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August 2011

news

Issue 9

Inside this Issue:

Dear Friends,

2 "Benefits of Integrated

We are back!

Learning model for adolescent personality development – NIOS setting”, by Shuchita D,

During a visit to USA last year, Smita (founder and co-partner) and I had the opportunity of visiting Children’s Health Council, a Stanford based NGO that offers multiple services to the special needs population of the area. We met with Dr. Lynn Huffman, Director of Outcome Measurements and Research to learn how a large organization like CHC manages integration of services - seamlessly offer multiple services to patients who need them in a way that is efficient and effective. While the facilities and resources that CHC brings to the community are extremely impressive, it came as a bit of a surprise to us that they struggle with some of the very same issues that we at Drishti deal with in our relatively modest practice and integration was one of them.

Madhura P & Mirriam C

3 "Case Studies" 4 "QnA" Core team at Drishti: Smita Desai (Ph.D) - Partner Psychologist Anand Desai (MSc, MA), - Partner Psychologist Poonam A (MA) - Business Development Mirriam C (DSE, MA) - NIOS Iteshree D. (DSE, Med) - Special Ed Navleen C (Bed, MA) - Training & Development Madhura P (MA) - Psychology Louiza G (BA) - Admin

205-206 Midas Chamber Andheri (W), Mumbai 400053 India p. +91-22-26732496/97 f. +91-22-26732494 e. drishti@drishtionline.com www.drishtionline.com

As an organization that is comprised of over 20 mental health professionals (psychologists, special educators, speech and OT) and offers a multitude of services, we at Drishti are often required to not just sequentially coordinate our services but also offer these services (to individuals and schools) in such a way that it is not just efficient but also most effective. Integration of services offered to the school by us poses its own unique set of challenges. We have not arrived at a way of creating a master plan yet, although I know that our team is working on it. However, as Dr. Huffman commented (jokingly, I think) - it would be useful to see who gets there first, CHC or Drishti! Through various organization wide initiatives, we have managed to improve our ability to integrate services for our clients. However a lot still remains to be done. With each of our newsletters we strive to share with you some things that we may have learnt and which have benefitted the clients we serve. This particular issue is devoted to the aspect of using a multidisciplinary approach to serving our clients. Hope you enjoy reading this issue! Anand Desai On behalf of the entire team at Drishti


Psychologists Corner Benefits of Integrated learning model for adolescent personality development – NIOS setting Ms. Shuchita Dua with inputs from Ms. Madhura Pathare and Ms. Mirriam Correa

An individual's personality is an aggregate conglomeration of decisions we've made throughout our lives (Bradshaw). There are inherent natural, genetic, and environmental factors that contribute to the development of our personality. According to process of socialization, "personality also colors our values, beliefs, and expectations ... Hereditary factors that contribute to personality development do so as a result of interactions with the particular social environment in which people live." - http://en.wikipedia.org/wiki/Personality_devel opment

Students, who, for differing reasons, are unable to compete in the normal educational board curricula, but are desirous of obtaining a 10th/12th class nationally recognized board certification, have the option of obtaining one through the National Open School Curriculum (NIOS). Within the overall scheme of integrated special needs, NIOS tutoring model at Drishti uses specially designed skill based development programme in addition to the prescribed curriculum to tutor students. Based on the remedial model, the NIOS cater to groups of students with cognitive and/or information processing difficulties which may/ may not be accompanied with behavioural or developmental issues. Teaching and evaluation is done taking into consideration individual capacity of each student. The curriculum consists of a minimum of one language (English) and four other subjects that are spread over a period of two years.

focus does not only remain on the academic development of the student but also on the overall grooming and personality enhancement. Personality development classes lay great emphasis on the overall growth of the student. Areas of concern range from simple general etiquette of clothing, eating/sitting in the class room, teaching basic cooking/craft, to bigger areas of managing stress, problem solving, decision making and handling emotional reactions. Outbound programs involving over night field trips serve to provide opportunities to explore student’s inner potentials, ability to overcome their fears, physical and mental difficulties, gain confidence and learn adequate social skills. Each student is assessed and rated on certain predefined areas at the time of enrolment and then again at the end of the each term in order to closely monitor and quantitatively measure the effectiveness and success of the program in bringing about a change. The personalized, integrated approach to handling each student ensures that not just one or two students are helped but each and everyone in the group is ready to use their identified strengths and awareness about weaknesses, to overcome any obstacle in the world outside home and classroom.

Information about NIOS can be obtained from: www.nos.org

Personalized attention and care provided by specially trained educators ensures that the Drishti-Newsletter9.docx

Views expressed in this newsletter belong to the individual authors.

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Case Study Corner S, 14.4 years, with delayed speech, single episode of febrile seizure, enlarged adenoid reported difficulties in written language along with emotional and behavioral difficulties (distractibility). A psycho-educational assessment plan included tests for assessing psychological functioning, educational assessment, emotional & behavioral state and ADHD. Results indicated borderline range intellectual ability with severe deficits in the area of reading, written language and math. These were accompanied by deficits in visual perception, auditory perception and information processing skills. Manifestations in areas of hyperactivity, impulsivity, inattention & deficits in personality adjustment, emotional conflicts and behavioral difficulties were also seen. Interventions included NIOS placement, remedial education and emotional & behavioral counseling. At Drishti, the student started with NIOS, along with certain modifications in the classroom setting. System Management of Individualized Program (SMIP) was used to design personalized remedial instruction and counseling plans. Teaching included working on areas such as reduction in misbehavior, teaching grammar, writing, handwriting, spelling words, study skills, helping in exam preparations. The counseling plan focused primarily on helping with behavioral issues of sustaining attention on a task, impulse control, improving self esteem and social skills. Parental sessions were included in order to help the parents set firm and consistent limits. The integrated approach used for tackling the problem resulted in marked improvement in child’s academic performance, self confidence, building interest in academics, reducing distractibility and behavioral problems. She became better adjusted socially as well as with self. She was comfortable sharing her personal thoughts and receiving criticism.

