so the child knows what to expect next.

Try not to punish a child by having them lose their recess/playground time. Children need movement time and by removing it, behaviors may actually become more difficult later on.

diagnostic

Diagnosing Autism

By Joshua Weinstein Autism is a developmental disability that appears within the first three years of a child’s life. It is four times more common in boys than in girls, affects about 1 in 150 individuals, and is the third most common developmental disability in the U.S. Its impact on the brain is largely manifested through discrepancies and delays in social interaction and communication skills.

Autism is difficult to diagnose in very young children because a number of the disorder’s key symptoms, such as the child’s relationship with peers, entail behaviors that don’t fully develop in children until later in childhood.

Many parents are worried, in part because autism is so much in the headlines these days. It’s a good idea to keep a close eye on your young child, because children as young as 18 months old can be diagnosed.

Research shows that the earlier the diagnosis and treatment, the better the prognosis for good outcomes.

So what should you be looking for? According to the National Institute of Mental Health, these are some of the red flags for autism: Possible Indicators of Autism Spectrum Disorders There are a number of symptoms that parents and teachers can look for. These may be apparent even in a child as young as one year old, or they may not become obvious until age three or older. Some signs to look for include: • Unresponsiveness to people, and/or intent focus on one item to the exclusion of others for long periods; • Lack of response to their name; • Lack of eye contact; • Difficulty interpreting what others are thinking or feeling; • Delay in gaining speech and/or odd speech patterns; • Repetitive movements such as rocking or twirling • Self-abusive behavior such as head-banging • Speaking in a flat or sing-song voice; • Unusually low or high sensitivity to pain, noise, light or crowds.

If you think that you or someone you love may be autistic, you’ll probably have noticed certain symptoms. Perhaps you’ve observed a lack of eye contact, difficulty with social relationships, speech delays, or odd physical behaviors such as rocking, finger flicking or toe walking. These are the “red flags” that suggest something might be wrong -- and that something might be autism.

Early diagnosis of autism is extremely significant as treatments for this potentially devastating developmental disorder can halt its advance. Research is beginning to show that the earlier the disorder is diagnosed, the better the prognosis.

Babies develop at their own pace, and many don’t follow exact timelines found in most parenting books. Children with autism usually show some signs of delayed development by 18 months. If you suspect that your child may have autism, discuss your concerns with your doctor. The earlier treatment begins, the more effective it will be.

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speech, language and psychological issues.

Although the signs of autism often appear by 18 months, the diagnosis Your child’s doctor will look for signs of sometimes isn’t made until age 2 or 3, when Autism developmental delays at regular checkups. If there may be more obvious delays in lanyour child shows some signs of autism, you guage development. Early diagnosis is immay be referred to a specialist in treating chilportant because early intervention- preferadren with autism. Working with a team of profesbly before age 3 — seems to be associated with sionals, this specialist can perform a formal evalua- the best chance for significant improvement. tion to check for the disorder.

In general, children with autism have problems in three crucial areas of development- social skills, language and behavior. The most severe autism is marked by a complete inability to communicate or interact with other people.

Because the symptoms of autism vary widely, two children with the same diagnosis may act quite differently and have strikingly different skills.

There has been some recent groundbreaking news in the field of autism. Dr. Harvey J. Kliman, of the Yale School of Medicine, is one of a team of researchers who have made a potentially revolutionary discovery. In a preliminary study, he and his colleagues found that the placentas of babies who are later diagnosed with autism are physically different from those of typical babies.

The Yale study is just a beginning, and further studies will be necessary to corroborate its conclusions. Nonetheless, there are two potentially major outcomes. Both will be of great interest to parents as well to medical and therapeutic practitioners.

First, this discovery could answer the question of when autism begins. Kliman truly believes withTwo children with the out any doubts: “It’s genetic; happens when sperm hits the egg, in the first trimester. That doesn’t mean same diagnosis may act that there are no continued problems -- autistic brains quite differently and have become extra large at 4 years of age, [and there are strikingly different skills. other issues.]. But we do know that there’s a clinical history to these diseases, it’s clinically genetic.”

No medical tests can detect autism, and there Second, the finding could lead the way to are other conditions that have symptoms resem- very early diagnosis of autism, with the outcome bling those of autism, which include hearing loss, that children could receive valuable early intervenspeech problems, mental retardation and neuro- tion. This is how Kliman stipulates the “message logical problems. But once these possibilities have to parents”: “If your child is born and his placenta been eliminated, parents should send the child to a has this abnormality, the check engine light is on. I professional who specializes in autism: a child psy- would suggest as early as you can to see an autism chiatrist, child psychologist, developmental pedia- expert, and see if you can see anything. If there are trician or pediatric neurologist. any hints, do early intervention; anything to help Autism specialists use a variety of methods to the brains form as well as they can. The earlier we identify the disorder: Using a standardized rating scale, do that the better.” n a specialist can evaluate the child’s language and social Supplementry reading behavior. The specialist may also test for certain genetic and neurological problems. Watching family vidOvercoming Autism: Finding the Answers, Strategies, eotapes and looking at photo albums may help parents and Hope That Can Transform a Child’s Life

by Lynn Kern Koegel and Claire LaZebnik recall when each behavior first occurred and when the child reached certain developmental issues.

Ten Things Every Child with Autism Wishes You Knew Because autism varies widely in severity and

by Ellen Notbohm manifestations, making a diagnosis may be diffiAutism Spectrum Disorders: The Complete Guide cult. There isn’t one specific medical test to pinto Understanding Autism, Asperger’s Syndrome, point the disorder. Instead, a formal evaluation Pervasive Developmental Disorder, and Other ASDs consists of observing your child and talking to you (Paperback) by Chantal Sicile-Kira and Temple Grandin about how your child’s social skills, language skills http://skhov.org/ and behavior have developed and changed over http://www.autism.org/ time. To help reach a diagnosis, your child may http://www.autismspeaks.org undergo a number of developmental tests covering Joshua Weinstein has been an educator and administrator for over three decades. He holds two Masters Degrees in Educational Administration and Supervision and an MBA in executive administration. He has been a CEO in healthcare, social services, business corporations. He’s the president and founder of Shema Kolainu-Hear Our Voices, Tishma for children with autism in Jerusalem and iCARE4Autism. He can be reached via email at: jweinstein@skhov.org or through icare4autism.org and shemakolainu.org Building Blocks

September 2007

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®

diagnostic

Down Syndrome

By Alyssa Kallenos and Andreas Kallenos

by abnormal cell division after fertilization.

Translocation DS: This is a very rare form of DS. Part of chromosome 21 becomes attached (translocated) onto another chromosome before conception. The cells have the usual two copies of chromosome 21 and they have additional material from chromosome 21 stuck to the translocated chromosome.

What is Down Syndrome and its cause?

Down Syndrome (DS), scientifically termed Trisomy 21, is the most commonly seen genetic disorder. There are no known behavioral or environmental factors that cause DS. Human cells normally have 46 chroDown mosomes (the gene holders) arranged in 23 Physical Characteristics and Health Syndrome pairs. In Down Syndrome, there is an extra Concerns of Down Syndrome 21st chromosome resulting in 47 chromoSome of the following characteristics somes instead of the normal 46 chromosomes. are common differences people with DS display Many errors can happen in cell division either be- (the difference in the physical appearance does not fore of after fertilization of an egg cell. According affect their health): there is commonly a flat facial to the Mayo Clinic, the cause of DS is 1 of 3 types profile, skin folds at the inner corner of the eyes with of abnormal cell division of the 21st chromosome. an upward slant of the eyes. The nose bridge is flatAll result in extra genetic material from chromo- tened, and the ears can be low and small. There can some 21, which is responsible for the characteristic be a single crease across the center of the palms as features and developmental patterns of DS. The well as curved pinky fingers, and there is usually a three types of DS are as follows: gap between the first and second toe. The tongue Trisomy 21: 90-95% of cases are this type. There tends to be enlarged, and short stature and being are 3 copies of the 21st chromosome instead of 2 cop- overweight in adulthood is common. ies in all cells. This is caused by abnormal cell division DS can affect health as well. One third of all during development of the sperm or egg cell. children born with DS have heart defects. Many Mosaic DS: 5% of cases are this type. Only other conditions such as vision/hearing impairment, some cells have an extra copy of chromosome 21. dental problems, intestinal abnormalities, respiraA mosaic of normal and abnormal cells is caused tory issues, thyroid disease, higher risk of childhood leukemia, increased susceptibility to infection, slow or delayed growth and development, and obesity are common.

Fortunately, most if not all of these health issues are treatable.

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Building Blocks

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Screening Tests for Down Syndrome Women after the age of 35 have a significantly higher risk of having a child with DS, even though 80% of children are born to mothers under the age of 35 due to higher fertility rates in younger women. At age 20-24 there is a 1:1490 chance, at age 30 there is 1:1000 chance, age 35 1:400 chance, age 42 1:60, and by age 49 a 1:11 chance of having a child with DS. There are a number of screening and diagnostic tests available which your doctor can perform.

1. Nuchal Translucency Testing (performed at 11-14 weeks of pregnancy). It is an ultrasound used to measure the clear space in the folds of tissue

behind the baby’s neck.

2. The Triple Screen and Alpha Fetoprotein Plus (performed at 15-20 weeks of pregnancy). It is a simple blood test 3. Detailed Ultrasound (performed at 15-20 weeks of pregnancy).

4. Amniocentesis (performed at 16-20 weeks of pregnancy). This is removal of a small amount of amniotic fluid from the uterus.

5. Chorionic Villus Sampling (CVS). This is performed at 8-12 weeks of pregnancy. It is sample of the placenta.

After a baby with DS is born the diagnosis is confirmed with a “karyotype” blood test that gives a complete picture of the individual’s chromosomes.

The Baby Born with Down Syndrome Children born with DS usually are “floppy” babies, meaning that they exhibit low muscle tone.

They might have difficulty breast feeding and coordinating their suck and swallow. There may also be underlying digestion problems that can lead to poor weight gain and constipation. These children are usually born average size but tend to grow at a slower rate and stay smaller than their peers. As toddlers, there will usually be delays in speech and language, gross motor skill acquisition and selfhelp skills such as feeding, dressing and toilet training. There is a wide variety of features and physical characteristics of Trisomy 21, along with a wide range of mental retardation and developmental delay. Every child’s cognitive ability varies, with most having mild to moderate mental retardation.

How to help the baby born with Down Syndrome: Love and enjoy the baby.

Take care of yourself.

Stay in touch with the doctor/ and follow up with any/all specialists.

Seek support from family and friends.

Enroll child in an Early Intervention (EI) program.

Find disability related resources in your community and state.

Growing Up and Living with Down Syndrome There is no treatment to reverse DS. Many of the associated medical and developmental conditions can be treated and improve the child’s development and their quality of life. Research has shown that stimulation during early development improves a child’s chances of reaching their fullest potential.

Continued on next page

diagnostic Down Syndrome continued from previous page Early intervention centers can provide the child with physical therapy (PT), occupational therapy (OT), speech and language therapy (ST) and special education (SpEd) services free of charge. These services can begin during infancy, and can help provide exercises to improve their muscle strength, sensory stimulation, and language and educational skills. These therapists will also educate the family on how to deal with their child during the many aspects of their growth and development.

Some children with DS may have what is called Atlantoaxial Instability, or what is a misalignment of the top two vertebrae of the neck. These individuals are prone to injury if they participate in activities that overextend or flex the neck. Parents should have their child seen by their doctor to determine if they should be restricted from activities that place stress on the neck. This misalignment can be a serious condition, yet proper diagnosis can help to prevent serious injury.

Once a child is three years old, he/she is guaranteed educational services under the Individuals with Disabilities Education Act (IDEA). Where to school a child with DS is an individual decision. Some children’s needs are met in specialized programs, while others do well in inclusion classes

The History of Down Syndrome In 1866, an English physician named John Langdon Down published an essay in which he described a set of children with common features who were distinct from other children with mental retardation.

He referred to these children with DS as mongoloids, based on his notion that these children looked like Asian people from Mongolia. In 1959, Jerome Lejeune and Patricia Jacobs first determined the cause of that condition to be trisomy of the 21st chromosome. In the early 1960’s, the term mongoloidism came under ethnic fire from Asian genetic researchers. The term was dropped from scientific use and the condition came to be called Down’s Syndrome. In the 1970’s an American revision of scientific terms changed it to Down Syndrome, while in some other countries it is still referred to as Down’s Syndrome.

alongside their peers without DS. Children with DS do learn and are capable of developing skills throughout their lives, though achieving their goals at a different pace. Teaching tasks in a step-by-step manner with frequent reinforcement and consistent feedback has proven successful. Continuing education, positive

Alyssa Kallenos, PT and Andreas Kallenos, MSPT are both practicing physical therapists and the owners of Kids in Shape Therapy Center in Boro Park Brooklyn.

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public attitudes and a stimulating home environment help to promote the child’s self esteem.

Any medical issues should be routinely followed during the aging process. If obesity should occur, a supervised diet and exercise program should be set in place.

As with anyone, it is impossible to predict future achievements with people with DS. The duration of DS is lifelong, however, people with DS are achieving an opportunistic lifestyle. With encouragement and support, many can live in independent living centers and group shared/supervised apartments, take care of themselves, have a job, and participate in all aspects of regular social activities. n Supplementary Reading Support Groups for Down Syndrome National Down Syndrome Society (NDSS) 800-221-4602 or 212-460-9330 www.ndss.org National Down Syndrome Congress(NDSC) 800-232-6372 or 770-604-9500 www.ndsccenter.org Down Syndrome Newsgroup www.downsyndrome.com Woodbine House Publishing – resource for books 800-843-7323 www.woodbinehouse.com

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September 2007

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diagnostic

® How Do I Know If My

Child Needs Therapy?

By Ephraim Yablok MS, PT, DPT Let’s consider two scenarios: #1: The mother of a 6-week-old infant is concerned with her son’s poor head control. “He never seems to be able to keep it straight and it flops around when I hold him up,” she tells her friend, who echoes her concern and gives her the number of a local Early Intervention agency to request an evaluation.

#2: During a well visit at the pediatrician’s office, a father worries that his 14-month-old daughter is not yet walking independently.

“The babysitter tells us that whenever she puts her on the floor she cries almost immediately and doesn’t even attempt to get up and take a step.

Unless she’s picked up right away, she just won’t stop crying.”

There often exists a certain level of anxiety in a parent’s mind as they observe their infant or toddler in the first year of life and anticipate the timely acquisition of gross motor skills (large movements of the body). This anxiety becomes magnified with the perception that there may be a delay in developmental milestone achievement.

The prospect that a child will not roll, sit, crawl, or walk at the same age as their sibling, cousin or neighbor can evoke concern about developmental delay, independence, social or academic readiness and the like. Such feelings are easily enhanced by inaccurate or over-generalized information obtained from a variety of media sources or wellmeaning family or friends.

Given this concern, how might a parent or caregiver distinguish between perhaps slower, yet appropriate, development and a bona fide developmental delay that requires professional intervention?

There are a several important factors to consider when faced with this question. Here are some: First, there is a range of weeks or months during which any single fine or gross motor skill can emerge and be deemed “on time.” While one infant may take his or her first steps as early as ten months of age, another may not do so until they are sixteen months old. Second, just as each child possesses a unique personality, they may demonstrate distinct and varying tendencies with regard to motor development. We therefore must exercise a great deal of caution when comparing one child to another.

Third, it is important to look at the big picture: is the child generally active and does he appear to have difficulty with just one or two skills, or does he exhibit passive behavior and struggle with many ageappropriate movements or activities? Finally, delay in skill acquisition is often influenced by behavior.

An infant who becomes used to being held by a parent or caregiver might react negatively when placed

in a challenging position. If every expression of displeasure prompts a swift rescue back into their comfort zone, when can he or she learn to develop strategies for independence?

Keeping these guidelines in mind, a parent can provide their child with the opportunity to “tolerate” an age-appropriate developmental position or to perform a basic movement or activity.

(Suggestions for such activities would vary depending on a child’s age and area of perceived weakness in function and are therefore too numerous to list.

It is recommended that parents seek out information on age-appropriate activities and developmental milestones either from a pediatrician, pediatric therapist, or from reputable websites such as www. aap.org or www.zerotothree.org).

Once an activity is chosen and attempted, four scenarios can ensue: The child does the activity (maybe they just needed a chance to really try it?)

The child attempts the activity but has difficulty or requires substantial assistance.

The child refuses to perform the activity (exhibiting challenging behavior).

The child is unable to do the activity altogether.

If the result is #2, 3 or 4, the first step to take is to encourage practice. If a child is given regular opportunities to perform a new task in a non-stressful atmosphere, perhaps the desired skill(s) will emerge.

This obviously requires a certain level of discipline on part of the parent or caregiver (especially with the child in #3) coupled with the proper motivation (i.e. toy, positive response from observers).

However, if despite consistent attempts (over the course of 1-2 weeks) the child still has difficulty or is unable to perform age-appropriate tasks, therapeutic intervention might indeed be warranted.

By contacting a New York City-based early intervention agency, the arrangements for an evaluation can be made. This evaluation and any therapy services that may follow are free of charge, as they are provided under the federally mandated Individuals with Disabilities Education Act.¹ A child can become eligible for services if he or she exhibits either 33% delay in one area of development (i.e. physical) or a 25% delay in two or more areas of development (i.e. physical and communication).² The services provided by the early intervention program are comprehensive and accessible, and provide vital assistance to thousands of children with developmental delay. It is important to recognize, however, that there is a great deal that can be done with children during the first year of life that can encourage and promote physical development. After all, this precious window of time is when true early intervention can take place.

The following two suggestions can facilitate this process: 1) An infant’s day should be replete

Ephraim Yablok is a Brooklyn-based physical therapist who treats children of all ages in both the home and school settings. He is a certified Cuevas MEDEK Exercises Level 2 practitioner who recently received his post-professional Doctor of Physical Therapy degree from Long Island University.

Building Blocks

September 2007

Is Therapy Needed

There is a range of weeks or months during which any single fine or gross motor skill can emerge and be deemed ‘on time.’ with opportunities to learn independent movement. This can begin as early as several weeks old by placing the baby in a variety of positions while awake, such as on their belly or side, and should continue until the child is moving about their environment independently. Car seats, “bouncers,” and swings each serve a purpose, but allowing an infant to remain sitting in them passively for extended periods of time has very little developmental value. 2) The rapport that you have with your child’s pediatrician regarding his or her medical and immunological health should be complemented by regular discussions about developmental health as well.

