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Autism Spectrum Disorder

1.

Definition:

Autism spectrum disorder (ASD) is a group of developmental disabilities that can cause
significant social, communication and behavioral challenges. CDC is committed to continuing to
provide essential data on ASD, search for factors that put children at risk for ASD and possible
causes, and develop resources that help identify children with ASD as early as possible.

2.

Articles:

http://www.helpguide.org/articles/autism/autism-spectrum-disorders.htm
http://www.nimh.nih.gov/health/publications/a-parents-guide-to-autism-spectrumdisorder/index.shtml
http://www.cdc.gov/ncbddd/autism/signs.html

3.

Treatment:

There are no medications that can cure ASD or treat the core symptoms. However, there are
medications that can help some people with ASD function better. For example, medication might
help manage high energy levels, inability to focus, depression, or seizures.
Medications might not affect all children in the same way. It is important to work with a health
care professional who has experience in treating children with ASD. Parents and health care
professionals must closely monitor a child's progress and reactions while he or she is taking a
medication to be sure that any negative side effects of the treatment do not outweigh the benefits.
It is also important to remember that children with ASD can get sick or injured just like children
without ASD. Regular medical and dental exams should be part of a childs treatment plan. Often
it is hard to tell if a childs behavior is related to the ASD or is caused by a separate health
condition. For instance, head banging could be a symptom of the ASD, or it could be a sign that
the child is having headaches. In those cases, a thorough physical exam is needed. Monitoring
healthy development means not only paying attention to symptoms related to ASD, but also to
the childs physical and mental health, as well.
Early Intervention Services
Research shows that early intervention treatment services can greatly improve a childs
development.[1],[2] Early intervention services help children from birth to 3 years old (36
months) learn important skills. Services include therapy to help the child talk, walk, and interact
with others. Therefore, it is important to talk to your childs doctor as soon as possible if you
think your child has an ASD or other developmental problem.
Even if your child has not been diagnosed with an ASD, he or she may be eligible for early
intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that
children under the age of 3 years (36 months) who are at risk of having developmental delays
may be eligible for services. These services are provided through an early intervention system in
your state. Through this system, you can ask for an evaluation.
In addition, treatment for particular symptoms, such as speech therapy for language delays, often
does not need to wait for a formal ASD diagnosis. While early intervention is extremely
important, intervention at any age can be helpful.
Types of Treatments

There are many different types of treatments available. For example, auditory training, discrete
trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music therapy,
occupational therapy, physical therapy, and sensory integration.
The different types of treatments can generally be broken down into the following categories:

Behavior and Communication Approaches

Dietary Approaches

Medication

Complementary and Alternative Medicine


Behavior and Communication Approaches
According to reports by the American Academy of Pediatrics and the National Research Council,
behavior and communication approaches that help children with ASD are those that provide
structure, direction, and organization for the child in addition to family participation.
Applied Behavior Analysis (ABA)
A notable treatment approach for people with an ASD is called applied behavior analysis (ABA).
ABA has become widely accepted among health care professionals and used in many schools
and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors in
order to improve a variety of skills. The childs progress is tracked and measured.
There are different types of ABA. Following are some examples:

Discrete Trial Training (DTT)

DTT is a style of teaching that uses a series of trials to teach each step of a desired
behavior or response. Lessons are broken down into their simplest parts and positive
reinforcement is used to reward correct answers and behaviors. Incorrect answers are
ignored.

Early Intensive Behavioral Intervention (EIBI)

This is a type of ABA for very young children with an ASD, usually younger than five,
and often younger than three.

Pivotal Response Training (PRT)

PRT aims to increase a childs motivation to learn, monitor his own behavior, and initiate
communication with others. Positive changes in these behaviors should have widespread
effects on other behaviors.

Verbal Behavior Intervention (VBI)

VBI is a type of ABA that focuses on teaching verbal skills.


Other therapies that can be part of a complete treatment program for a child with an ASD
include:
Developmental, Individual Differences, Relationship-Based Approach (DIR; also called
"Floortime")
Floortime focuses on emotional and relational development (feelings, relationships with
caregivers). It also focuses on how the child deals with sights, sounds, and smells.
Treatment and Education of Autistic and related Communication-handicapped CHildren
(TEACCH)
TEAACH uses visual cues to teach skills. For example, picture cards can help teach a child how
to get dressed by breaking information down into small steps.
Occupational Therapy

Occupational therapy teaches skills that help the person live as independently as possible. Skills
might include dressing, eating, bathing, and relating to people.
Sensory Integration Therapy
Sensory integration therapy helps the person deal with sensory information, like sights, sounds,
and smells. Sensory integration therapy could help a child who is bothered by certain sounds or
does not like to be touched.
Speech Therapy
Speech therapy helps to improve the persons communication skills. Some people are able to
learn verbal communication skills. For others, using gestures or picture boards is more realistic.
The Picture Exchange Communication System (PECS)
PECS uses picture symbols to teach communication skills. The person is taught to use picture
symbols to ask and answer questions and have a conversation.
Dietary Approaches
Some dietary treatments have been developed by reliable therapists. But many of these
treatments do not have the scientific support needed for widespread recommendation. An
unproven treatment might help one child, but may not help another.
Many biomedical interventions call for changes in diet. Such changes include removing certain
types of foods from a childs diet and using vitamin or mineral supplements. Dietary treatments
are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of
ASD. Some parents feel that dietary changes make a difference in how their child acts or feels.
If you are thinking about changing your childs diet, talk to the doctor first. Or talk with a
nutritionist to be sure your child is getting important vitamins and minerals.
Medication
There are no medications that can cure ASD or even treat the main symptoms. But there are
medications that can help some people with related symptoms. For example, medication might
help manage high energy levels, inability to focus, depression, or seizures.

4.

Comorbidity:

SEIZURES, EPILEPSY AND AUTISM

One in four children with an Autism Spectrum Disorders will develop seizures. These may not
necessarily begin in early childhood, but can start as late as adolescence. Seizures are caused by
abnormal electrical activity in the brain and are a common comorbid disorder with autism and
Asperger's syndrome. There is usually a temporary period of unconsciousness, a body
convulsion, unusual movements, or staring spells. Sometimes a contributing factor is a lack of
sleep or a high fever.
WHAT IS EPILEPSY?
Epilepsy is a chronic condition produced by temporary changes in the electrical function of the
brain, causing seizures which affect awareness, movement, or sensation. Before a seizure some
may get a feeling of unease called an aura. With medication, most patients with epilepsy who are
otherwise healthy are able to live full and productive lives. However, some patients lives are
devastated by frequent, uncontrollable seizures or associated disabilities. Not everyone who has a
seizure has epilepsy. Epilepsy is a long-term, ongoing chronic disorder that causes repeated
seizures if it is not treated. It may contribute to, or even cause, brain injury but may also develop
after a brain injury.

There are two major types of seizures. The first type, a general seizure, begins on both sides of
the brain. Full convulsions or brief staring episodes are often the result. The second type, known
as a partial seizure, originates in one region of the brain. In a simple partial seizure, the seizure
related brain messages remain localized so that one experiences a feeling, sensation, movement,
or other symptom without any change in the level of awareness. Some may suddenly become
confused, fumble, wander or repeat inappropriate words or phrases.
TREATMENT OF SEIZURES AND EPILEPSY
An electroencephalogram, or EEG, records the electric currents in the brain through electrodes
applied to the scalp and can help to confirm the diagnosis of seizures or epilepsy. There is no
cure but anticonvulsant medications are the most common treatment. The dosage of the
medication is adjusted so that the least possible amount of medication will be used to be
effective. A medication must be taken when specified to maintain a constant level in the blood. A
regular blood test is usually done to measure the amount of drug in the blood stream. Too much
may have side effects such as dizziness or an upset stomach. Too low and there may be a risk of
seizures. Parents should keep track of the frequency of their child's seizures and notify the doctor
or nurse of medication side effects in case the medication needs adjusting.
Interactions may occur between an anticonvulsant and other medications. It is important to tell
any doctor prescribing medication that your child is also taking anticonvulsants. Surgery, which
is another treatment option, is generally not performed unless drug treatment has failed. For
some, other treatments may include a ketogenic diet (high in fats and oils, low in carbohydrates)
and biofeedback.
WHAT TO DO DURING A SEIZURE
For a tonic-clonic seizure (grand mal, convulsion) you should get the child into a lying position
and then onto one side. Place something soft under the head. Loosen tight clothing. Do not
restrain the arms or legs. Do not put anything into the mouth. The seizure itself should only last a
few minutes. Afterwards the child may be very sleepy and confused and should be talked to in a
calm and quiet manner. A trip to the hospital is usually not necessary unless there has been an
injury, the seizure itself lasts for more than ten minutes, or if one seizure goes into another
without recovery.
If a person has a partial seizure, stay with them, talk calmly, and protect them from self-injury.
Do not restrain them. They may be able to respond to simple commands such as sit down. After
the seizure explain where you are and what has happened.
PUBERTY AND SEIZURES
Seizures may begin in the teenage years and some theorize this is due to hormonal changes in the
body with the onset of puberty. Parents should be on the look out for this as the seizures may not
be the highly noticeable convulsions but a partial seizure. Some possible symptoms include:
Behavioral issues such as aggression, self-injury, and emotional outbursts
Regression or lack of advance in school performance
Regression or lack of advance in cognition.
If seizures are suspected, an EEG can be used to confirm or rule out seizures.
LIVING WITH EPILEPSY AND AUTISM

Having to cope with epilepsy as well as other problems arising from an Autism Spectrum
Disorder is not easy. But there are steps parents can take to minimize the effects of epilepsy:
Ensure medication is taken on time
Make sure your child avoids alcohol, coffee and other stimulants as they get older
Take steps to ensure your child sleeps well
Minimize conditions that trigger seizures such as stress
Make sure your child wears a Medic-Alert bracelet
Get medical advice before a teenage child starts driving.
Inform your family, school teachers and friends openly about epilepsy. They will feel more
comfortable around your child and be able to assist if your child has a seizure.
AUTISM AND BIPOLAR DISORDER

Bipolar Disorder is a psychiatric diagnosis involving both elevated and depressive mood states.
The duration and intensity of mood states varies widely among people with the illness.
Fluctuating from one mood state to the next is called cycling. Mood swings can cause
impairment or improved functioning depending on their direction (up or down) and severity
(mild to severe).
There can be changes in ones energy level, sleep pattern, activity level, social rhythms and
cognitive functioning. Some people may have difficulty functioning during these times, and the
disorder can involve great distress and disruption and is associated with a higher-than-average
risk of suicide.
Bipolar Disorder is commonly categorized as either Type I, when there are full-blown manic
episodes (not triggered by medication), or Type II, when the episodes do not go beyond
hypomanic. In addition there are rapid cycling subtypes. Because there is so much variation in
the severity and nature of mood-related problems, the concept of a bipolar spectrum of subtypes
is often employed, and sometimes the concept of a continuum of mood variation merging in to
the normal range.
CAUSES
Bipolar disorder is considered to be a result of complex interactions between genes and
environment. The disorder runs in families, with over two thirds of people with bipolar disorder
having at least one close relative with the disorder or with unipolar major depression, indicating
that the disease has a genetic component.
Researchers suggest that abnormalities in the structure or function of certain brain circuits could
underlie bipolar and other mood disorders, and studies have found anatomical differences in
areas such as the prefrontal cortex and hippocampus.
The nature of personality and temperament may play a role. Some studies suggest that bipolar
patients were significantly more extroverted, intuitive, and perceiving, and less introverted,
sensing, and judging than were unipolar patients.

