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December 2011 Archives

One of today's standards of American education is the concept of 'heterogeneous grouping' within 'mainstream' classrooms: Children of every skill level remain together in every subject. This may be a pushback against a time when grouping children according to their abilities lead to a sense of isolation, with kids seeming to languish on the special education track. Yet to meet any long-term goal of integrating children with their peers, the short-term concern should be addressing immediate educational needs--a goal not always accomplished in the mainstream.
Individualized planning requires an objective exploration of strengths and weaknesses. This perspective often reveals a need for smaller, more structured classrooms and more refined placements; for any student who has extensive academic, behavioral or social difficulties, we need to consider all possible options. Yet due to policy trends in education and presumably the pressure of economics, many schools have eliminated these possibilities entirely. Now, left behind is a ubiquitous policy of placing every child in a single setting; a trend that fails many of our children.
All for One ...
School districts today tend to educate everyone lumped together. Instead of modifying content, this style of 'individualized' plan doesn't adjust the basic material--even though a student may not yet have grade-level skills. Children with special needs receive a few minutes of direct attention targeted to their particular abilities during the day, but the vast majority of time is spent trying to keep up with everyone else.
Academic motivation develops best through success and mastery and is undermined when children flounder with work that is over their heads. Steve, a ninth grader in my practice with reading disabilities, is a good illustration of this. He was asked to read Ulysses over the course of several months, in spite of the fact, that he lacked the ability to decode the words and comprehend the story. A teacher's aide outlined and helped him with vocabulary when he felt like asking questions. As that had become habitual, Steve instead checked out on the entire project.
Given a more skillfully chosen book that Steve was capable of reading with minimal support, he might have continued to engage. With remediation to close the gap in his reading skills, which he was no longer receiving, he might have caught up. Even with tutoring he struggled, not only with reading, but motivation in general, overwhelmed by school work far beyond his abilities. Any potential benefits of spending his days with mainstream peers were completely overshadowed by his belief, mostly correct at that point, that he couldn't do the work even when trying his best.
... And One for All
Leaving students together throughout the day also means the curriculum is not tailored for remediation. Academic interventions are typically added by having teachers and therapists visit kids in their classroom, often called 'push-in' services. These in-class networks of therapists and special educators work for some children, but many feel singled out. Living as the only one who doesn't easily 'get it' in a classroom of kids who generally do, leaves many children dwelling on the difference, and feeling like failures. Why am I the only one who has all these extra teachers?
Another push-in approach adds a special education teacher to an otherwise mainstream classroom. This set up (often called an 'inclusion' or 'integrated' setting) helps children whose primary requirement is additional adult attention, such as those with behavioral issues. And having a second adult in the room with a special education background can be beneficial to all, lowering the teacher-student ratio and adding a specialist's expertise. Yet, as a catch-all intervention inclusion does not inherently address the needs of all children with special needs such as those with learning disabilities, ADHD, autism, or any other concern that requires a more targeted curriculum.
There are also logistical issues when adding a special education teacher to a mainstream class. Grouping children for direct instruction by the special educator, while another teacher continues a lesson for the rest of the classroom is often distracting for all the children, and limiting for the special educator. And like other push-in services, children may feel more stigmatized, not less, when pulled aside from peers in the same classroom. Lastly, as in mainstream settings there is frequently a requirement that children tag along with grade-level content and pacing most of the day instead of following their own prescribed curriculum.
A Custom Fit
On a practical level, contained settings address the needs of children in ways often impossible to implement otherwise, and they still do exist in places. There are classrooms and even entire schools geared to evidence-based academic instruction for children with learning disabilities. Some are structured to meet the needs of children with ADHD, allowing these intelligent, typically well-motivated children an opportunity to learn as well as any of their peers. Others are tailored for development of social and communication abilities in children with autistic spectrum disorders.
Every fall, I see children blossom after switching rooms, able to manage their work on their own, and to master it with the same level of help all the children around them receive. In spite of fears to the contrary, children generally feel more at ease when moved to a well-supported setting. Suddenly, they realize that their issues don't define them: Here I am with ten other kids, all of us are smart and all of us can't read well! I'm not different after all! Reduced stress and gains in self-esteem lead not only to academic growth but to social and emotional benefits outside the school setting. While kids should never be 'stuck' on a special-education track, self-contained settings are sometimes their clearest path to social-emotional well-being and academic success.