Drishti-Newsletter9.docx

M, 2.5 years, with delayed speech and motor milestones, Asthma since 1 year of age reported difficulties in hyperactivity, inattention and traits falling along the Autistic Spectrum. A developmental assessment plan included tests for assessing developmental functioning, social/adaptive skills, pre-academic skills, screening for ASD and ADHD. Results indicated diagnosis of Developmental delays (cognitive, social and adaptive skills and pre-academic skills) accompanied by Autistic Spectrum Disorder. The speech assessment indicated Delayed speech and language development. Interventions included consultation with a developmental paediatrician, individualized developmental learning program, speech therapy and behaviour modification program. At Drishti, the student started with individualized developmental learning program and speech therapy. System Management of Individualized Program (SMIP) was used to design personalized individualized developmental learning program and speech therapy plans. His developmental learning program plan included working on areas such as Activities of Daily Living (ADL) – dressing and eating, fine and gross motor skills, social skills, sensory motor integration in the areas of body spatial organization, laterality, visual acuity and perceptual skills. It also included Behaviour Modification therapy to reduce hyperactivity and temper tantrums. The speech plan focused on expressive skills like answering social questions, labelling possessions, categories, emotions and imitation. The integrated approach used resulted in marked improvement in child’s self help skills and it made him more independent. He showed improvement in social interaction as he could give basic information about himself and at the later stage he started identifying and expressing emotions.

Views expressed in this newsletter belong to the individual authors.

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QnA —My child is 7 years of age and he has difficulty in Spoken English language and Reading. Her school counselor has suggested psychoeducational testing. What is a psychoeducational evaluation? A psycho-educational evaluation is a set of assessment procedures which are administered and interpreted to obtain information about the child’s development, learning, memory, academics, behaviour and mental health. Different assessment procedures, or combination of procedures, are used, depending upon the referral questions, presenting problems and the past tests administered. There is careful consideration of cultural differences and possible impairments in speech/language, hearing, vision and motor development. Depending on the assessment findings, adequate intervention strategies are recommended/ formulated. —My child has Asperger’s and not Autism. Isn’t it the same thing? Asperger's Syndrome is conceptualized as being part of what is called the 'Autistic Spectrum Disorder (ASD).' Some people refer to Asperger's Syndrome as 'high functioning Autism', while others think they are not quite the same. But in general Asperger's involves impairment in some key areas of functioning. Perhaps the most important is that social skills are markedly deficient. While there are many similarities between children with Autism and those with Asperger’s, there are also quite a few differences that can be noted. Individuals with Asperger’s Syndrome reach most developmental milestones within a typical time frame. Normal to above average intelligence and appropriate language development is common in children with Asperger’s. In Autism, the person’s intellectual functioning is usually below average on an IQ test, and communication delays are present. Most children with Autism are delayed at developing verbal language. Some may be nonverbal. Asperger’s is often detected later in a child’s life than Autism. There are various other individual differences that are present.

Drishti-Newsletter9.docx

—My 7 year old son has been diagnosed with mild AD/HD. I understand what it is but I don’t know what to do next? As a first step, it would be best to consult a paediatric neurologist as AD/HD is a neurological disorder and only a medical examination can confirm its presence and suggest management! Following which, a behavioural assessment is usually recommended. Intervention may be unimodal; i.e. either medication or behavioural counselling. Else, it could be bi-modal, i.e. an intervention plan which combines medication as well as behavioural counselling. These intervention approaches will help management of inattention, hyperactivity and impulsivity.. —My daughter who has a learning disability goes for regular tuition classes. However her school counsellor is insisting on remedial instruction classes. Should I enroll her in and stop the tuition classes? Academic Tuitions and Remedial instruction provide two different kinds of educational support for your child and one cannot be substituted for the other. While tuition classes are focusing on helping your child complete and cope up with school curriculum needs, remedial education will focus on utilizing your child’s inherent strengths to work on the identified academic skill deficits. Remedial instruction does not focus on the academic curriculum content, but instead on working on the child’s skill deficits (e.g. reading comprehension, spellings, written expression, etc). Remedial instruction also uses specialized teaching methods and materials. Once the child learns to read correctly, he can read any subject and will not have difficulty in comprehending different subject matter. Remedial instruction should always come first in the sequence, only then can tutoring in the subject areas be of any use. —After a recent fight with a fellow student, my son has become very irritable and angry. He was punished and humiliated at school by his teacher, in spite of not being at fault. He has started crying over petty issues. I am worried! A psychological assessment involving emotional and behavioural tests will help a psychologist understand the extent of impact of this incident on your child. Following which, a personalized intervention plan involving different counselling strategies can be used for him.

Views expressed in this newsletter belong to the individual authors.

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Drishti-Newsletter-2011-August