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Entries in Development and Learning (30)

Wednesday
Aug112010

Executive Functions in Adopted Kids

Julia Bledsoe, MD, just did a webinar on a hot topic in development and psychology: Executive Functions, which are higher-level cognitive skills that are frequently impacted in internationally adopted children.

Julie's talk is great - she gave it at our latest Resilient Rascals conference and at the national JCICS conference. She defines executive functioning, why it's vulnerable in our population of kids, and what you can do about it! You can see the webinar after a free registration with Children's Home Society & Family services here. Her teaser for the talk:

What can improve brain function? Many children adopted internationally and domestically have learning difficulties, specifically problems with higher order learning – what we call “executive functioning”. There are now many programs that claim their systems and supplements improve executive functioning. I will review these programs and the evidence about whether or not they work.

Saturday
Mar062010

Advocating for Your Child's School Needs

At our recent adoption and foster care conference, Raising Resilient Rascals … Takes Flight, we had a panel discussion that was so full of useful tips that I couldn't resist sharing them here. Thanks so much to our panelists: Julia Bledsoe, Larry Davis (of www.specialeducationadvocacy.org), Lisa Konick-Seese, Gwen Lewis and Kate Molendijk. Some of their "pearls" follow, but first, some basics:

Getting Started

For children under three with developmental concerns, parents can (and should) call their local Early Intervention (also know as "Birth-to-3", or "ITEP") Center. You don't need a referral to start the process. They should do any necessary screening tests, and if your child falls below a certain threshold, they will qualify for subsidized developmental therapies. Increasingly, the center's therapists will meet the child at their home or child care center to provide these services. Find out more here.

For children over 3, your local school district is responsible for developmental screening and providing supports, even if your child isn't in school yet, or is home-schooled, or attends private school. In the latter cases, accessing those supports may not be easy or convenient, but it should be possible. Contact your school district's "Child Find" office to initiate this process.

IEPs and 504 Plans

If your child has a documented disability, which has an impact on your child's education, then your child should be eligible for either 504 Plan accommodations, or an Individualized Educational Plan (IEP).

Generally speaking, if tweaks to general education are deemed adequate to meet your child's needs, a 504 plan will be suggested. One drawback to 504 plans is that the school is not so accountable, oversight being at the federal level.

If your child needs more significant "specially designed instruction," then they should receive an IEP. With an IEP, the school is more accountable (oversight tighter, at the state level).

General School Tips

  • It helps to develop an ally or friendly resource at the school that seems to understand and appreciate your child. This person can be invaluable for informal mediation, advocacy, advice about next year's classroom, and so on.
  • Invite the teacher to dinner once a year. This used to be common, and some teachers still do it, in the younger grades. It gives them a more holistic sense of your child, and helps build a collaborative relationship.

Tips for IEP Meetings

  • IEP meetings, especially your first, can be very stressful for parents, and it's easy to feel powerless, unable to effectively advocate for your child. These tips should help.
  • Make sure you "check your own pulse" before the meeting starts. It's natural to feel defensive, or scared, or upset at how things have been going (or not going). You may find that you're in revved-up "mama bear" or "papa bear" mode. That's understandable, but also counter-productive. Make sure you're as calm and centered as possible, and use some of the following strategies to advocate for your child.
  • The room may be packed with professionals, but remember that you are the expert in your child.
  • Feel free to "stack the deck" in your favor at IEP meetings.
  • Bring friends, support, other caregivers, prev. teachers, consultants.
  • If you've developed an ally at school, have them there if possible.
  • Bring treats. Break bread together. It can't hurt.
  • Consider passing around a sign-in sheet (if unfamiliar folks will be there), with phone/email info for later contact.
  • School culture can be geared toward "no", especially in these budget crunch times. Build a succession of yes's about your child first, instead of starting with your requests or demands.
  • Do that by creating a sense of shared understanding, based on data if possible, about your child's unique background, weaknesses, and strengths. You and the staff should be recognizing your child in what each other has to say: "Yes, that's my child/student." Then the requests should flow more naturally and collaboratively.
  • Then again, it may take 3-4 meetings for some staff to "get it." Call followup meetings if need be (it's your right, when you have an IEP), until they do.
  • Before a school transition, have a meeting the preceding spring with a representative from the new district/school, to develop the IEP using folks that know your kid, and get a headstart on next year's plan.
  • Think carefully about closing out an IEP, even if you decline services. They can be harder to get later.