The kindling theory asserts that people who are genetically predisposed toward bipolar disorder
can experience a series of stressful events, each of which lowers the threshold at which mood
changes occur. Eventually, a mood episode can start (and becomes recurrent) by itself. Not all
individuals experience subsequent mood episodes in the absence of positive or negative life
events, however.
Individuals with late-adolescent/early adult onset of the disorder will very likely have
experienced childhood anxiety and depression. Some argue that childhood-onset bipolar disorder
should be treated early.
DIAGNOSIS OF BIPOLAR DISORDER
Flux is the fundamental nature of bipolar disorder. Both within and between individuals with the
illness, energy, mood, thought, sleep, and activity are among the continually changing biological
markers of the disorder. The diagnostic subtypes of bipolar disorder are thus static descriptions
snapshots, perhaps of an illness in continual change. Individuals may stay in one subtype,
or change into another, over the course of their illness.
There are currently four types of bipolar illness. The DSM-IV-TR details four categories of
bipolar disorder, Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise
Specified). The behavioral manifestations of bipolar disorder are often not understood by patients
nor recognized by mental health professionals, so people may suffer unnecessarily for many
years before receiving proper treatment.
RECOGNIZING MANIA IN A CHILD WITH AUTISM
While depression can be quite obvious, recognizing mania may be more difficult in a child with
autism. The following seven categories follow the symptoms of mania or hypomania.
Inflated self-esteem or grandiosity
When a child cannot talk or has a communication disorder, it may be hard to identify this
symptom. Many of our kids act like they are in charge of the world anyway. What you may see
in a child with autism is a marked improvement in the child's usual mood. The child may seem
overly happy, silly, or laugh inappropriately or even hysterically. A child who once feared certain
situations may show no fear. The child may show irritability rather than a good mood. Behavior
may become more aggressive than usual. Tantrums may increase dramatically. The child may act
like the rules no longer apply to him or her. The child may act as if he or she has "super powers".
The child may say he or she will report others to the principal or to the police, etc.
Decreased need for sleep
Many children with autism have sleep issues to begin with so this may be a difficult symptom to
track. What you may see in a child with autism is that the child may not sleep at all or their
normal sleep times are decreased significantly. Alternatively, since sleep is usually a pleasurable
activity, the child may sleep too much in the beginning of a manic cycle. Many children and
adults with Bipolar Disorder have a "crash" after a manic phase and may not want to get out of
bed at that time.
More talkative than usual or pressure to keep talking

For children who have a communication disorder this symptom would not seem to apply.
However, many children and adults with autism and Bipolar Disorder show an increase in their
speech and vocalizations during a manic cycle. I have had many parents report the "good news"
that their child is suddenly more verbal only to later report that the child is driving them crazy
with the accompanying manic behavior. Children with autism may use more words, talk/vocalize
faster than normal, be difficult to stop or interrupt, and/or may talk through the night.
Flight of ideas or subjective experience that thoughts are racing
The child's interest in activities may increase dramatically. The child will be restless, bombard
you with "requests" for activities or other things, and will flit from one activity or thought to
another. If the child is verbal he or she may be able to talk about their many conflicting thoughts
and interests. Their speech may make no sense, may be a series of unrelated sentences or words,
or may be songs or rhymes that have little relation to what is going on. May be expressed as
extreme hyperactivity.
Distractibility
Attention is too easily drawn to unimportant or irrelevant external stimuli. Many children with
autism and ADHD have this symptom already. However, in a manic cycle the distractibility
would be more than usual. May focus on unusual aspects of objects that are different from their
usual interests.
Increase in goal-directed activity or psychomotor agitation
It may be impossible to redirect ritualistic behaviors. Once the child starts an activity he or she is
almost impossible to stop. May repeat activities over and over (with more intensity than usual).
The child may masturbate or engage in other sexual activity to an extreme degree.
Excessive involvement in pleasurable activities that have a high potential for painful
consequences
Examples involve unrestrained buying sprees, sexual indiscretions, or foolish business
investments in an adult context. As above, sexual activity/interest may be taken to the extreme.
The child may sleep excessively, self-stimulate excessively, eat excessively, toilet excessively, or
engage in any other pleasurable behavior with more frequency and intensity.
WHAT PARENTS DO IF THEY SUSPECT BIPOLAR DISORDER?
If you suspect your child has Bipolar Disorder, talk with your child's physician about a referral
for an evaluation. Usually a psychiatrist will make the diagnosis. Treatment often involves
medication but there are behavioral interventions and alternatives to medication that are also
effective. An important fact to remember is that Bipolar Disorder is not something that "takes
over" your child - he or she is a participant in the process. There are steps you can take to lessen
the impact of a manic phase. For great strategies, see this link: How To Avoid a Manic Episode.
CHILDREN, BIPOLAR DISORDER AND PROBLEMS WITH DIAGNOSIS
Children with bipolar disorder do not often meet the strict DSM-IV definition. In pediatric cases,
the cycling between elevated and depressed mood states can occur very quickly, sometimes
within the same day or the same hour. When the symptoms of both mania and depression occur
simultaneously, mixed cycling occurs.

Often other psychiatric disorders are diagnosed in bipolar children. These other diagnoses may
be concurrent problems, or they may be misdiagnosed as bipolar disorder. Depression, ADHD,
ODD, schizophrenia, and Tourette syndrome are common comorbid conditions.
Misdiagnosis can lead to incorrect medication. Incorrect medications can trigger mania and/or
suicidal ideation and attempts. The energy, impulse control difficulties, and lack of maturity in
bipolar children can make suicide risk a serious concern, even with children younger than 8 years
old.
During severe episodes of mania and mixed states, a child may suffer from symptoms of
psychosis. These episodes can be negative (such as thinking their poster on the wall is staring at
them angrily) or positive (such as telling people that a rock band is coming to his or her birthday
party).
There are many medications which can help calm the symptoms of bipolarity, including in
children and adolescents. However, finding the right medicine or combination of medicines is
not easy. An exact scientific means of choosing medication for bipolar treatment does not exist.
With children this problem is made worse by the fact that as children grow, their weight,
metabolism, hormones, brain structure, etc. changes. These changes often require adjustments in
the medication(s), significantly more often than adults.
Bipolar children are often both bullies, and the victims of bullies. They rarely see how their
actions result in severe social problems at school, home, and elsewhere. These children are
confusing for parents, teachers and other professionals, because bipolar disease is one that
cycles. Bipolar children may have periods of sweetness, success, creativity, and other wonderful
behaviors. Unfortunately, they may also show behaviors that are also extremely negative. This
combination makes parenting, teaching, and counseling these children challenging.
Family and friends of the parents of bipolar children rarely understand how difficult things can
get when the child is having severe symptoms. This may lead to strained relations with the
friends and families of the parents of the affected child.
Fortunately, research and resources for bipolar children have been rising increasing steadily since
the year 2000. As of 2005, the level of research has increased at a faster rate, though the results
are still sketchy at best.
While finding professionals to help with bipolar children is difficult in a metropolitan area, it can
be impossible in areas with smaller populations. Parents with bipolar children need to do as
much research as possible in order that they are able to better understand the changes that the
child is going through and be informed of the most current information.
TREATMENT OF BIPOLAR DISORDER
Currently, bipolar disorder cannot be cured, though psychiatrists and psychologists believe that it
can be managed. The emphasis of treatment is on effective management of the long-term course
of the illness, which usually involves treatment of emergent symptoms. Treatment methods
include pharmacological and psychotherapeutic techniques such as Cognitive Behavioral

Therapy. Ultimately ones prognosis depends on many factors, which are, in fact, under the
individuals control: the right medicines; the right dose of each; a very informed patient; a good
working relationship with a competent medical doctor; a competent, supportive, and warm
therapist; a supportive family or significant other; and a balanced lifestyle including a regulated
stress level, regular exercise and regular sleep and wake times.
There are obviously other factors that lead to a good prognosis, as well, such as being very aware
of small changes in ones energy, mood, sleep and eating behaviors, as well as having a plan in
conjunction with ones doctor for how to manage subtle changes that might indicate the
beginning of a mood swing. Some people find that keeping a log of their moods can assist them
in predicting changes. The goals of long-term optimal treatment are to help the individual
achieve the highest level of functioning while avoiding relapse.
SENSORY PROBLEMS AND AUTISM

Children with Autism Spectrum Disorders such as autism or Asperger's syndrome see their world
in a very different way. The filtering mechanism in their brains often works in a different way in
assimilating the senses such as touch, smell, hearing, taste and sight. They may be extremely
sensitive to some senses and find seemingly routine events fascinating - the patterns of light on a
wall, or the rustling leaves in the wind. The autistic child may also be unresponsive to sensations
that their parents find unpleasant, such as extreme heat, cold or pain.
Sensory experiences that parents don't even notice may be extremely frightening or unpleasant
for a child - the feel of a certain fabric, sounds of certain frequency, particular colors or
seemingly bland foods. The child's reactions can easily be interpreted as wilful misbehavior.
Along with this will frequently be difficulties in movement, coordination and sensing where
one's body is in a given space, leading to clumsiness and difficulty with tasks such as dressing.
These are problems with sensory integration, as the nervous system has difficulty receiving,
filtering, organizing and making use of sensory information, commonly known as Sensory
Integration Dysfunction.
Sensory Integration involves various systems in our bodies:
The vestibular system responds to movement and gravity
The proprioceptive system receives feedback from joints and muscles and joints
Our five senses - sight, hearing, touch, eyesight and smell.
CHARACTERISTICS OF SENSORY INTEGRATION DYSFUNCTION
Following are some signs that a child may have a dysfunction in sensory-motor processing:
Repetitive behaviors such as spinning, head banging or flapping of hands
Poor coordination and handwriting
Poor eye contact
Short attention span
Avoidance or over reaction to touch

Difficulty identifying objects by touch


Clumsiness and lack of balance
Repetitive or slow speech
Lack of body image and awareness
Raised shoulders
Fear of movement, avoids motor play
Fear and anxiety in new situations or changed routines.
Children with autism or Asperger's syndrome may be overly sensitive to certain textures, sounds,
smells and tastes. Wearing certain fabrics, tasting certain foods, or normal everyday sounds may
cause emotional outbursts. The opposite is also possible - the child with an Autism Spectrum
Disorder may feel very little pain or actually enjoy sensations we would dislike: strong smells,
intense cold or unpleasant tastes.
The brain seems unable to balance the senses appropriately in cases of Sensory Integration
Dysfunction. The brain may not be able to filter out background stimuli yet admit what is
important, so the person with autism or Asperger's may have to deal with overwhelming amounts
of sensory input day and night.
EXPRESSING AFFECTION WITH HYPERSENSITIVE CHILDREN
Babies who are later diagnosed as autistic are often observed to go stiff when held due to a
sensory overload. This coping behavior is one of the earliest observable symptoms of autism,
although it does not occur in all cases. It can be very difficult for parents who feel their child is
rejecting them personally when the child doesn't want to be touched. Some guidelines to consider
in these situations include:
The child may find it easier to initiate hugging than receiving one
Touch is usually more tolerable when the child anticipates it
Firm, unmoving touch is better than light or moving touch
Light touch may be tolerable after firm unmoving touch
Initial stimulation may be unpleasant but tolerated later.
TREATMENT OF SENSORY INTEGRATION DYSFUNCTION
In some cases, parents can minimize unpleasant sensory stimulation. For example, parents can
avoid certain clothing fabrics that their child finds intolerable. Others may buy secondhand
clothing, or wash new items repeatedly, to minimize the unpleasant rub of new fabrics. It can be
very difficult for parents to find these causes of distress especially when the child is very young
or does not communicate well. There may be some detective work and experimenting needed to
find the sources.
Where are source of distress cannot be realistically avoided, there are behavioral techniques to
allow a child to gradually accept the unpleasant sensory sensation. With time and patience,
Desensitization can be a powerful technique. For example, a child may scream uncontrollably in
supermarkets. The parent will explain to the child that they will stand outside the supermarket for
30 seconds then go home. The next time, it may be explained that they will go in for 30 seconds
then go home. Time spent in the supermarket is gradually lengthened until the child has adapted

to this environment. There are other interventions available that help autistic children to integrate
their senses and have more pleasurable interactions with people and their environment.