New ADHD guidelines encourage improved preschool diagnosis and intervention

The American Academy of Pediatrics just released updated guidelines for the evaluation and treatment of ADHD. Although specialists have been identifying ADHD in preschool children before now, the guidelines expand the 'official' age range for diagnosis down to age four. They still encourage behavioral interventions before medication in preschool children. Early identification often allows families to address issues before they escalate, and helps keep children on track in their development.

Among several other recommendations, the guidelines also emphasize looking for conditions that co-occur with ADHD, a vital aspect of care. Most children with ADHD have something else going on with it, ranging from a learning disability to oppositional behavior to any number of concerns.  For families using medication, the importance of 'titration' is reaffirmed, as best results frequently require trying more than one medication and various doses before choosing what fits for any individual child. While there is little emphasis in the paper on the role of executive function, the guidelines should improve care and clarify evaluation and treatment of childhood ADHD.

Full text of the guidelines is available here.  

A Holiday Gift to Yourself!

English: Gift ideas for men - wrapping paper e...

The holiday season can be a time of great, uncomplicated joy -- honestly it can. It doesn't have to be an intense, draining, consumer-driven mess. We cram into four weeks a stew of stress-raising ingredients for our families, letting it simmer until New Year's Day. But with a little mindfulness and mental effort, we can keep ourselves grounded and together and help our families find a sense of peace in the midst of it all.
We can start by taking an honest look at what we're doing to ourselves these next few weeks. Forewarned is forearmed. A short list of what the season serves us: Too little sleep, too much food, too little sunlight, too much alcohol, strained budgets, challenging gift purchases, hours of schmoozing with people we see once a year at the same party but never in between, too little exercise, too much travel, extreme weather, and various family crises. And our kids live through the season on sugar and poor sleep and lack of exercise, and probably have become certain that the only path to true happiness is to have the hottest new ... whatever fits their vision of nirvana.
It's stressful even writing about it. The holiday season, meant to bring us all together in happiness, consistently accomplishes exactly the opposite for so many people. So what's the point? What can we do instead?
There is another option. Instead of letting it all just happen, we can remind ourselves what matters most -- and what we'd like our kids to learn. Emphasize, for our own sanity and for that of our children, the simpler side of the holidays. Find time for fun activities outdoors or in the city or wherever else, without settling for the lowest common holiday denominator of overspending and overscheduling.
In spite of the external pressures, we can value taking care of ourselves. Too little sleep amplifies stress; exercise reduces it. Also helpful is eating healthily, not necessarily at the parties themselves but perhaps the rest of the month. Schedule quiet time alone or with someone who calms you or makes you laugh. Find the humor in the midst of the seasonal insanity. Whatever works for you the rest of the year, instead of letting it slide for a month, protect it, a holiday gift for yourself.
Avoid perfectionism. We sometimes amplify the emotional impact of buying gifts or hosting parties by unconsciously holding them to impossible standards, fitting them to the storybook pictures we've created in our minds. Not only do we invite all our family and friends but we expect angelic behavior from our kids, or stay up late meticulously centering the candy noses on cookie reindeer, or maybe actually expect our parents not to bicker this year, although they have fought fairly consistently over the last few decades. "No bloodshed and a few good laughs" may be more than enough for any given event.
Let yourself mentally quiet down at times throughout the day. Left unattended, one stressful thought leads to another, and the cycle ramps up all day long. Eventually, life feels like a crisis even on a relatively ordinary December day. Without disrupting your schedule, without adding another "thing to do," take fifteen slow breaths as needed, focusing as best you can only on the physical sensations related to breathing. 
Instead of letting your thoughts escalate, let your mind settle. Spend a moment not doing or planning anything. Don't expect a holiday miracle; your mind will remain busy much of the time. We can't completely stop ourselves from thinking, and there's no need to try. But on the train, in the aisle of the toy store, trying to get the children to the dinner table, or whenever you feel yourself ratcheting up, give yourself a break for a few moments. 
As suggested in a recent New York Times article, one other trick to lowering stress is to make a practice of gratitude. In spite of the millions spent in seasonal marketing to convince us our long-term well-being depends entirely on a massive TV set or a diamond necklace, we know better. Instead of buying into the hype, express appreciation at the end of every day for several things that went well. On an off day maybe simply relish the opportunity to put it behind you and go to sleep. Whatever you discover, small or large, write it down or spend a few moments mentally giving thanks.
We can't eliminate all that the season throws our way. We can't do anything about that or the people around us who may be more wound up than usual. But we can acknowledge the inevitable challenges without getting sucked in. Instead of letting the holiday season run amiss, we can find the opportunity to celebrate and connect with friends and family and create for ourselves and those around us healthier, more relaxing, and restorative times. 
So really, go for it: Happy holidays!
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