School Bureaucracy

  • School districts have strict timelines for responding to requests around evaluations and special education. Learn them, and keep track. 
  • Use email or get copy of letter stamped at school when dropped off. This starts the clock ticking.
  • Keep notes, folders for each child, or email folders, to a court-worthy standard (dated, no missing pages from notebooks, etc). Hopefully you won't end up there, but if you do ...

If Things Still Aren't Going Well

  • You may consider an independent educational evaluation (IEE), a "second opinion" about your child's abilities.
  • An educational advocate may also be useful.
  • Consider formal mediation as well.
  • Your child has the right to a "Free and Appropriate Public Education"; unfortunately, this does not equal a "Free and Perfect Public Education." We are not funding our schools as we should, and they have limited resources to meet the needs of many students. 
  • Trust your instincts about whether this school or program is working for your child (but get some second and third opinions too!). Some families decide that private, parochial, or home-schooling is a better fit for their child's needs. This, of course, can be expensive, especially with added private therapists if those are necessary.

Resources

  • WrightsLaw is an excellent resource for special education law, education law, and advocacy for children with disabilities.
  • For local info, see the WA State official special education website.
  • The WA State Office of the Education Ombudsman (OEO) "helps solve conflict and disputes between Washington families and elementary and secondary public schools so that students have every opportunity to stay in school and succeed." They are part of the Governor’s Office and function independently from the public school system.
  • Another excellent source of info in our state is Kristin Hennessey, the Special Education Ombudsman at OSPI, at (360) 725-6075 or kristin.hennessey@k12.wa.us.
Sunday
Oct092005

Screening for Autism in Toddlers

The Modified Checklist for Autism in Toddlers (M-CHAT) is "designed to screen for Autism Spectrum Disorders in toddlers (i.e., over the age of 12 months, and ideally over the age of 18 months). A parent can complete the items independently. The M-CHAT does not allow a clinician to make a diagnosis of an Autism Spectrum Disorder, but is a very useful clinical tool that has excellent sensitivity and specificity. Positive results suggest a high risk for an Autism Spectrum Disorder, and may necessitate referral."

This checklist was not designed for post-institutionalized children, and in fact, distinguishing "post-institutional autism" from "ordinary" autism can be quite challenging, and may require a period of observation. Many of the institutional features (repetitive self-stimulating/self-soothing behaviors and lack of appropriate spontaneous social interactions) do show dramatic improvement with time, in contrast to the autistic spectrum disorders.

Sunday
Oct092005

Developmental Milestones

Here are some resources to help understand the order and timing of typical developmental milestones. Remember that institutionalized children are often delayed by up to 1 month for every 3 months in that setting, that there's a wide age-range of "typical" even in family-raised children, and that it's usually more useful to focus on the sequence and tempo of developmental achievement rather than strict timing of milestones. If you do have concerns about your child's development, please share them with your child's providers, and consider an Early Intervention evaluation.

Friday
Oct072005

Tools for Assessing and Managing ADHD

The National Initiative for Children's Healthcare Quality (NICHQ) has developed a free toolkit for providers to help with standardized assessment and monitoring of ADHD (attention deficit/hyperactivity disorder) in children ages 6 and up, available from the NICHQ website.

ADHD is not a do-it-yourself-at-home sort of diagnosis, but I thought it would be helpful to make these available for completing before appointments, and there are excellent handouts here as well. You should not be filling these out if your child is less than school-age, or if you have a child who was only recently adopted in the past few months. Please bring these in to discuss with your health care provider if you have any concerns about ADHD, learning, or behavior.

Thursday
Sep012005

Parenting by Temperament

If you are raising a child aged 4 months to 5 years old, get thee to the "Preventive Ounce" website. I'll let their blurb do the talking ...

"No child is average.

Unfortunately, most parenting advice is written for the average child.

This interactive web site lets you see more clearly your child's temperament, and find parenting tactics that work for your child.