5.

Support Groups/How you can support:

This Tool Kit will help parents:


1
2
3
4
5

Learn about autism and how it may impact your family.


Find strategies and resources for raising a child with autism.
Find support so you don't feel alone or isolated.
Reduce the negative impact of the diagnosis on your family.
Promote a positive future for your child and family.

Dads 4 Special Kids


A network of support, resources and encouragement by men caring for children with special
needs.
Contact information:
Phone: (602) 909-5463
Contact: Ray Morris-Email: ray@dads4specialkids.com
AZA Parent Support Group
The Parent Support Group is a safe venue where parents of children with autism can discuss
various topics related to home life, school issues, treatment and every day challenges. Parents
will be equipped with relevant information from other experienced parents.
-Meetings: Last Monday of Every Month
-Address: At the Arizona Autism United main office, located in the Disability Empowerment
Center, 5025 E. Washington St., Suite 212, Phoenix, AZ 85034
-Contact: Diane Martin, LPC
AZ ASSIST
AZ ASSIST, Inc. is a group of parents in the Greater Phoenix area who, through experience, are a
wealth of information and eager to ASSIST each other through the process of our children
growing up and away. Our mission is to provide education, strategies, and support related to
transition into the community after high school to parents of teens and young adults on the
autism spectrum and to provide transition education and create opportunities for social skill
development for teens and young adults on the Autism Spectrum. Check calendar for meeting
information.
-Meeting: 3rd Monday of the month, Campus of EdOptions 7-9 PM, 2150 E Southern Ave,
Tempe
Teens & Young Adults are encouraged to attend in order to socialize with multiplayer video
games (no games rated M or above), air hockey, outdoor games and/or arts & crafts.
-Website: http://azassist.com/
-Email: info@azassist.com
Asperger Parent Network

Resource for families and professionals in the Greater Phoenix Area including family life
coaching and special education advocacy services available. Monthly meetings, e-group and web
site.
Contact information:
Webpage: http://www.apnarizona.com
Phone: 480-759-6329
Contact: Carolyn Warden
Family Fundamentals Parent Training Program
This program is a 7-week training course for parents to learn strategies that will improve their
childs communication, socialization, and/or behavior. The class alternates between lecture-based
discussions to focus on theory and individual coaching sessions to focus on implementing
practical strategies.
Contact information:
Meets: Contact for upcoming schedule
Address: At the Arizona Autism United main office, located in the Disability Empowerment
Center, 5025 E. Washington St., Suite 212, Phoenix, AZ 85034
Email: paulina@AZAunited.org
Raising Special Kids Parent Leadership
Raising Special Kids offers many different Parent Leadership opportunities. Whether its an hour
a month or an hour a day, your time is valued and appreciated. If you are interested in
volunteering to help support families of children with disabilities or special health needs visit
http://www.raisingspecialkids.org/ways-to-help/parent-leadership/ to learn more and submit a
Parent Leader Application.
West Valley Autism Parent Support Group
Contact information:
Phone: (623) 572-5289
Contact: Shelly V.
Email: shellyvin@cox.net
Meets: 2nd Monday of each month from 7-9pm
Location: New Life Community Church located at 8155 W Thunderbird Rd. Peoria AZ 85381.
East Valley Parent Group
This group is for all parents of children with autism. Meets the first Tuesday of every month.
Contact information:
Phone: (480) 632-5719
Contact: Janet Kirwan
Email: janet@autismcenter.org
Meets: 1st Tuesday of each month

East Valley Autism Support Group for Spanish-Speakers


Group meets with experts from different fields related to autism. Group shares valuable
information and offers support to families.
Contact information:
Phone: (480) 831-1009
Contact: Alberto Serpias
Meets: 2nd Tuesday of each month
Teacher supports:
1. Set Clear Boundaries and Expectations
Autistic kids are very rule oriented. They like procedure and need to know exactly what is
expected. Visual schedules are great tools to keep them on track no matter what their ability
level. Write directions out in a way that they can clearly understand, and let them know that if
they meet a small list of expectations, then they can have a brief, agreed-upon reward. For
example, if you finish your 20 problems in math, then you can draw for ten minutes. This would
be for a child that sees drawing as a reward. Most importantly, keep your directions short. Dont
overwhelm them with too many at one time!
2. Be Aware of Sensory Issues
Autistic kids are strongly impacted by their senses. Imagine trying to go through your day with
someone poking you repeatedly. How hard would that be to ignore? Kids with sensory issues
have to try to filter out the things that bother them all day, which is no easy feat. You have to be
aware of their specific issues. Some issues that may affect them are:
Touch: Either an aversion to touching or a need to touch too hard. Some need deep pressure to
calm down, and some cant stand touch at all. They can also be irritated by clothing tags, tape,
band-aids, dirty hands, certain clothing materials, and the feel of their chair.
Smells: You may not smell what they are smelling: they may be hypersensitive to certain smells.
Tastes: You may notice that they tend to have a specific range of foods that they stick to. There
are actually therapies that can be done by occupational therapists to help them expand their
realm.
Sounds: Loud noises can be EXCRUCIATING to them. My son is almost nine and still cannot
tolerate the noise of the vacuum cleaner. We keep headphones for him at all times just in case.
Assemblies and sports can be torture.
Space: Some autistic kids feel better if they are up high. They climb on the roofs of their homes,
to the top of the swing set, up trees, you name it. Others may be terrified of heights. Some need
to feel closed in and feel safer UNDER the desk or sitting in a specific place. Work with them
and be aware. They often cannot foresee the danger of hiding when stressed, running away when
angry, or climbing everything, inside and out. They do it because they NEED it at the moment as
a way to de-escalate some sensation.
Crowds: These can be over-stimulating for many people. Now imagine how overwhelming it
can be for someone with autism, who already has the issues above.
Eye Contact: For some kids, eye contact is a form of torture. While YOU may need the eye
contact, it may utterly destroy their ability to listen to what you have to say if you are talking to
them one on one. You can help them ease into it, but dont push it if it is upsetting to them.
3. Find What Motivates Them

Use what they love to help inspire them to learn. My son loves music, computer games, science,
animals, and drawing. His teachers and I work together to find ways to motivate him through his
loves. For instance, he is on the gifted spectrum, but still has some language issues. Thus, I really
have to work hard to get him to read. We had to come up with a different set of rules for his
Accelerated Reader books. The only way to get him to read is to let him choose books that he is
interested in regardless of the AR level, such as the Magic School Bus Series. In addition, we set
up rewards at home for good reports from his teacher because he does have to do work that he
may not like. We try to work with the teacher to reward the positive and to set up a system that
supports his classroom expectations. You have to do what is best for them, and not what is best
for everyone else.
4. Be Proactive
Know their triggers. Try to avoid causing a meltdown unless you are trying to work them
through an issue (which has to be in SMALL increments). Know what the signs are when their
negative behaviors are escalating, and have plans in place for what to do if they occur. If there's a
safe place in the room for them to go, where you can still see them, let them go there to calm
down before you address an issue. Many problems can be avoided if you just prepare them for
what is coming. If it is a change in schedule, explain it to them ahead of time. This will help
them cope with the change. Change happens. Help them deal with it, and you will find that it
gets easier each time.
5. "I Am a Kid!"
Dont ever forget that you are dealing with a kid! While they are not average, they do have the
same issues that kids have. They WANT to be liked. They just need help with social issues. They
WANT to have fun. They want to be included. However, it is hard to fit in when you have trouble
with eye contact or you have quirky mannerisms. Try to help them.
However, they are also like every other kid in that they want things their way or may not feel like
cooperating. You have to distinguish when their issue is that they are just being a kid and when it
is a result of their autism, and deal with it appropriately. Remember that they probably cannot
explain very well what the issue is. For instance, they may not feel well or may not understand
how to do the work and THAT is why they are digging their heels in. That doesnt mean they can
verbalize that. Start by asking what the problem is. Throw out some possibilities, and then help
them work through it.

6.

Community Resources:

The support groups are all community support groups and resource for parents. These are
some of the websites the resources were found on:
http://azautism.org/resources/family/support-groups/#10
http://phxautism.org
http://www.azdisabilitylaw.org
http://www.phoenixchildrens.org/health-information/the-emily-center
http://www.bistacenter.org
RESOURCES FOR THIS DOCUMENT:

http://www.autism-help.org/comorbid-disorders-autistic-spectrum.htm
http://www.cdc.gov/ncbddd/autism/index.html
http://azautism.org/resources/family/support-groups/#10
https://www.autismspeaks.org/family-services/tool-kits/family-support-tool-kits
https://www.azed.gov/giftededucation/files/2012/10/arizonagiftededucationstatutesadministrativecode.pdf

Epilepsy
1. Definition
Any of various disorders marked by abnormal electrical discharges in the brain and
typically manifested by sudden brief episodes of altered or diminished
consciousness,
involuntary movements, or convulsions.
Absence Seizures:
An absence seizure causes a short period of blanking out or staring into space. Like other kinds
of seizures, they are caused by abnormal activity in a persons brain. You may also hear people
call absence seizures petit mal (PUH-tee mahl) seizures, although that name is not common
anymore.
Atypical Absence seizures:

Atypical (a-TIP-i-kul) means unusual or not typical. The person will stare (as they would in any
absence seizure) but often is somewhat responsive. Eye blinking or slight jerking movements of
the lips may occur. This behavior can be hard to distinguish from the person's usual behavior,
especially in those with cognitive impairment. Unlike other absence seizures, these seizures
usually cannot be produced by rapid breathing. These seizures usually last 5 to 30 seconds
(commonly more than 10), with a gradual beginning and ending.
Myoclonic seizures:
Myoclonic (MY-o-KLON-ik) seizures are brief, shock-like jerks of a muscle or a group of
muscles. "Myo" means muscle and "clonus" (KLOH-nus) means rapidly alternating contraction
and relaxationjerking or twitchingof a muscle. Usually they don't last more than a second or
two. There can be just one, but sometimes many will occur within a short time.
Even people without epilepsy can experience myoclonus in hiccups or in a sudden jerk that may
wake you up as you're just falling asleep. These things are normal.
In epilepsy, myoclonic seizures usually cause abnormal movements on both sides of the body at
the same time. They occur in a variety of epilepsy syndromes that have different characteristics:
Others are:
Atonic Seizures
Clonic
Tonic
Tonic-Clonic
Simple Partial
Complex Partial
Secondarily Generalized
Febrile
Non epileptic
Refractory Sezures
Gelastic and Dacrystic

2. Articles
http://kidshealth.org/parent/medical/brain/epilepsy.html
http://www.aboutkidshealth.ca/En/News/NewsAndFeatures/Pages/Stigma-and-epilepsy-Whatparents-can-do.aspx
http://www.sciencedaily.com/releases/2015/04/150420100824.htm

3. Treatment
What Are the Treatments for Epilepsy?
The majority of epileptic seizures are controlled by medication, particularly anticonvulsant
drugs. The type of treatment prescribed will depend on several factors, including the frequency
and severity of the seizures and the person's age, overall health, and medical history. An accurate
diagnosis of the type of epilepsy is also critical to choosing the best treatment.
Drug Therapy
Many drugs are available to treat epilepsy, several of which have only recently been released.
Although generic drugs are safely used for most medications, anticonvulsants are one category
where doctors proceed with caution. Most doctors prefer to use brand name anticonvulsants, but

realize that many insurance companies will not cover the cost. As a result, it is acceptable to start
taking a generic anticonvulsant medication, but if the desired control is not achieved, the patient
should be switched to the brand name drug.
Classic medications used to treat epilepsy include:
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Dilantin or Phenytek
Phenobarbital
Tegretol or Carbatrol
Mysoline
Zarontin
Depakene
Depakote, Depakote ER
Valium and similar tranquilizers, such as Tranxene and Klonopin
Newer drugs to treat epilepsy include:
Aptiom
Felbatol
Fycompa
Gabitril
Keppra
Lamictal
Lyrica
Neurontin
Oxteller XR
Topamax
Trileptal
Vimpat
Zonegran
The choice of drug is most often based on factors like the patient's tolerance of side effects, other
illnesses he or she might have, and the medication's delivery method.
Although the different types of epilepsy vary greatly, in general, medications can control seizures
in about 70% of patients.
Side Effects of Epilepsy Drugs
As is true of all drugs, the drugs used to treat epilepsy have side effects. The occurrence of side
effects depends on the dose, type of medication, and length of treatment. The side effects are
usually more common with higher doses, but tend to be less severe with time as the body adjusts
to the medication. Anti-epileptic drugs are usually started at lower doses and increased gradually
to make this adjustment easier. One of the best rules in medicine is to ''go low and go slow.''
There are three types of side effects:
Common or predictable side effects. These are common, nonspecific, and dose-related
side effects which occur with any epilepsy drug, which affects the central nervous
system. These side effects include blurry or double vision, fatigue, sleepiness,
unsteadiness, and stomach upset.
Idiosyncratic side effects. These are rare and unpredictable reactions which are not doserelated. Most often, these side effects are skin rashes, low blood cell counts, and liver
problems.

Unique side effects. These are those that are not shared by other drugs in the same class.
For example, Dilantin and Phenytek (phenytoin) can cause the gums to swell and
Depakene (valproic acid) can cause hair loss and weight gain. Your doctor will discuss
any unique side effects before prescribing the medication.
How Long Epilepsy Treatment Lasts
In some types of epilepsy, patients can be taken off treatment after a few years, while other types
of epilepsy require lifelong treatment. With few exceptions, patients who are seizure-free for a
certain period should be re-evaluated to determine whether the drug can be discontinued. How
long the seizure-free period should be varies among the types of epilepsy and is controversial
even for a given type. The decision to discontinue a medication also depends on more than the
length of the seizure-free period.
What is clear, however, is that epilepsy drugs should at least be considered for discontinuation in
patients who are seizure-free for 10 years. If a medication is going to be discontinued, it should
be weaned gradually to avoid triggering a seizure.
Surgery for Epilepsy
Most patients with epilepsy do not require surgery. However, if seizures are not controlled after a
trial of two or three medications (usually accomplished within two years) then re-evaluation is
suggested. This information is critical in deciding if epilepsy surgery is an option. Of the 30% of
patients whose seizures cannot be controlled with drugs, approximately one third (more than
100,000 in the U.S.) may be candidates for epilepsy surgery. However, only about 3,000 epilepsy
surgeries are performed annually. Before surgery is considered, a comprehensive presurgical
exam is performed. This evaluation is performed to ensure that the operation will likely improve
the seizures and will not cause damage to essential functions such as speech and memory. The
evaluation requires prolonged EEG-video monitoring and other tests to pinpoint the exact
location of the injured brain cells causing the seizures. The location of the damaged cells
determines whether the surgery can be performed and what technique should be used.
The multidisciplinary evaluation is directed by a neurologist specializing in epilepsy (an
epileptologist). A patient's eligibility for surgery is determined jointly by the neurosurgeon,
neuroradiologist, neuropsychologist, social worker, and epileptologist. The decision to have the
surgery is made jointly by the patient and the epileptologist after carefully reviewing the risks
and benefits of the procedure.
Surgery is most commonly performed to treat partial epilepsy, since only one area of the brain is
involved. During surgery, the area of the brain that triggers the seizures (usually a portion of the
anterior temporal lobe) is removed. After surgery, some patients will be completely free of
seizures; in others, the seizures will be better controlled. A few patients may need additional
surgery.
Other surgical approaches are reserved for specific types of epilepsy and are most often
performed in young children. One approach is to remove a large part of one side of the brain (a
hemispherectomy); another is to cut the nerve fibers connecting the two sides of the brain (a
corpus callosotomy).
Surgery is also done to implant devices. In vagus nerve stimulation (VNS), a device that
electronically stimulates the vagus nerve (which controls activity between the brain and major
internal organs) is implanted under the skin. This reduces seizure activity in some patients with
partial seizures. Theres also the responsive neurostimulation device (RNS), which consists of a
small neurostimulator implanted within the skull under the scalp. The neurostimulator is
connected to one or two wires (called electrodes) that are placed where the seizures are suspected

to originate within the brain or on the surface of the brain. The device detects abnormal electrical
activity in the area and delivers electrical stimulation to normalize brain activity before seizure
symptoms begin.
Other Epilepsy Treatment Options
The ketogenic diet -- a high-fat, low-carb plan -- has received much attention lately and is
effective for treating certain types of epilepsy. Specifically, it is used most frequently in children
with seizures that have not responded to medical therapy. However, the diet requires careful
planning and may be difficult to follow, so it is usually not recommended in older children or
adults. The diet is usually started in the hospital, and when successful, it is most often maintained
for two to three years.

4. Comorbidity
THE CO-MORBIDITIES OF INTRACTABLE EPILEPSY
Both parents and educators agree that the co-morbidities of intractable childhood epilepsy
are often more serious than the seizures themselves. These co-morbidities are summarized
below:
Co-Morbidities of Intractable Epilepsy
COGNITIVE
Lowered IQ
Developmental delay
Selective cognitive deficits (related to partial seizures)
Global memory problems due to seizures
Global memory problems due to the sedative side-effects of anticonvulsant drugs
PSYCHOSOCIAL
Low self esteem
Psychiatric disturbances (found in at least 30%)
AD/HD (20-30% of children)
Personality changes due to the side-effects of anticonvulsant drugs
If seizures cannot be stopped by drug or non-drug therapy, the co-morbidities must be
addressed, and strategies for dealing with them must be evolved.
Intractable epilepsy and cognitive impairment
Intractable epilepsy is often, but not always, associated with cognitive impairment. Impairment,
however, may be associated with many forms of intractable seizures. In children, this often
becomes evident during the school years. Children with intractable seizures have lower IQs,
often in the low normal range of 80-85. Studies have also found a significant correlation
between low IQ and the duration of the childs seizure disorder. IQ can change with seizure
improvement, and intractable epilepsy does sometimes improve over time.
Even when IQs are in the normal range, children with uncontrolled seizures do less well
in school than non-epileptic children.
Sleep Disorders / Daytime Drowsiness
People with uncontrolled seizures often suffer
from sleep disturbances. These are believed to be caused both by their seizures, and by some of
the anticonvulsant drugs. This disturbed sleep leads to daytime drowsiness, and poor cognitive
performance. As children grow, the co-morbidities of intractable epilepsy grow with them. The
focus of trouble simply shifts from the school to the work place. Cognitive deficits, once

acquired, are likely to remain. The after-effects of seizures still occur in adults, as do the sedative
side-effects of anticonvulsant medications.
Intractable epilepsy and psychosocial impairment
Emotional and psychosocial difficulties are disproportionately high in people with
intractable epilepsy. In one large study, about 50% of the children with intractable epilepsy were
identified as having serious psychosocial problems. In another study, clear-cut psychiatric
disorders were identified in 33% of children with epilepsy, as compared to 7% in the general
population and 12% in children with other chronic illnesses.
Some of the more common problems include anxiety, depression, irritability, aggression,
and irrational periods of rage. In children at risk for suicide, there is a fifteen-fold
overrepresentation of children with epilepsy.
Emotional disturbances, especially anxiety and depression, are also common in adults
with uncontrolled epilepsy. Self-confidence is low. Often there is social isolation and
withdrawal. Adult children may continue to live with their parents.
The suicide rate is five times higher than in the general adult population. People with seizures are
also over-represented in the prison population.
In addition to anxiety and depression, some people with intractable seizures develop a
schizophreniform psychosis. This occurs in about 5-10% of people with intractable epilepsy.
Usually the patient has complex partial seizures with a focus in one of the temporal lobes, and
usually he or she has had uncontrolled epilepsy for at least 10 years. In occasional patients, the
psychosis will clear after a seizure, and then gradually reappear.
A recent study on adults with uncontrolled seizures and normal IQs reported that
about 30% had psychiatric disorders, including psychosis, antisocial personality disorders,
anxiety and depression.
Both in children and adults, these psychiatric problems are responsive to therapy
including therapy with antidepressant medications. Unfortunately, these psychiatric problems
are seldom diagnosed or treated. Therapy focuses on seizure control, and emotional problems
are neglected.
Intractable epilepsy and ADHD
In addition to emotional problems, children with uncontrolled seizures may have
problems with hyperactivity. It is estimated that 20-30% of children with epilepsy suffer from
concurrent attention deficit/hyperactivity disorder (ADHD). A still larger number of children
with seizures show deficits in attention or in impulse control, without showing the full ADHD
syndrome.
The emotional and behavior problems noted above may be compounded by the effects of
the anticonvulsant drugs. ADHD is exacerbated by sedatives, and many of the anticonvulsants
have sedative side-effects. Children on anticonvulsants, therefore, may suffer a change of
personality. They may become impulsive, hyperactive and irritable and they may engage in
both verbal and physical aggression. These problems disappear when the drug is stopped.
Anecdotally, neurologists report that most of the anticonvulsants can produce behavioral
side effects. The worst problems, however, are probably associated with clonazepam (Rivotril).
A related drug, clobazam (Frisium), causes fewer problems. In children, phenobarbital also
sometimes causes a hyperactive syndrome. One of the new drugs, vigabatrin (Sabril), is
associated with depression or outright psychosis in a small number (2-4%) of patients.
Vigabatrin is not prescribed much any more, however, since it also tends to cause visual field
defects.

Such paradoxical excitability may also be seen in elderly patients, but it is less likely to
occur in adults.
The connection between anticonvulsants and behavior problems is often overlooked. If a
patient has a change in behavior after the initiation of a new drug, the possibility of behavioral
side-effects should be considered. A patient with severe behavior problems on one drug may be
quite normal on another.

5. Support Groups/How you can support


Epilepsy Foundation Arizona
240 W. Thomas Road, 2nd Floor
Phoenix, Arizona 85013-4407
United States
(602) 406-3581
(888) 768-2690
Raising Special Kids
Phone - Toll-free:
1-800-237-3007
Phone - Local:
602-242-4366
Website:
www.raisingspecialkids.org
Email:
info@raisingspecialkids.org
Fax:
602-242-4306
Meets:
5025 E. Washington St. #204
Phoenix, AZ 85034
Teacher supports:
Parents and health care providers need to hear from teachers when attention, concentration,
memory, lethargy-related, or language problems arise; this is in part because these problems
might be AED side effects. EdMedKids suggests that any epilepsy treatment adjustments
targeting improved classroom attention or work completion include monitoring the students
classroom attention (or work completion) before, during, and after treatment adjustments.
Feedback to the health care team via school team members such as school nurses, school
psychologists, or school counselors, is important in these circumstances. Use of observation
checklists when treatment changes are made can help determine if there is a concomitant
improvement in attention and work completion (see the Teacher Toolbox for a sample
observation checklist).
Interventions that teachers can use (and monitor for effectiveness on a per case basis) include:

Frequent repetition of material

Redirection

Cueing

Memory learning strategies such as mnemonics

Extra time for assignments and exams


Non-timed assessments to measure performance

Break tasks down into simpler steps

Provide several brief tests instead of one long one

Use a recognition format for exams rather than a recall format

Test for understanding rather than specific facts


When work completion or classroom inattention remains problematic, an OHI or 504 designation
may be in order (see Disability Rights). With or without such a designation, using a behavioral
consultant or school psychologist to conduct a functional behavioral analysis (often simply called
an FBA) may reveal antecedents and consequences associated with effective and ineffective
work completion (see the Teacher Toolbox for sample letters requesting assistance).
Considerable educational research confirms the utility of FBAs for promoting classroom success,
including improved work completion.