Ask questions and stay informed!

If we can now go back and recall the two youngsters mentioned in the beginning, we most likely have arrived at the same conclusion. Neither child is likely to require therapy. Our 6-week old has plenty of time to develop control in the musculature that supports and moves the head, and what our 14month old appears to need is some uninterrupted opportunities to learn what taking steps is all about.

May we all experience the blessing and joy of raising children in happiness and good health! ¹ U.S. Department of Education (2007). Early Intervention Program for Infants and Toddlers with Disabilities. Updated 10/13/06. Retrieved 6/20/07 from http://www.ed.gov/offices/OSERS/IDEA. ² The New York City Department of Health and Mental Hygiene (2007). Early Intervention; “Basic Information”. Retrieved 6/20/07 from http://www.nyc.gov/ health n

diagnostic Eating Disorders

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The Faces Of Hunger: Portraits Of Eating Disorders

By Shoshana Lewin Consider a few stories, conglomerations of different people who have eating disordered symptoms. The names and stories are not the biography of any one person, and complete similarities to an individual are accidental in nature. However, if you recognize someone with similar behavior, try to find out if you can help him or her get psychological help. The sooner an eating disorder is treated, the easier it can be for a person to recover from it.

Eating disorders are emotional disorders; they are expressed through behaviors, thoughts, and feelings. In some ways, they are like addictions, in that a person is trying to impact an emotional state (i.e. feelings of inadequacy or depression) with an unhealthy behavior. Eating disordered behavior is the favored coping skill that a person with an eating disorder uses. There is a lot of secrecy in the presence and maintenance of an eating disorder, so parents or even friends may be unaware of its existence or severity. As such, it is useful to consider “warning signs” when trying to find help for a person who seems to have an eating disorder. This is especially vital since untreated eating disorders can be fatal.

Both males and females can have eating disordered behaviors. Media exposure, which has become more pervasive in recent years, has a positive correlation with eating disordered behavior – the more media a person is exposed to, and the more often that exposure takes place, the greater the risk for development of an eating disorder. Anorexia is more likely to begin in early to middle adolescence, while bulimia is more likely to begin in late adolescence or early adulthood.

Chanit, a 15 year old, shivers from feeling cold. Her body is not insulated, and she fits into a size 6. There is a big selection of clothes at the store she shops in; not like there had been when she wore a size 16. Not that it mattered so much – she still feels so fat. And she’s still wearing the size 16’s, even though they are bulky and hang from her. She pinches her skin, finding the small amounts of fat. She hates how she looks, and doesn’t feel great about herself either.

At first, people complimented her weight loss, but she doesn’t believe them. Recently, her mother seems a little worried. But not too much, since it’s better to be thin for shidduchim. It doesn’t really matter that it’s a few years off. Chanit hasn’t told her mother that she has stopped menstruating; she doesn’t know that her anorexia can affect her fertility. She exercises frequently, 2 hours in the morning and 3 hours in the evening, even when she’s exhausted. Perfectionist by nature, Chanit wants to do her di-

eting exactly right. Just like all the women in her family, Chanit is always on a diet.

This is why they don’t comment when she eats 2 crackers, a cup of broth, and a small Israeli salad for dinner. They don’t know it is only meal she’s eaten all day.

High school is stressful, with its new girls and its many classes. Her Bubbie always consoled her with a piece of fresh babka when she was stressed out as a young girl, and now it has become her main means of coping. And Bubbie was nifteres two weeks ago, and now everyone at home is absorbed in their own pain. At the pizza shop, the problems have compounded. Hadassah is so stressed out after a hard day at school and she is surrounded by the delicious and fresh smells of tasty foods. She is allowed to eat an unlimited amount there, and she certainly does - in the employee lounge when no one else is there. She has gained a lot of weight from her compulsive overeating, but she can always get the next uniform size.

She just doesn’t know another way of handling the pressure. She is very frightened, though, that her boss at the pizza shop seems to have noticed.

Binge eating disorder, or compulsive overeating, includes fears of not being able to control eating, and once eating, the inability to stop. There is often excessive weight gain, and related physical symptoms (i.e. high cholesterol, high blood pres-

Continued on next page

Eating Disorder Warning Signs Pronounced increase or decrease in weight.

Her mother seems a little worried. But not too much, since it’s better to be thin for shidduchim.

Secrecy, including routine secretive behavior following meals.

Change in appetite from previous history.

Preoccupation with weight.

Preoccupation with poor body image.

Anorexia Nervosa includes severe restriction of calories, significant weight loss, denial (including denial of weight loss and denial of hunger), prolonged exercise, ritualistic behaviors regarding food, fears of weight gain, hatred of one’s body and self, and loss of menstruation (in females).

There is often a preoccupation regarding calories, foods, and weight loss. As such, the person may frequently research diets and eating disorders in books or on the Internet. There are several cases in which what began as dieting morphs into a more severe pathology, a full-blown eating disorder. This is especially important to keep in mind; I have heard 8-year-old children talk about how they are on “diets.”

Hadassah is a 14-year-old girl who has recently started working in a pizza shop after school. She has stresses – lots of them.

Shoshana Lewin, Psy.D. is a clinical psychologist affiliated with Jamaica Hospital in Jamaica, Queens, NY. She specializes in addictions, mood disorders, anxiety disorders, and eating disorders. She can be reached at drshoshilewin@yahoo.com.

Compulsion to exercise.

Depression and/or irritability.

Ritualistic or abnormal eating habits (hatred for previously favorite foods, avoidance of food, preference for strange foods, playing with food rather than eating it, refusal to eat in public).

Wearing very baggy or layered clothing to hide weight loss.

Isolation and social withdrawal, or development of a social cohort similarly obsessed with weight loss.

Obsession with clothing size, scales, mirrors.

Obsession about food type and fat or calorie content.

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® Eating Disorders continued from previous page sure, joint pain). Binge eating is defined as the rapid intake of many high calorie foods in a short period of time. Eating is often done secretively, and the person will isolate him or herself.

Dieting is done chronically, and there is a belief that life will improve after weight loss is achieved. When the person does binge, s/he will feel a sense of personal failure, and will blame society for the weight gain.

Sandi, a 21 year old woman, is feeling a lot of emotional pain, the kind of pain she has turned to chocolate chip cookies to heal. And a gallon of ice cream. And a can of whipped cream. She buys these items for those times she knows she’ll need a binge.

She feels isolated and depressed, and the food makes her feel better. After a binge, she retreats to the restroom, where she vomits it all up. She feels relieved – her secret binging is preserved, and she will not

diagnostic

gain weight. She doesn’t lose any weight either – Sandi looks like an average sized woman her age. But her teeth are suffering the effects of stomach acid, and her heart may soon be affected by the electrolyte imbalances result from frequent vomiting.

Bulimia Nervosa includes episodes of binge eating, which are followed by restriction (i.e. fasting) or purging (i.e. vomiting, taking laxatives). The binging and purging is generally done in secrecy, though there can be indicators that this is taking place, such as the person secluding themselves after meals, the smell of vomit, the sound of running water in the restroom after meals, or excessive use of mouthwash or breath fresheners.

The person experiences depressive moods after a binge. There are often physical affects of binging, including kidney problems, irritated esophagus, eroding tooth enamel, electrolyte imbalances, low potassium, stomach and intestinal problems, and dry skin.

Our society talks more about obesity and dieting than about development of healthy eating and exercise patterns. We forget that children and adults come in all shapes and sizes, and stigmatize

people who come in certain ones. To truly help ourselves, our families, and our communities, we must consider this issue from two sides: that of prevention and that of treatment. Prevention of eating disordered behavior includes teaching healthy eating and patterns of activity, recognizing when food is being used to affect emotional stressors or problems, and discouraging formal dieting among youth unless it is prescribed by the pediatrician. Treatment of eating disorders includes recognizing the warning signs and developing a treatment plan with your physician, which may include outpatient counseling, or in severe cases, hospitalization. May we merit eating food in a way that satiates our bodies and nourishes our souls, giving us strength to serve Hashem with strength and fortitude. n Supplementry reading When Your Child Has an Eating Disorder: A Step-ByStep Workbook for Parents and Other Caregivers by Abigail H. Natenshon Helping Your Child Overcome an Eating Disorder: What You Can Do at Home by Bethany A. Teachman, Marlene B. Schwartz and Bonnie S. Gordic The Eating Disorders Sourcebook by Carolyn Costin

www.anred.com www.eatingdisorderinfo.org www.anad.org

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Building Blocks

September 2007

diagnostic

Asperger’s Syndrome

By Dr. Stuart Ibel

to visit, he ignored them. At the playground, he never interacted with other children.

Asperger’s Syndrome (AS) is a type of highShimi’s parents were given a lot of unsolicfunctioning autistic spectrum disorder. Individu- ited advice by friends and relatives, the gist of als with AS have normal intelligence (or often which was that they were “spoiling him,” and, higher). Although children with AS learn to speak “they should stop giving in to his craziness.” at or near the usual age, they usually have People told them, “just set limits.” But it was an odd style of speech and difficulties with not so simple. When the parents tried to folnonverbal communication and under- Asperger’s low the advice of others, Shimi’s tantrums standing social and emotional conventions. Syndrome would escalate to the point where he would They may also have obsessions with parhit himself in the head or bite his wrists. ticular objects or subjects, and difficulty with Others tried to reassure his parents that he change in routine. Left untreated, these children would “grow out of it,” or “he’ll straighten out are often ostracized by their peers, or far worse, when he starts school.” become the victims of teasing, taunting and bullying leading to intense anger, resentment, loneliIt was not the result of poor ness and/or depression. parenting, nor something For illustrative purposes, we present below a fictional case history of a child representing a that Shimi would composite of actual cases. “grow out of.”

Shimi was a precocious child. By age 2, he could recognize all the letters of the alphabet and count to a hundred. He could identify complex shapes and name all the colors in his deluxe set of Crayola crayons. His vocabulary was surprisingly large for his young age. Relatives always referred to him as the “budding genius” of the family.

However, Shimi had some significant behavioral issues. Shimi demanded to be dressed and fed in particular sequences. For instance, when getting dressed, there was an exact order that had to be followed: shirt, pants, socks, and shoes. His mother had to put on the right sock first, and then the left. Socks had to go on after the pants only.

At mealtime, the plate had to be placed on his tray before the cup. If his mother tried to vary the order of any of these things, a terrible tantrum would ensue. Tantrums could continue for hours.

Shimi’s parents soon learned that it was easier to During one of his regular medical checkups, go along with him than exhausting themselves Shimi’s parents voiced their concerns about his trying to feed and dress him in a different order. behavior. The pediatrician referred them to a loDuring the day, Shimi’s favorite activity was cal Early Intervention agency. lining up toys repeatedly, in a particular order.

At the Early Intervention center, Shimi was He loved to arrange them either by color, size, or evaluated by a multi-disciplinary team of profescategory. He would repeat this activity over and sionals including a psychologist, a speech patholover again, for hours. Should someone move one ogist, an occupational therapist and a special eduof Shimi’s toys, he would have what his parents cator. The evaluation included a detailed history described as a “meltdown.” taken from Shimi’s parents, behavioral observaHis parents were also concerned because tions, and test administration. The team reported Shimi did not seem to be at all interested in other that they found Shimi’s physical and self help children or their activities. When his cousins came skills to be within normal limits. His cognitive development was well above average. Shimi had Supplementary Reading a large vocabulary, spoke in complete sentences, and was able to follow multi-step directions. HowAsperger’s Syndrome: A Guide for Parents and ever, he did not use speech in the way expected of Professionals by Tony Attwood children his age. He never greeted anyone unless Asperger Syndrome And Difficult Moments: Practical specifically instructed. He could not verbally exSolutions For Tantrums, Rage And Meltdowns press feelings. His spoken language was limited

by Brenda Smith Myles and Jack Southwick primarily to requesting what he wanted and talking about his specific interests. It was not reciproA Parent’s Guide to Asperger Syndrome and HighFunctioning Autism: How to Meet the Challenges and cal in nature. His voice had a monotonous tone to Help Your Child Thrive by Sally Ozonoff and Geraldine it. He did not use gestures, facial expressions or Dawson typical body language when attempting to comStuart Ibel, PhD is a Licensed Psychologist and Board Certified Behavior Analyst. He is Program Director of Challenge Early Intervention Center, located in Brooklyn, NY.

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municate nor did he seem to be able to read these things on others. Additional findings were that Shimi had no self initiated imaginative play. Left on his own, he would line up toys and engage in other repetitive activities.

Based on results of the evaluation, the team concluded that Shimi met the diagnostic criteria for Asperger’s Syndrome. At this meeting it was explained to the parents that AS is a neuro-biologically based developmental disorder. It was not the result of poor parenting, nor something that Shimi would “grow out of.”

Soon after his evaluation, an individualized family service plan (IFSP) was developed to address Shimi’s specific needs. The plan included the family’s direct involvement in his therapy.

Shimi was taught social/communication skills such as facing people and looking into their eyes when speaking to them. As time went by, he was taught how to use and understand gestures, facial expressions and body language. Using contrived situations, he worked hard on how to cope when things did not go the way he wanted. He developed the ability to carry on conversations and share other’s interests. His play repertoire was expanded.

Shimi was fortunate to have been diagnosed and have begun treatment at an early age. Many children with AS are not identified until grade school or later. Many are misdiagnosed and may receive inappropriate treatment. The reason for this is that the various symptoms of AS overlap with other disorders including anxiety disorders such as Obsessive/Compulsive Disorder (OCD), mood disorders such as Bipolar Disorder and depression, other childhood disorders such as Oppositional Defiant Disorder (ODD), and/or Attention Deficit/Hyperactivity Disorder (ADHD).

With early detection, the prognosis for people with AS is much brighter than it was in the past. Given appropriate treatment and support, children with AS can fully integrate into society, becoming indistinguishable from their peers. n

TIPS FROM PARENTS Homework time was always a big problem for my child diagnosed with ADHD. He was constantly looking around at his siblings and couldn’t concentrate on his own work. I found that purchasing a tri-fold board from Staples helped with this problem a lot. I taped it around the front and both sides of his desk so he wouldn’t get distracted by his environment. A really inexpensive solution to a big problem.

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treatment

Interview With MEDEK Founder Ramon Cuevas parents, and more difficult ones for a local therapist to carry out when they return to their homes. A video of the exercises is typically produced to help the parA few moments with the originator of the ents in their new role. After a few months, the parents CME/MEDEK program is enough to make one might bring the child back for more CME treatment, realize that this dynamic individual is no ordinary obtained directly from Mr. Cuevas. therapist. Ramon J. Cuevas is obviously fired with GOOD NEWS TRAVELS FAST While some parents travel to Chile for treatdetermination, dedication to a cause, and gratefulMr. Cuevas’ reputation began to spread via ment, Mr. Cuevas does spend a few weeks each ness for G-d’s role in it all. word of mouth, and the start of international ac- year in the New York/New Jersey area (particularly The story begins in 1969, when Ramon Cuevas claim came as a result of treating the children of Monsey and Lakewood) and in Canada treating pagraduated from the University of Chile with a degree two families in Toronto, Canada. The extremely tients. Rumor has it that community rabbis in in Physical Therapy. Like others in his field, Cuevas satisfied parents recommended CME to other some of these areas had to decree that time Motor started his career by providing traditional physical families desperately searching for help for slots be evenly apportioned, so as to meet the Development needs of the many frantic parents anxious to therapy to his patients. However, after a while, Ra- their developmentally delayed youngsters. mon became increasingly frustrated with his efforts, Although Mr. Cuevas began his work make sure their children were attended to. after noting only minimal progress in his patients. with infants and children up to the age of three, Somehow, he knew there was more who could be manipulated most easSPREADING CME that could be accomplished. ily due to their small stature and low Ramon has only 24 hours in his day, and can In 1971, he began his research, weights, parents who heard of his only be physically present in one location at a time. and with the permission of parents eawork soon arrived at his door, begging Therefore, he has embarked upon an ambitious plan ger to see their children advance their him to intervene with their older chil- to spread the practice of CME to others. He began motor skills, Ramon initiated experidren. This would require a tremen- instructing physical therapists, occupational theramentation with new techniques he himdous amount of strength in his arms, pists, and physicians in the implementation of his self had devised. Working with babies 3 and particularly thumbs, as oftentimes program. In the year 2000, The Cuevas Medek Ex- 4 months of age, his research entailed the child’s entire body weight has to ercise Continuing Education Program was conceived placing them in various positions, usbe supported solely by the therapist at to enhance the quality of CME teaching. The Cueing manual exercise to incite progress ankle level. vas Medek Exercises Therapy Continuing Education (all the while carefully monitored the Still here, CME seemed to help Program offers four levels of learning in four locainfants to ensure that the movements and even produce astounding results tions: New York, Montreal, Toronto, and Jerusalem. were not causing them any harm). in the children who were brought to him from all By this method, Mr. Cuevas discovered that over the world.

WHAT’S HE REALLY LIKE? placing his small patients in certain positions caused One child arrived at his doorstep, capable You might think that someone as successful their brains to react, thus triggering the automatic only of walking completely bent forward, while as Ramon Cuevas might consider himself to be a motor responses pre-programmed in the child’s grasping a parent’s hand on both sides. After just pretty fantastic guy- ambitious, money-hungry, and brain. (In a healthy child, the aging process auto- three days of intense therapy, the child was walk- egotistical. Yet you’d be very wrong, because Mr. matically causes these responses to kick in.) ing freely. Ramon even took on a twenty-year-old Cuevas believes he was inspired, and he attributes This research led to the development of Cue- patient, which was an extreme challenge (CME is this inspiration to G-d. He feels it is his mission to vas’s original method of physical therapy known as only designed for children). The young man was help children and that G-d gifted him with unusual “MEDEK” or CME (Cuevas Medek Exercise). CME getting around with great difficulty, with the aid of dexterity and the discovery of a new method with is a therapeutic approach based on manual exercise, two canes. Within a year, this boy’s life was trans- which to achieve this goal. developed to treat children with motor development formed, as he gained the ability to walk freely.

He relates the following story: On a Saturissues. MEDEK can be applied to youngsters and day in Antwerp, he used a copy machine in a local babies with Cerebral Palsy, Down Syndrome, Spina IS CME FOR EVERYONE? store and upon returning to his hotel room, discovBifida, various orthopedic conditions, and low muscle “We have a 75% success rate,” explains Mr. ered amongst his copies a rather strange sheet of tone. (MEDEK is not appropriate for any progressive Cuevas. ”This is not a miracle,” he warns, as not paper. He recognized the letters as Hebrew, and degenerative neuromuscular disease.) every child with motor issues will progress through asked a rabbi that he knew to interpret it for him.

CME. He is very forthright with parents who come It turned out to be a copy of chapter 127 from HOW DOES MEDEK/CME WORK? to seek his help. He generally suggests an eight- Tehillim [Psalms]. He was most moved by the pasAs Mr. Cuevas points out, MEDEK or CME week trial period with a new patient, by which time sage “Like arrows in the hand of a warrior, so are works very differently from traditional therapy. he hopes to help the child achieve three new func- the children of youth.” Ramon feels that this was a “Where traditional therapy facilitates patients to tions. If he does not achieve these goals, he sug- message to him, depicting him as that warrior who do things, CME provokes progress- literally forces the gests that the parents seek other forms of help. launches his young patients like arrows, allowing brain to react.”

CME is not easy on the practitioner or the child. them to move with new freedom and gain the moThe idea is to expose the child’s body to ex- At the end of a CME session, both practitioner and bility that they had never known before. treme situations, thus producing a reaction. This ex- child can be covered in sweat from the efforts and exNot satisfied with all of the aforementioned perience creates new connections in the brain, also ertions. Yet the thrill of independence and the impact activities that fill his life, Mr. Cuevas just produced known as synapses. Ironically, the “plasticity” of the it has on the patient’s future is inestimable. his first English language book, a CME manual that brain - its amazing ability to create new pathways The typical program for a patient traveling to offers an understanding of CME therapy, devoting and thus new capabilities – has become a very hot see Mr. Cuevas is a 24 session course of treatment, for the first time a great deal of space to its genesis, topic in the world of science today. Yet, Mr. Cuevas carried out in two weeks’ time. For the first twenty theory, cases and exercise practice. The author instumbled upon this discovery 35 years ago, purely by sessions, Mr. Cuevas pushes the child to the maxi- sists that the book is not a commercial effort, but instinct. Only recently has the scientific world borne mum of her potential at the time, and devotes the last written purely with the intention of promoting his witness to this incredible phenomenon through vari- four sessions to selecting simple therapies to teach the techniques to benefit the children. (See sidebar for information about obtaining a copy of this book.)

Ramon Cuevas developed the CME approach (formerly MEDEK) in the early 1970’s. He has more than thirty five years of experi“I have everything,” he assures me with a ence in the treatment of children with neurological and musculoskeletal dysfunction. Cuevas teaches students and professionals grateful smile, “I have a wife and four children.” around the world and has participated in conferences in South America and USA. He can be reached at (56-2) 4265334, (56-2) And, indeed, for Ramon Cuevas, it is all about the 4329050 or by e-mail: cme@cuevasmedek.com. Visit his website at www.cuevasmedek.com children. n

By Perel Grossman

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ous laboratory experiments and the like.

Ramon explains that “any child that enjoyed progress through my therapy already had the recovery potential.” It is just a matter of provoking, using and enriching the brain’s capabilities.

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Music Therapy

By Toby Williams

on language development and communication.

Early speech development begins with vocalizaWhen I tell people that I am a music thera- tion and babbling sounds prior to the formapist, most people look at me with confused inter- tion of words and phrases. Music is inherently est and ask me how I use music for therapy. Am I motivating to most children and is a useful way a music teacher? Am I a therapist? I am both, to help them move through the stages of trained both as a musician and as a psychospeech development, while also providing therapist, in addition to separate music Language early music learning. I collaborate with the therapy training that is its’ own domain. Development speech-language pathologists to coordinate There are many misconceptions about the speech goals. For children who self-soothe field of music therapy. It is a way of using with singing, I match their sounds and help music as a therapeutic medium with a variety of to bring them into a meaningful focus by moving populations. From developmentally delayed chil- vocal sounds into words and creating a musical dren to adults recovering from surgery, and the context. mentally ill and geriatric adults with Alzheimer’s disease, music can be used in different ways to Music is inherently reach people while working on therapeutic goals. motivating to most Music therapists are highly trained professionals, either at the Master of the Arts or Bachelor’s Dechildren and is a useful gree level. Music therapists must be board certified and in New York, they must also be licensed. way to help them move Music can play an important role in facilitatthrough the stages of ing connection and emotional learning as well as providing opportunities for speech development, speech development motor coordination and educational learning.

The American Music Therapy Association explains the use of music therapy with children on the autism spectrum as follows: “The literature reports that most individuals with autism respond positively to music (DeMyer, 1974; Edgerton, 1994; Snell, 1996; Thaut, 1992).

People with diagnoses on the autism spectrum often show a heightened interest and response to music, making it an excellent and effective therapeutic tool. Music is a very basic human response, spanning all degrees of ability/disability. Music therapists are able to meet clients at their own levels and allow them to grow from there. The malleability of music makes it a medium that can be adapted to meet the needs of each individual.

Music can promote relatedness, relaxation, learning and self-expression. Music therapy addresses multiple developmental issues simultaneously.

Music therapy can provide success-oriented opportunities for achievement and mastery. The structure and sensory input inherent in music help to establish response and role expectations, positive interactions, and organization”.

The children and I play guitar, percussion inIn my work, I use vocalization and song struments, and keyboard together. Playing instrusinging to help speech-delayed children work ments provides many opportunities for children to work on motor planning, coordination and execution. The sound stimulus provides immediate Supplementary reading feedback. Music activities are either structured or Music Therapy, Sensory Integration and the Autistic improvisatory depending on the specific needs of Child by Dorita S. Berger and Donna Williams the child. One example of a structured activity is the use of an octave xylophone with a differMusic Therapy: Another Path to Learning and Communication for Children in the Autism Spectrum by ent color for each note while singing a song called Betsey King “Let’s Play the Color (Number or Letter).” This song activity can help a child to visually attend Music Therapy for the Autistic Child by Juliette Alvin while learning the numbers 1-8 and the letters of and Auriel Warwick the octave, as well as identifying colors. Improviwww.musictherapy.org sation is often indicated to help a child to explore www.centerformusictherapy.com creatively and to foster a therapeutic relationship through a musical connection. Therapist and Toby Williams is a music therapist at Reach for the Stars Learning Center, and holds a M.A, MT-BC, LCAT. She can be reached at www.tobywilliams.net.

child may improvise together on the same instrument or on separate instruments. Improvisation provides the child with a way to express emotionally and creatively while working on connection through rhythmic, dynamic and tonal coordination. In addition, motor skills such as finger isolation, gripping and crossing the midline are explored during instrument play.

In group music therapy sessions, we work on socialization, movement, rhythmic attunement, vocalization and singing, among other goals. I try to have at least one song that fits into the learning theme of the month to keep music therapy group consistent with what the children are focusing on in the classroom. Songs provide a great way for children to both learn and to find success in expressing concepts.

Music can be stimulating or calming, loud or soft, fast or slow or anything in between. By using music to work on therapeutic goals, children find a wide range of expression and a fun, motivating way to work. Speech, motor and emotional goals can all be worked on through music with a trained music therapist. Physically disabled children often find new ways to express themselves through music that are unavailable to them in other therapeutic mediums. Working in music with children on the autism spectrum is extremely rewarding.

The moment of connection with a child who is otherwise difficult to reach always feels miraculous. To see the improvements the children are making in the classroom translated into music can be stunning. If you are interested in learning more about music therapy, a great resource is the American Music Therapy Association Website (www.musictherapy.org). Many music therapists come into the home to do private work. If you are interested in receiving music therapy services, make sure your music therapist is board certified and licensed. n

TIPS FROM PARENTS When going to a public place with a lot of noise and people, I bring along a walkman with soothing classical music. When my son shows signs of impending meltdown from sensory overload, I take him outside and put on the classical music with earphones.

It really works to calm him down.

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treatment

® Are You Listening?

By Pnina Bravmann, MS, CCC/SLP-A, SAS, Cert AV-T

What are causes of CAPD? Possible causes of (CAPD) include family history, head trauma, and chronic ear infections. The “She can hear just fine, she’s just not listening.” infections may have caused auditory deprivation, so “He gets so frustrated in a noisy environment.” that the child was not exposed to all speech sounds “He hardly ever gets it right when I ask him to do and listening experiences as an infant or very young something.” child. As a result, she/he may not have devel“He seems so smart yet he’s having such a hard oped appropriate listening skills. Often the Auditory time following in school.” cause is unknown.

“She does great one-on-one, but falls apart in Processing CAPD may be present with other isa group setting.” sues including global processing disorders, “She can tell me a whole story, but can’t follow ADHD, learning disabilities, dyslexia, autiswhen I tell a story and can’t answer questions.” tic spectrum disorders or pervasive developmenParents and teachers know what it’s like when tal disorders. Children with these diagnoses often a child seems like they are not paying attention. have problems processing visual perception and These are all common complaints. But what’s re- tactile perception as well as auditory perception. ally going on?

But while these children may have problems with School has become more complex and de- auditory perception, they are very different from

Imagine trying to learn a foreign language while wearing earplugs. manding nowadays, and we are all busier than ever. There’s a lot to remember and a lot to do. But sometimes children may seem to be more than simply distracted by being so “busy.” Although a child’s hearing may be normal, children with “central auditory processing disorders”(CAPD) can’t process the information they hear in the same way as others because their ears and brain don’t fully coordinate. We hear with our ears, but if the brain is unable to correctly process what is said, the message is lost or misunderstood – it’s “what we do with what we hear” (Dr. Jack Katz).

Imagine trying to learn a foreign language while wearing earplugs. This can be compared to what children with CAPD face in the classroom each day. It is easy to understand how they could fall behind academically, lose self-esteem, or be labeled as having behavioral problems.

CAPD is an often misunderstood problem, because many of the behaviors may also appear in children with learning disabilities, ADHD (attention deficit hyperactivity disorder), hearing loss, and even depression. Therefore, it is critical that children are evaluated by specialists who can clearly differentiate between these disorders, so that appropriate treatment plans can be implemented.

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a child who has an isolated auditory processing disorder. Both require intervention to treat the listening problem, but the approaches may be quite different.

How is CAPD diagnosed?

Teachers or day care providers may be the first ones to notice symptoms. Parents should always speak to daycare providers/caregivers and preschool teachers about how their child performs in a group setting.

Diagnosis may involve a number of professionals to rule out other disorders. An audiologist who specializes in CAPD is critical in order to correctly diagnosis CAPD. There are many audiologists without special training to diagnose processing, and it is therefore important to do the research before making an appointment. It is also critical that speech-language pathologists with specialized training in CAPD evaluate the child’s receptive, expressive, and auditory skills to determine linguistic and auditory functioning.

First, a hearing test is performed to rule out hearing loss. Then a range of auditory tests

Continued on next page

SIGNS AND SYMPTOMS OF CENTRAL AUDITORY PROCESSING DISORDER Below is a list of some common characteristics found in children with Central Auditory Processing Disorders: Your child has difficulty following conversation when background noise is present.

Your child is disorganized and forgetful.

Your child has problems following directions.

Your child has difficulty with speech and language: reading, writing, spelling.

Your child has problems with verbal math problems.

Your child has problems understanding abstract concepts and absorbing information.

You think your child isn’t hearing properly, even though hearing sensitivity is normal.

Your child refuses to participate in classroom discussion or responds inappropriately.

Your child becomes sullen or withdrawn.

Your child asks for frequent repetition, or often says, “huh,” “what?” or “I didn’t hear you.”

Your child has extreme trouble paying attention.

Your child is easily distracted.

Your child requires special instruction from the teacher to get organized in class.

Your child’s verbal IQ scores are lower than performance scores.

Your child may exhibit poor singing and music skills.

Your child may have fine and/or gross motor skill deficits (manifests as “clumsiness”).

Your child has a history of ear infections or other middle ear problems.

Children who present with any of the listening difficulties described above should be assessed to determine the source of the problem.

Genevie Davitt

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When You See Something, Say Something

By Kreindi Myers, MS

When I first told a mother that her child had an autism spectrum disorder, she totally refused to believe it.

“Autistic? My child is definitely not autistic!” she argued. “Children with autism live in their own worlds, flap their hands and never make eye contact. My child is not like that at all.”

Many of us do not realize that children can have a spectrum diagnosis and be so high-functioning that even a parent, teacher, friend or Bubbi do not see the issues clearly.

No one wants to be told that their child is not like other children. All parents want their children to be part of the group, to be what is considered “normal.” They want them to play with friends, interact with their siblings, get excited when Tatty and Mommy come home, and ask for help from adults in their environment when they need it.

The fact is that there are some children who are verbal, bright and capable, but something about their development is a bit “off.” We see these children when they are 3 or 4 years of age, but we also see them when they are 7, 8 or even 12.

When we observe these children closely, certain characteristics emerge.

They may include:

NOT understanding “pretend” play or how to play appropriately with toys.

NOT making appropriate and consistent eye contact.

NOT dealing well with any changes whether in their routines or food, or anything else that is new or different in their lives.

NOT seem to be aware of the unwritten rules of socially appropriate conduct in and out of the classroom.

NOT seem to be aware of the role that an adult should play in their lives.

NOT playing interactively with siblings or other children and prefer to play alone.

NOT “getting it” and are often teased by siblings or friends.

It is important to note that some highfunctioning children with an autistic spectrum

Kreindi Myers, MS, has worked in Early Intervention doing hundreds of evaluations after years in the classroom. At present she is Administrative Director of the Yeled V’Yalda ABA program and oversees social skills training groups. As clinical supervisor in both Special Education (6-21) and Early Intervention (birth-3), Kreindi supervises therapists and coordinates services with our Speech, Occupation, Physical and Counseling departments.

Are You Listening? continued from previous page are performed in the sound booth to determine where the area of listening breakdown occurs. A treatment plan is then designed according to the child’s area of difficulty.

Who should be evaluated?

Specialists can screen processing for children as early as age three. Children with a delayed response time (if you wait a few seconds after you ask a question, they just may answer it); children who may repeat the last few words of a question instead of answering it; children with difficulty following directions; children with difficulty answering “wh” questions, and children who appear to perform better expressively than receptively, may have characteristics of CAPD, and should be evaluated. School aged children who present with difficulty in listening activities, children who have more difficulty in less than ideal listening environments (performing worse when there is background noise, distractions present, when speaker

talks rapidly, when topic is unfamiliar, when they are not paying close attention, or when they have to remember several tasks in a row); children who have weak phonemic systems, as well as kids who don’t always grasp exactly what was said, and may respond off topic should be evaluated.

Children as young as 3 can be screened—the earlier a child is diagnosed, the better the prognosis. More formal testing begins at age 5, and most comprehensive testing is performed by age 7 or 8.

Children who have been diagnosed with CAPD should be monitored on a consistent basis.

Treatment and Management of CAPD Management of CAPD includes a three-pronged approach: direct therapy techniques, environmental modifications (both at school and at home) and compensatory strategies. All three are necessary for effective intervention. The details of each component are ideally developed specifically for each child based on his areas of breakdown and the unique circumstances of his/her learning or communicative difficulties and needs. No interventionist should take a single approach towards children with CAPD. It is critical that children

Pnina Bravmann, founder of the largest auditory oral pre-school in the world, Director of the Auditory Oral School of New York and StriVright Early Intervention Program in Brooklyn, NY, is an audiologist, speech language pathologist, licensed teacher of the speech and hearing handicapped, certified auditory verbal therapist, and a well-known presenter on oral deaf education and auditory processing. She can be contacted at pbrav@auditoryoral.org (718)531-1800.

Genevieve Davitt is Board Certified and holds a Master’s Degree of Science in audiology. She has worked as a Clinical Audiologist, Research Audiologist and an Aducational Audiologist. She provides audiological evaluations and services at StrivRight Early Intervention Program and Auditory/Oral School of NY for the past 6 years. She provides specialized Central Auditory Processing Evaluations and therapy. She can be contacted at gdavitt@auditoryoral.org (718) 531-1800.

disorder are able to make good eye contact and seem to speak beautifully. On a superficial level, they seem to have no language issues at all. However, if one listens to their speech very closely, it often sounds more like adult speech than the speech of a child. Children with autistic spectrum disorders often repeat phrases they hear and use them when it sounds ‘right.’

They take everything literally and their speech is literal as well.

Children with spectrum disorders are frequently very rigid. Time and again they feel that they must follow the “rules” regardless of the consequences. They don’t understand a teacher’s stare, other children’s facial expressions or their parents’ body language. They are the ones who are usually the “tattletales.” They often cannot empathize or sympathize with others. They may be inappropriate at home, in school, and on the playground. They will follow the rules even when they know they will get punched, ignored and made fun of, and will tattle on anyone who does not follow the rules. They just don’t “get it,” and no amount of explanation really helps- telling them that the other children won’t like them or won’t play with them makes no impression. It is as if they cannot stop themselves. Their rigidity of thought impairs their ability to see the “big picture.”

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be treated by SPECIALISTS who are trained to tailor make a treatment plan for each individual based on their unique characteristics and symptoms of auditory processing. There is no one-size-fits-all solution.

A team approach is necessary to accurately diagnose a child with CAPD, and the same is true for treatment. A well-coordinated and effective CAPD team includes specially trained audiologists, speech-language pathologists, the parents, teachers, and other professionals on an as-needed basis (occupational therapists, reading specialists, etc). Specialized computer therapy programs may be appropriate in certain cases. Parents must be an integral part of the team and ongoing reinforcement as well as environmental modifications must be consistent at home.

CAPD is an invisible disability. Accurate diagnosis and treatment of CAPD with appropriate modifications are essential in school and at home to prevent academic failure, behavior and communication breakdowns, and loss of self-esteem. These steps are all necessary to help CAPD children succeed! n Supplementary reading When the Brain Can’t Hear : Unraveling the Mystery of Auditory Processing Disorder by Teri James Bellis Central Auditory Processing Disorders: New Perspectives by Gail D. Chermak, Frank E. Musiek and Chie Higuchi Craig www.audiologyonline.com/ www.audiology.org www.asha.org

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® If You See Something continued from previous page Sometimes children with spectrum disorders exhibit an unusual interest in a specific topic. The topics vary and can range from an interest in airplanes and trains to an interest specific to the community they live in. In our world, these children sometimes exhibit an excessive interest in Shtreimels, Rabbanim or Shabbos and other religious rituals. When children are young, parTony Attwood, an international expert on Asperger’s Syndrome – one of the Autistic Spectrum Disorders – describes a classroom situation: A teacher is giving a lesson, and when he turns his back on the class to write on the board, Moshe, an impish little fellow, begins to chirp like a bird. The teacher quickly turns around to face the room and asks, “Who did that?” Everyone in the class is quiet. Suddenly Yaakov speaks up. “Teacher, Moshe did it.” The teacher realizes that the entire class is angry with Yaakov for tattling and he tries to diffuse the situation by saying, “I don’t care who made that noise. I never want to hear it again.” He then turns back to the board. But Yaakov won’t give up. He knows right from wrong and Moshe is wrong. So Yaakov stands up and repeats, “Teacher, Moshe did it.

Everyone knows he did it!”

According to Attwood, unless Yaakov has a standing feud with Moshe, the chances are really good that Yaakov has a spectrum disorder.

ents may see these interests as cute. They may buy their children lots of airplanes or trains and spend time talking about Shabbos all week long.

But as time passes and the child grows older, parents may finally realize that their child’s interest in the topic is all absorbing – often to the point of exasperation.

One mother described her child to me. Her four and half year old son was a regular “kid.”

He did, however, prefer to play by himself. If he ever tried to play with his classmates before long they were making fun of him. His eye contact was inconsistent. Most of all, he hated change. Any change in his environment was very difficult for him. He needed things to be the same and did not deal well with changes in routine.

Many parents would be reluctant to confront the possibility that there was something wrong with their child and pin their hopes on his outgrowing this “awkward” stage. This mother was different.

An educator herself, she was not willing to take the “wait and see” route. Deep down she knew that this was the time to address her son’s issues. She understood that her wish that he would “grow out of it” was a wish that might never come true.

Instead, she brought her child to a neuro-developmental pediatrician who diagnosed the child with PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified). PDD-NOS is one Building Blocks

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treatment of several Autistic Spectrum Diagnoses. This diagnosis clarified that although the boy was a very high functioning child with tremendous intellectual potential, he was having serious difficulties with attention issues, with the ability to understand socially appropriate behaviors and an impaired ability to read body language. He also had language issues that had nothing to do with being able to speak.

After just three months of intensive intervention, the mother reported to me that her son has made good progress in his behaviors and understanding. As far as progress in his social development, especially with his friends, the mother knows that he still has a long way to go. “I think he now realizes that he is different,” she states, “but he is

child’s odd behavior. The longer the odd behavior is allowed to go on the harder it is to intervene.

Before any intervention can take place, we need to clarify the issues and not just label the disability. We need to know the child’s weaknesses to address them, and we need to know the child’s strength so we can teach the child through them.

Diagnosis is crucial to better understand what a child is really coping with. Unfortunately, few neurologists are really knowledgeable about child development. Parents need to look for professionals with many years of experience in diagnosing and working with children who have autistic spectrum disorders. Once a diagnosis is made, an intervention program can be put together that will help the child succeed. Parents need to partner with those professionals and therapists who can support them and their family while they are helping the child.

Children with autistic spectrum disorders need to learn from the bottom up. They need to fill in their developmental gaps in terms of understanding emotions, imitation, appropriate behaviors and other skills. Once they gain the skills they need to function and interact well with others in their environment, they are on the way to being successful in school as well as in life.

The popular saying “if you see something, say something” applies just as much to developmental issues as it does to terrorism – maybe even more.

We need to keep in mind that ignoring the issues won’t make the problem disappear. n

Many of us do not realize that children can have a spectrum diagnosis and be so high-functioning that even a parent, teacher, friend or Bubbi do not see the issues clearly.

The profiles of abilities in persons with an Autistic Spectrum Disorder often include the following characteristics:

watching more, imitating more, and putting effort into fitting in with the boys.”

The educator/mother who came to see me about her child showed a lot of courage. By not letting her love for her son ‘blind her,’ she was able to look at him realistically, obtain a much-needed assessment of his problems, and get him the intervention he needed. Unfortunately, not every parent is willing to take this first step.

Adults are good at finding excuses for the children they love. Parents are quick to explain “why” the child is doing what he is doing. What we need to do is stop and ask ourselves if making excuses or explanations is actually helping the child.

When a pediatrician responds to a parent’s concern over their child’s odd behavior by saying that the child will outgrow it, he is doing them a disservice. When a father or a Bubby or Zeidy tells a mother: “he’s a child, and children do that” or when the teacher just nods and ignores the problem – that doesn’t mean the problem goes away. An anxious parent will grasp at any explanation of the

A qualitative impairment in social interaction: • Failure to develop friendships that are appropriate to the child’s developmental level.

• Impaired use of non-verbal behavior such as eye gaze, facial expression and body language to regulate a social interaction.

• Lack of social and emotional reciprocity and empathy.

• Impaired ability to identify social cues and conventions.

A qualitative impairment in subtle communication skills: • Fluent speech but difficulties with conversation skills and a tendency to be pedantic, have an unusual prosody and to make a literal interpretation.

Restrictive Interests: • The development of special interests that is unusual in their intensity and focus.

• Preference for routine and consistency.

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Cognitive Restructuring And The AIM™ Methodology

By Dr. Michael Foox and Rabbi Reuven Bernstein

minds so that students are actively creating links among and between the information they are processing. Reading comprehension flourishes, instructor lessons are more meaningful and the world begins to look like a set Dear Dr. Foox, of data that has logic, structure, and form.

My son is having difficulty with reading comThe above is an example of a Cognitive Reprehension. When I read him a story he knows all structuring approach to a reading issue. Dr. Foox has the facts, yet, when he reads it on his own he can identified several core skills that one must have fully not tell me what he has read. In addition, he finds operational in order to function adequately in our soreading very frustrating. ciety. The skill to link, to communicate, to be mentally Mrs. J, Cedarhurst NY organized, to communicate, to compare and use logic Dear Mrs. J, are the fundamental building blocks of thought.

Reading should be a source of enjoyment and For example, I often ask participants, “Who was exploration. However many children have difficulties holding the back of your bicycle when you first learned comprehending what they read. We have discovered how to ride?” Often the answer would be a parent, a that many children have difficulty in the basic skill to brother, a cousin. The achievement is so paramount link, connect, to match and to listen. Your child that the link to details surrounding the event can be views reading data, as separate pieces of inforrecalled after many decades. No doubt most of us mation. Each word and each sentence has no can recall what we were doing quite preciously Cognitive common link to each word and certainly not to at 8:45 am on September 11, 2001- yet what Restructuring each sentence. Your child is forced to continualabout September 10, 2001 at 8:45am? ly check back to prior sentences to maintain the Getting back to the bicycle anecdote, what meaning of the sentence in the paragraph. The actually occurred when you were first able to ride? expenditure of mental energy creates confusion and Five minutes before that point, you had the skill of frustration and turns your child off to reading. balance, gross motor coordination, fine motor coordiThe world of association in a child’s life builds up nation, eye hand coordination, spatial awareness etc. his ability to compare and enhance his ability to read. However, you lacked the skill that coordinated all of Most people can recall what they were doing on 9/11 as these skills that you already possessed. In fact, once this they heard about the Twin Tower tragedy, yet are uncer- coordinating skill is acquired you never loose it. tain about 9/10. We suspect that the average skill level We look at many of the “isms,” “syndromes” for recall hovers somewhere between both extremes. and other issues given a variety of abbreviations (e.g.

Therefore the utilization of daily events should take ADHD OCD, LD, etc.) as being related to missing place in the process of reading and formal learning. one or more of the fundamental skill sets listed above.

Look at the following paragraph, it will help you Many common approaches provide a means to “live sense part of our approach: with” what you have-- called compensation. But we Believe it or not, you can read it: have found that no amount of compensation can ever I cdnuolt blveiee that I cluod aulacity take the place of providing the missing skills. Individuuesdnatnrd what I was rdanieg. The Phaon- als are labeled for life and placed in settings that are not mneal pweor of the human mind. Aoccodmig a part of our world. to a rscheearch at Cmabrigde Uinervtisy, it Some parents will not except this premise and deosn’t mttaer in what oreder the ltteers in a perpetually seek some new solution to their child’s isword are, the oinly iprmoatnt tihng is taht the sues. They will read this article very carefully and hope frist and lsat ltteer be in the rghit pclae. The that maybe, if their child’s issues are looked at differrset can be a taotl mses and you can sltil raed ently and their child gets a different type of treatment, it wouthit a porbelm. This is bcuseae the hu- then they will achieve a different result. This unique man mind deos not raed ervey lteter by istlef, approach upsets many others whose programs and but the wrod as a whole. Amzanig huh? Yaeh theories are being significantly challenged. and I awlyas thought slpeling was ipmorantt.

Another example: autism is becoming the numWe teach children to look at words as a whole and, ber one issue that affects children today. Researchers most importantly, to read as one speaks. If it does not are trying to determine why this is the case- are childsound right, then the word is not right. At the same time hood inoculations problematic? Is there something in we engage students in activities that require an active use the environment? We do not know. We have found that of their linking skills and more. As an example, children many children labeled “autistic” have difficulties in the learn that the doctor uses a stethoscope, the carpenter a general area of communication and specifically in the saw, and the air plane pilot a compass. The result is that filtering area. All of us are constantly bombarded by with this approach, we activate the interactivity of their much information in the form of sound, sight, touch

Dr. Michael Foox is a leading clinician in the field of education with considerable research in the learning process and a pioneer in the AIM™ methodology. He is the author of six books on his methodology and philosophy. The main center is at 241 North Main Street, Spring Valley, NY. 845-371-6787. E-mail mf@miil.org.

Rabbi Reuven Bernstein MA SDA, a New York State District Administrator and a doctoral student at New York University, trains under Dr. Foox and is AIM™ Certified. He specializes in treating Stroke victims, Traumatic brain injuries, Parkinson’s, Autism, ADHD, LD, OCD, Aspergers & Other Psychosocial Syndromes. He is the program director at the Five Towns AIM™ center, LIFETECH, 112 Spruce Street, Cedarhurst, NY 516-374-4564 and is available for private sessions. E-mail -reuven1836@aol.com.

and smell. If our minds were constantly drawn to all of our senses at the same time, we would not be able to function. Instead, our minds filter out the essential information given the requirements of the task. Many parents of an autistic child report that their child is very sensitive to some or all of their senses.

At our centers, we develop the skill to filter the essential sense given the demands of the situation. We do this by simple filtering. The same way you were forced to read the jumbled word paragraph, each word as a whole, we will “force” the autistic child to filter information in a predefined and specific manner.

Dr. Foox’s research has yielded the formula for presenting the autistic participant with an enjoyable, non-threatening and achievable task that requires filtering. The genius of Dr. Foox is that he knows just how much stimulation can be given, what type of information, which senses are being challenged and in what sequence that will allow the autistic participant to use their filtering skill. In fact, he has produced his own computer software, specialized keyboard, 240 square foot interactive computer (that’s right, you get on it and in it) and a host of table games with specially designed pieces. Yes, the therapy always looks like a game, and games generally have zero resistance as opposed to “another therapy session.” But how can they “use” a skill they do not have?

This is the secret behind the AIM™ methodology. I once had a high school basketball coach who always said, “No pain, no gain.” Most teachers tell their students the right answer and believe if they tell them enough times they will somehow understand and acquire the information. Almost 100% of the special populations don’t. Our mantra is, “Tell me and I might know, show me and I may understand, involve me and it will become a part of me.”

In our approach we make the mind work- always.

We never give answers, but ask leading questions. The best facilitator (i.e. the individual who facilitates the interaction between the individual and the information) is the one who can provide the least amount of clues to help the participant arrive at the correct answer themselves.

So how can we call upon a skill one seems not to have? The answer is that all of us have the primal capacity to filter. This why we stated above that this is a fundamental skill needed to function. However the skill set is immature, inaccessible and atrophied- but it can be stimulated to develop.

The power of the AIM™ Methodology is not limited to just learning issues. Victims of Strokes, Traumatic Brain Injury, Parkinson’s etc. have areas of their brain loose its ability to function. At our centers we “rewire” the brain to find alternative neurological pathways to retrieve information or send signals to and from parts of the body.

This approach is consistent with the Jewish concept that there is a soul (mind), brain and body. Cognitive restructuring, once lampooned by science for being supernatural, unscientific and unproven, has begun to capture the attention of serious researchers. We, the authors, believe that the mind knows the best way to rewire the brain, and our goal is to challenge the mind to complete this task. n Building Blocks

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®Orthotics:

Pediatric Bracing A Primer For Parents

By Ray Marx When we think of “bracing,” many of us think of wires and brackets applied in our teenagers’ mouths to improve the alignment of their teeth, and hopefully their smile. There is another field of bracing, however, which is fascinating and

Simple malalignments such as flat feet can affect a child’s ability to develop good balance

weight metal alloys.

To understand the science of orthotics and why bracing may be recommended for your child, we can consider simple foot orthoses, known to many as “molded insoles,” “inserts” and “cookies.” These orthoses are used to effect changes in ing neuromuscular issues that affect the developforces upon the body as the foot hits the ground. ment of children. If bracing is prescribed as a necFit and fabricated by a knowledgeable orthotist, essary intervention, you will be referred to a board properly designed orthoses can create slight an- certified orthotist. An orthotist is an expert in the gular changes in the bony alignment of the foot field of evaluation, design, fabrication and impleto improve function. Many times, simple mentation of bracing. Many orthotists have malalignments such as flat feet can affect a exceptional expertise working with children child’s ability to develop good balance, and Pediatric and some even specialize in children with Bracing can unfortunately lead to resulting complineuromuscular disorders. In most instances, cations through development and in later the orthotist will make a mold of the part of years. These misalignments can be addressed the body requiring the orthosis. A model will by providing appropriate support and correction be made from this mold where modifications will controls precisely where needed with a foot ortho- be performed to help assist the body part, improve sis. Other indications often improved with the use alignment and control position. Following comple-

The benefits of pediatric bracing and the capabilities orthotics offer have given tremendous possibilities to many of our children across the globe.

has exploded with potential and technology called orthotics. Orthotics is the branch of medical engineering concerned with the design and fitting of devices, such as braces, in the treatment of orthopedic disorders. Orthotics can provide control, support and protection of the lower extremities, upper extremities or spine and can improve alignment and function, similar to the concept of braces applied to the teeth but in a different fashion. Over decades of research and application, the science of orthotics has progressed dramatically in design, effectiveness and comfort. Many are reminded of the long leather straps, metal uprights and orthopedic shoes donned by a young Forrest Gump when thinking of orthotics. Today’s orthotics are markedly different, however, with many incorporating plastics, foams, natural materials and light

of appropriately designed orthoses are situations that involve increased or decreased muscle tone, commonly the result of a neuromuscular disorder, which may be subtle or severe. In these instances, orthoses may be designed to cross multiple joints of an extremity to affect controls where needed.

For example, if a child is found to have weakness in certain muscles or muscle groups, this will affect his or her capacity to develop a functional walking pattern. The design and application of an orthosis to assist these weaker muscles or muscle groups can improve the child’s ability to progress in walking.

Conversely, a child with increased muscle tone may also be affected with issues of balance and function. Orthoses can be designed to reduce the actions imposed by these inappropriate and excessive muscular forces thus improving the child’s abilities, thwarting complications and possibly controlling the development of future deformities.

The provision of orthoses should be made in concert with your child’s physician and therapist.

If you have noticed that your child is not reaching the milestones that other children are making or is reaching them much later, make your child’s pediatrician aware of your concern. If your pediatrician identifies an issue that requires attention they will likely make a referral to have your child evaluated by pediatric specialists in physical or occupational therapy or a specialized physician like a pediatric physiatrist, orthopedist or neurologist.

These individuals are specially trained in evaluat-

Raymond Marx, CPO, FAAOP is a graduate of the NYU Prosthetic and Orthotic program, trained at Shriners Children’s Hospital in Massachusetts and president of Ortho-Bionics Laboratory, Inc., a facility serving the five boroughs of New York and Long Island for over 30 years.He can be reached at (718) 845-5572.

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tion of the model, the orthosis is fabricated to this corrected model. Once the brace is completed and provided to your child, a period of familiarization and training is usually required. Experience shows that most children adapt very quickly to the use of orthoses, and when they find that the brace is helping them, they will usually wear it quite willingly and preferably.

The complexity of the design and function of an orthosis as well as the severity of your child’s disorder are good rulers to determine the degree of therapeutic training required to ensure that the benefits of the brace are achieved. Children with less complex involvement will require less training and, in fact, sometimes none at all. Conversely, those children that are more severely affected may possibly require continuous therapy and training to ensure the benefits of bracing are achieved. Professionals and parents need to understand that bracing is not usually a singular solution but part of a team approach including the physician, therapist and orthotist to reach the maximum benefit.

The benefits of pediatric bracing and the capabilities orthotics offer have given tremendous possibilities to many of our children across the globe. Advances in design, fabrication, and application are ongoing. Today, orthotics is a dynamic approach to addressing the needs of our children and is helping them to achieve greater degrees of independence and function than previously imaginable as they continue to grow and develop into young adults. These kinds of braces are not worn on their teeth, but watch a child walk who could not before – and be sure to note an improvement in the smile, as well. n

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Aquatic Therapy

By Biana Spektor M.S., OTR/L What comes to mind when you think of summer? Many people say that one of the first things to come to mind is “heat,” “humidity,” and “just how very hot it gets.” We all know that a great way to beat the heat is heading to a local pool, beach or lake to cool off and relax. What people do not realize is that along with all that cooling off, fun and relaxation, they can take advantage of the wonderful therapeutic benefits of water.

Water exercise, also known as hydrotherapy or aquatic therapy, consists of activities and exercises that are performed in the water. These activities are particularly beneficial in dealing with numerous health issues Aquatic such as: muscle pain, back pain, Therapy Arthritis, healing fractured bones, movement disorders, balance issues, Cerebral Palsy, sports injuries, obesity, pulmonary, cardiovascular and many other orthopedic, neurological and developmental disorders. Aqua therapy can also increase endurance levels, muscle strength, coordination and overall fitness for children and adults alike.

The unique properties of water allow a person to experience movement that would otherwise be difficult or even impossible to do on land. Water changes the effects of gravity, and buoyancy allows an object immersed in water to float or at least seem lighter. The water acts as a cushion for the body’s weight bearing joints, reducing stress on muscles, tendons and ligaments. People who have difficulty walking or balancing on land will have an easier time of it in the water. Many find it easier to perform exercises in the water, which would normally be very challenging on land. Water therapy can be a very good prelude to starting

heart to circulate the blood. That in turn decreases swelling and increases blood circulation throughout the body when it is in the water. This pressure increases with depth and opposes the tendency of blood to pool in the legs. Water is viscous and is denser than the air around us; it also provides re-

Along with all the physical benefits, spending time in the water can do wonders for the spirit.

sistance when we exercise and move our body parts through it. This helps strengthen weak muscles.

Water temperature is a very important factor

Aquatic therapy provides an environment for exploration and development for children of all ages. a therapy program on land. Gentle strengthening and stretching in the water can help build endurance and muscle strength needed for completing a more demanding routine on land.

The hydrostatic pressure of water provides resistance during movements that strengthens muscles and improves cardiac and respiratory conditioning. This effect takes place because the water pushes equally on all body surfaces and helps the Suppelementary information Essential Principles of Aquatic Therapy and Rehabilitation by Ruth Sova Aquatic Exercise Therapy by Andrea Bates and Norm Hanson www.aqcuticnet.org www.atri.org

use assistive devices to walk may need virtually no assistance to walk in the water due to its unique properties. Many children with Autistic Spectrum Disorders and other developmental disorders show improved performance and function while receiving therapy in the water; as well as longer periods of relaxation and calm after aquatic therapy treatment.

Aquatic exercise is a wonderful option for the pregnant mother. It offers many benefits during all

that should be seriously considered during aquatic therapy. Warm water increases blood circulation throughout the body, allows for easier muscle stretching, lengthening and pain reduction. It also helps your muscles relax which in turn helps many people relieve their stress. However, it is very important to make sure that the water temperature is not too hot when exercising and exerting oneself to keep from overheating.

Aquatic therapy provides an environment for exploration and development for children of all ages. Water therapy can be useful in helping children develop a sensory awareness of their environment. It helps reduce hypersensitivity to touch, develops gross and fine motor coordination, and strengthens muscles to build self-esteem and a positive body image. Providing children with a physical and emotional challenge while having fun can help them become more independent. Children who

Biana Spektor, M.S., OTR/L is the Director of Rehabilitation Services at Brooklyn Community Management, where two new state of the art pools (one for women and one for men) provide an elegant environment for rehabilitation and therapy. Brooklyn Community Management is located at 2555 Nostrand Avenue, Brooklyn NY, 11210, and can be reached at (718) 336-9500 or (718) 951-8800.

stages of pregnancy, by providing a safe and supportive atmosphere for movement and exercise.

The body is immersed in water, which provides support from all directions during movement. Water also exerts pressure and helps relieve swelling, while providing a cool environment for exercise, without the worry of overheating. The water environment helps improve circulation throughout the muscles of the body and can help with relieving soreness, back pain and stabilizing blood pressure.

Water can also be a great option for getting back into shape post delivery for new mothers.

Along with all the physical benefits, spending time in the water can do wonders for the spirit. It is a natural way to elevate your mood, relieve your stress and provide an opportunity for some fun and relaxation. Positive experiences in the aquatic environment can help with increasing self-esteem and body image. The many health benefits of water can be enjoyed by people of all ages. They include a healthier body, mind and spirit. Aquatic therapy can be the first step to improving your quality of life.

Aqua therapy is prescribed by many primary care physicians and surgeons. Every patient receives personalized care based on a wide range of doctor recommended services. If the option is available, aqua therapy is the way to go for a number of disabilities and medical conditions. Aqua therapy is covered by most insurances, Medicare and Medicaid. n

TIPS FROM PARENTS My four year old son with Down Syndrome had a very difficult time when asked to clean up his toys. He would dump all his toys into one place. One day, I came up with an idea. I bought clear shoe boxes, one for each type of toy. I then took a picture of each toy and placed one picture on each box so that he would know which toy belongs in each box.

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® From Handwriting to Life Skills

By Todd Misura, OTR/L

sion of strokes begins with children acquiring the ability to form vertical and horizontal strokes first, so Our society stresses the importance of read- letters consisting of these lines should be taught first. ing and writing, pushing children to learn these Diagonal line strokes are the most difficult strokes to skills earlier and earlier. So why is it that count- form and develop last. Unfortunately, when teachless students still can’t write legibly? They find the ing the alphabet to young children, teachers often physical task of writing daunting, they’re confused begin by teaching the letter “A”—even though this is about how to form letters, and they’re frustrated often one of the most difficult letters to form. because they can’t express themselves.

In addition, teachers and parents often are In fact, Mel Levine, M.D., author of A too eager to start young children learning Mind at a Time (Simon & Schuster Paperlower case letters too early. This strategy ofbacks, 2002), says, “Graphomotor dysfunc- Handwriting ten causes more problems down the road. tions are one of the most common reasons For parents who are eager to start their why children are referred to occupational children on language skill development, I entherapists. Parents and teachers are often baffled by courage them to redirect rather than put off. For a bright kid who can’t or won’t write.” example, games like Boggle Junior are great for If so many students find handwriting difficult, pre-writers. The game uses blocks to teach spellhow much more difficult is it for children with spe- ing and letter recognition, so children can develop cial needs to master this critical life skill? these important language skills even before they Unfortunately, specialists often put so much are ready to pick up a pencil and form letters. emphasis on sensory issues for children with deJournaling too soon is another common probvelopmental challenges that they often do not get lem. In several of the schools where my clients attend, around to teaching them important life skills such children are forced to journal before they’ve even as writing their names, filling out forms, and craft- learned how to form letters. In my opinion, we can’t ing simple messages. expect children to write before they have learned proper letter formation. That approach leads to frusStart Right tration and encourages the practice of bad habits. As A treatment approach that focuses purely on a a child’s writing matures, these bad habits hamper child’s sensory issues ofspeed and legibility. ten leaves the child sorely Language devellacking the tools necesopment is paramount. sary to perform successMany parents need to fully in school. Treatment understand the ramifimust also use strategies cations of fine motor that help with a child’s skills and their role in academic success. writing and language I’ve found the development.

Handwriting Without Tears® program to be Go Capitals First extremely effective for What’s the best kids of all learning abiliplace to start teaching ties because it incorpoletters? Capitals! Capital rates a multisensory apletters are ideal because proach in a developmenthey are so easy to teach tally appropriate curriculum. Children start by building and to learn. Best of all, capital letter formation is detheir fine and gross motor skills through the use of music velopmentally appropriate for early kindergarteners and manipulatives. From there, they develop pencil grip and for kids with special needs. Capital letters are all and letter formation skills. Eventually, children use these the same size, the letters are BIG, BOLD and FAMILfoundational skills to acquire higher language skills.

IAR and all letters start at the same place…at the top!

Children shouldn’t have to write before they Teaching lower case letters too soon can do are developmentally ready. You’ll know a child is more harm than good. That’s because when we ready if he or she has established handedness, can teach lowercase letters, we typically don’t teach tell the difference between big lines and little lines, proper letter placement. Children who learn lowcan distinguish shapes and colors, and has devel- ercase letters to early often improperly size or posioped a proper pencil grip. tion their letters on the lines Starting with capitals makes life so much easGet a Grip ier. Think about it… preschoolers are pre-readers.

Pencil grip must be taught; it is not an innate Common fonts in a child’s environment are in capability. [AK2] Putting a writing utensil in a three- ital letters (MEN, WOMEN, WALMART, EXIT, year-old child’s hand is not natural. In fact, research STOP, etc.). You need to start children with someshows us that only 50 percent of 3-year-olds have thing easy that builds their confidence. the fine motor ability to grasp a pencil correctly.

The preferred grip is a clean tripod where the Follow Function thumb does not wrap over the top of the pencil.

One of my favorite handwriting success stories is Transition Effectively Research also shows us that the natural progresBuilding Blocks

September 2007

Developmental Stages of Writing Kindergarten This is the most critical time in teaching good handwriting habits. By the end of kindergarten, most children should be able to form capital letters, numbers, and lower case letters. Children begin by imitating the teacher in printing letters, then very simple words and sentences and finally write original thoughts and ideas. By the end of the year, an automatic pencil grip has developed.

First Grade By this stage, children can write words and sentences and begin simple paragraphs.

They are refining their pencil grip and writing is becoming increasingly automatic.

Second Grade By second grade, children can write words, sentences, paragraphs, and stories. They should be independent writers.

Third Grade Children learn cursive and/or continue to improve their printing.

Fourth Grade Children often refine their cursive and use it for composition writing and other writing that flows. They use print for labels, forms, math, and other technical/functional communication.

that of Jonathan, a 14-year-old boy with Downs Syndrome. Jonathan struggled to put words on paper—he couldn’t even write his name. Jan Olsen, the founder of Handwriting Without Tears®, took him back to block capital formation, which he found easier and more natural than lower case formation. Capitals proved to be a completely functional way for him to communicate. Within weeks, Jonathan was writing not only his name, but legible letters to his girlfriend! The youth gained a sense of pride and achievement.

Functionality is critical. Don’t give children (especially those with special needs) busy work. It’s frustrating and demoralizing.

Any instruction in handwriting needs to use consistent and easy to understand language. Lower case and cursive formation is completely inappropriate for very young children and those with special needs. Therefore, such exercises are a waste of time.

Build the Foundation What do you look for in a handwriting program?

You want a curriculum that addresses the needs of children of all learning abilities. Look for one that embraces a child’s natural developmental progression.

Also, be sure that the language used in the handwriting program is child friendly and consistent. These criteria are so important because when children learn naturally and easily, they develop confidence. And confidence is the key to lifelong learning and success.

Ultimately, good handwriting is the bedrock of language arts skills and must be part of every child’s education. n

Todd Misura is an Occupational Therapist and former tenured teacher. He has almost 20 years of experience teaching and is an expert in addressing the needs of children. To learn more, contact Todd at 301.741.1325 or visit www.writehererightnow.com.

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Hearing Loss

By Tziona Bin Nun Dovid and Simcha are twins. I saw them for an audiological evaluation at the age of three and a half, back in the days when there were no newborn hearing screenings. They did not talk and did not communicate except with gestures. They seemed to live in a world of their own, and did not relate to anyone besides each other. Not surprisingly, they were diagnosed as being somewhere on the autistic spectrum and were placed in a special program to suit their presumed diagnosed needs. Their hearing had been tested some time before they came to me, and was said to Hearing be within normal limits. When I Loss tested Dovid and Simcha, I found that they both had profound hearing loss, so profound that hearing aids w e r e not effective. Ultimately, they were both implanted with cochlear implants and the difficult task of catching up to their appropriate speech, language, and communication levels was begun.

First, they started to produce sounds, then words, and slowly, slowly, became communicative human beings. After several years of speech/language therapy, they were able to be mainstreamed with the aid of shadows. This story is a true one, and is repeated far too often when hearing loss is missed and a different, incorrect diagnosis is made.

Communication is one of the primary needs of a human being. Anything that impedes com-

When I demonstrated to the father what was going on, he burst into tears, feeling so guilty about the unwarranted spanks his child had endured.

High risk factors which put a child at risk for sensorineural hearing loss: Apnea (lack of oxygen at birth) Hyperbilirubinemia (high bilirubin) Very low birth weight A family history of hearing loss Children who have these factors in their health history should have their hearing tested for the first few years of life to make sure their hearing remains good even if it is deemed fine at birth.

munication is very serious and needs to be dealt with quickly and effectively. A child learns how to communicate through hearing. Not only is a child exposed from infancy to language that is directed at him, but he is also constantly bathed in language which surrounds him most of his waking hours because people are always talking in his vicinity. Today, in the year 2007, state law requires newborn hearing screening of every baby born in most states in the United States, because of the realization that hearing is not merely a luxury; it is a necessity.

But passing a newborn hearing screening is not a guarantee that hearing loss will not develop. It is the role of both the parents and professionals Educational, dealing with the child Behavior to be cognizant of the symptoms of hearing Evaluations and loss at all stages of deRemediation in velopment.

Kriah & Reading Being aware of the most common causes Reading and Writing of hearing loss is helpclasses on all grade ful in increasing early identification of hearlevels taught by a ing loss. A very typical highly experienced, cause of hearing loss renowned professional,

Tziona Bin-Nun, M.S., CCC/A is an audiologist whose specialty is pediatric audiology. She has worked at the League for the Hard of Hearing, Beth Israel, Long Island College Hospital, and Touro College. Mrs. Bin-Nun has maintained a large private practice for the past decade and a half. She has participated in several research projects, (i.e.Connexin 26) and is a lecturer of notable repute.

educator and reading specialist

in early childhood is otitis media and serous otitis media, or, more simply put, ear infections and/or fluid in the middle ear. Some children seem to be more prone to having fluid stay in their middle ears for periods of time. Fluid may cause what is called conductive hearing loss. It is called conductive because the fluid does not allow the normal conduction of sound waves through the middle ear. It’s like trying to hear when you’re under water; you can hear, but sounds are very muffled. For a child, who needs to be exposed to speech and language in order to learn it, long term fluid can be a disaster. It can lead to speech/language delay and/ or poor articulation. I once tested a little boy of 3 whose father complained that his son was disobedient and needed to be spanked to make him listen.

When I tested his hearing, I found that the poor child couldn’t hear well because he had a moderate conductive hearing loss. When his father was close to him or raised his voice, the child heard well. However, when his father spoke softly or was at a distance of more than three feet away from him (distance decreases the intensity/loudness of speech), he really could not hear his father, and wasn’t mature enough to be able to realize what was happening. When I demonstrated to the father what was going on, he burst into tears, feeling so guilty about the unwarranted spanks his child had

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WORKING

WITH

THE WHOLE CHILD! Social Skills Coaching Private sessions available on all grade levels in Hebrew, vthre, and English Regents and Clep Tests Preparation in all subjects Preparation for NY State English Language, Arts and Math Exams Pre1-A Boys / Girls Reading readiness class preparation for Grade 1!

Separate classes for girls and boys Classes and private sessions given throughout the year Learning in a fun atmosphere Maximize your child’s potential

MRS. RIFKA SCHONFELD 718-376-5437 (KIDS) Building Blocks

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treatment

Hearing Loss continued from previous page endured. A visit to the otolaryngologist (a specialist in diagnosing and treating ear, nose, and throat disorders) and a pair of PE tubes later (tubes inserted into the eardrums to drain out the fluid from the middle ear), father and child returned. The child had become very obedient since he could now hear well, and the father had learned a very important lesson: A child with middle ear fluid can have a hearing loss and must be tested by an audiologist if the situation lasts for more than a few weeks.

Middle ear fluid is not only a medical condition; it can sometimes hinder communication by reducing hearing sensitivity. There are some parents who will do anything to avoid the minor surgical procedure of myringotomy (placement of PE tubes). They go to chiropractors or try to treat the condition with herbs or other natural remedies, not realizing that a child who is not hearing during the formative years of speech and language development does not have time to try alternative medicine.

Impacted cerumen (a lot of earwax) can also block sound from getting into the ear efficiently and well. It can cause some conductive hearing loss. It is a condition that is easily remedied by going to a pediatrician or otolaryngologist who can usually painlessly remove the excess wax.

There are childhood illnesses that can also cause hearing loss, but most of them are now history (i.e., German measles, mumps). A sequella of Meningitis may be hearing loss, so that any child who contracts meningitis should have his hearing tested. Genetics can play a role in hearing loss, in some cases causing a syndrome (a cluster of symptoms, including hearing loss), and in some cases causing just hearing loss. There are some genes that are dominant and some that are recessive.

Connexin 26, a gene that has been identified in the past few years, is a recessive gene (both parents have to be carriers in order for a child to be affected), and it is associated with genetic hearing loss in Ashkenazic Jews. In the above cases, sensorineural hearing loss is the type of hearing loss that is of concern. It is the inner ear that is affected, and in

How do you know when you should be concerned about hearing loss?

If a child has poor articulation.

If a child has a speech/language delay.

If a child frequently asking for repetition.

If a child seems to misunderstand what is said to him.

If a child wants the CD player louder than typical.

If a child doesn’t follow instruction.

Please note that if hearing is an issue, therapy alone will not be effective.

important to have preferential seating in the classroom. But preferential seating is not enough- he must be amplified. A severe hearing loss makes it extremely difficult for a child to develop speech and language without amplification. Articulation will be grossly affected. Amplification is imperative as

Hearing is not a luxury; it is a necessity. our generation it is not known how to treat the inner ear except with amplification (hearing aids).

There are several degrees of hearing loss.

A mild hearing loss can adversely affect articulation and the development of speech and language.

Amplification is usually indicated, because a child is first learning how to communicate, and has so much to learn in life that even a mild hearing loss will impede learning. It is difficult to learn when everything sounds soft and muffled. So much energy is expended on hearing that learning becomes more difficult than it has to be. A moderate and a moderately severe hearing loss begin to impact more on the ability to communicate, on articulation, and on the development of speech and language. Schoolwork is adversely affected because it is an enormous strain to try to follow classroom instruction. For every degree of hearing loss, it is Building Blocks

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soon as possible after identification of the hearing loss. Speech/language therapy is also needed for the child with a moderate, moderately severe and severe hearing loss to help him cope with the hearing loss and adjust to his hearing aids and learn to use them effectively. A profound hearing loss means that the child will not develop speech and language without amplification, classroom learning will not take place without appropriate amplification. Cochlear implants are used very successfully for children who do not perform well with hearing aids because of the severity of their hearing loss. They are implanted in the cochlea of the child and are absolutely amazing. There is an external portion to the cochlear implants which picks up sounds, transforms them into electrical impulses which are then sent on to the nerve endings in the cochlea, to the eighth nerve, and then to the brain which

translates them into meaningful words.

Whatever the degree of hearing loss, an audiologist is a critical part of the team, which will work with the affected child and his family. A pediatric otolaryngologist is a second integral part of the team. The speech/language pathologist is a third member of the team. Teachers, rebbeim, and other professionals should be included in the group of people who will work to make the hearing impaired child a successful adult who can achieve his full potential. But the most important part of the team is the child’s family, especially the parents. It is difficult for parents to accept hearing loss. Unfortunately, I have too often come against a brick wall when hearing aids are indicated.

The child is suffering, and the parents are prepared to let him continue suffering to avoid the stigma of hearing aids. One boy of approximately 7 came to me for a hearing test. He had had middle ear surgery at the age of 4 and remained with a conductive hearing loss in both ears. The otolaryngologist who had done the surgery had advised hearing aids, because the child had a moderately severe conductive hearing loss as a result of the surgery. When I tried hearing aids on the child, his eyes lit up and he said in wonder, I can hear! One would think the rest of the process would have been easy. It wasn’t. The mother’s face revealed her anguish at the sight of her child wearing hearing aids. The child should not have had to deal with that aspect of his hearing loss. I had a long talk with the mother, explaining her role in the amplification process. She needed to be the Rock of Gibraltar. Her role was to ease her son’s amplification process by being positive, supportive, and totally upbeat. Shidduchim were a thing of the future, and the here and now dictated the need for hearing aids for her son. If people thought he was retarded, it would not help shidduchim despite his lack of visible hearing aids.

Choosing an audiologist is clearly a critical part of the process of identifying and caring for a hearing loss. Professional credentials should be checked, the type of experience he/she has had (if the audiologist has only dealt with adults and you have a 2 year old, don’t go to that audiologist), the audiologist’s knowledge of current updates, his/ her approach to you and your child - all these factors have to be considered when choosing an audiologist. It is a good thing to find out the audiologist’s reputation among his/her peers and among his/her patients. And then, ultimately, how well you get along with him/her. Personalities don’t always blend and if you are unable to get your questions answered, if you don’t understand the treatment plan, or if you don’t like the way your child is treated, find a different audiologist. It’s a shidduch of sorts; not every professional is a match for every family.

If you suspect a hearing loss, get a referral to a pediatric audiologist and a pediatric otolaryngologist. If you have any doubts about the test, go for a second opinion. Once you have the diagnosis, make sure the otolaryngologist does testing for etiology (the source) of the hearing loss. If the child is under 3, make sure you get him enrolled in early intervention. Get a referral to a speech/language pathologist who has experience with hearing impaired children and hire him/her to work with your child. Once everything is in place, talk to your child, talk, and talk some more. Ultimately, your child will be able to reach for the stars, and may you have much nachas from him. n

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General Listing Of Services Aim High Children’s Services

CAHAL

Address: 37 Parkville Ave, Brooklyn, NY 11230 Phone: 718-853-1750 Services: ABA, SEIT, Evals, Integrated Classroom.

Address: 540-A Willow Avenue, Cedarhurst, N.Y. 11516 Phone: 516-295-3666 Contact: Naomi Nadata, Sheldon Ehrenreich Services: Special Ed Program for Learning Disabilities in 11 Yeshivas.

Association for the Help of Retarded Children (AHRC NY) Address: 83 Maiden Lane, NY, NY 10038 Phone: 212-780-2500 Contact: Rachel Shapiro Services: EI, Residential Facilities, Direct Care, Home Care.

All Children’s Therapy Address: 999 Central Ave, Suite 308, Woodmere, NY 11598 Phone: 516-374-7914 Contact: Susan Kurman, Bernadette Tompkins Services: OT, PT, Play Therapy/Counseling, Parent Training. CPSE, CSE, S/L, Sensory gym.

Birch Family Services, Inc. Address: 104 W. 29th St., 3rd Floor, NY, NY 10001-5310 Phone: 212-616-1800 Services: Advocacy, Center & home-based services, Day Hab, EI, CPSE, CSE, Evals, after school programming, In-home Respite, MSC, Parent Support, Referral, Res Hab, residential services.

Blanche Kahn Family Health Center Address: 1221 E. 14th St., Bklyn, NY 11230 Phone: 718-535-1942 Contact: Dr. Chaim Waslak Services: Children & adults with disabilities.

Neurology, OT, PT, Primary care medicine, Psychiatry, S/L.

Board of Jewish Education of NY (BJENY) Address: 520 8th Ave, 15th Floor, NY, NY 10018 Phone: 646-472-5300 Contact: Dr. Jed P. Luchow or Phyllis Miller Services: Advocacy, AJSE (Association of Jewish Special Educators), Annual Parent Empowerment Conference & Resource Fair, Assistive Technology, J-PAC (Jewish Parent Advocate Coalition), Project SIR: Success In Reading for Early Literacy, Workshops for Professionals & Parents.

LEGEND CPSE - Committee on Preschool Special Education CSE - Committee on Special Education Day Hab - Day Habilitation EI - Early Intervention MSC - Medicaid Service Coordination OT - Occupational Therapy PT - Physical Therapy ResHab - Residential Habilitation RSA - Related Service Authorization S/L - Speech and Language Pathology SEIT - Special Education Itinerant Teacher

CAY Community Services Organization, Inc. Address: 81 Willoughby St., Suite 801, Bklyn, NY 11201 Phone: 718-624-5585 Contact: Claudia Morgan Services: Advocacy, Assistive Technology, Computer Training, Day Hab, Medicaid Waiver, MSC.

Phone: 718-252-6682 Contact: Rachel Shamah Services: Advocacy

First Step Evaluations Address: 6010 New Utrecht Ave., Bklyn, NY 11219 Phone: 718-431-0115 Contact: Ellen Shimoni, Sarah Tyberg Services: CPSE Evals for children ages 2-5.

Freedman Fish & Grimaldi Address: 9201 4th Ave., Bklyn, NY 11209 Phone: 718-238-6960 Contact: Marcie G. Roth Esq. Services: Law firm, practicing in Elder Law, Trusts & Estates with a focus on planning for the disabled.

Challenge Early Intervention Center Address: 649 39th St., Bklyn, NY 11232 Phone: 718-972-0880 Contact: Dr. Ibel Services: EI, Family Education, Counseling & Support groups, Feeding, Nutrition Consultation, OT, PT, Special Ed & S/L.

Child Development Center of the Jewish Board of Family & Children’s Services

FEGS Health & Human Services System Address: 6900 Jericho Turnpike, Suite 309, Syosset, NY 11791 Phone: 516-496-7550 Contact: Robert Greenberger Services: Advocacy.

Joseph M. Fein

Address: 120 W. 57th St., NY, NY 10019 Phone: 212-632-4733 Services: CPSE services include special education TN, SEIT & Related Services of Counseling, EI Parent/Child & Enhanced Developmental Groups, S/L, OT, Outpatient Counseling Services.

Location 1-Address: 1175 West Broadway, Suite 22, Hewlett, NY 11557 Phone: 516-792-9119 Location 2-Address: 271 Madison Ave, 22nd Flr, NY, NY 10016 Phone: 212-679-9119 Contact: Joseph M. Fein Services: Special Ed Lawyer

Comprehensive Kids Developmental School

Hamaspik Center for Human Services

Address: 460 & 383 Grand St., NY, NY 10002 Phone: 212-539-0257 ext. 3006 Contact: Ms. Jane Bowers Services: ABA SEIT, center & home based services, CPSE, OT, PT, RSA, Special Ed school.

Address: 58 Rt. 59, Suite 1, Monsey, NY 10952 Phone: 845-356-8400 Contact: Joseph Landau Services: Day Hab, EI, Medicaid Waiver, Respite & Transition.

Comprehensive Network INC

Hand in Hand Development, Inc.

Address: 1663 East 17th St, Bklyn, NY 11229 Phone: 718-338-3838 Services: EI, OT, PT, S/L, Special Ed.

Address: 465 Grand St., 2nd Fl, NY, NY 10002 Phone: 212-420-1999 ext 149 Contact: Leah Esther Lax, Director Services: Group classes for young children with multiple delays, serious Behavior Management issues, Autism Spectrum Disorders. EI, CPSE, S/L, PT, OT, Sensory Gym, Nutrition, Vision Therapy, Counseling & Psychological Services, Parent/Child groups, Parent/Caregiver Support groups, & Service Coordination.

Creative Business Resources Address: 1566 38th St., Bklyn, NY Phone: 718-853-5635 Contact: Perela Mayer, Program Coordinator Services: Supported Employment program for developmentally &/or severely learning disabled adults.

Down Syndrome Amongst Us Magazine Address: 32 Rutledge Street, Bklyn, NY Phone: 718-834-2055 Contact: Sarah Sander Services: Chizuk, Education & Information.

Educational Advocacy Services Address: 1359 Coney Island Ave, Bklyn, NY 11230

Hasc Center Address: 1221 E. 14th St., Bklyn, NY 11230 Phone: 718-535-1920 Contact: Karen Fireman Services: Evals, Day Hab, Medicaid Waiver, & Respite.

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General Listing Of Services

HASC Center Address: 5601 1st Ave, Bklyn, NY 11220 Phone: 718-535-1942 Contact: Dr. Chaim Wakslak Services: Advocacy, Assistive Technology, DayHab in Flatbush, Boro Park & Williamsburg, E-MODS, Evals, Group Homes, In home ResHab, MSC, Medicaid Wavier, Medical Clinic, after school Respite & Sunday respite for children with Autism, Support Groups, PreVocational services, Supported Employment, Work readiness.

Hebrew Academy for Special Children/HASC at Remsen Address: 555 Remsen Ave, Bklyn, NY 11236 Phone: 718-495-1696 Contact: Debbie King or Stacy Zeitz Services: CPSE Evals, services, half & full day center based program, SEIT, CSE.

Helen Keller Services for the Blind Address: 57 Willoughby St., Bklyn, NY 11201 Phone: 718-522-2122 Contact: Deborah Samuelson Services: Academic Remediation/Vocational Training, Assistive Technology, Braille & Large Print Library, Camp Helen Keller, Children’s Learning Center, Day Treatment Vocational Assessment, Low Vision Clinics, Preschool Vision Screening Program, Rehab, Work Experience Internships.

Phone: 718-435-5700 Contact: Helen Reznik-Intake Coordinator, Faye Wilbur-Director Services: Children Socialization groups. Male/ Female therapists (Hebrew, Yiddish, French & Arabic speaking), Group/Family counseling, Mother Parenting groups.

Kids in Shape Address: 1336 50th St., Bklyn, NY 11219 Phone: 718-435-6906 Contact: Alyssa & Andres Kallenos Services: OT & Pediatric/Child Physical.

Kulanu Torah Academy at HAFTR Address: P.O. Box 305 Cedarhurst, NY 11516 Phone: 516-569-3083 Contact: Jonathan Cooper, Alyse Middendorf Services: CPSE, CSE, SEIT, RSA, Transition, Pre-vocational & vocational training, Advocacy, Assistive Technology, Day Hab, EI, Evals, Group home, Inclusion, Medicaid Waiver, Resource center, Respite, Shabbat Shadow program, Camp, Sunday activities.

Manhattan Children’s Program at UCP Address: 122 E. 23rd St., NY, NY 10010 Phone: 212-677-7400 Contact: Dianna Lee ext. 406 Services: Assistive Technology, CPSE, Orthotics.

MASK Human Care Services Address: 1575 50th St., Bklyn, NY 11219 Phone: 718-854-2747 Contact: Esther Lustig Services: Day Hab, Family Reimbursement, Group Home Residences, Home-based Community Waiver, MSC, Respite, Res Hab.

Ichud Mosdos Hachinuch of Brooklyn Address: 1583 40th St., Bklyn, NY 11218 Phone: 718-854-2400 Services: Self-contained Special Ed classes within mainstream schools.

Address: 2566 Nostrand Ave., Bklyn, NY 11210 Phone: 718-758-0400 Contact: Ms. Ruchama Bistritzky-Clapman Services: Advocacy, Community prevention/ Awareness of At-Risk behaviors, Confidential Hotline, Elementary & high school programs including GED, Evals, Prevention & Emotional Wellness, Referrals, Support groups.

National Association of Family Development Centers Address: 1114 Avenue J, Bklyn, NY 11230 Phone: 718-258-7767 Contact: Bonnie Services: CPSE, Evals, OT, PT, SEIT, S/L.

InterActive Therapy Group Address: 19 W 21st St., Suite 701, NY, NY 10010 Phone: 646-230-8190 Contact: Jared Bauer Services: CPSE, Home-bases EI therapy & home-based EI Evals, OT, PROMPT trained Speech Pathologists, RSA, Special Ed, S/L, feeding/swallowing disorders.

New York Therapy Placement Services, INC

Michael I. Inzelbuch, Esq.

Novogrow, LLC;

Address: 555 Madison Ave., Lakewood, NJ 08701 Phone: 732-905-0325 Services: Special Ed lawyer.

Address: 1033 River Suite C, New Milford, NJ 07646 Phone: 201-836-6251 Contact: Azriel Novogroder Services: Pediatric PT.

Address: 150 West 56th St, NY, NY 10019 Phone: 718-264-1640 Contact: Debbie Powder Services: EI, CPSE, CSE, OT, PT, S/L, Special Ed, ABA specialists.

Phone: 718-851-6300 Services: Housing, Foster Care, Outpatient Counseling, At-Home Services, School-Based Services, Sexual Abuse Services, Camps.

Services available in New York City, Nassau, and Rockland counties, as well as New Jersey.

MSC, Life Coach, ResHab, Respite, Sunday Recreation Programs, Summer Camp Programs, After School Programs, Shabbaton Programs, Shabbos Bnos Programs, Day Hab. Residential services, recreation & respite programs for children with autism & other developmental disabilities.

Ohr V’dass/Rockland Institute for Special Education Address: 972 Chestnut Ridge Rd., Chestnut Ridge, NY 10977 Phone: 845-352-3307 Contact: Dr. Tzivia Feldman Services: Special Ed School ages 5 – 21.

Ohr HaLimud Address: 1681 42nd St., Bklyn NY, 11204 Phone: 718-972-0170 Contact: Leah David Services: Bais Yaakov for Girls with Dyslexia, after school tutoring for Boys & Girls.

Omni Childhood Center Address: 1651 Coney Island Ave, Bklyn, NY 11230 Phone: 718-998-1415 ext 158 Contact: Sheila Selig Services: CPSE, CSE, EI, Audiology, Evals, RSA, SIET, Transition, OT, PT, S/L in home, clinic, or schools. OT gym with has interactive multi sensory room for relaxation, stimulation & Pediatric Sensory gym.

Otsar Early Childhood Center Address: 779 E. 49th St., Bklyn, NY 11203 Phone: 718-946-1413 Contact: Ann Brand, Director Services: CPSE, EI, Evals, Parent Support Groups, Special Ed School.

Pesach Tikvah – Hope Development Address: 18 Middleton St., Bklyn, NY 11206 Phone: 718-875-6900 Services: Recovery Based Residences, Respite, Family Counseling, Psychiatric Assessment & Treatment, Continuing Day Treatment, Holocaust Survivors Program, Summer Program for Children with Disabilities.

P’Tach

Jewish Board of Family & Children’s Services

Ohel Bais Ezra

Address: 1273 53rd St.. Bklyn, NY 11219

Address: 4510 16th Ave, Bklyn, NY 11204

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Address: 1428 36th St., Bklyn, NY 11218 Phone: 718-854-8600 Contact: Rabbi Burton Jaffa Services: Advocacy, Special Ed School with classes in Bais Yaakov D’Rav Meir & Chaim Berlin with emphasis on mainstreaming, Support groups.

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General Listing Of Services Resources for Children with Special needs, Inc.

Services: EI Evals & services in all Boroughs.

Address: 116 E. 16th St., NY, NY 10003 Contact: Helen Craner Phone: 212-677-4650 Services: EI, CPSE, Advocacy, Professional & Parent Training, Online database and directory of agencies, children with physical and psychosocial needs, Publications for Camps, After school programs, Transition, foster care programs, support groups, recreational services, & residential programs.

Address: 1600 Parkview Ave, Suite B, Bronx NY 10461 Phone: 718-829-7744, ext 14.

Contact: Gloria Morales Services: CPSE, CSE, EI, Evals, Medicaid Waiver, Respite, RSA, SEIT, Special Ed.

Rabbi Asher Y. Sabo Address: 1062 E. 12th St, Bklyn, NY 11230 Phone: 718-377-3904 Contact: Rabbi Asher Y. Sabo Services: Educational Consultant

SOS Strategies for Optimum Student Success Address: 1542 E. 19th St., Bklyn, NY 11230 Phone: 718-382-5437 Services: Academic & Social Skills, Coaching for Children & Adults, Educational & Institutional Consulting, Teacher Coaching, Performance & Skill Evals.

Social Learning Institute Sara Schenirer’s Institute for Special Education Address: 4622 14th Ave., Bklyn, NY 11219 Phone: 718-633-8557 Contact: Batsheva Shonek Program Coordinator, Leah Donn Adult Education Division Services: Special Ed School with morning program for adult women.

Schneider Children’s Hospital Address: 269-01 76th Ave., New Hyde Park Phone: 516-802-6100 Contact: Division of Developmental & Behavioral Pediatrics Services: Diagnostic & treatment services to children with disabilities & behavior issues, Development Pediatric Consultation, Outpatient, Inpatient, NICU Follow-up, ADHD Center, Autism Evals.

Jo Anne Simon P.C. Address: 356 Fulton St, Bklyn, NY 11201 Phone: 718-852-3528 Contact: Jo Anne Simon Services: Special Ed Lawyer

Special Education Academy of Deal (SEAD) Address: 1 Meridian Rd, Eatontown, NJ 07724 Phone: 732-460-1700 ext. 116 Contact: Mashy Guterman Services: Children with learning, behavioral or neurological challenges. Special Ed School for CPSE & CSE.

Shema Kolainu Address: 4302 New Utrecht Ave, Bklyn, NY 11219 Phone: 718-686-9600 ext 118 Contact: Suri Green Services: ABA school & center for children diagnosed with ASD.

Address: 2127 59th St., Bklyn NY, 11204 Phone: 718-331-3601 Contact: Devora Samet Services: Courses & Workshops, Social Skills training & groups for children.

Step by Step Infant Development Center Address: 1049 38th St., Bklyn, NY 11219 Phone: 718-633-6666 Contact: Chava Halberstam Services: EI & Evals or children with multiple disabilities, behavior issues, cleft palate, dysautonomia & chromosomal, feeding problems, hearing& vision impairments, metabolic & other rare disorders & motor dysfunction, Medicaid Waiver, Respite, Transition.

Strivright Address: 3623 Ave L, Bklyn, NY 11210 Phone: 718-531-1800 Contact: Pnina Bravmann Services: Specializing in hearing impaired & Auditory Processing difficulties. Auditory/Verbal, Counseling & Special Ed services, center based toddler program (age 2-3) for children with language & hearing impairment, develops auditory, speech, cognitive & social skills; Dispensing of hearing aids & FM units, Evals, Home based speech, Newborn hearing screen & pediatric audiological testing, OT, PT, Vision, Parent-Infant groups, Service Coordination. Evals for central auditory processing disorders.

The Friendship Circle at the Jewish Children’s Museum Address: 792 Eastern Parkway, Bklyn, NY Phone: 718-907-8852 Contact: Tzirl Goldman Services: Volunteer services & programming for children with special needs.

The Haven for Stuttering Address: 2723 Avenue R, Bklyn, NY 11229 Phone: 718-375-5444 Contact: Batsheva Sheps Services: S/L for language, voice, & public speaking, also specializes in stuttering

Theracare Address: 116 W. 32nd S., NY, NY 10001 Phone: 212-564-2350 Contact: Kathleen Macias-Torres Address: 3250 Westchester Ave, Suite 108, Bronx, NY 10461 Phone: 718-597-5558 Contact: Sihar Derman 97-45 Queens Blvd. Suite 900, Rego Park, NY 11374 Phone: 718-830-9274 Contact: Laurie Hooper Address: 101 Tyrellan Ave., Suite 300, Staten Island, NY 10309 Phone: 718-966-4552 Contact: Cheryl Smith Address: 101 20 Cedar Drive, Suite 302, New Rochelle, NY 10801 Phone: 914-576-5292 Contact: Stephanie Metro Services: CSE, SEIT & related services.

Therapeutic Resources Address: 36-36 33rd St., Suite 500, Long Island City, NY 10012 Phone: 212-529-9780 Contact: Jacky Rangel Services: EI, SEIT, ABA & Evals EI

Testing & Training (TTI)

Therapy for Kids

Address: 2001 79th St., Bklyn, NY 11214 Phone: 718-376-0974 ext 2,1 Contact: Devorah Tessler Services: Masters Program in Special Ed Childhood & early Childhood. Leads to state certification in Special & Regular Education.

Address: 68-68 Main St., Flushing, NY 11367 Phone: 718-793-5202 Contact: Judy Avigdor Services: Autism, Cerebral Palsy, CPSE, CSE, RSA, Evals & therapy in indoor gym & outdoor sensory area, Learning Disabilities, OT, PT, S/L, Sensory Processing, Counseling, Handwriting remediation, & therapeutic listening programs.

The Auditory/Oral School of NY Address: 68-41 79th Street, 2nd Floor, Middle Village NY 11379 Phone: 718-569-0068, ext 4.

Contact: Robin Cohn

hearing impaired children & those with auditory processing difficulties. SEIT, Evals, Speech & Hearing education in mainstream schools in the five boroughs. Center based classes with S/L, Counseling, OT & PT.

Address: 1350 E. 37th St., Bklyn, NY 11210 Phone: 718-531-1800 Contact: Pnina Bravmann Services: Specializing in the needs of

Therapy in Motion Address: 856 46th St., Bklyn, NY 11220

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General Listing Of Services

Phone: 718-435-7000 Contact: Dr. Abe Kopolovich, MS, DPT Services: PT.

Tzofiah Address: Nachal Michah 13/1, Ramat Bet Shemesh, Israel 99094 Phone: 972-2-999-8096 Contact: Rabbi Shaked Services: Therapeutic residential home for at-risk high school age girls.

Women’s League Community Residences, Inc. Address: 1556 38th St, Bklyn, NY 11218 Phone: 718-853-0900 Contact: Hindy Roth, Intake Coordinator Services: Residential Group Homes & supportive apartments for developmentally disabled children, teens & adults, MSC, HCBS Wavier program.

Yachad/The National Jewish Council for Disabilities Address: 11 Broadway, 13th Floor, NY, NY 10004 Phone: 212-613-8229 - Batya Jacob, Nechama Braun Services: Information & Referral, RBC – Social

Skills Training Groups, Family Services, social, recreation & educational programs, National social, recreational & educational programs, Summer Programs, Educational Services, IVDU Elementary & High School, Day Hab, Vocational Services, Our Way for the Deaf & Hard of Hearing.

Phone: 718-686-3700 Contact: Mina Sputz Services: ABA, EI, CPSE, CSE, Feeding, multidisciplinary Evals, OT, PT, S/L, SEIT, Counseling, sensory integration, & social skills training.

Yeshiva Tehila L’Dovid YAI/NY League for Early Learning Address: 460 W. 34th St., 11th floor, NY, NY 10001 Phone: 212-273-6169 Contact: Human Resources Services: Special Ed Provider, with educators & clinicians for CPSE.

Yedei Chesed

Address: 1714 E. 17th St., Bklyn, NY 11229 Phone: 718-645-0028 Contact: Rabbi Gershon M. Kranczer Services: Special Ed school for boys with learning disabilities.

Yeshiva Education for Special Students/YESS

Address: 48 Scotland Hill, Monsey, NY 10977 Phone: 845-425-0887 Contact: Tova Pollen Services: Advocacy, Camps for Special Needs, Day Hab, EI, Family Care, Group Homes, Medicaid Waiver, Respite, Res Hab.

Address: 147-37 70th Rd., Room 310, Flushing, NY 11367 Phone: 718-268-5967 Contact: Rabbi Yaakov Lustig Services: Special Ed School for children with ADHD, Auditory Processing Disorders, Language Delays & Learning Disabilities.

Yeled V’Yalda

Compiled by Ruthie Abraham and Jewish Press editors

Address: 571 McDonald Ave, Bklyn, NY 11213

Listings by Category In this section are providers of services by category with only the names of the various organizations, services and practitioners. For more detailed information, the general listing has extra information such as address, phone number, contact name and other services provided.

Advocacy CAY Community Services Organization, Inc.

CPSE

Committee on Preschool Special Education

Manhattan Children’s Program National Association of Family Development Centers

Educational Advocacy Services All Children’s Therapy

New York Therapy Placement Services

Birch Family Services, Inc.

Omni Childhood Center

Child Development Center

Otsar Early Childhood Center

Michael I. Inzelbuch, Esq.

Comprehensive Kids Developmental School

Resources for Children with Special Needs, Inc.

Kulanu Torah Academy

Hand in Hand Development, Inc.

Shema Kolainu

MASK

InterActive Therapy Group

Therapy for Kids

P’Tach

Kulanu Torah Academy

Yeled V’Yalda

FEGS Health & Human Services System Joseph M. Fein Hasc Center

Resources for Children with Special Needs, Inc. Jo Anne Simon P.C. Building Blocks

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CSE

Birch Family Services, Inc.

All Children’s Therapy

CAY Community Services Organization, Inc.

Birch Family Services, Inc.

Day Habilitation

Committee on Special Education

® ResHab

Residential Habilitation Birch Family Services, Inc. Human Care Services

Hamaspik Center for Human Services

Hebrew Academy for Special Children/ HASC at Remsen

Ohel

Hasc Center

Kulanu Torah Academy

Yedei Chesed

Human Care Services

New York Therapy Placement Services

Kulanu Torah Academy

Omni Childhood Center

Ohel

Shema Kolainu

Yachad/The National Jewish Council for Disabilities

Theracare Therapy for Kids

Yedei Chesed Yeled V’Yalda

Respite Birch Family Services, Inc. Hamaspik Center for Human Services Hasc Center Human Care Services Kulanu Torah Academy

EI

Early Intervention

Medicaid Waiver Provider

Association for the Help of Retarded Children

CAY Community Services Organization, Inc.

Birch Family Services, Inc.

Hamaspik Center for Human Services

Challenge Early Intervention Center

Hasc Center

Child Development Center

Human Care Services

Comprehensive Network INC

Kulanu Torah Academy

Hamaspik Center for Human Services

Shema Kolainu

Hand in Hand Development, Inc.

Step by Step Infant Development Center

InterActive Therapy Group Yedei Chesed

Ohel Pesach Tikvah Shema Kolainu Step by Step Infant Development Center Yedei Chesed

SEIT

Special Education Itinerant Teacher Aim High Children’s Services Child Development Center

New York Therapy Placement Services

Comprehensive Kids Developmental School

Omni Childhood Center

Hebrew Academy for Special Children/ HASC at Remsen

Otsar Early Childhood Center Resources for Children with Special Needs, Inc.

RSA provider

Related Service Authorization

Shema Kolainu

Comprehensive Kids Developmental School

Step by Step Infant Development Center

InterActive Therapy Group

Therapeutic Resources

Kulanu Torah Academy

Yedei Chesed

Omni Childhood Center

Yeled V’Yalda

Shema Kolainu Therapy for Kids

Kulanu Torah Academy National Association of Family Development Centers Omni Childhood Center Shema Kolainu The Auditory/Oral School of NY Theracare Therapeutic Resources Yeled V’Yalda Building Blocks

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resources

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Other Information Provided By Resources For Children With Special Needs, Inc.

Independent Living Skills Instruction Baltic Street Mental Health Board (718)667-1609 Clarkson Avenue 681 Clarkson Avenue Bklyn, NY 11203 125th Street 160 West 125th St 11th Floor NY, NY 10027 Seaview Avenue 777 Seaview Ave Staten IsLand, NY 10305

681 Clarkson Avenue Bklyn, NY 11203 125th Street 160 West 125th St 11th Floor NY, NY 10027 Seaview Avenue 777 Seaview Ave Staten Island, NY 10305

333 Ave X Bklyn, NY 11223 (718)339-5300

New Dimensions In Care 772 Vermont St Bklyn, NY 11207 (718)272-2363

Helen Keller Services For The Blind 57 Willoughby St Bklyn, NY 11201 (718)522-2122

New Dimensions In Care 3047 Brighton 2nd St Bklyn, NY 11235 (718)272-2363

Lifespire 350 5th Ave Suite 301 NY, NY 10118 (212)741-0100 184-10 Jamaica Ave 5th Floor Hollis, NY 11423 (718)454-6940

Ohr Halimud: The Light Of Learning The Multisensory Learning Center

Jewish Guild For The Blind

Chai Lifeline

Pesach Tikvah

15 West 65th St NY, NY 10023 (212)769-6200

151 West 30th St 3rd Floor NY, NY 10001 (212)465-1300

18 Middleton St Bklyn, NY 11206 (718)875-6900

League For The Hard Of Hearing

Child Center Of NY

The Epilepsy Institute

50 Broadway 6th Floor NY, NY 10004 (917)305-7700

60-02 Queens Boulevard Lower Level Woodside, NY 11377 (718)651-7770

Helen Keller Services For The Blind 57 Willoughby St Bklyn, NY 11201 (718)522-2122 Or One Helen Keller Way Hempstead , NY 11550 (516)485-1234

257 Park Ave South Suite 302 NY, NY 10010 (212)677-8550

Travel Training Baltic Street Mental Health Board (718)667-1609 Clarkson Avenue

ABC’s continued from page 4 Deafness - IDEA disability category; impairment in processing information through hearing that adversely affect educational performance Developmental Aphasia - A severe language disorder that is presumed to be due to brain injury rather than because of a developmental delay in the normal acquisition of language.

Direct Instruction - An instructional approach to teaching academic subjects that emphasize the use of carefully sequenced steps that including demonstration, modeling, guided practice and independent application.

Disability - In the Americans With Disabilities Act, defined as impairment that substantially affects one or more major life activities; an individual who has a record of having such impairment, or is regarded as having such an impairment.

Dyscalculia - A severe difficulty in understanding and using symbols or functions needed for success in mathematics.

Dysgraphia - A severe difficulty in producing handwriting that is legible and written at an age-appropriate speed.

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September 2007

Tutoring Services Jewish Board Of Family And Children’s Services (Jbfcs) Southern Bklyn Office / Madeleine Borg Community Services

Dyslexia - A severe difficulty in understanding or using one or more areas of language, including listening, speaking, reading, writing and spelling.

Dysnomia - A marked difficulty in remembering names or recalling words needed for oral or written language.

Dyspraxia - A severe difficulty in performing drawing, writing, buttoning, and other tasks requiring fine motor skill, or in sequencing the necessary movements.

Early intervention (EI) - Special education and related services provided to children under age of 5.

Education Code (EC) - State law.

Emotional disturbance (ED) - Disability category under IDEA; includes depression, fears, schizophrenia; adversely affects educational performance.

ESY - Extended school year services.

Family Educational Rights and Privacy Act (FERPA) - statute relating to confidentiality and access to education records.

FAPE - Free appropriate public education; special education and related services provided in con-

1681 42nd St Bklyn, NY 11204 (718)972-0170

This List Is A Small Sampling From The Resources For Children With Special Needs, Inc. (Rcsn) Database, Which Is The Source For Direct Information And Referral Services, Published Directories, And Free And Subscription-Based Database On The Web™ (Www.ResourcesNYcdatabase.Org).

formity with an IEP are without charge, and meet standards of the SEA (State Educational Agency).

General curriculum - Curriculum adopted by LEA or SEA for all children from preschool through high school.

Guardian ad litem - Person appointed by the court to represent the rights of minors.

Hearing impairment - Disability category under IDEA; permanent or fluctuating impairment in hearing that adversely affects educational performance.

IDEA - The Individuals with Disabilities Education Act of 1997 (reauthorized in 2004 as IDEIA) IDEIA - The Individuals with Disabilities Education Improvement Act of 2004 IEE - Independent educational evaluation IEP - Individualized Educational Plan IFSP - Individualized family service plan Inclusion - Practice of educating children with special needs in regular education classrooms in neighborhood schools. See also mainstreaming

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ABC’s continued from previous page

numbers while saying a number fact aloud would be an example of a multisensory learning activity.

and least restrictive environment.

Native language - Language normally used by the child’s parents.

explanations of procedural safeguards that describe a parent’s right to an independent educational evaluation, to examine records, to request mediation and due process.

Neuropsychological Examination - A series of tasks/tests that allow observation of performance that is presumed to be related to the intactness of brain function.

Psychological services - Related service; includes administering psychological and educational tests, interpreting test results, interpreting child behavior related to learning.

Norm-referenced tests - Standardized tests designed to compare the scores of children to scores achieved by children the same age who have taken the same test. Most standardized achievement tests are norm-referenced.

Public Law (P.L.) 94-142 - The Education for All Handicapped Children Act; enacted into law in 1975.

Intelligence tests - Tests that measure aptitude or intellectual capacities (Examples: Wechsler Intelligence Scale for Children (WISC-III-R) and Stanford-Binet (SB:IV).

Learned Helplessness - A tendency to be a passive learner who depends on others for decisions and guidance. In individuals with learning disabilities, continued struggle and failure can heighten this lack of self-confidence.

Learning Modalities - Approaches to assessment or instruction stressing the auditory, visual or tactile avenues for learning that are dependent on the individual learning strengths.

Learning Strategy Approaches - Instructional approaches that focus on efficient ways t learn, rather than on curriculum. Includes specific techniques for organizing, actively interacting with instructional material, memorizing, and monitoring any content or subject.

Least restrictive environment (LRE) requirement to educate special needs children with children who are not disabled to the maximum extent possible.

Mastery Test - A test that determines whether an individual has mastered a unit of instruction or skill; a test that provides information about what an individual knows, not how his or her performance compares to the norm group.

Mediation - Procedural safeguard to resolve disputes between parents and schools; must be voluntary, cannot be used to deny or delay right to a due process hearing; must be conducted by a qualified and impartial mediator who is trained in effective mediation techniques.

Mental retardation - Disability category under IDEA; refers to significantly sub-average general intellectual functioning with deficits in adaptive behavior that adversely affects educational performance.

Minimal Brain Dysfunction (MBD) - A medical and psychological term originally used to refer to the learning difficulties that seemed to result from identified or presumed damage to the brain. Reflects a medical, rather than educational or vocational orientation.

Multiple disabilities - Disability category under IDEA; concomitant impairments (such as mental retardation-blindness, mental retardationorthopedic impairment, etc.) that cause such severe educational problems which cannot be accommodated in special education programs solely for one of the impairments; does not include deaf-blindness.

Multisensory Learning - An instructional approach that combines auditory, visual and tactile elements into a learning task. Tracing sandpaper

Occupational therapy - Related service; includes therapy to remediate fine motor skills OCR - Office of Civil Rights Orientation and mobility services - Related service; includes services to visually impaired students that enable students to move safely at home, school, and community Orthopedic impairment - Disability category under IDEA; orthopedic impairment that adversely affects child’s educational performance.

OSERS - Office of Special Education and Rehabilitative Services.

OSEP - Office of Special Education Programs.

Other health impairment - Disability category under IDEA; refers to limited strength, vitality or alertness due to chronic or acute health problems that adversely affect educational performance.

Parent - Parent, guardian, or surrogate parent; may include grandparent or stepparent with whom a child lives, and foster parent.

Perceptual Handicap - Difficulty in accurately processing, organizing and discriminating among visual, auditory or tactile information. A person with a perceptual handicap may say that “cap/cup” sound the same or that “b” and “d” look the same. However, glasses or hearing aids do not indicate a perceptual handicap.

Reasonable accommodation - Adoption of a facility or program that can be accomplished without undue administrative or financial burden.

Recreation - Related service; includes therapeutic recreation services, recreation programs, and leisure education.

Rehabilitation Act of 1973 - Civil rights statute designed to protect individuals with disabilities from discrimination; purposes are to maximize employment, economic self-sufficiency, independence, inclusion and integration into society.

Rehabilitation counseling services - Related service; includes career development, preparation for employment, vocational rehabilitation services funded under the Rehabilitation Act of 1973.

Related services - Services that are necessary for child to benefit from special education; includes speech-language pathology and audiology services, psychological services, physical and occupational therapy, recreation, early identification and assessment, counseling, rehabilitation counseling, orientation and mobility services, school health services, social work services, parent counseling and training.

Remediation - Process by which an individual receives instruction and practice in skills that are weak or nonexistent in an effort to develop/ strengthen these skills.

Physical therapy - Related service; includes therapy to remediate gross motor skills.

Resource Specialist/Program - A program model/service in which a student is typically in a general education classroom environment for all or most of the school day but also receives special education services and supports which may be integrated into the general education environment and/or delivered in an alternative environment by a resource specialist.

Power Test - Measures performance unaffected by speed of response; time not critical; items usually arranged in order of increasing difficulty.

Section 504 - Section 504 of the Rehabilitation Act protects qualified individuals from discrimination based on their disability.

Prior written notice - Required written notice to parents when school proposes to initiate or change, or refuses to initiate or change, the identification, evaluation, or educational placement of the child.

Special Education Itinerant Teacher and Related Services(SEIT/RS) - Special Education teacher or therapist who provides services to the child with a disability in their home, nursery school, day care or play group environment.

Pro se - Representing oneself without assistance of legal counsel Procedural safeguards notice - Requirement that schools provide full easily understood

Special education - Specially designed instruction, at no cost to the parents, to meet the unique needs of a child with a disability.

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PRODUCTS, WEBSITES & SERVICES

ABC’s continued from previous page Specific Language Disability - A severe difficulty in some aspect of listening, speaking, reading, writing or spelling while skills in other areas are intact. Commonly referred to as Specific Language Learning Disability (SLLD) and usually diagnosed as a Specific Learning Disability.

DISCOVERY TOYS! Educational Consultant • Alicia Goldstein 718-692-0552 917-345-2190

DISCOVERYTOYSLINK.COM/ALICIAGOLDSTEIN

Toy Parties

Fund Raisers

1 on 1 Shopping Earn Free Toys Discovery Toys has business opportunities too!

Pocket Full Of Therapy A CATALOG OF UNIQUE LEARNING MATERIALS

“We help make learning and development fun!”

Materials to address: • HANDWRITING • SCISSORS SKILLS • VISUAL PERCEPTION • MOTOR COORDINATION • LANGUAGE • CRITICAL THINKING • SENSORY PROCESSING • FIDGETY STUDENTS • AND SO MUCH MORE! Call today for a free catalog!

Join our e-mail list for specials & activity ideas!

Specific learning disability (SLD) Disability category under IDEA; includes disorders that affect the ability to understand or use spoken or written language; may manifest in difficulties with listening, thinking, speaking, reading, writing, spelling, and doing mathematical calculations; includes minimal brain dysfunction, dyslexia, and developmental aphasia. The official term used in federal legislation to refer to difficulty in certain areas of learning, rather than in all areas of learning – synonymous with learning disabilities.

Speech-language pathology services Related service; includes identification and diagnosis of speech or language impairments, speech or language therapy, counseling and guidance.

Speech or language impairment - Disability category under IDEA, includes communication disorders, language impairments, voice impairments that adversely educational performance.

Standardization - A consistent set of procedures for designing, administering, and scoring an assessment. The purpose of standardization is to ensure that all individuals are assessed under the same conditions and are not influenced by different conditions.

Standardized tests - Tests that are uniformly developed, administered, and scored. Normreferenced test that compares child’s performance with the performance of a large group of similar children (usually children who are the same age).

PO Box 174 • Morganville, NJ 07751 (800) PFOT-124 • (732) 441-0404 • www.pfot.com

State education agency (SEA) - State departments of education.

Do you have a child with special needs?

Do you work with children with disabilities?

Subtype Research - A recently developed research method that seeks to identify characteristics that are common to specific groups within the larger population of individuals identified as having learning disabilities.

ALL NEW! from

The Comprehensive Directory, 2 Ed. Programs and Services for Children and Youth with Disabilities and Special Needs and their Families in the New York Metro Area nd

1,500 pages; 3,000+ agencies; services for every type of disability - physical, emotional, development. Your one-stop information source for programs for education, recreation, health, community supports, and much much more. $75.00 plus $8.00 S&H.

BUY IT NOW - USE IT OFTEN To order or for more information, contact Resources for Children With Special Needs, Inc 116 East 16th Street/5th Fl. NY, NY 10003 P: 212-677-4650 • FAX: 212-254-4070 www.resourcesnyc.org • www.resourcesnycdatabase.org

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September 2007

Are you struggling with a medical issue?

Don't Suffer Alone!

Meet other frum people who are suffering from similar conditions

www.FrumSupport.com Free & Anonymous online support group

Supplementary aids and services Means aids, services, and supports that are provided in regular education classes that enable children with disabilities to be educated with nondisabled children to the maximum extent appropriate.

Test bias - The difference in test scores that is attributable to demographic variables (e.g., gender, ethnicity, and age).

Transition services - IEP requirement; designed to facilitate movement from school to the workplace or to higher education.

Transportation - Related service regarding travel; includes specialized equipment (i.e., special or adapted buses, lifts, and ramps) if required to provide special transportation for a child with a disability.

Traumatic brain injury - Disability category under IDEA; includes acquired injury caused by external physical force and open or closed head injuries that result in impairments; does not include congenital or degenerative brain injuries or brain injuries caused by birth trauma.

Visual impairment (including blindness) - Disability category under IDEA; impaired vision that adversely affects educational performance.

Vision Therapy - Therapeutic treatment to address difficulty in accurately processing, organizing and discriminating among visual information.

This is not the same as physical malfunction of the eye. Sight dysfunction necessitating corrective lenses or glasses does not indicate or correct this condition.

Visual Processing/Perceptual Disorder - Difficulty in accurately processing, organizing and discriminating among visual information. This is not the same as physical malfunction of the eye.

Sight dysfunction necessitating corrective lenses or glasses does not indicate or correct this condition.

This is addressed by a Developmental Optometrist and often necessitates ‘Vision Therapy.’

Vocational Programs - Programs that provide specialized training for various jobs. Examples would be job training to work in computer, electrical, mechanical or other areas of employment. n

RESOURCES Chaim Sender, LCSW & Associates Child, Adolescent & Adult Psychotherapy

English and Yiddish 1802 Avenue K Brooklyn, NY 11230 718-677-0095

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We are pleased to announce our GRAND OPENING!

PEDIATRIC PHYSICAL THERAPY CENTER

1033 River Road; Suite C, New Milford, NJ 07646 Phone: (201) 836-6250 • Fax: (201) 836-6251 E-Mail: Novogrow@optonline.net All of our staff of highly skilled therapists have completed 8 week NDT Pediatric Course and are trained in CME (Cuevas MEDEK Exercises) by Ramon Cuevas PT. PLEASE CALL FOR AN APPOINMENT Azriel Novogroder PT CME Level III Diplomat, Owner

OT,PT,SLP,LLC. 68-68 Main St. Kew Gardens Hills 718-793-5202 We provide Occupational, Physical, Speech/Language, Counseling Services, “Evals/Therapy”, a Sensory Gym, Parking on site.

We have late hours available.

We accept private pay, RSA’S & CPSE “Preschool Contracts”.

SIPT Certified “Sensory Integration”.

845-222-0580 • 914-646-3164

RIFKA SCHONFELD, DIRECTOR

Representing students with disabilities in standardized testing and higher education JO ANNE SIMON, P.C.

: 802 64th Street, Suite 3G

CSE

Educational evaluations and remediation in kriah, reading & all hebrew and secular studies... ...as well as social skills coaching.

Jo Anne Simon, P.C.

356 Fulton Street, Brooklyn, New York 11201 (718) 852-3528 V/TTY • (718) 875-5728 Fax info@joannesimon.com

ZEVA CITRONENBAUM, LCSWR, CSAT Specializing in Thought & Behavior Modification

STRATEGIES FOR OPTIMUM STUDENT SUCCESS

®

ORGANIZATIONS & PRACTICES

CPSE

3521 Avenue S, Brooklyn, NY 718.336.3832 • Physical Therapy • Occupational Therapy • Speech Therapy

GROUP OR INDIVIDUAL SESSIONS AVAILABLE.

Pesach Tikvah Door Of Hope

RIFKA SCHONFELD 718-382-5437 (KIDS)

Family & Children Services PESACH TIKVAH HOPE DEVELOPMENT, INC.

18 Middleton Street Brooklyn, NY 11206 Tel: 718-875-6900 Fax: 718-875-6999 Web: www.pesachtikvah.org E-Mail: Info@pesachtikvah.org

• Services for Children with Special Needs • Recovery Based Residences • Respite Program • Family Counseling Center • Psychiatric Assessment and Treatment • Continuing Day Treatment Program • Holocaust Survivors Program • Summer Program for Children with Developmental Disabilities

MICHAEL I. INZELBUCH Attorney-at-Law “Every child deserves an appropriate education at the school district’s expense” • IEP Development • Due Process Hearings • Service Procurement

Phone: (732) 905-0325 Fax: (732) 886-0806 Member NJ & NY Bars

YEAR ROUND SHABBATONS AND WEEKEND RETREATS CAMP EXTREME FOR BOYS- WEST COAST CAMP EXTREME FOR GIRLS- CANADIAN ROCKIES WILDERNESS PROGRAMS YOMIM TOVIM/ HOLIDAY PROGRAMS

swwxc

Office: 718-549-2355 Cell: 917-345-5750 Specializing in: Children with Behavior Problems: Adoption or Unresolved Trauma

,ca rnua

projectextreme.org . projectextremeay@aol.com Rabbi A.Y. Weinberg, Director . Chaim Winter, LCSW

over 25 years of experience working with teens Endorsed by: R’ Aryeh Malkiel Kotler, R’ Avrohom Chaim Levine, R' Moshe Tuvia Lieff, R’ Yaakov Perlow, R’ Shlomo Avigdor Altusky, R’ Shmuel Berenbaum, R’ Reuven Feinstein, R’ Shmuel Fuerst, R’ Hershel Shachter, R’ Aaron Shechter, R’ Matisyahu Solomon, R’ Yoel Chonon Wenger “Providing innovative solutions for teens at risk, their families and communities.”

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RESOURCES

® for       

with

..       

RECRUITMENT

Services & Employment Opportunities:  Evaluations  Special Education  Counseling, Occupational, Physical, and Speech Therapies ∙ Early Childhood ∙ Preschool ∙ School-age

           

ADVERTISER INDEX A Helping Hand.....................................................45 AHRC ...................................................................71 Aim High Children Services..................................33 Board of Jewish Education ...................................20 Brooklyn Community Management ......................19 CAHAL..................................................................39 Catapult Learning ...........................................13, 68 Challenge Early Intervention Centers...................70 Chana Mark, LCSW..............................................69 Chewytubes.com ..................................................45 Comprehensive Kids ............................................25 Comprehensive Network Inc ................................71

Women’s League Community Residences, Inc. a tradition of caring, in our homes and yours . . .

Seeking enthusiastic, responsible men and women wishing to make a HUGE difference in the lives of special children and adults living in our Brooklyn residences. Weekdays 3 - 11 p.m. and other shifts available.

Breaking News!

Group home for autistic women in Crown Heights opening soon.

Creative Business Resources ..............................39 Discovery Toys .....................................................68 Eliot Kaplan, PhD, CAS ........................................69 First Step Evaluations...........................................19 Freedman Fish & Grimaldi....................................20 Frumsupport.com .................................................68 HASC Center..........................................................7 HASC School Age Program..................................15 Human Care Services ..........................................17 Jewish Board of Family & Children’s Services .....72 Jo Anne Simon P.C...............................................69 Joseph M. Fein .....................................................23 Jumpstart Early Intervention.................................71 KCM Therapy .......................................................69 Michael Inzelbuch Esq..........................................69

For job opportunities, call Brenda at (718) 853-0900 or fax resume to 718-853-0818.

Mothers Aligned Saving Kids................................29 New York Therapy Placement Services, INC .......21 Novogrow LLC......................................................69 Ohel Bais Ezra................................................25, 71 Ohr Halimud .........................................................44 Onward Healthcare...............................................71 Pesach Tikvah/Door of Hope................................69 Pocket Full of Therapy..........................................68 Princeton HealthCare System ..............................71 Project Extreme ..............................................69, 71 P’TACH................................................................. 11 Rabbi Asher Y. Sabo.............................................69 Resources for Children with Special Needs .........68 Schneider Children’s Hospital ..............................27 SensoryResources.com .......................................41 Shema Kolainu/Hear our Voices...........................23 SOS ................................................................59, 69 Strivright ...............................................................12 Testing & Training International ............................29 The Ability Center ...........................................69, 71 The Auditory/Oral School......................................52 The Beacon School ..............................................22 The Haven for Stuttering ......................................35 The Institute for Special Education.......................35 Therapy for Kids ...................................................69 Therapy in Motion.................................................38 Tzofiah..................................................................26 Wilsonlanguage.com ............................................68 Women’s League..................................................70 YACHAD/NJCD Seminar......................................31 Yeled V’Yalda........................................................70 Yeshiva Bonim Lamokom ....................................48 Yeshiva Education for Special Students (YESS)....2 Zeva Citronenbaum LCSW, CSAT .......................69

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RESOURCES EDUCATION IMMEDIATE OPENINGS AHRC Special Ed Schools have the following positions available immediately: Head Teacher – Assist Principal with Program Administration. Immediate tuition reimbursement for candidates currently enrolled in SAS programs or eligible to enroll in SAS programs. MA in Special Ed & Certication req’d. Min 5 yrs classroom exp. Experienced with ABA a plus.

Teachers/Behavior Trainers – BA/MA in Special Ed & Certication req’d. (Internship Certication & Transition B Certication Candidates are encouraged to apply).

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THE ABILITY CENTER

SEEKING HEAD OF SCHOOL:

3521 Avenue S, Brooklyn, NY 11234

PROJECT EXTREME (projectextreme.org), a full service organization dedicated to servicing at-risk Jewish youth, will open a residential high school with therapeutic programming for young women in the Midwest, scheduled to open September 2008. Prefer to ll position by late Fall ‘07/ early ‘08 subject to strong credentials of applicant.

Phone: (718) 336-3832 • Fax: (718) 336-2392

For more information and resume submissions, please contact Noriega Associates at joeecms@optonline.net.

Pediatric Physical Therapists and Occupational Therapists

needed for center based positions in Brooklyn.

Pre-school and School-age.

Excellent salary & benets package including medical, dental, vision, & a 403b retirement plan. Many locations: steps away from Central Park, Borough Park, Carroll Gardens, Dyker Heights, Bensonhurst, Pelham Parkway and Astoria.

Please e-mail or FAX your resume, copies of NYS Certication, and references to:

Forward resume or call. New Grads Welcome!

Rachel Shapiro, Fax: 212-477-9696 Email: Rachel.Shapiro@ahrcnyc.org AHRC is an Equal Opportunity Employer

®

RECRUITMENT

Therapists – Speech and Language Pathologists (bi-lingual a plus), Physical Therapists and Occupational Therapists.

Behavior Trainer Assistant/Teacher Assistants - NYS teacher assistant certication & min. 45 college credits req’d.

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Seeking OT’s & SLP’s

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to work in Shomer Shabbos therapy clinic with children 3-21.

“B”H we are growing at a rapid rate and we need more help”.

After school hours in private pediatric clinic. In KGH with sensory gym on site, exible hours available until 9 p.m. Also need therapists for the upcoming year, Yeshivas & Public Schools.

System of Opportunity.

When you join the Princeton HealthCare System, not only are you joining a team of seasoned therapists, you are becoming part of a growing healthcare system that offer multiple opportunities for your career growth and development.

We are currently hiring for:

Competitive pay, available immediately.

Fax resume to 718-793-5207.

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Inpatient Rehab New grads welcome!

Home Care

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Occupational/Physical Therapists SEIT/Psychologists/SLP

$1,000 at 3 months

NYC DOE public schools, pre-schools, Yeshivas & home care.

JPCallcolor Chess ad Debbie.Powder@nytps.com. small 8/22/07 3:43 PM 718-264-1640 or email

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$1,000 at 6 months

$1,000 at 12 months

Interested therapists may call Suzan Rogers at 609-497-3087 to schedule an interview. EOE

Immediate openings in

Many other positions available throughout Long Island and 5 boroughs. Work as an independent contractor PT or FT & receive high rates & fast payment with a flexible schedule.

TRIPLE PAY BONUS

Princeton HealthCare System Redefining Care.

www.princetonhcs.org

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Jumpstart Early Intervention

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Join the leader in pediatric opportunities Early Intervention, Preschools, NYCDOE & Yeshivos

Occupational & Physical Therapists, Speech-Language Pathologists, CFYs, Psychologists, LMSWs, LCSWs, TSHHs, TSLDs, Registered Nurses, and Certified Health Aides

BILINGUAL HEBREW & YIDDISH

A PLUS

Call today: 718-382-2027 www.comprehensivenet.com • outreach@comprehensivenet.com

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is currently seeking therapists (speech, OT, PT, special instructors) to work with infants and toddlers in all Brooklyn neighborhoods. Bilingual abilities (i.e., Spanish, French, Russian, etc.) a major plus.

Call Margie at

Jumpstart EI (718) 853-9700

or fax resume to (718) 853-5533.

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EOE Quality

Integrity

Stability

sm

since 1985

SALARY . . BENEFITS . . MONEY & TIME FOR SCHOOL!

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Early Intervention Therapists Needed

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Speech therapists, Special Education, Occupational Therapists, Physical Therapists, Center or home based, FT/PT, per diem, bilingual a plus, new grads welcome, top salary.

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therapyik@aol.com

Working any one of three full time shifts assisting individuals with disabilities, will help you pay your bills, will provide free medical benets for you and your family, and give you the time you need for classes.

Annual tuition reimbursement and 50% paid Masters or PhD programs available!

Part time shifts too!

We Make Life Do-able!

Call OHEL BAIS EZRA 718-686-3102 Building Blocks

September 2007

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Gbnjmz!boe!DijmesfoÖt!Tfswjdft!dbo!ifmq/ Bnpoh!uif!nboz!tfswjdft!xf!pggfs!uispvhipvu!Ofx!Zpsl!Djuz!bsf!qsphsbnt!efwpufe! up!dijmesfo!boe!uffot!xjui!tqfdjbm!offet!boe!uiptf!gbdjoh!fevdbujpobm!boe!fnpujpobm! dibmmfohft/!Tpnf!pg!uiftf!qsphsbnt!!bsf!eftdsjcfe!cfmpx/ Services for Adolescents • (718) 676-4280 Our longstanding and highly regarded work with teens is represented in a network of support programs including counseling at yeshivas by social workers, our own counseling center in Flatbush staffed by heimishe/yeshivish male and female therapists, teacher and parent training at girls yeshivas, and consultation to yeshiva principals and teachers.

Children’s Socialization Groups • (718) 435-5700

Ezrat Chayim Project • (718) 423-6200

Our Boro Park Counseling Center offers a wide range of supportive counseling programs to adults and children. Separate groups for girls and boys provide a safe environment for learning how to make and keep friends and techniques for developing other social skills.

The Ezrat Chayim Project links Orthodox Jewish communities – yeshiva prinicipals, Rabbis and Rebbetzin, and Jewish community councils – to mental health programs supporting students and families at our Pride of Judea Community Services located in Northeast Queens.

Girls groups available for Grades 3-5 and Grades 6-8. Boys groups now forming.

A Special Place for Special People • (718) 851-7100

Learning Centers • (212) 632-4499

Every child is a unique combination of blessing and challenge and deserves to be treated with caring attention to his or her special needs.

Our Learning Centers in Brooklyn, Riverdale, Manhattan and Queens offer comprehensive assessments and evaluations, working with the child and family to create a remedial or support plan as needed.

Mishkon serves developmentally disabled people in nine residences in Boro Park which offer warm, home-like settings sensitive to religious and cultural needs of Orthodox Jewish residents.

Our waiver services and respite care for parents have immediate openings.

Call our Learning Resource Network if you would like more information about the Learning Centers or just have questions about a child’s development or learning situation.

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Building Blocks

September 2007