Developed by the Preventive Ounce over the past ten years, this program has been used by more than 20,000 parents in health maintenance organizations in the Western United States.

Outcome studies show that parents who use this service avoid the anxiety, frustration and guilt that comes when they can't understand why their child acts "that way". They also avoid escalations into behavioral problems, conflicts with spouses and relatives, and unnecessary doctor visits.

As a community service, we now offer this preventive program free to all parents. To start using this program, click on Image Of Your Child. You can then:

  • Complete a short, temperament questionnaire and see immediately on-line a profile of your child's temperament.
  • Learn general strategies for managing the highs or lows of your child's temperament.
  • Discover what specific behavioral issues are normal for your child's temperament.
  • See when and how often these issues are likely to occur in the next year.
  • Get information, tailored to your child's temperament, for managing each issue you are likely to encounter. See what other parents of similar children say works well, and what doesn't."

What more can I say? It works as advertised, and it's free. You'll learn where your child is on scales of Sensitivity, Movement, Reactivity, Frustration Tolerance, Adaptability, Regularity, and Soothability. Make sure you click on the scale/subscale links first to learn what these scales mean. Then check out a wealth of sound, temperament specific parenting advice on issues that your child is likely to encounter in the next year. Some of the advice is mildly out-of-date (1990s, so not that ancient, but playpens are less common these days, for example), so use your parental "sniff test" for what's right for you and your kids, as always.

Monday
Jul112005

Culture for Kids

There apparently was a day and time when a Korean adoptee in a small homogenous American hamlet could grow up with most everyone pretending they were just as all-American, assimilated, and, well, white as the rest of their adoptive family and town.

Well, it's getting harder and harder to do that these days. The good revolutionaries of Adoption Nation have taken care of that ... But now that the importance of celebrating a child's culture of origin is widely acknowledged, where oh where does one turn to find appropriate bilingual and multicultural items, especially if you don't live in a big multiculti cornucopia like Seattle?

One great adoption-friendly catalog is available from Culture for Kids, who also produce Asia for Kids. The print catalogs are easier to browse than the website, in part because they carry so many bilingual and multicultural books, videos, dolls, and toys - picture dictionaries, translated children's classics from Guess How Much I Love You to Harry Potter (in 8 different languages!), immigrant stories, factbooks, the Language Little bilingual talking dolls, and more ...

Region-specific adoptive family organizations like Families for Russian and Ukrainian Adoption (FRUA) and Families with Children from China (FCC) are also good places to turn to for ideas on raising children from other cultures, meetings of local adoptive families, local language classes, and activities like culture camps.

Thursday
Jun232005

The "Difficult" Child

Some children, whether we blame temperament, genetics, neurochemistry, prenatal exposures, and/or early childhood experiences, are just plain difficult to parent - intense, needy, easily frustrated, inflexible, inattentive, hyperactive, impulsive, and so on. Or, if you prefer to look on the bright side of life ... spirited, sensitive, perceptive, persistent, and energetic.

If you're nodding your head, read on ... there are effective ways to parent, and perhaps even embrace these traits. The good news is, kids can change - but often we need to change our understanding and approach first. A good place to start would be with one or more of these resources. But bring it up with your doc as well, and consider a specialized parenting class, family counseling, "positive behavior support", or consultation with a developmental/behavioral specialist if you find yourself out of ideas or optimism.

You and your providers may also consider diagnoses such as ADHD, RAD, SPD, ODD, OCD, FASD, and other 3- and 4-letter-words. I'm not label-happy, and agree that it's easy to get lost in this "alphabet soup", but I am a believer in early, accurate diagnosis and treatment when neurologic and mental health disorders are involved. One way to start evaluating concerns about emotions, behavior, attention, and peer difficulties is with a screening tool like the Strengths & Difficulties Questionnaire.

Transforming the Difficult Child, by Howard Glasser and Jennifer Easley, is my favorite book for parenting, and yes, transforming, older children (over 5-6yo) who are difficult to parent, including kids with ADHD. It's also a lovely, positive parenting approach for "easier" kids. If you want a sample, check their website, and I've posted the first 2 chapters on our site as well. Glasser's belief is that normal parenting and teaching methods are designed for the "average child", and that the harder normal methods are applied to difficult children, the worse the situation can get, despite the best of intentions.