6. Community Resources
Under support groups, I have posted community resources to reference to.
http://www.epilepsy.com/arizona

RESOURCES:
http://www.ice-epilepsy.org/comorbidities-of-intractable-childhood-epilepsy.html
http://www.epilepsy.com
http://www.webmd.com/epilepsy/
http://edmedkids.arizona.edu/content/educational-implications-1
http://www.scholastic.com/teachers/classroom-solutions/2012/04/autism-classroom--whatcan-you-do-achieve-success

Cerebral Palsy
1. Definition
Defined by specific functional characteristics rather than by the underlying
cause.
Hallmarks of cerebral palsy:
o limitations and mobility
o handy use in association with signs of neurological dysfunction
CP is characterized by impaired control of movement and posture that
appears early in life. There is variability and overall motor functions, with
commonly associated non-motor impairments and sensation, cognition,
communication, and behavior.

Types of CP:
Spastic Cerebral Palsy
The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.
People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a
result, their movements can be awkward. Spastic CP usually is described by what parts of the
body are affected:

Spastic diplegia/diparesisIn this type of CP, muscle stiffness is mainly in the legs, with
the arms less affected or not affected at all. People with spastic diplegia might have
difficulty walking because tight hip and leg muscles cause their legs to pull together, turn
inward, and cross at the knees (also known as scissoring).

Spastic hemiplegia/hemiparesisThis type of CP affects only one side of a person's


body; usually the arm is more affected than the leg.

Spastic quadriplegia/quadriparesisSpastic quadriplegia is the most severe form of


spastic CP and affects all four limbs, the trunk, and the face. People with spastic
quadriparesis usually cannot walk and often have other developmental disabilities such as
intellectual disability; seizures; or problems with vision, hearing, or speech.

Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral
palsies)
People with dyskinetic CP have problems controlling the movement of their hands, arms, feet,
and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow
and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a
hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that
can change (varying from too tight to too loose) not only from day to day, but even during a
single day.
Ataxic Cerebral Palsy
People with ataxic CP have problems with balance and coordination. They might be unsteady
when they walk. They might have a hard time with quick movements or movements that need a
lot of control, like writing. They might have a hard time controlling their hands or arms when
they reach for something.
Mixed Cerebral Palsy
Some people have symptoms of more than one type of CP. The most common type of mixed CP
is spastic-dyskinetic CP.

2. Articles
http://www.cdc.gov/features/cerebralpalsy/index.html
http://www.cdc.gov/features/cerebralpalsystory/index.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051278/
http://www.medicalnewstoday.com/articles/152712.php

3. Treatment
Most of the causes of cerebral palsy do not have specific, curative treatments. However, children
with cerebral palsy present many medical problems that can be treated or prevented. The initial
stage of treatment involves an interdisciplinary team, consisting of a pediatrician, preferable one
with experience in neurodevelopmental disorders, a neurologist (or other neurological
practitioner), a mental health practitioner, an orthopedic surgeon, a physical therapist, a speech
therapist, and an occupational therapist. Each member of the team has important, independent
contributions to make in the care of the affected child.

The physical therapist evaluates muscle tone, strength, and gait (walking).

The occupational therapist reviews the child's ability to perform tasks of self-help and
care -- from feeding to manual dexterity.

The speech therapist evaluates the child's ability to speak and understand speech.
Most children with neurological impairment have significant emotional distress and also require
therapy from a mental health practitioner.
Virtually all states have federally-mandated programs for the assessment and treatment of
children with cerebral palsy and other developmental conditions. In many states, these programs
are termed "Regional Centers" and can be found in local phone books. Also Children's Hospitals
usually have special clinics with experience with children with cerebral palsy. Furthermore,
when a child reaches the age of 3 years, the school district may become formally involved in the
review of at-risk children. These programs protect children up to the age of 21 years.
At the present time there is a vacuum in the provision of medical care for adults (young and old)
with cerebral palsy living in the community settings. There are a limited number of services in
adult hospitals geared to the treatment of adults with cerebral palsy or developmental disabilities.

Seizure medication
If the child has seizures, the treatment is based on the type and frequency of the seizures.
Complete seizure control can often be achieved using a single medication, but some children
with cerebral palsy have particularly difficult-to-control seizures. Medication can have side
effects affecting the brain, ranging from sedation to hyperactivity. They can also affect liver
function, white and red blood cells, and bone metabolism. Side effects are usually not harmful
and resolve when the offending medication is discontinued. The goal of the treating physician
should be for the child to become seizure free with few or no side effects. It must be noted that it
is of no benefit to the child to be seizure-free but significantly impaired by medication side
effects.
Medications for spasticity: The treatment of spasticity can involve multiple health
professionals. Treatments involve the use of medications and surgical procedures to decrease the
spasticity, facilitate movement, and prevent contractions. Among the most common medications
are dantrolene sodium (Dantrium) and diazepam (Valium). Diazepam is both a muscle relaxant
and a sedative. Baclofen (Lioresal) can be taken by mouth or infused continuously with an
implanted pump (intrathecal infusion) directly in the cerebrospinal fluid (the liquid that bathe the
spinal cord and the brain). This treatment might be specifically useful for patients with spasticity
in the lower legs. The most common complications with these medications are drowsiness,
sleepiness, and some degree of weakness. The sedative side effects of such medications often
limit their usefulness. In the case of the baclofen pump the most common complication seen in a
small number of patients is the infection of the catheter. Additionally, a muscle relaxing agent
called botulinum toxin can be injected into tight muscles to relax them. When used prudently,
this procedure may prevent surgical intervention.
Surgery
Surgery for spasticity: In the case of severe muscle spasticity, surgery may be a valuable
option. Tendon release procedures, usually performed by an orthopedic surgeon, allow improved
range of motion in some cases. Such procedures are usually performed on the muscles of the calf
or inner thigh. A less commonly used procedure, is the dorsal rhizotomy. During this operation,
the surgeon cuts some of the nerve roots that send sensory information from the muscles to the
spinal cord and brain. This procedure relieves some of the spasticity and thereby helps the child
walk with a more normal gait. Most neurosurgeons performing dorsal rhizotomies very carefully
select only those patients whom they feel may be helped by the surgery. From time to time, other
surgical interventions are required in children with cerebral palsy. In very rare cases of
choreoathetoid cerebral palsy, in which the writhing movements severely limit the ability of the
child to function, highly selective neurosurgical techniques can curtail these movements without
significantly harming other functions.
Other surgical procedures
Ophthalmologists (eye specialists) can help strabismus by operating on the muscles that control
the movement of the eye or to correct some other complications such as cataracts.
Neurosurgeons can treat intractable seizure control. Operations such as callosotomy,
hemispherectomy, and focal resections of areas of abnormal brain tissue responsible for the
seizures, might be indicated in some cases. An alternative procedure for the treatment of epilepsy
is the vagal nerve stimulation, an implantable device, that can be useful in selected patients with
difficult to control seizures.
Scoliosis, or curvature of the spine, is often the result of severe hypotonia. This condition can
create discomfort for the patient and difficulty for caregivers in performing the activities of daily

living. Furthermore, severe scoliosis may actually restrict a patient's ability to breathe. Several
surgical procedures are available in specialized centers for the correction of scoliosis.
Children who are unable to take adequate calories by mouth may require the placement of a
feeding gastrostomy tube (PEG tubes) directly into the stomach.
Therapy
The treatment of spasticity can involve multiple allied health care professionals. Physical and
occupational therapists play an important role.
Physical therapy: The extent of physical therapy depends on the degree of spasticity, hypotonia,
and motor impairment. The main therapeutic effect of physical therapy is maintaining range of
motion at the joints, thereby preventing contractures. Some scientists and therapists feel that
physical therapy actually helps maintain the connections in the brain, although this is
controversial. Other skills, such as improved gait, stance, and balance can be helped by physical
therapy. A strong, proactive physical therapy program greatly aids in the life of a child with
cerebral palsy.
Occupational therapy: Occupational therapy assists children with the skills needed for day-today life in school and at home, including eating, writing, and work skills. In early infancy,
occupational therapists can provide assistance in feeding a child with a poor or uncoordinated
sucking response.
Speech therapy: Speech and language pathologists are involved with the development and
improvement of speech production. Using different techniques the speech pathologist helps to
improve the quality and the quantity of the speech production. The role of these specialists is not
limited to speech production alone, but they also teach the patients other communication
techniques (sign language, use of communication boards) to facilitate the communication
abilities.
Medical care
Medical care of children with cerebral palsy is often seriously hampered by the inability of the
child to communicate his or her needs and sensations. Relatively common childhood illnesses in
children with cerebral palsy, such as ear infections, urinary tract infections, and appendicitis,
which are easily treatable in most children, may prove to be life-threatening due to delayed
recognition on the part of caregivers and physicians. Each child with cerebral palsy should have
a primary care professional that is experienced with the special medical needs of affected
children.
Because physicians have offered limited hope in curing cerebral palsy, many families have
turned to alternative methods in the treatment of their children. Such therapies may include diets,
herbal remedies, aromas, play with animals, and hyperbaric oxygen. The scientific evidence
supporting the use of diets is inadequate. Some of them such as hyperbaric oxygen therapy,
which is delivered in specialized centers, can be quite expensive and has not been scientifically
proven to help children with cerebral palsy. Other remedies must be investigated on a case-bycase basis. Hopefully, the family of the affected child will be able to approach their physician
regarding these alternative treatments.

4. Comorbidity
Muscle weakness, muscle spasticity and coordination problems can contribute to a number of
complications either during childhood or later during adulthood, including:

Contracture. Contracture is the shortening of muscle tissue due to severe tightening of the
muscle (spasticity). Contracture can inhibit bone growth, cause bones to bend, and result in
joint deformities, dislocation or partial dislocation.

Malnutrition. Swallowing or feeding problems can make it difficult for someone who has
cerebral palsy, particularly an infant, to get enough nutrition. This may cause impaired
growth and weaker bones. Your child may need a feeding tube for adequate nutrition.

Mental health conditions. People with cerebral palsy may have mental health (psychiatric)
conditions, such as depression. Social isolation and the challenges of coping with disabilities
can contribute to depression.

Lung disease. People with cerebral palsy may develop lung disease and breathing disorders.

Neurological conditions. People with cerebral palsy may be more likely to develop
movement disorders or worsened neurological symptoms over time.

Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity


may result in the early development of painful degenerative bone disease (osteoarthritis).

Other conditions that may be comorbid with Cerebral Palsy include: deformities
of the limbs, epilepsy, obesity and autism.

5. Support Groups/How you can support


Support groups fill an important role in the lives of both an individual with cerebral palsy and
their families. Many people find that sharing experiences with others in the comfort of an
organized group to be especially important as they tackle issues unique to cerebral palsy. Below
is an assemblage of cerebral palsy support groups that provide both in-person meetings as well as
on-line support.
http://www.cerebral-palsy-faq.org/resources/support-groups/

https://groups.yahoo.com/neo/groups/ParentsofSeverelyDisabledKids/info

http://www.cpparentcolumbus.org/

http://www.classcommunity.org/

http://ucp.org/

Recommended Teaching Methods for Students With CP


http://www.sess.ie/resources
When deciding that a student with CP would have their interests best served in a mainstream
classroom environment, teachers, parents, and therapists should develop an Individualized

Educational Plan (IEP). The IEP should detail information on the child's diagnosis and the degree
to which the child is affected by the condition. This includes listing the child's present level of
performance in the various subject areas. These performance levels should describe in detail
what the child is able to accomplish and what their current skill levels are. In any of the areas in
which the child is functioning below age level, goals and objectives should be written to address
the areas of weakness.
The IEP should also include a list of services and accommodations that the school district will
provide. Teaching children with cerebral palsy is often an unfamiliar circumstance for a regular
education instructor, but with assistance from therapeutic programs and access to modifications
in the classroom, students with CP can thrive in a general setting alongside their non-disabled
peers.
It is important for children with CP to have an educational program that is conducive for
learning. When setting up a learning program, teachers should consider the childs capabilities as
well as limitations, and keep in mind that unrealistic expectations can be frustrating for the child
as well as the parents. Patience is a key factor when working with children with CP, as studies
have shown that these students take longer to respond than their neurotypical peers.
It is important for students with CP to assume a variety of positions throughout the school day in
order to prevent tightening of muscles. Equipment needs are extremely important, as proper
positioning can facilitate eye-hand coordination and improved motor control. Most importantly,
teachers should maintain open communication with the childs family in order to encourage
carry-over regarding home programs and recommendations.

6. Community Resources
Several community resources in Arizona can be found here:
http://cerebralpalsyresources.com/arizona

http://www.nau.edu/ihd/aztap

http://www.raisingspecialkids.org

http://www.familyinvolvementcenter.org

RESOURCES:
http://www.cdc.gov/ncbddd/cp/articles.html
http://www.medicalnewstoday.com/articles/152712.php
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051278/
http://www.medicinenet.com/cerebral_palsy/page10.htm
http://cerebralpalsy.org/about-cerebral-palsy/associative-conditions/

Bipolar Disorder:
1. Definition:
Bipolar Disorder falls under the IDEA category of Emotional Disturbance, which is
defined as: a condition exhibiting one or more of the following characteristics over a long
period of time and to a marked degree that adversely affects a childs educational performance:
(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.
(B) An inability to build or maintain satisfactory interpersonal relationships with peers and
teachers.
(C) Inappropriate types of behavior or feelings under normal circumstances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symptoms or fears associated with personal or school
problems.
Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistical Manual
of Mental Disorders (DSM). To be diagnosed with bipolar disorder, the symptoms must be a
major change from your normal mood or behavior. There are four basic types of bipolar disorder:
1. Bipolar I Disorderdefined by manic or mixed episodes that last at least seven days, or
by manic symptoms that are so severe that the person needs immediate hospital care.
Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
2. Bipolar II Disorderdefined by a pattern of depressive episodes and hypomanic
episodes, but no full-blown manic or mixed episodes.
3. Bipolar Disorder Not Otherwise Specified (BP-NOS)diagnosed when symptoms of
the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the
symptoms are clearly out of the person's normal range of behavior.
4. Cyclothymic Disorder, or Cyclothymiaa mild form of bipolar disorder. People with
cyclothymia have episodes of hypomania as well as mild depression for at least 2 years.
However, the symptoms do not meet the diagnostic requirements for any other type of
bipolar disorder.

A severe form of the disorder is called Rapid-cycling Bipolar Disorder. Rapid cycling occurs
when a person has four or more episodes of major depression, mania, hypomania, or mixed
states, all within a year. Rapid cycling seems to be more common in people who have their first
bipolar episode at a younger age. One study found that people with rapid cycling had their first
episode about 4 years earlierduring the mid to late teen yearsthan people without rapid
cycling bipolar disorder. Rapid cycling affects more women than men. Rapid cycling can come
and go.
When getting a diagnosis, a doctor or health care provider should conduct a physical
examination, an interview, and lab tests. Currently, bipolar disorder cannot be identified through
a blood test or a brain scan, but these tests can help rule out other factors that may contribute to
mood problems, such as a stroke, brain tumor, or thyroid condition. If the problems are not
caused by other illnesses, your health care provider may conduct a mental health evaluation or
provide a referral to a trained mental health professional, such as a psychiatrist, who is
experienced in diagnosing and treating bipolar disorder.

2. Articles
http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
http://www.parentcenterhub.org/repository/emotionaldisturbance/#bipolar
http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/definition/con-20027544
http://www.bpchildresearch.org/edu_forums/issues.html
http://ibpf.org/article/accommodations-students-bipolar-disorder-and-related-disabilities
Fact sheets in English:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Key
word.aspx
Fact sheets in Spanish:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Spa
nish.aspx
Fact sheets in other languages | Including Chinese, Malaysian, Polish, Icelandic, Arabic, Urdu
and Hebrew.
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Home.aspx

3. Treatment:
Bipolar disorder cannot be cured, however for most people with bipolar disorder, mood
swings and related symptoms can be stabilized over time using an approach that combines
medication and psychosocial treatment. Medications that be prescribed for children with bipolar
disorder include: mood stabilizers such as lithium, anti-convulsants (used as mood stabilizers)
such as Depakote, atypical antipsychotics (Abilify, Seroquel), and antidepressants. In addition to
medications, psychotherapy may be used to treat bipolar disorder. Some psychotherapy
treatments that may be used to treat bipolar disorder include:
Cognitive behavioral therapy (CBT), which helps people with bipolar disorder learn to
change harmful or negative thought patterns and behaviors.
Family-focused therapy, which involves family members. It helps enhance family coping
strategies, such as recognizing new episodes early and helping their loved one. This therapy
also improves communication among family members, as well as problem-solving.
Interpersonal and social rhythm therapy, which helps people with bipolar disorder improve
their relationships with others and manage their daily routines. Regular daily routines and sleep
schedules may help protect against manic episodes.
Psychoeducation, which teaches people with bipolar disorder about the illness and its
treatment. Psychoeducation can help you recognize signs of an impending mood swing so you
can seek treatment early, before a full-blown episode occurs. Usually done in a group,
psychoeducation may also be helpful for family members and caregivers.

4. Comorbidity:
People with bipolar disorder are also often diagnosed with ADHD, sleep disorders, anxiety
disorders, post-traumatic stress disorder (PTSD), addiction or substance abuse, and physical
health problems such as thyroid disorders or obesity.

5. Support Groups/How you can support:


Students with bipolar disorder may require additional supports and accommodations in school.
Examples of modifications and accommodation include:
increased access to water, unlimited access to restrooms (particularly students taking Lithium)

decreased reading assignments or having books on tape or computer screen-reading due to


blurred vision
modified school arrival, shortened day, scheduling of core content during the students most
alert time, reducing homework and extending deadlines, providing notes, allowing longer or
more frequent breaks, allowing exercise or other movement due to sleep impairment or to
sedation of medications
provision of notes and listening guides, work monitoring, extended time on assignments, extra
set of books for home use, breaking assignments into more manageable pieces, use of
checklists, providing written instructions and/or other visual cues, use of word banks on fill-in
types of tests and other modifications that aid retrieval/memory, testing in a separate room, or
extended test time, use of multiple choice formats, use of oral exams rather than written
demands, use of noise-canceling headsets, - all for impaired concentration, memory
reducing or discontinuing homework may be necessary for some students due to difficulties
with concentration, sleep patterns, mood irritability. For these students it may be necessary to
schedule a resource room period at the beginning of the day to get assignments ready for the
day, or at the end of the day to complete assignments before leaving school
preferential seating can be used to help with vision, focus, reduce visual or auditory distraction,
allow for discrete monitoring
Support groups in Arizona include:

6. Community Resources:
Mental Health America | 1.800.969.6642
http://www.mentalhealthamerica.net/find-affiliate
NAMI | National Alliance on Mental Illness | 1.800.950.NAMI
http://www.nami.org/template.cfm?section=Your_Local_Nami
National Mental Health Consumers Self-Help Clearinghouse
1.800.553.4539 | http://www.cdsdirectory.org/

http://ibpf.org/article/how-find-good-therapist

Down Syndrome:
1. Definition:
Down syndrome is a set of physical and mental traits caused by a genetic malfunction that
happens before birth. Children who have Down syndrome tend to have certain features, such as a
flat face and a short neck. They also have some degree of intellectual disability. This varies from
person to person. Down syndrome is caused by a problem with a baby's chromosomes. Normally,
a person has 46 chromosomes. But most people with Down syndrome have 47 chromosomes. In
rare cases, other chromosome problems cause Down syndrome. Having extra or abnormal
chromosomes changes the way the brain and body develop.
Most children with Down syndrome have:

Distinctive facial features, such as a flat face, small ears, slanting eyes, and a
small mouth.

A short neck and short arms and legs.

Low muscle tone and loose joints. Muscle tone usually improves by late childhood.

Below-average intelligence.

Many children with Down syndrome are also born with heart, intestine, ear, or breathing
problems. These health conditions often lead to other problems, such as airway (respiratory)
infections or hearing loss.

2. Articles and Additional Information:


http://www.medicinenet.com/down_syndrome_overview/article.htm#what_is_down_syndrome
http://www.ndss.org/Down-Syndrome/What-Is-Down-Syndrome/
http://ghr.nlm.nih.gov/condition/down-syndrome
http://www.marchofdimes.org/baby/down-syndrome.aspx
http://kidshealth.org/parent/medical/genetic/down_syndrome.html#
http://www.webmd.com/children/tc/down-syndrome-topic-overview

3. Treatment:
While Down syndrome is not curable, providing support and treatment for a patient with Down
syndrome is meant to improve their quality of life. Infants with Down syndrome may experience
developmental delays including time to sit, crawl, walk, and talk so parents need to know that
developmental delays are common in children with Down syndrome. Using a team approach to
care, physical therapists, occupational therapists, and speech therapists may help improve
language, motor, and social skills to the maximum achievable by the individual person. Medical
conditions associated with Down syndrome, including those affecting the heart or the
gastrointestinal system, may require evaluation and care, sometimes requiring surgery.

4. Comorbidity:

The outlook for individuals with Down syndrome is brighter than it once was. Most of the health
problems associated with Down syndrome can be treated, and life expectancy is now about 60
years (2). Individuals with Down syndrome are more likely than unaffected individuals to have
one or more of the following health conditions:
Heart defects: Almost half of babies with Down syndrome have heart defects. Some defects are
minor and may be treated with medications, while others require surgery. All babies with
Down syndrome should be examined by a pediatric cardiologist, a doctor who specializes in
heart diseases of children. They also should have an echocardiogram, a special ultrasound of
the heart, in the first 2 months of life so that heart defects can be detected and treated, if
needed.
Intestinal defects: About 12 percent of babies with Down syndrome are born with intestinal
malformations that require surgery.
Vision problems: More than 60 percent of children with Down syndrome have vision
problems, including crossed eyes (esotropia), near- or far-sightedness and cataracts. Glasses,
surgery or other treatments usually can improve vision. A child with Down syndrome should
be examined by a pediatric ophthalmologist (eye doctor) within the first 6 months of life and
have regular vision exams.
Hearing loss: About 75 percent of children with Down syndrome have some hearing loss
(3). Hearing loss may be due to fluid in the middle ear (which may be temporary) and/or
defects involving the middle or inner ear. Babies with Down syndrome should be screened for
hearing loss at birth and again during the first months of life. They also should have regular
hearing exams so any problems can be treated before they hinder development of language and
other skills.
Infections: Children with Down syndrome tend to have many colds and ear infections, as well
as bronchitis and pneumonia. Children with Down syndrome should receive all the standard
childhood immunizations, which help prevent some of these infections.
Thyroid problems: About 1 percent of babies with Down syndrome are born with congenital
hypothyroidism, a thyroid hormone deficiency that can affect growth and brain development.
Congenital hypothyroidism can be detected with routine newborn screening tests and treated
with oral doses of thyroid hormone. Children with Down syndrome also are at increased risk of
acquiring thyroid problems; they should be tested yearly.

Leukemia: Fewer than 1 in 100 children with Down syndrome develop leukemia (a blood
cancer). Affected children often can be successfully treated with chemotherapy.
Memory loss: Individuals with Down syndrome are more likely than unaffected individuals to
develop Alzheimers disease, which is characterized by progressive memory loss, personality
changes and other problems. Adults with Down syndrome tend to develop Alzheimers disease
at an earlier age than unaffected individuals. Studies suggest that about 25 percent of adults
with Down syndrome over age 35 have symptoms of Alzheimers disease.
Some individuals with Down syndrome may have a number of these problems, while others may
have none. The severity of these conditions varies greatly.

5. Support Groups/How you can support:


The National Down Syndrome Society has links to local support groups on their website:
http://www.ndss.org/Resources/Local-Support/
The Center for Parent Information and Resources has a great list of ways parents and educators
can support students with Down syndrome here:
http://www.parentcenterhub.org/repository/downsyndrome/#education

6. Community Resources:
42 Top Resources for Down Syndrome
http://downsyndromeinfo.org/resources/parents/
http://www.globaldownsyndrome.org/about-down-syndrome/resources/local-organizations/
http://www.parents.com/health/down-syndrome/down-syndrome-resources/

Section 4 of Title 15
Article 4.1
Gifted Education for Gifted Children
15-779 15-779.01 15-779.02 15-779.03 15-779.04
Definitions
Powers and duties of the school district governing board Gifted pupils; scope and
sequence; annual financial report Additional assistance for gifted programs
Powers and duties of the superintendent of public instruction
15-779. Definitions
In this article, unless the context otherwise requires:
1. "Gifted education" means appropriate academic course offerings and services that are
required to provide an educational program that is an integral part of the regular school
day and that is commensurate with the academic abilities and potential of a gifted pupil.
2. "Gifted pupil" means a child who is of lawful school age, who due to superior intellect
or advanced learning ability, or both, is not afforded an opportunity for otherwise
attainable progress and development in regular classroom instruction and who needs
appropriate gifted education services, to achieve at levels commensurate with the child's
intellect and ability.
15-779.01. Powers and duties of the school district governing board
A. Because it is in the public interest to support unique opportunities for high-achieving
and underachieving pupils who are identified as gifted, the governing board of each
school district shall provide gifted education to gifted pupils identified as provided in this
article.

B. The governing board shall modify the course of study and adapt teaching methods,
materials and techniques to provide educationally for those pupils who are gifted and
possess superior intellect or advanced learning ability, or both, but may have an
educational disadvantage resulting from a disability or a difficulty in writing, speaking or
understanding the English language due to an environmental background in which a
language other than English is primarily or exclusively spoken. Identification of gifted
pupils as provided in this subsection shall be based on tests or subtests that are
demonstrated to be effective with special populations including those with a disability or
difficulty with the English language.
C. If a pupil who was previously identified as a gifted pupil by a school district or charter
school transfers into another school district, the school district into which the pupil
transferred shall determine in a timely manner whether the pupil shall be identified as a
gifted pupil in that school district. The school district into which the pupil transferred
shall provide gifted education to transfer pupils who are identified as gifted without
unreasonable delay.
15-779.02. Gifted pupils; scope and sequence; annual financial report
A. The governing board of each school district shall develop a scope and sequence for the
identification process of and curriculum modifications for gifted pupils to ensure that
gifted pupils receive gifted education commensurate with their academic abilities and
potentials. Programs and services for gifted pupils shall be provided as an integrated,
differentiated learning experience during the regular school day. The scope and the
sequence shall:
1. Provide for routine screening for gifted pupils using one or more tests adopted by the
state board as prescribed in section 15-203, subsection A, paragraph 15 and section 15779.01. School districts may identify any number of pupils as gifted but shall identify as
gifted at least those pupils who score at or above the ninety-seventh percentile, based on
national norms, on a test adopted by the state board of education.
2. Include an explanation of how gifted education for gifted pupils differs from regular
education in such areas as:
(a) Content, including a broad based interdisciplinary curriculum.
(b) Process, including higher level thinking skills.
(c) Product, including variety and complexity. (d) Learning environment, including
flexibility.
3. Include criteria, which shall be reviewed by the state board of education and the
department of education at least once every four years, that address the elements of
program design, identification, curriculum, instruction, social development, emotional
development, professional development of administrators, teachers, school psychologists
and counselors, parent involvement, community involvement, program assessment and
budgeting. The budget information shall include separate data on identification and
program costs and any other data required by the superintendent of public instruction to
administer and evaluate the program effectively.

B. The governing board shall submit the scope and the sequence to the department of
education for approval on or before July 1 if any changes were made during the previous
fiscal year. The governing board shall submit the scope and the sequence to the
department of education for approval on or before July 1 every five years if no changes
were made during the previous five years. All school districts shall provide to gifted
pupils gifted education commensurate with their academic abilities and potentials.
C. If the governing board fails to submit the scope and sequence for gifted pupils as
prescribed in subsection B of this section or if the scope and sequence submitted by the
governing board fails to receive full approval by the superintendent of public instruction,
the school district is not eligible to receive state aid for the group A weight for seven per
cent of the student count and shall compute the weighted student count for pupils in
group A as provided in section 15-943 by adjustment of the student count accordingly. On
or before December 1 of each year, the department of education shall notify those school
districts that appear to be in noncompliance and note the specific areas of deficiencies
that must be corrected on or before April 1 of the following year to be eligible to use the
actual student count rather than an adjusted student count. On or before April 15 of each
year, the department shall notify those districts that must use an adjusted student count
for the next fiscal year's state aid as provided in chapter 9 of this title.
D. The annual financial report of a school district as prescribed in section 15-904 shall
include the amount of monies spent on programs for gifted pupils and the number of
pupils enrolled in programs or receiving services by grade level.
15-779.03. Additional assistance for gifted programs
A. School districts that comply with section 15-779.01 and that submit evidence that all
district teachers who have primary responsibility for teaching gifted pupils have obtained
or are working toward obtaining the appropriate certification endorsement as required by
the state board of education may apply to the department of education for additional
funding for gifted programs equal to seventy- five dollars per pupil for four per cent of
the district's student count, or two thousand dollars, whichever is more. As an alternate to
the individual district application process, a governing board may request that a county
school superintendent apply on its behalf as part of an educational consortium. The
consortium may include school districts in more than one county. If additional monies are
available after funding all eligible school districts or educational consortia, the additional
monies shall be used to increase the per pupil amount for each district or educational
consortium funded. If sufficient monies are not available to meet all requests, the state
board of education shall determine the allocation of monies based on the
comprehensiveness across grade levels, appropriateness to the population being served,
utility and demonstrated effectiveness of the scope and sequence and the likelihood of the
school district's or educational consortium's proposed program successfully meeting the
needs of the gifted pupils. A school district shall include the monies it receives for gifted
programs and services under this section in the special projects section of the budget.
B. School districts shall conduct evaluation studies of their programs for the gifted and
submit information to the department of education regarding the results of their studies.

The department shall develop evaluation guidelines, reporting forms, procedures and
timelines.
C. Monies distributed pursuant to this section shall supplement and not supplant monies
from other sources.
15-779.04. Powers and duties of the superintendent of public instruction
The superintendent of public instruction shall:
1. Apportion monies to each school district for which an application to offer programs for
gifted pupils has been approved by the department of education pursuant to rules adopted
by the state board of education.
2. On request, assist school district governing boards to design, implement and evaluate
programs for gifted pupils.
3. Ensure that the expenditure of monies authorized for programs for gifted pupils is
consistent with this article.
4. Encourage the development of locally designed, innovative programs for gifted pupils.
5. Assist school districts in the development and implementation of staff development
programs for administrators, teachers and counselors related to gifted pupils.
6. Encourage the development of procedures that assure the ongoing participation of
parents of gifted pupils in the planning and evaluation of gifted education programs and
services.

Section 504 of ADA


Section 504 states that "no qualified individual with a disability in the United States shall be
excluded from, denied the benefits of, or be subjected to discrimination under" any program or
activity that either receives Federal financial assistance or is conducted by any Executive agency
or the United States Postal Service.
Each Federal agency has its own set of section 504 regulations that apply to its own programs.
Agencies that provide Federal financial assistance also have section 504 regulations covering
entities that receive Federal aid. Requirements common to these regulations include reasonable
accommodation for employees with disabilities; program accessibility; effective communication
with people who have hearing or vision disabilities; and accessible new construction and
alterations. Each agency is responsible for enforcing its own regulations. Section 504 may also
be enforced through private lawsuits. It is not necessary to file a complaint with a Federal agency
or to receive a "right-to-sue" letter before going to court.
For information on how to file 504 complaints with the appropriate agency, contact:
U.S. Department of Justice
Civil Rights Division
950 Pennsylvania Avenue, N.W.
Disability Rights Section - NYAV
Washington, D.C. 20530
www.ada.gov
(800) 514-0301 (voice) (800) 514-0383 (TTY)

IDEA
Subpart AGeneral (http://www.parentcenterhub.org/repository/partb-subparta/)
Purposes and Applicability
300.1 Purposes.
The purposes of this part are
(a) To ensure that all children with disabilities have available to them a free appropriate public
education that emphasizes special education and related services designed to meet their unique
needs and prepare them for further education, employment, and independent living;
(b) To ensure that the rights of children with disabilities and their parents are protected;
(c) To assist States, localities, educational service agencies, and Federal agencies to provide for
the education of all children with disabilities; and
(d) To assess and ensure the effectiveness of efforts to educate children with disabilities.
(Authority: 20 U.S.C. 1400(d))
300.5 Assistive technology device.
Assistive technology device means any item, piece of equipment, or product system, whether
acquired commercially off the shelf, modified, or customized, that is used to increase, maintain,
or improve the functional capabilities of a child with a disability. The term does not include a
medical device that is surgically implanted, or the replacement of such device.
(Authority: 20 U.S.C. 1401(1))
300.6 Assistive technology service.
Assistive technology service means any service that directly assists a child with a disability in
the selection, acquisition, or use of an assistive technology device. The term includes
(a) The evaluation of the needs of a child with a disability, including a functional evaluation of
the child in the childs customary environment;
(b) Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices
by children with disabilities;
(c) Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or
replacing assistive technology devices;
(d) Coordinating and using other therapies, interventions, or services with assistive technology
devices, such as those associated with existing education and rehabilitation plans and programs;
(e) Training or technical assistance for a child with a disability or, if appropriate, that childs
family; and
(f) Training or technical assistance for professionals (including individuals providing education
or rehabilitation services), employers, or other individuals who provide services to, employ, or
are otherwise substantially involved in the major life functions of that child.
(Authority: 20 U.S.C. 1401(2))

300.8 Child with a disability.


(a) General. (1) Child with a disability means a child evaluated in accordance with 300.304
through 300.311 as having intellectual disability**, a hearing impairment (including deafness), a
speech or language impairment, a visual impairment (including blindness), a serious emotional
disturbance (referred to in this part as emotional disturbance), an orthopedic impairment,
autism, traumatic brain injury, an other health impairment, a specific learning disability, deafblindness, or multiple disabilities, and who, by reason thereof, needs special education and
related services.
(2)(i) Subject to paragraph (a)(2)(ii) of this section, if it is determined, through an appropriate
evaluation under 300.304 through 300.311, that a child has one of the disabilities identified in
paragraph (a)(1) of this section, but only needs a related service and not special education, the
child is not a child with a disability under this part.
(ii) If, consistent with 300.39(a)(2), the related service required by the child is considered
special education rather than a related service under State standards, the child would be
determined to be a child with a disability under paragraph (a)(1) of this section.
(b) Children aged three through nine experiencing developmental delays. Child with a
disability for children aged three through nine (or any subset of that age range, including ages
three through five), may, subject to the conditions described in 300.111(b), include a child
(1) Who is experiencing developmental delays, as defined by the State and as measured by
appropriate diagnostic instruments and procedures, in one or more of the following areas:
Physical development, cognitive development, communication development, social or emotional
development, or adaptive development; and
(2) Who, by reason thereof, needs special education and related services.
(c) Definitions of disability terms. The terms used in this definition of a child with a disability
are defined as follows:
(1)(i) Autism means a developmental disability significantly affecting verbal and nonverbal
communication and social interaction, generally evident before age three, that adversely affects a
childs educational performance. Other characteristics often associated with autism are
engagement in repetitive activities and stereotyped movements, resistance to environmental
change or change in daily routines, and unusual responses to sensory experiences.
(ii) Autism does not apply if a childs educational performance is adversely affected primarily
because the child has an emotional disturbance, as defined in paragraph (c)(4) of this section.
(iii) A child who manifests the characteristics of autism after age three could be identified as
having autism if the criteria in paragraph (c)(1)(i) of this section are satisfied.
(2) Deaf-blindness means concomitant hearing and visual impairments, the combination of
which causes such severe communication and other developmental and educational needs that
they cannot be accommodated in special education programs solely for children with deafness or
children with blindness.
(3) Deafness means a hearing impairment that is so severe that the child is impaired in
processing linguistic information through hearing, with or without amplification, that adversely
affects a childs educational performance.

(4)(i) Emotional disturbance means a condition exhibiting one or more of the following
characteristics over a long period of time and to a marked degree that adversely affects a childs
educational performance:
(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.
(B) An inability to build or maintain satisfactory interpersonal relationships with peers and
teachers.
(C) Inappropriate types of behavior or feelings under normal circumstances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symptoms or fears associated with personal or school
problems.
(ii) Emotional disturbance includes schizophrenia. The term does not apply to children who are
socially maladjusted, unless it is determined that they have an emotional disturbance under
paragraph (c)(4)(i) of this section.
(5) Hearing impairment means an impairment in hearing, whether permanent or fluctuating, that
adversely affects a childs educational performance but that is not included under the definition
of deafness in this section.
(6) Intellectual disability ** means significantly subaverage general intellectual functioning,
existing concurrently with deficits in adaptive behavior and manifested during the developmental
period, that adversely affects a childs educational performance.
(7) Multiple disabilities means concomitant impairments (such as intellectual disabilityblindness or intellectual disability-orthopedic impairment), the combination of which causes
such severe educational needs that they cannot be accommodated in special education programs
solely for one of the impairments. Multiple disabilities does not include deaf-blindness.
(8) Orthopedic impairment means a severe orthopedic impairment that adversely affects a
childs educational performance. The term includes impairments caused by a congenital anomaly,
impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from
other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).
(9) Other health impairment means having limited strength, vitality, or alertness, including a
heightened alertness to environmental stimuli, that results in limited alertness with respect to the
educational environment, that
(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or
attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead
poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and
(ii) Adversely affects a childs educational performance.
(10) Specific learning disability (i) General. Specific learning disability means a disorder in
one or more of the basic psychological processes involved in understanding or in using language,
spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read,
write, spell, or to do mathematical calculations, including conditions such as perceptual
disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.
(ii) Disorders not included. Specific learning disability does not include learning problems that
are primarily the result of visual, hearing, or motor disabilities, of intellectual disability, of
emotional disturbance, or of environmental, cultural, or economic disadvantage.

(11) Speech or language impairment means a communication disorder, such as stuttering,


impaired articulation, a language impairment, or a voice impairment, that adversely affects a
childs educational performance.
(12) Traumatic brain injury means an acquired injury to the brain caused by an external
physical force, resulting in total or partial functional disability or psychosocial impairment, or
both, that adversely affects a childs educational performance. Traumatic brain injury applies to
open or closed head injuries resulting in impairments in one or more areas, such as cognition;
language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory,
perceptual, and motor abilities; psychosocial behavior; physical functions; information
processing; and speech. Traumatic brain injury does not apply to brain injuries that are
congenital or degenerative, or to brain injuries induced by birth trauma.
(13) Visual impairment including blindness means an impairment in vision that, even with
correction, adversely affects a childs educational performance. The term includes both partial
sight and blindness
300.34 Related services.
(a) General. Related services means transportation and such developmental, corrective, and
other supportive services as are required to assist a child with a disability to benefit from special
education, and includes speech-language pathology and audiology services, interpreting services,
psychological services, physical and occupational therapy, recreation, including therapeutic
recreation, early identification and assessment of disabilities in children, counseling services,
including rehabilitation counseling, orientation and mobility services, and medical services for
diagnostic or evaluation purposes. Related services also include school health services and
school nurse services, social work services in schools, and parent counseling and training.
(b) Exception; services that apply to children with surgically implanted devices, including
cochlear implants.
(1) Related services do not include a medical device that is surgically implanted, the optimization
of that devices functioning (e.g., mapping), maintenance of that device, or the replacement of
that device.
(2) Nothing in paragraph (b)(1) of this section
(i) Limits the right of a child with a surgically implanted device (e.g., cochlear implant) to
receive related services (as listed in paragraph (a) of this section) that are determined by the IEP
Team to be necessary for the child to receive FAPE.
(ii) Limits the responsibility of a public agency to appropriately monitor and maintain medical
devices that are needed to maintain the health and safety of the child, including breathing,
nutrition, or operation of other bodily functions, while the child is transported to and from school
or is at school; or
(iii) Prevents the routine checking of an external component of a surgically implanted device to
make sure it is functioning properly, as required in 300.113(b).
(c) Individual related services terms defined. The terms used in this definition are defined as
follows:
(1) Audiology includes
(i) Identification of children with hearing loss;

(ii) Determination of the range, nature, and degree of hearing loss, including referral for medical
or other professional attention for the habilitation of hearing;
(iii) Provision of habilitative activities, such as language habilitation, auditory training, speech
reading (lip-reading), hearing evaluation, and speech conservation;
(iv) Creation and administration of programs for prevention of hearing loss;
(v) Counseling and guidance of children, parents, and teachers regarding hearing loss; and
(vi) Determination of childrens needs for group and individual amplification, selecting and
fitting an appropriate aid, and evaluating the effectiveness of amplification.
(2) Counseling services means services provided by qualified social workers, psychologists,
guidance counselors, or other qualified personnel.
(3) Early identification and assessment of disabilities in children means the implementation of
a formal plan for identifying a disability as early as possible in a childs life.
(4)Interpreting services includes
(i) The following, when used with respect to children who are deaf or hard of hearing: Oral
transliteration services, cued language transliteration services, sign language transliteration and
interpreting services, and transcription services, such as communication access real-time
translation (CART), C-Print, and TypeWell; and
(ii) Special interpreting services for children who are deaf-blind.
(5) Medical services means services provided by a licensed physician to determine a childs
medically related disability that results in the childs need for special education and related
services.
(6) Occupational therapy
(i) Means services provided by a qualified occupational therapist; and
(ii) Includes
(A) Improving, developing, or restoring functions impaired or lost through illness, injury, or
deprivation;
(B) Improving ability to perform tasks for independent functioning if functions are impaired or
lost; and
(C) Preventing, through early intervention, initial or further impairment or loss of function.
(7) Orientation and mobility services
(i) Means services provided to blind or visually impaired children by qualified personnel to
enable those students to attain systematic orientation to and safe movement within their
environments in school, home, and community; and
(ii) Includes teaching children the following, as appropriate:
(A) Spatial and environmental concepts and use of information received by the senses (such as
sound, temperature and vibrations) to establish, maintain, or regain orientation and line of travel
(e.g., using sound at a traffic light to cross the street);
(B) To use the long cane or a service animal to supplement visual travel skills or as a tool for
safely negotiating the environment for children with no available travel vision;
(C) To understand and use remaining vision and distance low vision aids; and
(D) Other concepts, techniques, and tools.
(8)(i) Parent counseling and training means assisting parents in understanding the special needs
of their child;
(ii) Providing parents with information about child development; and

(iii) Helping parents to acquire the necessary skills that will allow them to support the
implementation of their childs IEP or IFSP.
(9) Physical therapy means services provided by a qualified physical therapist.
(10) Psychological services includes
(i) Administering psychological and educational tests, and other assessment procedures;
(ii) Interpreting assessment results;
(iii) Obtaining, integrating, and interpreting information about child behavior and conditions
relating to learning;
(iv) Consulting with other staff members in planning school programs to meet the special
educational needs of children as indicated by psychological tests, interviews, direct observation,
and behavioral evaluations;
(v) Planning and managing a program of psychological services, including psychological
counseling for children and parents; and
(vi) Assisting in developing positive behavioral intervention strategies.
(11) Recreation includes
(i) Assessment of leisure function;
(ii) Therapeutic recreation services;
(iii) Recreation programs in schools and community agencies; and
(iv) Leisure education.
(12) Rehabilitation counseling services means services provided by qualified personnel in
individual or group sessions that focus specifically on career development, employment
preparation, achieving independence, and integration in the workplace and community of a
student with a disability. The term also includes vocational rehabilitation services provided to a
student with a disability by vocational rehabilitation programs funded under the Rehabilitation
Act of 1973, as amended, 29 U.S.C. 701 et seq.
(13) School health services and school nurse services means health services that are designed to
enable a child with a disability to receive FAPE as described in the childs IEP. School nurse
services are services provided by a qualified school nurse. School health services are services
that may be provided by either a qualified school nurse or other qualified person.
(14) Social work services in schools includes
(i) Preparing a social or developmental history on a child with a disability;
(ii) Group and individual counseling with the child and family;
(iii) Working in partnership with parents and others on those problems in a childs living situation
(home, school, and community) that affect the childs adjustment in school;
(iv) Mobilizing school and community resources to enable the child to learn as effectively as
possible in his or her educational program; and
(v) Assisting in developing positive behavioral intervention strategies.
(15) Speech-language pathology services includes
(i) Identification of children with speech or language impairments;
(ii) Diagnosis and appraisal of specific speech or language impairments;
(iii) Referral for medical or other professional attention necessary for the habilitation of speech
or language impairments;
(iv) Provision of speech and language services for the habilitation or prevention of
communicative impairments; and

(v) Counseling and guidance of parents, children, and teachers regarding speech and language
impairments.
(16) Transportation includes
(i) Travel to and from school and between schools;
(ii) Travel in and around school buildings; and
(iii) Specialized equipment (such as special or adapted buses, lifts, and ramps), if required to
provide special transportation for a child with a disability.
Subpart D of the Part B Regulations: Evaluations, Eligibility, IEPs, and Placement can be found
at: http://www.parentcenterhub.org/repository/partb-subpartd/

This document was made in collaboration with Kayla Marston.