I really think this approach has arrived at a simple, but essential truth about parenting ANY child - we need to reverse our typical, inadvertent pattern of paying more attention to misbehavior than to good behavior. Instead of making a big deal over negativity ("why water the weeds?"), make a big fuss over the good stuff. Their Nurtured Heart approach has 3 basic aspects:

  • Super-energizing experiences of success
  • Refusing to energize or accidentally reward negativity
  • While still providing an ideal level of limit-setting and consequences

In Glasser's words, this approach helps therapeutically shift intense children to using their intensity in wonderful ways, and creates a world of first-hand experiences of prosocial behavior: "Here you are being successful ..." This is more than "catching kids being good", it's about having powerful ways to make any moment an opportunity to create success, by finding the good in what IS happening, but also in what ISN'T happening.

Do I love this approach? Yes indeed. You're very likely to find something useful, if not transformative, in this resource. As for his take on medications, I find it to be provocative, but not as much in line with our experience. The "energy" that kids with significant ADHD or FAS have is not always a gift to be cherished, and medications can be invaluable, as part of a comprehensive plan like the Nurtured Heart approach and school accommodations. But I am increasingly recommending a dedicated trial of this approach, plus the therapeutic parenting ideas in Gabor Mate's Scattered, before prescribing medications.

Another book that folks have liked is The Difficult Child: Expanded and Revised Edition by Stanley Turecki, which focuses on nine particularly difficult temperaments: high activity level, distractibility, high intensity, irregularity, negative persistence, low sensory threshold, initial withdrawal, poor adaptability, and negative mood.

A classic in the "insert-euphemism-here" child literature is Raising Your Spirited Child: A Guide for Parents Whose Child Is More Intense, Sensitive, Perceptive, Persistent, Energetic by Mary Sheedy Kurcinka, and her Raising Your Spirited Child Workbook.

"Inflexible, intolerant, and explosive" child? Try The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children by Ross Greene.

"Challenging" child? See The Challenging Child: Understanding, Raising, and Enjoying the Five "Difficult" Types of Children, by child development guru Stanley Greenspan, for positive parenting insights into "the sensitive child, the self-absorbed child, the defiant child, the inattentive child, and the active/aggressive child".

A website that draws on a number of these books, as well as her own experience parenting and running groups, is Elaine Gibson's The Challenge of Difficult Children. Lots of good, opinionated, from-the-trenches advice to be found here.

My favorite temperament resource is the "Preventive Ounce" website, for children up to 5 years old.  Learn where your child is on scales of Sensitivity, Movement, Reactivity, Frustration Tolerance, Adaptability, Regularity, and Soothability. Then check out a wealth of sound, temperament-specific parenting advice on issues that your child is likely to encounter in the next year. A good temperament site for school-aged children is INSIGHTS, with its online temperament profile.

Finally, a brief note on The Strong-Willed Child. James Dobson and his "embrace-your-inner-bully" theories are emphatically NOT RECOMMENDED, particularly for a child who has already experienced lack of attuned caregiving, violence, or other trauma.  The man beats his pet daschund with a belt on page 3 ... this is the guy you want helping you raise your kids? There are much better Christian parenting books out there that don't involve spanking your children into submission. The research on corporal punishment is overwhelmingly against it, and no amount of "folksy take-charge wisdom" or selective Bible interpretations should convince you to hit your kids.

Thursday
Jun232005

Home Biofeedback

True confessions - both Dr Bledsoe and I have something at home called "Journey to Wild Divine". It's a home biofeedback system and "Myst-style" computer game that uses the same biofeedback technology (finger sensors measuring heart rate variability and skin conductance) that our local hospital's adolescent clinic uses to help with headaches, pain syndromes, self-regulation, and chronic stress.

We think it's an engaging and remarkably effective way to learn self-calming, better emotional control, and alertness, and have been recommending it to our older school-age patients with low frustration tolerance, poor self-regulation, ADHD, anxiety, and stress-related issues like headaches and chronic abdominal pain. The sensors measure signs of your nervous system's balance between sympathetic tone (energized, agitated, "fight-or-flight") and parasympathetic tone (calm, relaxed, "rest-and-digest"). Children who've experienced early stress and neglect tend to be chock-full of the former, with precious little of the latter. With practice, you and your kids can learn to calm yourselves much more quickly and effectively.

In the game, you move through an idyllic landscape, performing various tasks using your developing abilities to become calmer or more alert and energized. Levitating and gently lowering rocks, juggling balls, building stairways, and other nifty activities let you hone these skills until they become effortless. This game is begging for a Star Wars version, since it's really all about the Force, and Yoda would be quite at home with the game's collection of gurus ...

It's not cheap ($159), but that's about what one biofeedback clinic session would cost, and you can do it at home whenever you want. It's actually quite a good deal compared to other home biofeedback devices like HeartMath's emWavePC, handheld emWave (excellent portable device) and StressEraser, which I also like. You will need a fairly modern PC or MAC, since it uses a lot of processing and graphics power. You will also need a modicum of tolerance for SNAG's (Sensitive New Age Guys/Gals) and "what's my mantra?" mysticalisms.

I also recommend their followup game, "Wisdom Quest", which uses the same software but has 30 new biofeedback activities, which are easy to access through a new "Guided Activity Mode". You should also download a free update for their first game that enables a similar "Chapter Tour", so that you can revisit favorite activities without having to load saved games.

Another device that we have no experience with whatsoever but is appealing to my inner geek is S.M.A.R.T. Brain Games, a home neurofeedback device that uses actual brain wave sensors (instead of heart and sweat sensors) mounted in a bike helmet to help control Playstation (or Xbox) video games with your mental states. They use the ratio of beta to theta brain waves (a measure of focussed alertness and concentration) to control your speed and progress in off-the-shelf Playstation games, especially racing and jumping games.

The cost of this "brain training system"? $600 for the helmet, neurosensors, processor, and modified Playstation controller. Yowzah! But again, possibly cost-effective if you were planning on paying out-of-pocket for actual neurofeedback clinic sessions. For folks desiring neurofeedback treatment for a specific condition (like ADHD), you'd probably be best off starting, at least, with an experienced neurofeedback provider ... EEG Spectrum is a good place to start for general information and local providers.

The research on neurobiofeedback and ADHD is quite promising, if not yet definitive; see this "Play Attention!" article for a favorable take on this particular system, and The Role of Neurofeedback in the Treatment of ADHD for a review of the latest research. My opinion is that neurofeedback may well be a useful adjunct to other medical or behavioral treatments for ADHD. My hope is that it will be more broadly helpful for my patients with anxiety, dysregulation, PTSD, and perhaps even aspects of attachment difficulties. I'll keep you posted as I learn more ...

 

Tuesday
Jun212005

Language Development In Internationally Adopted Children

Initial delays in speech and language are almost universal in children adopted from institutions, with expressive language (talking) usually more delayed than nonverbal social interaction skills. Those of us who work with a lot of adopted children develop a rough sense of what are "typical" orphanage delays, but fortunately, we're also seeing some useful research data on what actually is "normal" language development in internationally adopted children.

The thing to remember (and remind your pediatrician, school district, mother-in-law, etc ...) is that this is not just an ESL or bilingual issue. Internationally adopted children from backgrounds of neglect or inadequate stimulation are usually delayed in their native language.  When they are adopted, they have "arrested" development of that 1st language (unless you happen to be fluent in Russian, Mandarin, etc). They then rapidly lose what abilities they had in their native language, before their "new first language" (English) has time to develop. This leaves them in the "language lurch" for awhile, without functional abilities in either their 1st or 2nd languages.  Not an easy place to be ... this may be partly responsible for those "the honeymoon is over!" behavioral issues that many families experience several months post-adoption.

Sharon Glennen, Ph.D., CCC-SLP, has done a lot of the research on this topic, including a longitudinal study of language development in children adopted as infants and toddlers from Eastern Europe. On her website, she reviews the effects of orphanage care on language development, presents some very useful tables of typical language development in international adoptees, as well as pre-adoption language questions for parents to ask.

Other Resources: