A SPECIAL NEEDS MAGAZINE
Supplement to the Jewish Press Periodical Publication
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INTRODUCTION TA B L E O F C O N T E N T S INTRODUCTION From the Editors Ilene Klass, Abe Kopolovich, Yaakov Kornreich and Jared Wasserman ..........................7
The Role of the Social Worker Bassie Morris, LCSW .........23
ISSUES & ANSWERS
Family Forum and Sibs Speak Perel Grossman ...............24-27
Governor Palin and Her Special Needs Child Juby Shapiro ........................9 An Interview with Dr. Temple Grandin Building Blocks Feature ......10-11 Autism Debate Various Respondents ..........12-15
Advocating for Your Child Rifka Schonfeld................22
Special Needs in Jewish History Rabbi Yaakov Klass .............7
Nimby – Residences in the Neighborhood A Community Activist’s Point of View .................................8 Page 12
Service Coordination Rabbi Ari Weichselbaum, MS, ED ...............................20-21
Ask the Advocates Juby Shapiro ......................16 A Birthday Present for Pamela Yaakov Kornreich ............17 Using the Wii for Therapy Kalman Greenberg .........18-19
EDUCATION Inclusion in Lakewood Schools Michael Inzelbuch...........28-29 Early Childhood Assessment Scott Mesh, Phd ..............30-31 Choosing a School for ASD Gili Rechany.....................32-33 Treatment for the ADHD Child Shoni Eidlisz, LMSW ..........34-35 Dyslexia Leah David ......................36
Family: How do the needs of your Special Needs family member affect others in your family, your family life, and your community, and who will help your family to obtain the services that your family and its Special Needs person needs? Here are the answers, from the experts, and in the words of the family members and siblings of the Special Needs individuals themselves.
Education: How has our education system responded to the needs of those with Special Needs, and what schools and services are available from the government for children in public schools and private schools, pre-school children, and children with Autism Spectrum disorders, ADHD, and Dyslexia?
The Role of the SIET Teacher Ilana Pasternak-Yeger ....37
DIAGNOSIS Gait Analysis Dr. Ellen Godwin ..............38 Genetics and Hearing Loss Tziona Bin-Nun .................39 Continued on next page
Page 42 Magazine Publisher: Moshe Klass firstname.lastname@example.org Senior Editor: Yaakov Kornreich email@example.com Associate Editor: Chumi Friedman firstname.lastname@example.org
Issues and Answers: Questions of vital concern to the Special Needs community on the nature of Autism, the demands of raising a Special Needs child, and changing community attitudes towards Special Needs facilities in our midst, drawn from today’s headlines.
Editorial Board: Chaya Ilene Klass, Abe Kopolovich and Jared Wasserman Products Editor: Chaya Ilene Klass email@example.com Product Section Contributors: Megan Petrizio-Randall and Helene Wasserman
Advertising Coordinator: Chaya Ritterman Recruitment Advertising: David Hoppenwasser firstname.lastname@example.org Product Advertising: Moshe Klass
For questions and comments or to order extra copies contact us at: email@example.com or 718-330-1100 ext. 352
Graphic Designer: Chaya Kornreich
INTRODUCTION TA B L E O F C O N T E N T S Apraxia of Speech Betty Aboff MA, CCC-SL/P .........................40-41 Prader-Willi Syndrome Glicksman PhD ................42
Chromosome 18 – a Shidduch Risk? Dr. Stuart Ibel, PhD ..........43 Selective Mutism Nina Rosengarten MS, CCC-SL/P .........................44-45 Hazardous Toys Sarina Roffe......................46
The Aging of the Mentally Challenged Devora Thau, MHCA, LNHA .................................47
TREATMENT Page 64
Stutter Haven Address: 2723 Ave. R, Brooklyn, NY Page 80-81
DIR/Floortime An Interview with Serena Wieder, PhD .....................48-49 Behavior Modification Rabbi Dr. Chaim Wakslak ............................50 Understanding Muscle Tone Dr. Ephraim Yablok..........51 Building Memory Skills Leah Donn, MS, ED ..........52 Kinesio Taping Yitty Rimmer, MS, OTR/L ..54
Using Art for Therapeutic Value Ellen Metrick .....................55
Prompt Therapy Megan Petrizio-Randall, MA, CCC ..........................56 The Stigma of Orthotics Rochelle Silberman .........57 Pilates for Children with CP Avi Kleinman, MSPT .........58 Autism and Sports Jared Wasserman ...........59 Crazy Bones Therapy – Using Everyday Objects Chaya Ilene Klass, MS, OTR/L ........................60-61
PRODUCTS Reviews of Special Needs Products Chaya Ilene Klass, Megan Petrizio-Randall and Helene Wasserman .........62-71
RESOURCES Directory Listing of Organizations and Practitioners .....................72-79 Directory Listing by Category ....................80-81 Directory Listing by Category Avi Sacks ..........................82-85 Book Reviews Brocha Holczer ................86-89 Recruitment Advertising .......................90-93 Index of Advertisers ........92
Diagnosis: From the frontiers of medical research, we explore the genetic risks connected to a number of disorders. We see how advances in video and computer animation technology can be applied to the diagnosis of children with problems walking. We are alerted to the dangers to our children’s hearing from excessively noisy toys. We look at the challenges of an aging Special Needs population. We examine two problems, which affect the ability of our children to speak, and the unusual problems of children suffering from PraderWilli Syndrome. Treatment: We explore
exciting new techniques for helping children with Autism, by teaching them sports and participating in their play. Read about advances in the use of orthotics, adhesive tapes that can assist in therapy, and the use of art therapy, behavior modification and memory skills to unlock the potential of children with Special Needs. Learn how to use everyday objects around the house to help your child to develop his basic skills. Learn about muscle tone, and an effective therapy technique helping children to speak. Products: Interesting and innovative products on the market today. Resources: Where to go, who to call, what to read. Its all here for you.
INTRODUCTION Introduction Over the past six months, we have seen the world of Special Needs become a more mainstream concern. With the controversy over the increasing incidence of Autism generated by the comments by radio personality Michael Savage, and the national focus on Republican Vice Presidential candidate Sarah Palin’s status as the mother of a Down syndrome child, the issues of the Special Needs community have become the concerns of the entire country. As a result, with this edition, we have added a new section to Building Blocks, called Issues and Answers. We also continue to bring our readers the latest developments from the frontiers of research in the worlds of Education, Diagnosis, Treatment and Therapy, as well articles on the impact of Special Needs individuals on our families, often in the words of the family members themselves. We are also proud to feature two exclusive, Building Blocks interviews in this edition. We wish to thank Dr. Temple Grandin, an out-
spoken advocate for, and an inspiring example of the potential of, people with Autism to succeed, and Dr. Serena Wieder, one of the leading authorities on the DIR/Floortime model for the diagnosis and treatment of Autism, for sharing their insights with the Building Blocks/Jewish Press audience. We have come a long way from the days when we refused to admit that the Jewish community had a need to formally address the needs of those with Special Needs among us, or even to admit their existence. Yet, despite great progress, significant challenges remain. It is the mission of Building Blocks both to celebrate the real accomplishments that we have made in this area, as a community, and to lay out the challenges and opportunities for progress that still lay before us. The Editors: Ilene Klass, Abe Kopolovich, Yaakov Kornreich and Jared Wasserman
An Appreciation of the Earliest Special Needs Jews By Rabbi Yaakov Klass Who was the greatest Jew in history? Who was the greatest leader of the Jewish People? Who was our greatest prophet? Any yeshiva child can answer you – Moshe Rabbeinu, of course. But who was one of the first Jews with Special Needs? The answer might be the same, Moshe Rabbeinu, who led our people from slavery to freedom, who gave us Hashem’s Torah, and who led us from our Egyptian slavery on our way to our promised land in Eretz Canaan. Yet he was a “k’vad peh.” He suffered from a serious speech impediment which caused him, at first, to doubt his own leadership abilities, and to defer somewhat to his brother Aharon to serve as his spokesman. But ultimately he was the leader, and he was, indeed, Klal Yisrael’s greatest leader. For sure, Moshe was not the only special needs personality in our earliest history, to rise
to the greatest heights. Chushim ben Dan, suffered a serious hearing deficit. He too learned to accommodate his disabilities. In fact as the only son of Dan ben Yaakov, his tribe was unique of all the tribes in that it had only one tribal mishpacha – family of which he was the head. And Dan, indeed, was second most populous tribe after the tribe of Judah. What better proof could the Torah give as to the inherent potential that is imbued in the Special Needs individuals in our midst that they hopefully may overcome their deficits and lead meaningful lives, contributing to our families and communities. We hope that the articles in this issue of Building Blocks will give our readers a clearer understanding of the many difficulties faced by Special Needs children and adults, and how to better help overcome them. Rabbi Yaakov Klass, is the Torah and Halacha Editor of the Jewish Press. He can be reached at firstname.lastname@example.org
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ISSUES & ANSWERS
Combating Our NIMBY “Not In My Back Yard” Attitudes By A Community Activist’s Point of View Thirty years ago, in 1978, this country was first coming to accept the fact that people with developmental disabilities had rights that had to be respected. Only three years earlier, Congress passed the landmark legislation, now known as the Individuals with Disabilities Act (IDEA), which requires state and local governments to provide every child with a disability with the same opportunity for education, employment and independent living that typically developing children receive, and, whenever possible, to educate them together. Meanwhile, a major scandal was unfolding in the Willowbrook State School in Staten Island, a huge, isolated facility which had been built to house 2,000 “mentally retarded” children, but which, by 1972, was home to almost 5,000 of them. After investigative reports revealed the shocking conditions of negligence and abuse there, a landmark lawsuit was filed against the state, which, in 1975, admitted and promised to correct the many violations at Willowbrook. Eventually, due to public demand, Willowbrook was closed, and many of its occupants were relocated to smaller group homes integrated within residential communities. But in many of our residential communities, the old prejudices, based upon ignorance and superstition, still held sway, and efforts to establish new homes there for the former residents of Willowbrook were met with suspicion and fear. Even the religious community was leery of accepting the return of its developmentally disabled. A Victory for Fear and Ignorance In 1978, when a non-sectarian organization proposed to buy a house on the same block with one the largest synagogues in Flatbush, and turn it into a kosher residence for that population, the local reaction
against it was strong. Most residents of the neighborhood said that they opposed it out of fears that it would depress the market value of their homes. They even suggested that the counselors who would be caring for the facility’s residents would pose a threat, which was an absurd argument, given the fact that an employment agency for domestic workers had been operating for years just across the street. At that time, Mrs. Rhoda Reece and her late husband were raising a daughter with a developmental disability. They were among the few who publicly supported the establishment of a group home in their community, and because of that, were shunned by many of their neighbors. The Reeces began to receive anonymous, threatening phone calls at home, and while riding down the street one day, noticed that they were being followed, menacingly, by an automobile. When the issue came up at a shul meeting, even the rabbi was pressured into joining the opposition. Local elected officials also submitted to the pressure against it. In the end, the sale of the building was blocked, due to the community opposition. But it did not take long for some of those who had opposed the group home to start privately admitting that they had been wrong. Some time afterward, when the shul rabbi saw Mrs. Reece at a community function, he felt compelled to go over and explain that, at the time, “I didn’t know any better.” When another non-profit group sought to open a similar facility, a local elected official who had opposed the previous one stopped Mrs. Reece on the street to tell her, “this time, I’ll see that it goes through.” But she was not appeased. She responded angrily that, “you had better see that this one passes, because, if it doesn’t, even though I am not a politically active person, I will get
the support of many people to run against you in the next election myself!” That facility was approved, but opposition in other neighborhoods to facilities serving the same population remained strong. To counter that opposition, Mrs. Reece decided to become more involved. In 1988, she became a member of Community Board 14 in Flatbush. Coincidentally, one of the items on the agenda of her first Community Board meeting was a request for the approval of a kosher group home for adults on East 27th Street and Avenue N, sponsored by Ohel/Bais Ezra. Of the 1,000 people who were at that public meeting, at least 800 were opposed to it. Practically everyone who rose to speak was against allowing the facility to come to the neighborhood. But Mrs. Reece was not deterred. She stood up and told the story of her own daughter, who was born with Down syndrome. Her daughter was not going to be one of the residents at the new facility, but Mrs. Reece argued that she was typical of those people who needed a kosher home in the midst of the Jewish community where they had been raised and near their families. She spoke from her heart, and by the time she was through, she had convinced her fellow Community Board members to vote unanimously in favor of the Ohel/Bais Ezra facility. Changing Community Opinions Once the East 27th Street group home opened, its neighbors who had opposed it realized that their fears had been unjustified. The residents of the home quickly won acceptance in the community, and a year later, when another house became available in the
same neighborhood, not a word was said in opposition to turning it into another group home. For the next 13 years, Mrs. Reece became a city-wide advocate for such facilities. She went to 15 other community board meetings to speak on behalf of opening both religious and non-sectarian group homes, and she took a lot of verbal abuse from local homeowners who repeated the same specious arguments that she had first heard in Flatbush years earlier. But by the time Mrs. Reece stepped down from her local board, in 2002, community sentiment had completely turned around. Now such facilities were being welcomed with open arms by shuls and community leaders, as experience proved them to be a positive asset to the neighborhoods in which they are located. When such facilities are opened, local property values go up rather than down, and their residents quickly win acceptance as fellow Jews to whom we all have a responsibility. They are regularly invited to local educational and social events, some of which are organized specifically with them in mind, and they are considered to be full-fledged members of the local community. This new, enlightened attitude has replaced the ignorance of the past, and we can all be proud of the way in which our community now embraces and welcomes into our midst, our brethren with developmental disabilities. (See related article on page 17)
ISSUES & ANSWERS
Sara’s Plains By Juby Shapiro In parshas Vayera, Hashem appeared to Avrohom in the “Plains of Mamre”. What did Mamre do to merit being mentioned in the Torah? Sifsei Chachomim quotes a midrash in Bereshis Raba that when Avrohom was commanded to perform a bris millah he asked Mamre whether he should perform this mitzvah privately or allow the public to know about it. Mamre answered that he should certainly make it known publicly as it would be a kiddush Hashem (sanctification of G-d’s Name). Mamre’s reward for his advice was that malachim (angels) came to visit Avrohom on his property. A more recent example of a public kiddush Hashem occurred this fall when Alaska’s Governor, Sarah Palin became the Republican Vice-Presidential nominee. This past spring, at the age of 44, Governor Palin gave birth to her fifth child, Trig. The Palins had been ad-
Govenor Sarah Palin
vised by doctors that their son would be born with Down syndrome, but unlike the estimated 80-90 percent of parents in the United States who choose to abort unborn children with Down syndrome, they welcomed their son into their family. Palin was already Governor of Alaska when Trig was born, but as a candidate for a national office, her personal life came under much more intense public scrutiny. Parents and advocates for children with disabilities were curious as to how
openly Governor Palin would deal with the issue of being a special parent. In her acceptance speech before the Republican National Convention, Sarah Palin told the world, “Sometimes even the greatest joys bring challenge. To the families of special-needs children all across this country, I have a message: for years, you sought to make America a more welcoming place for your sons and daughters. I pledge if we are elected, you will have a friend and advocate in the White House.” Throughout her speech, the cameras were also aimed at the Palin family. First her husband held baby Trig. Later her five-yearold daughter, Piper, cradled her brother in her arms and smoothed his hair with her fingers. After she finished her historic speech, Sarah Palin introduced her family and with great pride, she held Trig in her arms to the roaring applause from the convention floor. What Governor Palin accomplished by saying those few words, and with her gestures showing her love for her child, was of immeasurable value to people with disabilities and their families. For years, many parents who chose to raise their special children at home faced both the day-to-day challenges inherent in raising a child with special needs and the additional burden of dealing with the reactions of others to their child and family. In a support group for mothers of special children a few years ago, I asked mothers to write, anonymously, some of the hurtful comments that people had made to them. We shuffled the cards and read them aloud. Here are just a few examples: An acquaintance had asked one of the mothers, “How could you bring that child home? How will you marry off your other
children?” A salesman in a crowded shoe store asked a mother whether her child’s condition is genetic. A proprietor asked one woman, who had taken her teenage son who has Down syndrome to a clothing store to buy a suit,, “Why are you wasting such a nice suit on him?” Another mother recalled an incident at a playground where she had brought her daughter who has special needs; people distanced their children from her child as if her disability was contagious. The other mothers related similarly upsetting incidents. We spent the rest of the session discussing answers, both clever and serious, to these hurtful responses. We laughed and cried and empowered one another. The main thing that came out of the meeting was a consensus among the mothers that the way in which we carry ourselves helps to determine the way others view us. If we are openly proud of all of our children, when we include our special children publicly as integral members of our families, then the public will follow our lead and eventually learn to be more accepting and supportive. There are many dedicated individuals in the community, who like Sarah Palin, rose to the challenge when their children were diagnosed with special needs by going out in public and trying to change the world for the better. Some of these amazing and talented people founded many of the best social service agencies and special education schools
serving special children in our community today. They have also encouraged today’s parents to become far more open about children receiving therapy and special education services. Each individual parent who stands up and seeks services for their children makes things that much better for all of the others facing the same challenge. Thanks to their courageous example, the stigma of the past has been significantly diminished. Many in the community have begun to recognize the tremendous contribution that all of our children and families make to the community. Young people are encouraged by their parents and schools to spend time doing chessed (acts of kindness) working with special children. Many others have chosen to enter the special education field by becoming special education teachers, physical, occupational and speech therapists, psychologists and social workers. The result has been to make more options available for our special children and families. Governer Palin’s public statement helped many others to stand strong and be proud of all of our children. This message was heard around the world, and reverberated in the hearts of all special parents. It has changed our world for the better. Juby Shapiro is a special education advocate and is the founder and director of TAFKID a not-forprofit organization dedicated to helping families whose children have a variety of disabilities and special needs. TAFKID’s phone# is (718) 252-2236 or via e-mail at email@example.com
ISSUES & ANSWERS Exclusive Interview!
The Positive Side of Autism An Interview with Dr. Temple Grandin
A Building Blocks Feature
many years, autism was considered to be a rare, mysterious and severely disabling condition. But in recent years, due at least in part to a broadening of its medical definition, the incidence of the diagnosis of autism and related disorders has risen to about 1 in every 150 babies born in this country. Today, classic childhood or infantile autism is grouped with at least four other conditions known as pervasive developmental disorders, (PDD), which are now referred to as autism spectrum disorders (ASD’s). People suffering from ASD’s typically have difficulties with social interactions and communication, a severely restricted range of interests, and a tendency to engage in repetitive patterns of behavior. Severely autistic children cannot communicate at all verbally. They seem to be absorbed in a world of their own, and are unresponsive to most external stimuli. But ASD’s also includes higher functioning children who, with early intervention and intensive help from teachers, parents and therapists, may ultimately lead nearnormal lives. Some of those diagnosed with the ASD known as Asperger’s Syndrome actually exhibit superior intelligence, and their autistic tendency to screen out external stimuli enhances their ability to concentrate all of their mental faculties on a particular task or problem. It has even been seriously suggested that some of the greatest giants in the history of science and the arts closely fit the current profile of those with autism spectrum disorders.
Isaac Newton and Albert Einstein both exhibited conduct which is now associated with Asperger’s
syndrome. For example, Einstein was a loner as a child, and a late speaker. As an adult, he would become so obsessed with physics problems that he acted as if he was totally oblivious to his surroundings and his own physical appearance. In fact, during his later years at Princeton, Einstein defined the stereotype for the “absent-minded professor.” Behavior patterns consistent with autism spectrum disorders have also been identified with authors James Joyce, George Orwell and Lewis Carroll, philosophers Spinoza and Kant, composers Beethoven and Mozart, concert pianist Glenn Gould, and the author of the US Declaration of Independence, Thomas Jefferson.
through most of the 20th century, the potentially positive intellectual side effects of autism went largely unrecognized. Little hope was held out for young children like Temple Grandin who were diagnosed with autism. Born in Boston in 1947, Grandin did not begin to speak until she was three and a half years old. Thanks to the devoted efforts of her mother and teachers, young Temple received the understanding, guidance and attention
she needed to compensate for her autistic deficits, and find expression for her native intelligence and creativity. Encouraged to follow her natural affinity for animals, and exploit her heightened autistic sensitivities, Grandin won renown for devising more humane and efficient equipment for handling livestock on farms and in slaughterhouses. Today, Dr. Grandin is a Professor of Animal Science at Colorado State University. She is a consultant for fast food chains Burger King and McDonald’s, and the livestock equipment that she has designed handles half of the cattle in the United States. Her unique insights into the feelings and reactions of animals, combined with a self-taught understanding of the basic concepts of shechita, have enabled her to develop a new way to position and restrain animals while being shechted, which has been widely adopted by kosher slaughterhouses in the US and Israel. Grandin innovations have helped to speed up the shechita process and reduce various halachic complications, while at the same time making the experience less painful and traumatic for the animal. She is
widely recognized as an expert in the practices and technology of kosher slaughter, and a staunch defender of its humane character. Grandin is not Jewish, but her work with animals has deepened her faith in G-d and given her an enhanced sensitivity for Jewish traditions and beliefs. When she designed a new type of ramp to lead cattle into the slaughter pen, she named it, “The Stairway to Heaven.” Grandin attributes much of her success to the positive side of her autism. Her autobiographical book, “Emergence: Labeled Autistic,” published in 1986, helped to explode the myth that all autistic people live in a world of their own, shrink from human contact, and are unintelligent. It tells how she was able to grope her way “from the far side of darkness” to become living proof that “the characteristics of autism can be modified and controlled.” In her 1995 book, “Thinking in Pictures: And Other Reports from My Life with Autism,” Grandin explained that words are just a second language for her, and that she tends to think in “full color movies, complete with sound, which run in my head.” (See book review on page 87.) These books, as well as her numerous speeches and articles on the subject, have turned Grandin into one of the leading advocates for adults and children with autism spectrum disorders.
a telephone interview, Building Blocks asked Grandin what she would say to parents of young children diagnosed with an autistic spectrum disorder. Her first recommendation was not to give in to despair. “Autism is a wide continuum,
ISSUES & ANSWERS ranging from children who will never be able to talk all the way to geniuses like Albert Einstein,” she said. She also encourages parents of autistic children to begin aggressive remedial education as soon as possible. “Even if your child is just 2 or 3 years old, don’t let them sit in a corner. Doing nothing is the worst thing you can do for an autistic child. Get your child a really good educational program, of about 20-30 hours a week with a good teacher and a lot of 1 to 1 interaction.” Recalling her own strict upbringing in the 50’s, Grandin said, “autistic children do well in a highly structured environment.” She explained that children with autism do not instinctively, “understand social rules in the abstract. They must be taught all the rules of proper social behavior, one at a time, on a case-by-case basis. For example, they must
be taught to say ‘please’ and ‘thank you.’ When playing with others, they must learn how to take turns. When standing in line, they must learn not to push the child ahead of them. They must not eat with their hands, etc. These rules must be taught even to high- function-
“Doing nothing is the worst thing you can do for an autistic child.” - Dr. Temple Grandin ing autistic children, because they do not have natural instincts to guide their behavior in common social situations.” Grandin notes that autistic children are also often overly sensitive to sensory stimuli.
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“Some of them can’t stand noise. Others are distracted by too much starch in their clothes,” she said. She recalled meeting one autistic Jewish boy who was distracted because his yarmulka was too stiff, His behavior improved as soon as he was given a more comfortable yarmulka to wear on his head.
also urges parents to encourage their autistic children to follow their natural interests. “Don’t focus on their deficits. Rather, enable them to make the most of whatever skills and interests they have, be they mathematics, music or computers. In my own case, as a young girl I loved riding horses and electronics lab, and I was ultimately able to pursue a profession which combined them both,” Grandin said. She even held out hope for the future
of autistic children who remain non-verbal. “For example, if such a child has artistic ability, even without the ability to speak, he could still become a sofer [scribe],” Grandin said. Grandin believes that many of our leading scientists, mathematicians and computer “geeks,” with their “nerdy” lack of social skills, are actually high functioning people with undiagnosed Asperger’s Syndrome, whose success in their fields is at least partially due to their autism-enhanced ability to concentrate. Grandin’s life story carries a message of hope for the parents of every autistic child. It serves as an example of the kind of meaningful contributions that such children can achieve in their lives, if given the support, instruction, encouragement and understanding they need to take full advantage of the unique gifts that the Creator has given them.
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ISSUES & ANSWERS
What is Really Behind the Surge in Autism? Editor’s Introduction More than 30 years ago, Ronald Reagan injected the term “welfare queen” into the American political and social lexicon. It became a populist expression of outrage against the deliberate abuse of the government’s social welfare system. Welfare reforms implemented since then have clamped down on unscrupulous individuals seeking welfare benefits to which they are not entitled, but the American public still harbors a smoldering anger against those who unfairly exploit government programs intended to help the weak and helpless in our society. Since 1975, the federal Individuals With Disabilities Education Act (IDEA) has enabled state and local governments to provide a “free and appropriate public education” for all children with disabilities up to the age of 21. Until recently, the program enjoyed widespread public support. However, the recent dramatic increase in the frequency of autism diagnosed in children has raised troubling questions. Before 1998, less than 1 child in every 1,000 between the ages of 6 and 17 qualified for IDEA benefits due to a diagnosis of autism. By 2007, the frequency had climbed to more than 5 children per thousand. Why the sharp rise? Experts suggest a variety of possible reasons: First is the recent expansion of the definition to include a variety of related developmental disabilities, which are now known, collectively, as autism spectrum disorders (ASD). Second is a recent change in the accepted guidelines for pediatricians, which directs them to more aggressively screen all very young children for ASD. Finally, there are those who suspect that the dramatic increase in ASD may be due to the emerging effects of some still unidentified environmental factor.
But because medical science has yet to identify a single direct physical cause or telltale symptom for autism spectrum disorders, there are some, even within the field, who question whether the recent upsurge in the rate of diagnosis is justified. They suggest that it may be, at least in part, the result of “false positives” due to increased screening efforts. This legitimate public health question was sensationalized this summer by syndicated radio talk show host Michael Savage. On his July 16 program, Savage told his nationwide audience of 8.25 million listeners, the wave of autism diagnosis is due to deliberate fraud by parents who have coached their children to “fake” its symptoms in order to qualify for the generous benefits under IDEA provided at the expense of taxpayers. Savage called the recent upsurge in autism just a fad, “the illness du jour... I’ll tell you what autism is. In 99 percent of the
cases, it’s a brat who hasn’t been told to cut the act out.” Savage also challenged the authenticity of the communications impairment and unacceptable behavior exhibited by autistic children. He suggested that, when not deliberately faked, these “symptoms” were actually due to the failure by their parents to discipline their child properly, and that such
failures were turning the US “into a nation of losers and beaten men.” Savage’s accusations and provocative conclusions about autism prompted sharp denials by experts in the field. However, to the extent that his outburst reflects a real public concern over the sharp rise in the incidence of autism and confusion over its true nature and cause, Savage has highlighted the need to better educate the public as to what we know and still don’t know about autism spectrum disorders. That is the purpose of these responses, written by a respected psychologist, an elected official overseeing government mental health efforts, a senior educator and the mother of a child with Autism.
The Unﬁnished Evolution of Autism By Dr. Stuart Ibel In 2007, the Centers for Disease Control’s Autism and Developmental Disabilities Monitoring Network estimated that 1 in every 150, eight year olds, in multiple areas of the United States, had an Autism Spectrum Disorder (ASD). As indicated in the introduction, before 1998, less than 1 child in 1000 was diagnosed with Autism. The CDC has further estimated that up to 560,000 individuals between the ages 0 to 21 in the United States have an ASD. In 2006, 259,705 children ages 3-21 years were served under the IDEA “autism” classification for special education services. A study conducted in 2006, put the costs associated with autism at approximately $35 billion dollars per year. This article will clarify and expand on some of the reasons for the tremendous increase in the prevalence of Autism referenced in the introduction. In an article that appeared in the April, 2006 edition of the journal, “Pediatrics,” Paul Shattuck of the University of Wisconsin dis-
“The understanding of Autism has evolved over time. . . The entire category has been signiﬁcantly broadened to include less severe variants of the disorder.” cussed the contribution of “diagnostic substitution” to the growing prevalence of Autism. Analyzing data collected from schools across the US, Shattuck found that the prevalence of Autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003 (more than a 5 fold increase). However, during the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively, more than “offsetting” the rise in cases of Autism. These findings strongly suggest that a trend has developed whereby children who had previously been labeled as having mental retardation and learning disabilities are now being classified as having Autism. How is this possible and why should this be? A number of contributing factors have been identified. First, although IDEA was originally authorized in 1975, and schools were required to report data on children receiving special education services, Autism did not become one of the reportable categories until 1990. Schools did not begin reporting under the new guidelines until the1991-1992 school year. In essence, children receiving services prior to the 19911992 school year under the IDEA categories of mental retardation, learning disabilities or speech impairment, as well as new students entering the system could only be classified or reclassified as Autistic under IDEA after September 1991. Since prevalence estimates rely heavily on school data, it is no wonder that a spike in Autism appeared soon after
ISSUES & ANSWERS Autism Debate continued that. Second, the understanding of Autism has evolved over time. Changes in successive editions of the Diagnostic and Statistical Manual of Mental Disorders (1980, 1987, 1994, 2000), the standard reference guide for diagnosticians, have significantly revised the diagnostic criteria for the Pervasive Developmental Disorders (the general category under which Autism and its variants are classified). The entire category has been significantly broadened to include less severe variants of the disorder. As a result, the Autism label is now being applied to a much wider range of children and adults, ranging from those with severe intellectual disability, who avoid social interaction, don’t communicate and need full-time care, to those who experience some difficulties, but attend regular education and go on to work, get married, and engage in other typical pursuits. It is estimated that 50-75% of newly diagnosed cases of Autism are of the milder form, termed Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). They bear little resemblance to the more severe cases, which comprised the totality of those diagnosed as having Autism in the past. The likely impact of changing the diagnostic criteria on the measured incidence of Autism was revealed in a paper published in the April, 2008 edition of Developmental Medicine and Child Neurology. It reported on a study by Dorothy Bishop from Oxford University and her colleagues who identified a group of 38 adults and teenagers who had been previously diagnosed (as children) with developmental language disorder. They interviewed both their subjects and their subjects’ parents, and asked them questions based on current Autism diagnostic criteria. The results indicated that 8 out of the 38 fully met the current criteria for Autism, and 4 others met criteria for inclusion as being on the autism spectrum.
Another factor driving the increase in reported cases of Autism is the improvement in the outcome from treatment when Autism is diagnosed early, and the fact that an Autism diagnosis is necessary in order to access the services. Prior to 1987, there was little evidence for effective Autism treatment. However, in that year, Dr. O. Ivar Lovaas of UCLA published a paper in the Journal of Consulting and Clinical Psychology showing that some children (in the case of this study, 47%) who began intensive behavioral treatment by age 4 and continued treatment for at least two years progressed so much that they became indistinguishable from typical children their age. Lovaas and his colleagues published a follow-up study in 1993, demonstrating that the gains made by these children persisted. These studies, along with increased focus upon Autism in the media, due, in part, to the movie Rain Man, released in 1988, did much to increase interest research in Autism and in its treatment. As more children were diagnosed with Autism, advocacy groups sprang up to lobby for increased Autism awareness, and for more funding for research into the causes and treatment of Autism. Politicians and celebrities whose families had been affected by Autism came forward to discuss the disorder in the media. In the 1960s and 1970s, few outside the professional community had even heard of Autism. Today, an Internet search on the word “Autism” yields approximately 20 million hits! Some argue that increased awareness of Autism in both professional and lay communities, along with the availability of more effective treatment and enhanced services for children with Autism, has led more parents and doctors to apply the diagnosis. To date, there are no definitive blood or imaging tests for Autism. Although several genetic and medical conditions are now associated with the disorder, the cause of Autism remains elusive. We continue to rely
on behavioral criteria to define the disorder, while continuing to search for biological markers and relevant environmental factors. Research has made more progress in improving our ability to describe, identify, and effectively treat individuals with Autism. The question remains, are more children developing Autism today, or are we just getting better at finding and identifying the children with Autism who were always there, but never properly classified. Perhaps more children with Autism are being identified because both parents and professionals are now more aware of the disorder, and because the threshold for a diagnosis of Au-
tism has been lowered, and because the lack of a definitive biological or environmental cause for Autism has made its diagnosis, as opposed to other disorders, a subjective call. Only further research will reveal the answer to these questions. Stuart Ibel, PhD is a Licensed Psychologist with over 15 years of experience diagnosing and treating individuals with Autism. He is Program Director of Challenge Early Intervention Center, and maintains a private practice in Brooklyn, NY. Continued on next page
ISSUES & ANSWERS Autism Debate continued Autism from the Public Policy Perspective By Senator John L. Sampson It is understandable, in these difficult economic times that a general public, which is frightened by the prospect of our government searching for additional revenue, should be increasingly concerned about rooting out those taking unfair advantage of entitlement programs. I believe, that most people want to do the right thing; they work hard providing for their families, struggling to find ways to improve their quality of life, and expect their neighbors to do the same. At the same time, when there is a question about our children, we are ready, as a taxpayer society, to accept the responsibility of caring for their well-being and assuring their
“One diﬃculty with Autism, from a public policy perspective, is the subjective nature of its diagnosis because it is based on behavior and not a speciﬁc cause or mechanism.” ability to eventually lead productive lives regardless of the economic circumstances of their families. Unfortunately, there are those who lack a proper moral compass and are willing, wherever possible, to take financial advantage of the pull that children have on our heartstrings, regardless of the larger consequences. As a result, many programs dedicated to assisting children in need have garnered a sour reputation because of those trying to “work the system,” thereby endangering all the good work that they do. There is much evidence that the work
our state has done to help those unfortunately struck with Autism has had a positive effect. Time and again, early testing and intervention have proven to have a very real impact by improving the lives of those afflicted and the families that support them. Intensive, sustained special education programs and behavior therapy early in life is helping these children to acquire social and job skills, improve their ability to function and decrease the severity of their symptoms. One difficulty with Autism, from a public policy perspective, is the subjective nature of its diagnosis because it is based on behavior and not a specific cause or mechanism. This, unfortunately, does provide an opening for those looking to take unfair advantage of the government resources being provided to afflicted families. Individuals like Michael Savage have gone to extreme lengths, calling Autism a “fad,” and assuming that parents sit home at night making a detailed study of the disorder and then training their children at the age of eighteen months to replicate symptoms to qualify for the government benefits. I have news for you; there are easier ways to attempt to defraud entitlement programs. While I am sure that there are some sick and twisted parents who would subject their children to such endeavors, I would be surprised if it was more than a relative handful. But make no mistake about it, we do need to seek out those individuals and prosecute them to the full extent of the law. Medical science is not always an exact science. Because of the recent expansion of the definition of Autism, we certainly have seen a dramatic increase in the number of cases reported. The obvious question is whether, before the definition was changed, we were allowing many autistic children to slip through the cracks, or have we now become overzealous in categorizing too many children as suffering from an autism spectrum disorder. The average parent does not want to
have their child labeled with a condition that unfortunately may still subject them to a stigma in our society’s thinking. When the average parent sees that their child is not developing in a manner consistent with the expected norms, they rightfully seek assistance. Hopefully, medical advances will soon answer the scientific questions, but for now we have no choice but to help these children in need to achieve the level of competency necessary to be productive members of society. It may be an imperfect system, but its chief goal, to leave no child behind, remains a worthy and compelling moral and social imperative. John L. Sampson represents the 19th Senatorial District in Brooklyn, and is the ranking minority member of the NY State Senate Health Committee.
Has Michael Savage Done the Cause of Autism a Favor? By Joshua Weinstein, MA, MBA Michael Savage, host of “The Savage Nation” and the third-most-listened-to radio talk show host behind Rush Limbaugh and Sean Hannity, recently called Autism “a fraud” and “a racket.” He said, “I’ll tell you what autism is. In ninety-nine percent of the cases, it’s a brat who hasn’t been told to cut the act out” Instead, Savage believes, parents should just start telling their children to “Straighten up. Act like a man. Don’t sit there crying and screaming, you idiot.” He believes that the unacceptable behavior of these children is actually a result of parental failures. Savage’s remarks created a storm of criticism from all corners of the autism arena. Parents were outraged, and rightfully so. I wonder how Savage might feel if his child constantly met disapproving stares from strangers every single day who recommend that “if your child can’t behave maybe you shouldn’t take him out in public”? Savage clearly does not comprehend the fact that a child with autism can be
As an educator, I see children with autism daily. I see their challenges and stresses. What I don’t see, however, is a “brat.” sweet, funny, happy, sad, angry, silly, frustrating, irritating, gentle, kind, or any number of other adjectives you’d use to describe a typical six or seven year old. The epithet “brat,” however, usually only comes from those ignorant of what autism truly is. Because Savage is a highly listened to public figure, his remarks, born out of ignorance and insensitivity, are even more shameful. If Mr. Savage could, for one moment step into the shoes of a person with autism, he might better understand their uncontrollable impulses. Most children with autism lack the capacity to verbalize their feelings and instead, act them out. Their actions must not just be condemned and dismissed, as Mr. Savage would have us do, as the tantrums of a spoiled child or as a plot by greedy parents, but rather they must be understood as a desperate attempt at communication. As an educator, I see children with autism daily. I see their challenges and stresses. What I don’t see, however, is a “brat.” I also see the stress and frustration of their parents, and I feel their pain. No parent of a special needs child wants to be pre-judged, or isolated. What these parents need is support from those around them and a promise that their child will be treated with compassion, understanding, and most importantly, respect. In the end, I believe that Savage’s remarks, by shaking people up, have actually done us all a favor. There is no other way that he or anyone else could have given autism so much front-page attention. Our challenge is to use this attention in a constructive way, by educating and motivating those in power to treat autism with the seriousness that it
ISSUES & ANSWERS Autism Debate continued deserves and to devote more resources to fighting this condition. Joshua Weinstein has been an educator and administrator for over three decades. He holds two Masters Degrees in Educational Administration and Supervision and an MBA in executive administration. He has been the CEO in healthcare, social services, business corporations. He’s the president and founder of Shema Kolainu-Hear Our Voices, Tishma for children with autism in Jerusalem and iCARE4Autism. He can be reached via email at, icare4autism.org and shemakolainu.org. or firstname.lastname@example.org.
A Mother’s Response By Rivkie Kaufman* I would like to thank Michael Savage, our country’s self-appointed expert on child behavior, for exposing the “autism conspiracy,” and for supplying all of us parents with children who have been diagnosed with autism spectrum disorders with a simple, all-purpose and universally effective means of ending their problematic behavior – by calling them names, like “brat, “moron” and “idiot,” telling them to “cut the act,” and to “straighten up” and “act like a man.” I wish you had told me this 3 years ago, when my sixth and youngest child was diagnosed with PDD NOS at the age of 2. Mr. Savage, I had no idea at that time that giving him a little, old-fashioned discipline and having his father yell insults at him would be “99%” sure to stop him from crying inconsolably from morning to night, screaming, rocking, biting himself, flapping his hands, squinting his eyes, and banging his head so hard it bled. How I wish that you had been with us that day when we took him to the mall and he had a meltdown within minutes of our arrival, and there was nothing we could do to stop him until we were forced to admit defeat and go home. Tell me, Mr. Savage, if autism is just the “illness de jour,” why have we been suffering with its symptoms and consequences for the past three years. During those years of countless therapy sessions, painstaking efforts to try to communicate with our son and find out what was causing him to act irrationally
and out of control, why didn’t you tell us that all we had to do was tell him, “Don’t sit there crying and screaming.” As a mother, I want to learn more about your technique. When are you publishing your research paper on child discipline as the cure for autism spectrum disorders? I can’t wait to see your double blind lab study comparing the results of your scientific discipline methods to the results obtained using the autism therapies developed by conventional medical science over the past 15 years on a control group. But if your theory about autism is so accurate, how would you apply it to these cases with my son . . . One time, I was walking him home from school, and I asked him how his day was. He immediately began to cry and tantrum. When asked what was wrong, he replied, “You can’t ask me that because it’s not sleep time yet.” I immediately understood and rephrased my question to “How was your day till now?” he calmed down, and a tantrum was avoided. He thought that by my asking him how his day was, he would have to go to sleep as soon as we got home. Another time, I came home for a lunch break and he was very upset when I left, because I didn’t eat lunch. As we begin to understand more about how he perceives things, and as he learns how to express himself more, we are having longer periods of calm in our home. Although my son is very bright and has a high IQ (he could do math by the age of 2), he has difficulty understanding simple everyday things. Things are as they appear to him, and no other explanation makes sense. For instance, he was afraid of a children’s book because it had a picture of a headless child, which was really a picture of a child putting on a pullover shirt, which had not been pulled all the way down. His behavioral overreactions are not due to lack of discipline. It is his rigid way of thinking, his inability to deal with unpredictability, and his inability to understand that a word can have
more than one meaning. When things do not work out the way that he thinks it should, he cannot cope and feels his world is crashing down. My son is now five years old, and has had a wonderful team of therapists who have worked closely with my husband and myself. Although he still has significant issues with eye contact, attention, and social interaction, he is able to attend a regular class with a SEIT teacher. His early diagnosis and early intervention is the only reason he has come so far. I write this letter because I strongly feel that misguided comments such as the one made by Michael Savage will deter much needed services for children like my son, who likely would have otherwise ended up in special education. If you feel your child needs help, and that something isn’t right, don’t let judg-
“My son is now ﬁve years old, and has had a wonderful team of therapists who have worked closely with my husband and myself. mental comments like his deter you from seeking services. His comment is simply another attempt to blame the mother for a child having an autism spectrum disorder. Us “refrigerator moms” must unite, and call upon Mr. Savage to walk a day in our shoes before judging us. * Rivkie Kaufman is a pen name for a mother of a child on the Autism Spectrum.
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Ask the Advocates By Juby Shapiro
Is my child who goes to private school entitled to a P3? My nine-year-old daughter is having some difficulties keeping up with her class. The school recommended that I open a case with the Committee on Special Education to get her P3 services (a resource room tutor). The district met and approved her to receive SETTS (resource room) five days a week for 40 minutes a session. When they mailed me my daughter’s IEP, I also received a letter offering her the resource room services as well as a placement in a local public school in the area. Since my daughter goes to a private school isn’t she entitled to a P3? Also, why did they offer her a placement in a public school? Does that mean she must go there to get the services? I do not want to take her out of her private school but she desperately needs these services. Also, even if she is allowed to stay in her school, does that mean she will have to leave her school every day to go to the public school? Also, what if 40 minutes a day is not enough to help her keep up with her class? How do I get the services my child needs while keeping her in her school?
Answer: No, you do not have to remove your child from her private school. A parent has the prerogative of sending their child to the school of their choosing. The issue at hand is what your daughter is “entitled to” as a private school student. The first thing you should do is contact the public school where your daughter was offered a resource room placement. When you call the school, ask to speak with the special education supervisor. Have a paper and pen and take notes. Ask the supervisor the time of day that the resource room that your child was offered is in session. You should also ask how many students attend as well their ages, what grade they are in and whether there are any other children from private schools in the resource
room. If your child is bilingual on their IEP which means their dominant language listed on their IEP is not English, you can ask whether the resource room offers services to bilingual students who speak your child’s language. Make an appointment to go and observe the resource room in person. When you go, bring paper and a pen to take notes. Observe the size of the class, the ages and grades the other students are in. Take time to sit through the session and observe the interaction between the teacher and the students. Is the group cohesive and learning material as a group or are they on many different levels? How much time does the teacher spend working with each student individually? Is your child learning on a similar level? Some resource rooms are offered in the mornings before you child starts school. If resource room is offered during school hours, what subject(s) will your child miss in order to attend the resource room including travel time? If the public school resource room, is appropriate for your child and you want to send him/her there, write on the placement letter that you accept the resource room placement (SETSS) at the public school but your child will continue to attend the private school. The district may ask you to complete a PSF1 form in which you are asked to write the name, address and contact information of the school your child will attend. If you will be pursuing a tuition reimbursement hearing you should cross out the words “and will privately fund this placement”. It is advised that you consult an advocate or attorney before completing the form. The PSF1 form also has boxes to check off related services and resource room. Check the boxes of the services you are accepting and sign the form. If you do not accept the public school resource room placement, write on the form “I do not accept this placement because it is not appropriate for my child.” On the same
paper or a separate attached page, if there is no room, write a letter to the District that the placement is not appropriate. In the letter, it is important to note that you observed the program and that you found it not to be appropriate for your child. You should elaborate as to the reason(s) why the placement is not appropriate and then request that the district issue a P3 for your child. Mail the letter certified return receipt requested or hand deliver to the district and get a time and date stamped copy for your records. If you receive a P3 from the district, you will have to locate a provider who must be a licensed special education or reading teacher. Some private schools offer their own resource rooms. If the teacher meets the Department of Education’s requirements then they may be able to accept the P3. If the district does not issue a P3, you may then request an impartial hearing. It is advisable to take an advocate or attorney with you to the hearing.
Can my child have two periods of resource room/ P3 services a day if one is not sufficient?
Answer: If your child already receives one period a day of resource room, (SETTS) or P3 services, but you and your child’s teachers still feel they are not learning and progressing in a meaningful way, you can reopen your child’s case with the Committee on Special Education and request an additional period of resource room/ Special Education Teacher Support Services a day. When reopening you case, it is important to bring tests and other supporting documentation to the CSE meeting. If your child has been privately evaluated and you concur with the results, you should forward a copy of the testing to the district. The CSE may choose to conduct their own evaluation(s) to help them determine your child’s present level of functioning and
needs. It is important to have your child’s teacher present either in person or by phone at the CSE review/ IEP meeting to explain why the increase in services is warranted. If your child has an educational disability he/ she is entitled to a FAPE-a free and appropriate public education in the least restrictive environment with the necessary supports and services for he/she to learn and progress in school. Least restrictive environment means in a class that is closest to a mainstream classroom setting. A self-contained special education class would therefore be more restrictive than a mainstream class with resource room (SETTS). If the CSE does not recommend an additional period of resource room a day, they may recommend a placement for your child in a full time special education classroom. It is advisable to observe the recommended public school class to determine if it is appropriate. If you find that it is not appropriate i.e.: it is too restrictive for your child, you may request an impartial hearing and bring the issue before an appointed impartial hearing officer. It is not generally recommended for parents to go to hearings alone. It is recommended to seek the help of an advocate or attorney. At a hearing, it is important to bring evidence (disclosed to the district five days prior to the hearing) and witnesses such as your child’s general education teacher and special education/ resource room teacher or P3 provider. Juby Shapiro is a special education advocate and is the founder and director of TAFKID a not-forprofit organization dedicated to helping families whose children have a variety of disabilities and special needs. TAFKID’s phone# is (718) 252-2236 or via e-mail at email@example.com
A Birthday Present for Pamela By Yaakov Kornreich Pamela loves to visit Israel, but the other residents in her group home, and friends about her age who live at other group homes, aren’t all as fortunate. Many of them had never been to Israel, so when Stan and Rhoda suggested that it might be nice to take some of them with her on her next trip, Pamela said, “I like that. That would be a good idea.” Stan and Rhoda were planning to make a big 50th birthday party for Pamela anyway, but now they had another reason to make it a special occasion. They would ask everyone coming to the party, in lieu of a birthday present, to donate some money so that Pamela could bring her Ohel/Bais Ezra friends to Israel with her. Invitations were printed and sent out, along Pam and her friends at their Jerusalem headquarters, on the balcony at the with a letter from Stan and front of the Kings Hotel, standing behind an Ohel/Bais Ezra banner. Rhoda to explain the project. The party was a huge success. It was all Pamela was born with Down syndrome, but she believes that she is very fortunate. the more special because Pamela’s 94 year Thanks to the tireless efforts of her devoted old grandmother was there, along with mother, Rhoda, now cheerfully assisted by Pamela’s brother Howard and his family. EvPamela’s stepfather, Dr. Stanley Goldstein, erybody was enthused with the idea of conshe leads a rich and rewarding life, and tributing to Pamela’s very special present. Pamela even got up in front of everyone wants for nothing. She is comfortable and happy with the care that she receives at her to make a little speech. She talked about all group home. She has a job at a HASC work- of the things and people in her life for which shop during the day, and many friends and she is thankful, concluding with, “and most activities that take up the rest of her time. importantly, I thank Hashem.” The party and the letter-writing campaign She is part of the community surrounding the group home where she has lived since raised enough money to send Pamela and six 1991, and she takes an active part in all fam- other Ohel/Bais Ezra residents to Israel for 9 days, accompanied by four Ohel/Bais Ezra ily gatherings and events. She has even gotten the chance to visit staff members to look after all of their needs. her sister’s family in Beit Shemesh, Israel on And, of course, Stan and Rhoda came along, several occasions. By almost any measure, too. Stan, who loves to travel, made all of the Pamela’s life is both filled and fulfilling. So when Rhoda and Stan asked her what she arrangements for the trip himself. They left wanted that would be special for her 50th for Israel in February, almost three months birthday present, it took some creative to the day, after the party. They flew on El Al, Artzenu Tours made the ground arrangethinking to come up with the answer. “Make a wish!” That’s what we traditionally tell someone celebrating their birthday just before they close their eyes and blow out the candles on the cake. But what do you get for the birthday girl who has everything? On November 18th of last year, at Brooklyn’s Shang-Chai restaurant, more than 100 people gathered to celebrate the 50th birthday of Pamela Reece, a resident at the Ohel/ Bais Ezra group home on East 3rd Street in Kensington, in both the traditional and in a very special way.
ments in Israel, and the group made the Kings Hotel in Jerusalem their home base. As soon as they arrived, they went to the Kotel to daven. They visited Kever Rochel and Chevron, and toured the country north and south, in style, . Everywhere they went they received the royal treatment. The Kings’ management even put an Ohel/Bais Ezra banner out in front of the hotel. No corners were cut anywhere – all the food was Mehadrin Kosher. Throughout the trip, Pamela and her Ohel/Bais Ezra friends were on their best behavior. For many of them, it was the realization of the dream of a lifetime, and thanks to all of the planning and effort, there were no serious mishaps. Nine days rushed by, and it was time for
Y o u r
Pam blows out the candles on her birthday cake at her 50th birthday party.
them to fly home again, but Pamela and her friends will long treasure the precious memories generated by the experience. Needless to say, all of us who attended the birthday party were also pleased and grateful for the chance to have been a part of it. “Happy birthday, Pamela, and many happy returns!“
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How Can Wii Turn Therapy Into Living Room Fun? By Kalman Greenberg “Therapy is work.” This is the mantra that therapist have often used to prepare their patients for the effort they will have to make in order to see results. This is also why therapy is often though of as the very opposite of “fun,” which is defined by the dictionary as enjoyment, amusement, or lighthearted pleasure. Yet, if it were possible to combine therapy with fun, or to make the therapy itself into fun, this would vastly increase therapy’s appeal to both children and adults, and make it more likely to succeed in reaching its therapeutic goals.
Therapy for young children has long been deliberately designed to look and feel like play in order to give the child more motivation. Occupational therapists use arts and crafts projects to work on fine motor skills. Physical therapists use balls to enhance larger muscles. Yet, as children get older, their therapy generally gets more clinical and less play-like, and therefore much more like real work. Clients/patients are told to do stretches and exercise specific muscles, often using high tech, intimidating-looking equipment. In short, it isn’t that much fun anymore. But that may be changing. Today, the same computer animation and video technology that therapists are now using for diagnosis (see the article on Gait Analysis in this issue) is becoming found in various mainstream consumer devices and video games. That, in turn, is changing the nature of exercise and play in ways, which can make
therapy, for both older children and adults, much more like fun and less like work. We have already seen this concept widely implemented in modern commercial gym exercise equipment, which feature interactive video displays portraying the user’s performance using real time computer animation. As the subject rides the exercise bike, for example, the video screen shows him as a participant in a bike race. The display is interactive, which means the harder the subject exercises on the bike, the faster the bike on the video screen seems to go in the virtual bike race. This encourages the subject to pedal faster, and makes an otherwise tedious exercise much more enjoyable. Today’s video and computer animation technology has become more sophisticated, making the realism of the images and action on the screen becoming much more realistic. In recent years, some of this same technology has been utilized in the design of adaptive equipment that allows children and adults with special needs to control a computer. Until now, this technology has only been available in a treatment center. But that may now be changing thanks to new trends in the commercial video game marketplace. The fast pace of technical development in computer graphics and animation has meant that every few years, we have seen the introduction of a new generation of video game machines with impressive advances in their capabilities over the previous generation. Most often, those advances primarily had to do with improvements in the realism of the images and actions portrayed on the video screen. But when the current generation of video game machines was introduced, Nintendo decided to try to broaden the market for its video games by changing the interface used by the person playing the game to control the action on
the screen. Instead of being limited to pushing a button, turning a wheel or pushing a joystick in different directions, Nintendo designed its Wii video game console to accept user input in an entirely different way. In addition to the usual button pushes and joystick movements, the Wii uses an infrared motion sensor to detect and react to a broad range of natural body motions by the user as he sits or stands in front of the video screen. In the basic Wii tennis game, for example, where and how the tennis ball travels depends on how the user swings his arm in front of the motion detector, very much as if he were holding a real tennis racquet. In the basic Wii bowling game, the player simulates walking up and throwing a real bowling ball while holding the game controller in his hand. Thanks to the motion sensor, the player’s figure on the screen mimics the player’s body movements, and his virtual bowling ball is then depicted rolling down a virtual alley and hitting virtual pins, which react in exactly the same way they would if you threw a real bowling ball with the same position and body motion in a real bowling alley. This Wii’s motion detecting interface has proven to be tremendously popular, and has vastly expanded the game’s audience. Before the introduction of the Wii, video “gamers,” as they like to call themselves, were mostly youthful new technology enthusiasts. But the Wii’s motion sensitive interface meant that it was no longer necessary to have quick eyes, reflexes and trigger fingers in order to really enjoy a computer game. The Wii enabled older people and others with physical limitations to participate in very lifelike simulations of active games like tennis or bowling in which they may no longer be physically capable of participating in the real world. As a result, the Wii has become particularly popular in senior citizens centers and
residential complexes. This added demand has enabled Nintendo to sell as many Wiis as it can produce, totaling more than 15 million game systems sold in the US alone since its introduction two years ago. The same motion sensing capabilities of the Wii which make it easier to use and more popular with senior citizens than traditional video games also makes it of obvious interest to physical and occupational therapists. There are many videos on the Youtube web site of therapists using the Wii to help in the treatment of stroke and car crash victims, wounded veterans and children with disabilities. For example, if a child who has issues with his upper extremities can imagine that, while he is swinging his arm in the prescribed manner in front of a Wii motion sensor, he is holding a bat while standing at the plate in a baseball game, or holding a racquet on a court in a tennis match, then his exercises will seem to be a lot more like fun than work. He will be more eager to do those exercises, and to do them correctly, in order to increase his game score. The popularity of the Wii has also resulted in the introduction of motion sensing interface devices, which further expand the types of actions that it can simulate. The most popular of these, and the one of most
FAMILY interest to therapists, is a pressure sensitive floor pad known as a Balance Board, which senses the weight and movement of the player’s feet, allowing the Wii to emulate on the video screen the motions and experiences of a skier going down a slope, or an exercise workout on a treadmill. The Balance Board expands the types of therapies, which a child can perform on the Wii and enjoy, including balance exercises, muscle control, and kinesthetics. Because the Wii is a relatively affordable mass consumer product, the child can do these therapeutic exercises on the Wii at home as well as in the therapy center and with the active participation and encouragement of other members of his family. There are other therapeutic uses for the Wii as well. It can also play the same traditional video games, which have been used for years by therapists as part of their treatment for individuals with attention deficit disorder (ADD). For children with this disorder, the video game seems to satisfy a craving for sensory stimulation, and it enables them to focus for longer periods on academic goals. In addition, the stretching exercises, which are included in the Wii Fit package, along with the Balance Board, also seem to be useful in putting children with ADD into a calmer mood. But why should they have all the fun? Talk to your child’s therapists, and see how your child’s goals can be adapted to use the Wii, right in your own living room. Play the games with your child and enjoy yourself. You will be reinforcing the skills taught in the therapy center while bonding with your child. In addition, you may find the Wii useful for yourself. After all, isn’t it time that you got off the living room couch and lost some weight? Kalman Greenberg is a certified school psychologist and licensed mental health counselor with 14 years of experience in using innovative therapeutic techniques to treat individuals. He maintains a private practice and is a professor at Touro College. He can be reached at (718) 4357000, or via email: firstname.lastname@example.org.
1600 63rd Street, Brookyn NY 11204 T: 718-851-0123 F: 718-851-0455
Origins of the Wii The technology behind the Wii’s motion sensing interface has its origins in the 1970’s, when the US Defense Department poured hundreds of millions of dollars into the development of “heads up” displays for jet pilots, to help speed up their reaction times. Virtual reality technology is also used extensively in the ﬂight simulators used today by both the military and the airlines to train pilots, as well as simulators to help train soldiers to use other high tech weapons, such as attack helicopters and tanks. The simulators allow these soldiers to be trained for combat in a variety of extremely lifelike virtual environments and weather conditions, with realistic landscapes which reproduce precisely those areas around the world where it is most likely, or at least possible, that they may be sent into combat some day. The use of simulators for this training has cut down signiﬁcantly on the need for the US military to actually sending its soldiers into desserts or mountains or frozen regions to train under actual conditions. Furthermore, when a soldier in training crashes his plane or blows up his tank in a simulator, he remains unhurt (except for his pride) and can immediately get back into the driver’s seat of the simulator and try it again and again, until he gets it right. Greenberg
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From the Diary of a Service Coordinator By Rabbi Ari Weichselbaum MS, ED Hi. My name is Gila, and I am a Medicaid Service Coordinator (MSC). I use a person-centered planning process to develop, put into action and maintain an Individualized Educational Program (IEP). I place a high value on choice, individualized service, and support and above all, the satisfaction of the consumers I serve. One of my most vital tasks is to serve as an effective advocate for my consumer. As a Service Coordinator I am dedicated to going above and beyond the call of duty for my consumer, no matter what it takes. I am willing to tackle the largest obstacle, overcome the most daunting roadblock, cut through all red tape inherent to navigate the system on their behalf.
Here are some examples of real case histories taken from my diary as they actually occurred, with the exception that all names have been changed to protect the privacy of the consumers and others involved.
thought, I arranged for a special entertainer to perform at his birthday party. The joy on Chaim’s face was a sight to behold and made all my effort worthwhile!
is a teenage girl with Familial Dysautonomia (FD), an inherited condition common among Ashkenazi Jews. Devorah’s dream was to go to summer camp like any other girl her age, but her condition made going out in the summer heat dangerous to her. She has no sensation of pain, heat or cold, and would not realize that she was becoming dehydrated. I was not surprised when every camp I contacted did not want to take the risk of admitting her. I finally found a small camp for special needs children, which I hoped might be willing to take her, but when I told the director about Devorah’s problems, his first reaction was to say “no.” I called him back several times, and each time, he said “no,” but I refused to give up. Taking matters into my own hands, I drove Devorah and her mother up to the camp without an appointment to introduce Devorah to the director. I was sure that once he met her, he couldn’t turn her down again. I was right. After having a lengthy conversation with Devorah, he agreed to consider admitting her for the next summer. Winter passed, and when I called the director, I learned that there was another problem. Because the camp is located in a remote area of upstate New York there would be no place nearby where Devorah could be cared for in case she had a medical emergency, G-d forbid. I did some more research and found a small hospital near the camp and went there to talk about Devorah and her potential medical needs with their administrators.
is a terminally ill child. He is constantly in and out of the hospital. The situation is made even more heartbreaking by the fact that he is fully cognizant and aware of his dire situation. I would do anything to make him smile. When I visit him, his face lights up. His birthday was coming up and each of his birthdays is a big milestone. I gathered some different ideas from family members and from my colleagues. After much
Caring support for your family Our Mishkon program offers: W group homes for people with developmental disabililties W community support services W Camp Mishkon Sternberg W Medicaid Waiver and Respite care Jewish Board of Family and Children’s Services has a long tradition of caring support for Orthodox families impacted by developmental challenges For more information, call Suri: (718) 854-0454, Ext. 212
They had no prior experience with FD, and it was not until I gave them literature on the condition, and helped them to understand its treatment, that they agreed to care for Devorah, if she were ever to need their help. As a result, Devorah was able to go to that camp that summer, and for many summers thereafter. Beyond some minor issues, she never had any medical complications at camp, thank G-d, and was always one happy camper!
is a boy with a lot of behavioral issues. He is on medication and under the care of a psychiatrist. When I heard that his school was closing, I knew that finding a replacement would not be easy. I contacted Moishe’s mother, made a few appointments with potential new schools, and went down with them for the interviews. When one of the schools finally accepted Moishe we were ecstatic! That is, until we got a phone call informing us that to be admitted to this school,
I would do anything to make him smile. When I visit him, his face lights up.
FAMILY his IEP would need to be changed, which can only be done by personally meeting with representatives of the Board of Education. I set up the meeting, and, of course, was present myself to make sure that everything would go well, and it did! Finally, Moishe started his new school, but on his third day, I received a frantic phone call from his mother. Moishe had been sent home for bad behavior! I immediately contacted the school and his psychiatrist, who said that all Moishe needed, was for his medication to be changed. A letter to the school was drafted stating that the necessary change had been made, and that Moishe was being closely monitored by his doctor, who expected his behavior to improve after a few days. The school agreed to take Moishe back once the medication had the desired effect, so I arranged for respite care for Moishe for a few days until he could resume his normal
How We Help
school schedule. Now, everything is fine again. Moishe is back in school and doing great! As I reflect on these accomplishments, I feel great knowing the difference that I made in the lives of my consumers and their families, and that I have gone beyond the call of duty to make sure that their special needs have been fully addressed.
Rabbi Ari Weichselbaum is a licensed special education educator and MSC supervisor at Special Care for Families and Children’s Services. Special Care services include Residential Habilitation, Respite, Service Coordination, and summer day camp for children and adults with disabilities. For more information on Special Care’s services, please call (718) - 252-3365
The mission of the Medicaid Service Coordinator, as deﬁned by the New York State Oﬃce of Mental Retardation and Developmental Disabilities (OMRDD), is to assist people who have developmental disabilities and mental retardation (consumers) to access important services and support tailored to their needs. Weichselbaum
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You Are Your Child’s Best Advocate! By Rifka Schonfeld While we may be intellectually aware that our kids are far from perfect, nevertheless, it’s a rare parent who doesn’t feel like she just got kicked in the stomach when she’s told that her child is having ‘issues’ in school. Whether the issues are academic, social, or developmental, it is difficult for any parent to accept the fact that their own child might need some serious help. Invariably, our first panicked reaction is “What’s wrong with my child?” followed closely by, “What’s wrong with me?” and “Where did I go wrong?” It’s important, however, to stay focused on the challenge that lies ahead. Our proper response should be, “Where do I turn for help?” Fortunately, today there are a multitude of services, programs, capable professionals and specialists that are willing and able to help our children. The ‘catch’ is that we,
bility as parents to pick up the pieces and do what’s best for our child. It might seem more convenient or comfortable to allow someone else, like a teacher or a tutor to do the job. But this is not wise and it’s not in your child’s best interest. You, as the parent, understand your child’s strengths and weaknesses better than anyone else. You can track his progress better than any outsider. You can observe him in both social and academic settings as well as in private moments. Parents, especially mothers, have a gut instinct about their children. They instinctively know if something is wrong. When that feeling is strong or persistent, parents should take it seriously, and consider a professional evaluation or assessment, even if the “experts” dismiss it. The reason is simple: Nobody knows your child better than you do.
Observe your child very closely. Stay focused on a speciﬁc behavior or skill. And, ﬁnally, record what you actually see happening. Write down the details. as parents, are the ones who are ultimately responsible for coordinating the services and monitoring our children’s progress. Legally, The Individuals with Disabilities Education Act (IDEA) empowers parents to become their child’s best educational advocate. Since you are the one who knows your child best, the law entrusts you, as a parent, to speak effectively on your child’s behalf. The challenge for parents when they discover that their child is having trouble is to transform that negative energy from their disappointment and anxiety into positive power. We also have to accept the responsi-
Don’t let yourself be intimidated. Network with other parents who have had similar experiences with their children, reach out for guidance, and do some serious research on your own on the Internet or in a medical library to arm yourself with the facts. A good place to start is to observe your child very closely, and document those observations. As soon as you feel that something is amiss, start gathering information. How? In their classic book, “Negotiating the Special Education Maze,” experts Anderson, Chitwood, and Hayden recommend that you, “Begin by carefully looking at the central figure in the whole process – your child. You
know a lot about your child, but your knowledge is often ‘felt’ in a general sense rather than in specific terms. Become a skilled observer. Try to be open to aspects of behavior you may have overlooked before. Be alert. Stay focused on a specific behavior or skill. And, finally, record what you actually see happening and your interpretation of your child’s action.” Write down the details. Record the facts exactly as they happen. Start comparing your child’s behavior to others in the same age group. Are your daughter’s classmates having a much easier time making play dates than she is? Is your son spending an hour and a half on his math homework and still not ‘getting it’, when his classmates are finishing the same work in half an hour? Speak to anyone who can shed light on your child’s behavior, including grandparents, neighbors, babysitters, or even the school bus driver. Don’t be embarrassed. Your child’s welfare is at stake. Next, you must be ready to face the music when the time comes for a professional evaluation. Without it, you will never know whether the source of your child’s problem is serious or not. Sometimes children may be developing more slowly than their peers due to the natural variation in the rates at which children mature in different stages, which will probably correct itself over time. But a child’s development can also be delayed by physical impairments, learning disabilities or emotional problems that need to be identified before they can be corrected or ameliorated through appropriate treatment. When an evaluation is necessary, it is usually preferable to seek out an independent professional rather than a member of the school staff. While the school’s evaluation services may be more convenient, an independent evaluator who is looking at
your child for the very first time will be able to provide a fresh perspective, and recognize something that everyone else missed. As your child’s best advocate, you need to be in control of the situation. You have a right to a copy of the evaluation as soon as it’s available and you also have a right to understand what the results are. If you are not called to attend a meeting or conference of the professionals to discuss the recommendations, then insist upon another meeting at which the results of the evaluation and its recommendations can be explained to your satisfaction. You need to be fully informed in order to make the right decisions for your child and properly evaluate your child’s progress as time goes on. Your job is not over once the necessary remedial services for your child are put into place. You must continue to observe the child, closely monitor and document any changes, and keep the file current as time goes on. The knowledge that you are doing your best to make sure that your child is getting all the needed services will give you as a parent the peace of mind you will need to always be patient and loving with your child, and this, in turn, iy’h, will help you to see the nachas you are waiting for. Mrs. Rifka Schonfeld, the founder and Director of S.O.S. (Strategies for Optimum Student Success), has served the community as an educator for close to thirty years. She is a kriyah and reading specialist, with experience helping schools to set up reading labs. She also offers training, educational consulting services and evaluations, and social skills training working with the whole child. She can be reached at (718) 382-5437 (KIDS).
The Role of the Social Worker in Helping Our Children By Bassie Morris LCSW Social workers can play an essential part in evaluations and as part of a therapeutic team helping children and families in need. Many parents have never met a social worker. Some might be hesitant to provide information to a social worker that does not present them in the best possible light, because they know that some of them work for agencies that might take a child away from a family in which there has been emotional or physical abuse. Today our community provides help to children and their parents in such circumstances, but extreme cases are beyond the scope of this article. We are talking about the procedures to be followed when any parent has specific concerns about one of their children, and calls an Early Intervention agency for help. After first meeting with a service coordinator, the parent is interviewed by a social worker or school psychologist, in order to obtain, in a respectful way, an overall picture of the child and the family’s concerns, priorities, and resources, its internal dynamics and the parents’ ability to provide for the child’s needs. The service coordinator will then ask the parent if they want a more thorough family assessment, which would include all factors which could affect the parent-child relationship, among them emotional, physically or financial issues. Such an assessment is necessary when stresses on the family make it difficult for the parents to carry out the recommendations of the therapists for the child who needs help. Parents may already be overwhelmed with the care of their other children, or in the midst of a financial emergency, or undergoing an emotional crisis. The list goes on. But the bottom line is that the additional challenges of dealing with a child with special needs could make an already difficult family dynamic even worse. A social worker is uniquely trained to recognize and assess
these factors. You, as a parent, have a right to ask for an assessment by a social worker, but it must be done at the parent interview so that the request for the service can be included with your request for any other therapeutic services. If warranted, the social worker might recommend family training or family coun-
Together the parent and social worker will break down the family’s routine and try to make adjustments seling in addition to occupational therapy, physical therapy, speech or special instruction. The interview with a social worker is an opportunity for the parent to speak with a trained professional about the stresses in their life. Short-term goals will be developed in the Individual Family Service Plan (IFSP) and clarified at the first meeting with a social worker. C a s e ex a m p l e Mrs. S. has seven children ranging from ten years old to six months. They live in a small three-bedroom apartment without an adequate play area for the children. The two year old will be receiving occupational, physical and speech therapy for developmental delays. A social worker will visit once a week, and begin by discussing the rules of confidentiality as a start to gaining the parents’ trust. Since one child will be receiving speech therapy, the social worker might focus on trying to improve the flow of verbal and non-verbal communication between the parents and their children. She would
show the parents how to speak more slowly and clearly, facing the child and making eye contact. The parent would learn to use active listening skills, and reflect back the child’s feelings, so that the child truly feels “heard.” If a mother says that she does not have time to read to her toddler, the social worker might help her to prioritize her activities and delegate some tasks to older siblings to give her the extra time that she needs for her toddler. The social worker might work with the parent to model reading readiness skills for the toddler. Together, the parent and social worker will break down the family’s daily routines and try to make positive adjustments. Over time, the social worker will hold follow-up family conferences to find out which adjustments are working and which are not. Here are some other ways in which the social worker may be helpful, providing you with a “tool box” of strategies that you can adapt to your situation: a) C hallengi ng Behavi o rs A social worker might help you to observe the interactions in your family. How does this child transition from a playgroup to home? What generally triggers the child’s negative behavior? How do you usually respond? Can your child calm himself without an intervention? A social worker will help you react to your child’s challenging behavior in more constructive ways, and learn strategies that encourage the child to respond more positively. b) Physic al Fac tors A social worker can make you aware of and help you to access various community resources and support programs. She can help you fill out applications and explain how to access government services for which you may be eligible. c) Working with the child Sometimes the social worker will work with the toddler on specific behaviors by cre-
ating an emotionally safe environment and helping the toddler with issues of self-confidence, self control and self esteem. In New York City, counseling is offered to children through the Board of Education from the ages of three and up, typically twice a week for thirty minutes in a school setting, with regular follow-ups by phone. The counseling might address the child’s social skills training, classroom issues and any negative behaviors impacting on the child’s ability to function in the classroom. In all these ways, a social worker can be an important part of your child’s therapeutic team, providing support, insight, information and skills training for you and your child. Bassie Morris is the Social Work Supervisor at Yeled v’ Yalda Early Childhood Center. She can be reached at Yeled v’ Yalda at (718) 686-2402.
What Is a Social Worker? A social worker is someone who has completed a masters degree in social work, and generally has a LCSW (state license as a licensed clinical social worker). Her training generally covers areas such as family counseling, advocacy, interviewing skills and skills in accessing community resources. Most social workers receive additional training, and specialize in one area such as play therapy, addiction counseling, social skills training, etc. Morris
Family Forum Edited By Perel Grossman The Family Forum section of the Jewish Press’ Building Blocks magazine was introduced to allow parents, other relatives and friends of those with learning or physical challenges to share ideas and information, raise concerns, and take comfort in the triumphs of others over adversity. Please note: out of respect for the privacy of the individuals concerned, some names have been changed.
Our Special Daughter’s Accomplishments By Andrea Lieberman, North Belmore, NY In September 1984, we were expecting our third child. It had been a wonderful, uneventful pregnancy. My husband and I already had two daughters, and we were all excited to welcome a new baby into our family. Our new daughter, Devorah Gila, was born late at night, and all seemed fine until the next morning, when the doctor told us she had signs of Down Syndrome. A blood test soon confirmed this. Our family was resolved to give this baby all the love, care and advantages that we possibly could. At the age of two months, she started in a pre-school for Down Syndrome babies (which amazingly happened to be [only] one mile from our house). At the age of five, she entered a special education program in the local public school. She grew
What a problem our community has! So many yeshivas, each ﬁlled to capacity, and not one that can cater to my son’s needs. 24
to be into a very special, social, loving, funny and smart little girl, beloved by all who know her. Devorah learned to read and to write English in cursive script by the age of seven. Since there was no yeshiva program for her in our area of Long Island, she attended a local three day-a-week Hebrew School for seven years. There she learned how to read and write Hebrew, which enabled her to daven every day, bentch, say brachot and give divrei Torah. She taught her public school teachers the basics of kashrut, and won their utmost respect by behaving and dressing as a bat Torah. Upon graduation from the special ed high school, at the age of 22, she received a PTA scholarship award, amongst others. After high school, Devorah wanted to continue her Jewish education at a higher level. She has been pursuing that goal for the last two years at a girl’s seminary program in Jerusalem called Midreshet Darkaynu, which is the special education section at Midreshet Lindenbaum. Devorah lives in the dormitory and attends classes. She also has a daily morning job in an outside office. Her seminary program includes classes on Torah subjects, chesed projects, money management, time management, and a daily, one-on-one chavruta learning where she is paired with a Lindenbaum student. There are shabbatonim, tiyulim [trips] and tours throughout Israel. Devorah’s experiences during her two years at Midreshet Darkaynu have helped her become a more independent, worldly, mature and competent young lady. It is obvious that Devorah’s hard work and perseverance, to open a pathway for her “abilities”, have with Hashem’s help, overcome her Down Syndrome “disability”. We are very proud of her. For more information about Midreshet Darkaynu, email Darykaynu@yahoo.com. To
speak to another parent who previously sent her daughter to the seminary, call 718- 8511812 (evenings).
Is There a Place of My Child Dear Family Forum, We live in a very affluent and compassionate Jewish community. Baruch Hashem, there are many choices of yeshivas for our children. However, what happens when a child learns a little differently? He/she may need a smaller class, more individualized attention from the morah or rebbe, or he may need to learn with a multi-sensory approach, slowed down and repeated. These types of kids get lost in our large yeshiva classrooms and fall behind. My son is one of those kids. He started out in yeshiva just like most boys. But we had to pull him out when we realized the size of the class, and the curriculum, were too much for him. We want our son to learn in yeshiva very much. But for now, our little neshama is in his second year of public school. He has been put in a class of only 9 kids and 2 teachers where he gets so much individual attention. His teachers communicate with us daily, through a notebook, and he is doing well. At our parent-teacher conference, the teachers suggested he stay yet another year in public school to master his English skills before we bombard him with the dual curriculum of the yeshiva system they know we would prefer him to be in. As usual, I left the meeting choking back tears. I try to redirect my energy to just work harder to find the best place for him to learn and grow. Although he is doing well in this public school, he can’t stay forever. He will only continue to fall further and further behind his yeshiva peers. We try to keep him up to par with supplemental learning at home, but it is clearly not good enough. I finally got up enough courage to call his old
yeshiva to inquire about re-registering him for next year. I hadn’t realized I would have to go through all the paperwork and interviews all over again, as well as the invasive questions regarding his mental, social, physical and academic status. The lovely woman on the other end of the phone went on to tell me [that] not only was there no room in my son’s old class, but the younger grade was also closed out (in case I was considering leaving him back a year). I felt like I had gotten the wind knocked out of me! I thanked her politely and hung up. This was not what I had expected. I had always assumed when he was ready, he would just go right back to his yeshiva and his friends and start right back where they had left off. Just because we were brave and strong enough as parents to admit [that] the yeshiva system wasn’t working for our son, and to find him a better, temporary alternative, I feel we are being punished. All my dreams of my little b’chor learning aleph beis, davening, having friends, [all] with their tzitzis flying around and their little leybydik faces full of the light of Torah, have gone flying out the window. Bezras Hashem, soon our son will be ready to learn in yeshiva again. Only Hashem knows when that will be. Where? That only Hashem knows as well. But many people in Jewish education in this community don’t seem [to be] too concerned about it, because as I call around to yeshivas from my first choice to my second choice, etc., there is either no room or no proper classroom for my son.
FAMILY FORUM What a problem our community has! So many yeshivas, each filled to capacity, and not one that can cater to my son’s needs. So I ask myself, why rush to get my son out of public school? It seems there is nowhere for him to go [anyway]? At least now we are saving money. But this is not an answer. We, as a community, collectively, have a problem. There has to be something else for our children. Yes, we have great yeshiva resource rooms. Yes, there is a great special-ed yeshiva within the yeshiva system. But we need something in between. We need to have at least one smaller class, approximately 12-15 kids, per grade for both the boys and girls, with 2 teachers - a teacher and an aide. Even better, one could have a background in special-ed. I am not saying the students in this class have to be special-ed kids. Half the class can be typically developing kids who would benefit from a smaller classroom and the other half of the class could be kids who just need more assistance and a calmer environment. In the special-ed world this is called an “integrated classroom”. In such a large community, with many kids receiving related services, (e.g. speech therapy), something like this would be well worth the investment. It is an investment in our most valuable assets - our children and the future of the Jewish people. We need to put more time and money into finding ways to meet the new generations needs and not continue under the assumption that the way we got through the system will be ‘good enough’. It is not good enough for them. We have to do better. As Hillel said, “If not now, when”? Sincerely, R.P., Queens, NY
ROCKLAND BUBBY SHARES HER SECRET As the grandmother of a very bright young lady who is dyslexic, I wanted to share with you an idea that I had, which has
proven very helpful to my granddaughter. My daughter lives in an out of town community and her little girl attended the local yeshiva but was having trouble reading and writing. Testing helped determine her learning challenge. Unable to keep up with the other children in her class, the school left her back year after year. Finally, my daughter transferred her to a public school where she could get the help that she needed. She was learning to read English, but was not able to work on her Hebrew in the public school environment. I felt so bad. Here, the child wants to bentch, to daven. How could I help her? I toyed with the idea of moving to my daughter’s community so I could spend time with my granddaughter and teach and guide her, but it didn’t seem right to leave my friends, job and shul at the time. One day, when I was standing in the local Judaica store, a book caught my eye. It was a siddur. ‘Oh, if my little maideleh could only read from it! How happy she would be!’ I thought to myself. A closer look revealed it to be an Artscroll siddur with interlineal explanation and transliteration! This was it - the key to her problem, at least temporarily. I had it wrapped and mailed it to her for her birthday. She was thrilled to be able to read from the siddur, just like everyone else! She is now nearing bas mitzvah age, attending Hebrew school three times a week (which she loves!) and finally learning to read Hebrew. But that Artscroll siddur got her through a difficult time in her life and I just wanted to share that with you. Marsha, Suffern, NY
A MESSAGE TO SHADCHANIM In the religious community, the shadchanim are so busy worrying about how to set up “the best with the best”; they won’t even look at someone with a learning problem. Yet, what would happen if there are two sisters, and the younger one gets married first, but no one wanted to set up the
Each member of the community must ﬁt in and be treated with respect, and offered shidduchim if they are to stay a part of the group and have a family “within.” older one who has a learning issue? Would it be okay for that girl to find someone in one of the discos in the city or date outside the shidduch circles and become more modern than she was raised, or even, G-d forbid, secular? Maybe? No? What is the alternative if she wants to settle down and have a life with a husband and start a family? She’ll find someone on her own, won’t she? My point is, each member of the community must fit in and be treated with respect, and offered shidduchim if they are to stay a part of the group and have a family “within”. Otherwise, what is the point of staying within the group? So they can stay single without any dates? No! I want every shadchan to read this and take it seriously. Do they really want the girls they refuse to set up (because of their learning problems) to begin to dress inappropriately and find a mate in the discos of Ben Yehuda Street or … worse? I know of a family who experienced this. One of the daughters got married and the other was not being helped by the shadchanim in the community, so she was forced to find her own. She did, but underwent a drastic lifestyle change in the process. She became very, very modern, dressing in a way that embarrassed her family. The community she grew up in, because of their radically different level of religious observance,
shunned her and her children. And, with all this, it was lucky that she ended up with a Jewish husband, at all. She might have married out, out of desperation and loneliness. Shadchanim – please look out for the Special Needs singles. They desperately need your help. R. B., Brooklyn, NY
A Mother’s Pain Att: Family Forum There are many well meaning people here in The Five Towns area that show a great deal of compassion and support for kids; that may not be typical. Unfortunately, there is still a great deal of fear and insensitivity. And it is just that, that affects and hurts the kids that are different, and their parents. My son is one of these “different” kids. He was in mainstream nursery at a yeshiva just like many boys. But we had to take him out when we realized that he had too many challenges to keep up with the normal classroom and typically developing boys. Obviously, we didn’t want to take him out of yeshiva, and it was a very difficult decision, but we had to do what was best for our son, not what was best for us socially. Bli ayin hara, he is a special boy; a nurturing and fun boy who will engage anyone willing and patient enough to talk to him. The saddest thing is, he has no friends. I could cry every day, and most days, I do. Last year, his first year out of yeshiva, his friends still called to get together and for birthday parties, and we reciprocated. Now that he is into his second year out...the calls have all stopped. It seems they have long forgotten my adorable son. But, he hasn’t forgotten them. He remembers from time to time and asks for them. Unfortunately, I have stopped pursuing dates for him with these boys because, most recently when I would call, they would be “too busy” or “not available” and the interest was not reciprocated. Why can’t the Jewish kids in the neigh-
FAMILY FORUM borhood show more interest to include our public school children, socially, even if they are a little different or awkward? I know kids can be mean. But their parents don’t have to be meaner. Many people ask me, “But why did he have to leave yeshiva?” They don’t accept our decision to take our son out. I think that is because they just don’t understand. The truth is they don’t have to understand or accept our choice, but at least accept our child. If I weren’t in the position I am in, I probably would not realize how it important it is to go beyond our comfort zone, our social circle and our car pools, to reach out to a kid in need. We, as parents, have to teach our chil-
dren compassion and understanding. Hopefully, as our kids grow, these feelings will become more integrated and natural. I know I am not alone in this. I have heard it too much lately. People complain to me that since they have put their child in public school or a special-ed program, their play date options have dwindled and the social invites have ceased to exist. The more severe the diagnosis, the more severe the exclusions. For our children, social life is over. Whether it’s from shul friends, neighbors or even cousins, our kids suffer the pain of being excluded and alone. Try to put yourself in my shoes. How is a mother supposed to feel when her son,
Warning to Parents Torticollis, Plagiocephaly and Tummy Time Although this column is intended to be a forum for parents to exchange information and oﬀer support, I ﬁnd this topic to be extremely urgent, so I am submitting this letter to the “Family Forum.” I am a pediatric physical therapist with 32 years experience, and I want to speak directly to you, the parent of a child about to develop a special need. Many babies are diagnosed with Torticollis, or twisted neck. This condition is caused by a shortening or tightening of the Sternocleidomastoid muscle on one side of the neck, which pulls the head towards one shoulder and limits neck mobility. Torticollis has become more common since the “Back to Sleep” program to prevent SIDS was instituted. There is little connection between adult onset Torticollis and congenital or muscular Torticollis in babies. Torticollis is not only a diagnosis, but also a forerunner of possible developmental diﬃculties and bony abnormalities. Torticollis is a problem of the whole body in developing infants and must be treated as such. That is because the position of the head eﬀects vestibular function and eye movements, as well as righting reactions, normal functioning of the jaw, the tongue, trunk, pelvis, and normal development. Head control against gravity must be learned as each developmental milestone is achieved. A developing child with Torticollis is also at risk for scoliosis and abnormal development. Torticollis is often accompanied by condition called Plagiocephaly (ﬂat head). When parents notice that their baby always keeps his or her head to one side, this could be a sign of Torticollis. There are some other signs: When in the car seat, crib, or when changing a diaper their baby’s head, it is always tilting to one side or turned in one direction. If a parent turns its head the other way, the baby becomes fussy or just turns it back. Nursing may be more diﬃcult on one side because the baby does not like to turn that way. The baby may only look at one hand or use only one hand. Signiﬁcant ﬂattening or asymmetry of the back of the head may become apparent as well as facial asymmetry (Plagiocephaly).
with his kippah and tzitzis, comes home from public school asking for a play date with Enrique or Christina? These are good nice kids, but not exactly our ideal play mates. And as a frum, Jewish mother, I am consumed trying to make, plan and execute play dates that will enhance my son’s life and enable him to grow socially. I daven every day that my son should
have yiras shaymayim and that I should be able to provide my son everything he needs to be healthy, happy, successful, well adjusted and secure in this world, and at the very least that he should be able to say sooner than later (and really feel and mean it), “Moshie is my friend”. Reeva F.,
We would love to hear from you. If you have any issues or comments for the Family Forum or Sibs Speaks for our next issue in May-June 2009, please submit it to Perel@jewishpress.com. You can also mail it to: Perel Grossman, 7 Greenhill Lane, Spring Valley, NY 10977
Recognizing this condition at an early age, even when the child is only a few weeks old, is of the utmost importance. To counter the tendency toward Torticollis, parents can reposition the baby’s head, encourage them to turn to the less favored side with toys and play, give the baby supervised “tummy time,” limit the time the baby spends on his or her back awake, and in devices such as car seats, swings, and baby seats. Here are some other points worth noting: It is important not to push on your baby’s head as this may cause injury. Tummy time for a few minutes a day is not suﬃcient. Placing infants on their tummy, when awake, helps to strengthen their muscles and develop symmetry, mobility, and normal development. Tummy time can include putting the baby on your chest as you relax and laying the baby face down on your lap. It is very important to discuss any asymmetry with the baby’s pediatrician as soon as it becomes noticeable. Early intervention and physical therapy can prevent some of the most serious consequences of Torticollis and Plagiocephaly. Torticollis and the resulting Plagiocephaly do not correct themselves. The earlier a baby begins physical therapy and the greater the involvement of the family in treatment, the easier it is to remedy the Torticollis and prevent some of its possible severe consequences. Torticollis detected and treated early can be successfully resolved most of the time. Parents need to ﬁnd a physical therapist with an expertise in treating Torticollis. Please do not delay. The time to address the problem with physical therapy is as soon as the asymmetry is noticed! Thank you for allowing me to speak to you. Sincerely, Dr. Karen G. Lyman, PT, DPT firstname.lastname@example.org
FAMILY FORUM Edited by: Perel Grossman
to another exciting edition of Sibs Speak; the place where siblings of children with special needs get to share their thoughts and feelings, and tell us what’s on their minds. We asked our readers to tell us what makes their special brother or sister so special to them. It is interesting to note the similarities in the comments, which points to the many things that Special Needs children can teach us if we only take a moment to reflect upon them. Here is a sampling of some of the responses we got from our wonderful readers:
Ab o u t My B ro th er Ye huda By Zahava, age 8, grade 3, Brooklyn My brother Yehuda is very friendly to everyone. If he sees someone, he says “Hi”, even if he doesn’t know them. Sometimes he says “Hi” tons of times. Sometimes he likes to shake hands with people. Of course, he also says “good bye”! What I learn from him is to be more friendly [to] people. Now I am not so shy with people anymore. I am glad to have Yehuda as a brother. My Sister, Aviva By: Rochel, Brooklyn My sister, Aviva is a special child who has suffered from a medical illness since birth. She is a person full of love and happiness that she shares with everyone. Aviva is fifteen years old and is developmentally delayed. She has a beautiful, bright smile that always shines on her face. She constantly reminds me that I need to, “be happy and not to worry.” There have been moments in my life when I thought Aviva was going to leave me for the Next World. She has taught me that even in pain, you can still find the strength to smile. Growing up with a sister who has special needs has challenged me in different ways. My inspiration to be happy has been crushed during some serious, traumatic times. I was forced to elevate my mood and be there for my family when they needed me. When Aviva would be in the hospital, I would arrive for my visit with bags filled with presents for her, and treats for my Mom. Aviva is a person full of love and happiness that she shares with everyone. M y S p e c i a l B ro t h e r By: Esther, age 14, Passaic, NJ The thing I like best about my brother is that he’s cute and loving [but] I wish that he could communicate better. The funniest thing about him is the way he dances to music! The thing that I have gained most from having him as a sibling is that I have become a little more patient, although sometimes I get angry because he destroys everything! What I have learned from my special sibling is to be happy even when things aren’t the way you want them to be!
What I Have Learned Fro m M y Bro t her By: Rochel, Brooklyn My brother teaches me how to appreciate who I am [and] also makes me sensitive to people with disabilities. If I just listen to his “funny stories” for a few minutes I can really make him happy. It is so funny that he’s making bar mitzvah invitations [for himself] when he is only 10 years old! The thing I wish I could change about my sibling is to help him to be able to get along with people better. Sometimes I get angry with him because he repeats himself a lot of times. But he has taught me that it’s good sometimes to just “chill out” – don’t get nervous.
My Ver y Special Sister By: Galit, Age 11, Briarwood, NY The thing that I like best about my sister with a disability is [that] when my mom comes in from shopping with bundles, my sister is the first one to help her, and I don’t have to lift a finger. I would like to share a funny story about my sister. My sister went to the slide and I was standing on the top of the slide. When she was climbing up the steps of the slide she said to me, “You are so annoying sometimes! Just go down the slide so then I can go down after you!” I was laughing so hard, and I asked her, “Where did you learn those words?” She said, “My friend.” The thing I wish to change about my disabled sibling is: I wish she was “normal” and more like me and my other siblings, so that I could play games [suitable] for my age with her. Sometimes I get angry because she annoys me and always tells me what to do, like a little boss. She can be really bossy sometimes. But because of my sister I gained the ability to be more giving, and I learned to be polite because she is very polite and always says “please” and “thank you”.
We were greatly pleased to find that these beautiful responses had a number of inspirational common threads running through them. Our respondents told us that they learned from their Special Needs brothers and sisters to “be happy and not to worry”, “even when things aren’t the way you want them to be” and “to just ‘chill out’ – don’t get nervous.” They shared the lessons that “even in pain, you can still find the strength to smile”, and have “become a little more patient”, “sensitive to people with disabilities” and “more friendly”; even “to be polite”! Seems like these youngsters are out there doing great things for our community. It is my hope that we can all internalize these ideas and overcome some of our own “emotional disabilities” – a lack of patience, sensitivity, or perhaps even ‘emunah’, and learn to respect and love one another despite our differences.
EDUCATION Key Points
The Fight for Inclusion * The law requires children with special needs to be educated with their typical peers appropriate in Lakewood Schools when * This goal can often be accomplished if there is good-faith eﬀort to accomplish it By Michael Inzelbuch Inclusion, the right of a classified child to receive a meaningful and individualized education in a regular classroom with appropriate supports, modifications and strategies, is an issue that is often the subject of heated debate between parents of special needs children and school districts, sometimes leading to fierce legal battles. The philosophy of inclusion is at times touted by the school districts as a basis for denying parental requests to have their child educated at the school district’s expense in a smaller more restrictive setting other than at the local public school. On the other hand, many school districts today are ignoring the mandate of inclusion, and locking out children from the opportunity to interact with their typically developing peers in a regular mainstream classroom setting. The History of Inclusion The famous US Supreme Court case of Brown v Board of Education more than 50 years ago rejected the concept of “separate but equal” as inherently discriminatory, primarily in the context of racial segregation in public school systems prevalent at that time. It also noted that being forcefully separated from their peers fosters “a sense of inferiority [that] affects the motivation of a child to learn.” Building upon the latter concept were two subsequent court decisions that took exception to the often systematic exclusion of children with disabilities from a regular education setting, and established guiding principals for inclusion, often referred to as the “least restrictive environment mandate” of the Individuals with Disabilities Education Act (IDEA). That law, which was formerly known as the Education for All Handicapped Children Act, was originally passed by Congress in 1974. It established the principle that “placement in a regular public school
* Often an eﬀort must be made to overcome resistance in the schools to this concept class with the appropriate ancillary services is preferable to placement in a special school class.” That landmark federal legislation, which has been strengthened several times since then, spurred a national movement to educate special needs children in the same classroom with typically developing children. In 2003, I was retained by the Lakewood Board of Education to help guide the district into compliance with the federal and state mandates with regard to special education in general and in several specific areas of inclusion. The first step was to examine the state of special education affairs within the district, including the then technical intervention program (TIP), a high school program for classified children operated for several years by a state-approved Commission. This alternate program operated on the premise that special needs children assigned to the TIP program could not receive a free and appropriate education (“FAPE”), as required by law, in the regular classrooms at the public Lakewood High School, due to their behavioral, academic, and attendance issues. The district, instead, was providing these children with an education that was totally separate and apart from their typically developing peers. Bringing Children Back into Mainstream Classrooms After examining the documentation, including the classified students’ Individualized Education Programs (IEPs) and numerous files describing the program, speaking with individuals who were in familiar with the program, and consulting with independent educational experts, it became clear that the TIP program was in violation of the inclusion mandate. It was also, in large part, failing to deliver a free and appropriate public education to the students enrolled in the
TIP Program. As a result of that finding, an administrative decision was made to allow many of the students to re-enter Lakewood High School and to provide them with the necessary support, modifications, and strategies they needed, such as the placement of trained aides, behavioral supports and a Child Study Team member specifically assigned to
there remain hurdles yet to overcome, such as the need for a more concentrated effort to challenge the students academically and engaging them in the educational process while taking into account their social/emotional limitations. Nevertheless, today these students are receiving the benefit of a much more inclusive education in a far less restric-
children in the new STRIVE program. Presently, the Lakewood Board of Education can lay claim to facilitating the legal right of special needs children to be educated with their peers to the appropriate extent possible. Specifically, in the school year 200607 seven (7) High School Seniors in the newly created STRIVE Program graduated. In the 2007-08 school year, four (4) Seniors enrolled in the STRIVE Program graduated and, in the current school year, based on a review of academic records and graduation requirements, eight (8) students enrolled into the STRIVE Program are expected to graduate. It should be noted that more than half of these students were previously disaffected to the educational process resulting in the behavioral and truancy issues that had prevented them from obtaining a free and appropriate public education. Granted,
tive environment that better prepares them to function in the real world. Lakewood’s Non-Public Schools Prior to the year 2004, there were few, if any, opportunities for children with disabilities attending non-public schools in Lakewood, New Jersey, to receive a real opportunity to be meaningfully included with their peers. It almost appeared as if the limited funds then available were utilized to deny children the opportunities to be included, because the services then offered often required the students to leave their classroom, if not the school in order to receive them. There was no plan or effort to bring the appropriate educational supports into the school buildings and classrooms. After meaningful consultations with the non-public schools and parents in Lakewood,
Michael I. Inzelbuch, Esq., is an attorney licensed in the states of New Jersey and New York who has assisted hundreds of parents and their children obtain individualized and appropriate educational services. Mr. Inzelbuch can be reached at email@example.com or 732905-0325.
Recent for Inclusion
In 1998, the US Department of Education’s Office of Special Education and Rehabilitation Services found that in the New Jersey’s local school districts: “in many cases, children with disabilities were removed from the regular education environment for reasons other than the child’s needs.” In 1990, Congress reaffirmed its commitment to inclusion, while recognizing that people with disabilities “are still subjected to widespread discrimination and segregation in all significant areas of their lives,” by passing the Americans with Disabilities Education Act. In 2000, the author successfully represented a seven-year-old autistic boy who resided in Manalapan, New Jersey, whose parents insisted that the school district provide him with the appropriate supports and modifications to allow him to be fully educated with his peers in a mainstream first grade classroom. The district originally wanted to put the boy in a self-contained classroom for special needs children, and refused to provide additional training to the teacher and aide in the classroom. An Administrative Judge ultimately ruled that the district had to upgrade the child’s Individual Education Program and provide additional training for the school staff and parents and meaningful opportunities to be included. Since said time the author has successfully represented/consulted hundreds of students who desired to be included with their typical peers and provided with appropriate, individualized, and meaningful supports.
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as well as discussions and input from national educational and legal experts, the Lakewood District opted to provide meaningful educational supports to children attending nonpublic schools including, but not limited to, the provision of trained aides, behaviorist, social skills training, and the creation of selfcontained and resource-like programming on the premises of the non-public schools. Initially there was resistance by some in the non-public schools to “those children” (referring to classified students) attending as mainstream students. They saw it almost as an invasion of their “little Harvards” or “Volozhin replicas.” This included some parents who did not want anyone to know that their “little Johnny or Sarah” had learning issues, for fear that this would affect their future marriage prospects -- as if the school and their peers did not already know. With the help of many, today there are hundreds of children who receive educational benefits in no less than twenty-five (25) nonpublic schools in Lakewood, ranging from Calvary Academy to the Lakewood Cheder. Granted, their still exists a lack of adequate funding for the many children who desire and, in fact, require meaningful supports. However, today many children are making great strides with their typical peers in Lakewood. In conclusion, while the federal and state requirements to educate special needs children with their peers may seem evasive, and can be considered yet another unwelcome and under-funded directive from Washington and Trenton that cannot be easily accomplished at the schoolhouse, the benefits to children are too important to ignore, and, with a concentrated and sincere effort, can be accomplished.
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EDUCATION Early Childhood Assessment Made Simple: What You Need to Know
Key Points * With Early Intervention, the earlier the better * When in doubt, check it out * You have everything to gain from assessing your child
By Scott Mesh If you, as a parent, have ever fretted that your baby or toddler might not be developing at a fast-enough pace, welcome to the world of the worried. You need reliable and understandable answers to your questions so that you can either confirm your fears or put them to rest. The good news is that there are many experts in early childhood assessment who can answer your questions. Here are the some of the basic points that every parent should know: Should every child be evaluated developmentally? No. Should your child be evaluated if you have a significant, nagging question about his/her development? Definitely, yes. If you have strong suspicions or concerns, it’s important to seek reliable advice. The best place to start is with your child’s pediatrician. Sometimes those concerns are heard and validated, and sometimes they are not, but as a parent, you should know that there are other good options available to you. The Early Intervention Program (EIP) is a government-sponsored program which provides evaluations and services (when indicated), at no charge to the parent. The appropriate phone contact will depend on the state and county in which you live. In
Early Intervention Program. Parents can make a referral for their own child to the Early Intervention Program by themselves, with no need for approval by a pediatrician or other health professional. Once a referral is made, the process begins. Another option is to seek private practitioners on the Internet using Google searches and on-line professional directories in various fields. Finding more specific recommendations and information on the quality of services provided on-line can be more difficult. One way is to Google a practitioner by name, which may reveal hospital or university affiliations, and articles that a practitioner may have published in professional journals. UNDERSTANDING THE PROCESS What can you expect once your child is referred to the Early Intervention Program (EIP)? The EIP will assign your case to an agency that provides service coordination, or case management. The agency, in turn, will assign you to a service coordinator who will guide you through the evaluation process, and help to arrange and oversee the various services for which your child qualifies, based upon that evaluation. Remember, participation in an EIP is entirely voluntary. You and your child may opt out of it at any time. However, if you
Parents can make a referral for their own child to the Early Intervention Program without the need for approval by a pediatrician or other health professional. New York City, you simply call 311 (the city’s information number) to be transferred to the
have any serious concerns about your child, it makes sense to obtain evaluations so that
you can receive professional opinions about your child’s needs and the services being offered to meet them. If you disagree with the findings of the evaluation, you are under no obligation to follow its recommendations. As a general rule when working with young children, “the earlier the better,” because the sooner intervention starts, the more likely it is to be successful, and the sooner the desired improvement will be seen. YOUR CHILD’S EVALUATION Within days of a referral of your child to an EIP, you should receive a call from your assigned service coordinator, who will inform you about your choices for an evaluation site for your child, which often will include your own home. In many but not all cases, a child will do best being evaluated in a familiar home environment, if that is where he or she feels most comfortable. During the evaluation session, one or more evaluators may see your child at a time. If multiple evaluations are needed, it is best that they be carried out during the same session, so that each of the evaluators is seeing the same performance and behavior. As a parent, you can expect to get some general feedback from the evaluator(s) on the spot, but more detailed results will come later, in the form of written reports. If you have questions or concerns about the evaluation process or reports, you should discuss them with your service coordinator, or the coordinator from the evaluation site. It
is their job to answer your questions to your satisfaction. If you disagree with the results of the evaluation, you are entitled to obtain a second opinion. If the evaluation shows that the child does not have a specific difficulty, then the parents’ fears can be put to rest. If there is a difficulty that needs support or intervention, such as speech, physical, occupational therapy or special education services, then the evaluation allows the appropriate services and therapies to start as quickly as possible. A CRUCIAL MEETING The next, and often the most important step, is a meeting between you as the parent, your service coordinator, and the city representative (EIOD) in order to negotiate an agreement on an Individualized Family Service Plan (IFSP) for your child and family. To prepare yourself for the meeting, you should speak to the evaluation team representative
EDUCATION to answer any questions. You also have the option to bring another person with you to the meeting, such as a lawyer or a child or family rights advocate, to help you argue the case for the services that you believe your child and family needs in the IFSP. Once everyone agrees to the IFSP, it becomes the blueprint for the various services that your child and family will receive, which begin as soon as therapists and other service providers are able to schedule times with you. In my experience, having evaluated several thousand young children over the past 15 years, I find that the most important mistake that families make is not having their child evaluated early enough. Parents are often the ones who will notice problems with their child’s development first, and my experience has shown that their expressions of concern should be taken very seriously. Those who try to be helpful by dissuading concerned parents from seeking a
professional evaluation of their child may, in fact, be delaying the recognition and identification of the child’s problem. Once lost, that time cannot be regained. The delay will cause the child to fall further behind other children the same age, and make it more difficult for that child to catch-up than if the child had been evaluated and services started as soon as the parent first noticed a problem. DON’T BE AFRAID I have worked with many families who were not happy to receive news that their child had an Autistic spectrum disorder. This is quite understandable. But what is most important for such families to keep in mind is that they can expect to see significant improvements in their children from the good interventions that are now available, such as ABA therapy or DIR/Floortime. But first their child must be properly evaluated. Only then can the appropriate treatment can be
obtained as a result of the discussions and negotiations at the IFSP meeting. Many parents are concerned about negative consequences arising out of their child entering a “special education” program. My professional and personal experience is that the best way to minimize the need for intervention in school age children is to start developmental services as early as possible, before the child reaches school age, to give that child the best chance to catch up. One of my own children was identified as a special needs child at age 2, and now I have the very positive personal experience of seeing how quickly my child learned to speak after effective intervention. WHY YOU SHOULDN’T WAIT If a child is identified with a more serious condition, such as an autistic spectrum disorder (ASD), which is most often diagnosed as Autism or Pervasive Developmental Disorder
Not Otherwise Specified, known by its acronym as PDD-NOS, then the earliest possible evaluation and intervention becomes even more important. The bottom line is, “when in doubt, check it out.” Don’t wait. If you suspect that your child may need help, such help is readily available. Delay just makes that help less effective. On the other hand, if, hopefully, your child does not need intervention, there is no reason for you to continue living with needless fears. So act now. You and your child have everything to gain and nothing to lose. Scott Mesh, Phd, is the author of “A Practical Guide to Early Childhood Assessment,” and the CEO and co-founder of Los Niños Services. It is a multilingual agency, based in Manhattan, serving the developmental needs of young children and their families from all communities in New York City and Westchester County. It can be reached at (212) 787-9700.
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Expert Advice on Choosing a School for ASD By Gili Rechany These topics are the most important for a parent to research and consider prior to selecting a school for a child with an autism spectrum disorder (ASD). 1.
Educational Philosophy The educational philosophy of a school is key to understanding its operational structure and drive. The Mission Statement usually indicates the foundations, core beliefs and goals of an organization. It spells out what the school can offer and what methods are chosen to carry out their promise of hope, care and a better future for our children and families. The educational philosophy also tells a lot about the school’s stand on parental involvement, collaborative planning and community participation. “When looking for a school it is very important to choose a school that is able to collaborate across disciplines and with the family. Collaboration is the key to servicing the whole child and enabling the families to interact with their child. Working together as a multi-disciplinary team, one is able to address all the deficits the child exhibits as well as meet the needs of the family. A school should not only service the child but also service the families as well (Lisa Resto, Educational Director - Yaldainu Academy).” 2. Supervision Model Most schools for the Autism Spectrum Disorder (ASD) population have a large staff that requires diligent supervision. Supervision expertise and a high level of training is crucial for the program’s effectiveness. It is important for staff members to keep abreast of new research, attend workshops and engage in other forms of instruction to permit constant professional development, in order to assure that each child receives the most up to date tactics and treatment. There is no time to spare when a child is diagnosed with this disorder. Constant evaluation and review of the student’s educational, social, and physical goals is required to insure that the best services are being provided daily. A highly qualified supervision team increases the likelihood of success.
child with the tools needed to succeed. Find out the school’s policies regarding parent visits, how often training is offered, and what systems are in place for parent-teacher communication and educational updates. Dr. Ibel, Clinical Supervisor - Challenge, stated that, “the difference is evident when parent involvement is strong. The parents can assist in carryover of the skills that are then truly being utilized in all of the natural environments of the child. This allows for true mastery of the skills taught by the teachers and therapists.” 4. Related Services It is important to have qualified personnel properly assess and treat the individualized deficits of each child with Autism. In many schools, it is the integration of multiple therapy methodologies that create successful programs. Allen J. Frances, M.D. Chair, DSM IV - Advisory Council for Imagine Academy for Autism, wrote “a program that offers a uniquely integrative approach that combines creatively what is usually seen as the two leading competing methods—Applied Behavioral Therapy and DIR/Floortime while offering the very best in speech, physical, and occupational therapy. The various components work beautifully together so that the whole is even greater than the sum of its individually excellent parts.” The parent must
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Parent Training Parental involvement is crucial for the success of a child with ASD. A parent is the main source of comfort, love, drive, and support in their child’s life. By participating in training, learning more about the disorder and making frequent school visits, a caregiver can provide their
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EDUCATION decide which program provides the most appropriate balance of treatment package based on their child’s individual needs. 5. Alternative Communication Regardless of where a child is placed on the autism spectrum, communication is always a deficit that is treated continually. “Visual strategies can assist in both expressive and receptive language development and decrease the likelihood of challenging behaviors the stem from lack of language and social skill. (Carol Schaeffler, -Augmentative Communication SpecialistBrooklyn College).” Alternative and Augmentative Communication specialists are important for verbal and non-verbal children who experience language delays. The use of high and low tech devices and manual boards can assist children to learn the meaning of language as well as the structure of it. It can also assist in increasing peer interaction and improve group and classroom instruction. 6. Assessment Tools The Assessment tools that are used in a school and frequency of assessment delivery can be a strong indication of the school’s philosophy. Assessment can be used as a driving force for a specific curriculum or to assess development of skills over time. Assessment reviews can provide time for the parent to learn more about the child’s specific program and contribute to it beyond the yearly IEP meeting. 7. Behavioral Plan Policy Every school should have a Behavioral Plan Policy in place. A parent should be aware of the school’s policy and how it is implemented. The school’s policies regarding decreasing inappropriate behaviors, punishment procedures and parent notification can make a difference. 8. Generalization and Maintenance Generalization is defined as the ability to use specific skills in different environmental conditions than the one under which the child acquired the skills. This is an extremely difficult task for many children diagnosed with autism. It is crucial that a school have an educational plan to teach generalization since this skill does not occur naturally with population. Another concern is helping a child to maintain skills that have been previously mastered. Constantly working to maintain and generalize these skills decreases the possibility of the child regressing. 9. Scientific Involvement Research is one of the most important components of any program. Being involved in new developments, participating in the scientific world, and learning from outside experts in diverse fields is crucial for a strong and productive program. Whether or not a school participates in conferences, professional development training and other research programs is one indication of the program’s professionalism. 10. Parent intuition Saving the most important for last, I have a strong belief in the value of Parent Intuition. As a professional I have heard parents use this term repeatedly, but while I always respected their decisions and valued their opinion, I never truly understood what that meant until I was blessed to become a mother. Since then, I encourage all parents of children from different backgrounds and abilities to listen to that voice in their head, and their “gut feelings” before making decisions that can influence the lives of members of their family. Choosing the right school can be an extremely difficult task. While all schools that provide services for children diagnosed with ASD strive to provide the child with a place where they can grow and develop to the best of their ability, it is in their philosophy and execution that they differ. It is for this reason that parents must evaluate the relative merits of each school when choosing a program for their child. Gili Rechany is the Educational Director at Shema Kolainu-Hear Our Voices, a school and center for children with autism. Ms. Rechany received her BA in behavioral analysis, and is a board-certified behavioral analysis and a certified building leader. Over the years, Ms. Rechany has consulted for both private and public schools, conducted parent support groups, and advocated for children with special needs in the New York state area as well as Israel.
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Multimodal Treatment for the ADHD Child By Shoni Eidlisz, LMSW Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects 3-5% of all children and emerges in the preschool and early school years. ADHD is the result of chemical imbalances in certain areas of the brain. In the majority of cases, it is both genetic and inherited. Early treatment of ADHD improves the chances of preventing adverse school experiences, social issues and associated problems. Treatment of ADHD generally involves medical, educational and behavioral interventions. This “multimodal” approach to treatment consists of education about diagnosis and treatment, behavior management techniques, medication, school programming and support. Medications called stimulants are used to control the symptoms of ADHD by regulating the brain’s chemical functions. For many children with ADHD, stimulants dramatically reduce their hyperactivity and impulsivity, and improve their ability to focus and learn. The effects of sustained release stimulants,
Key Points * Options for treating ADHD include medication, behavior modiﬁcation and educational intervention * Medication just treats the symptoms - it is not a cure * A calm and orderly home environment helps a child with ADHD
which are administered once before the child leaves for school, generally last throughout the school day. To date, there is no evidence that stimulants used to treat ADHD cause drug abuse or dependence. Most side effects are minor. They include headache, decreased appetite, mild stomachaches, insomnia, increased anxiety and/or irritability, and are usually related to the stimulant dosage. Stimulants do not cure ADHD. They just control ADHD symptoms, as well as some of the associated behavioral problems, on the day the stimulants are taken. However, medication alone is usually not sufficient. Behavioral therapy, counseling and support are also generally needed to help the ADHD child and family cope with the condition. Behavioral Therapy Children with ADHD face problems in daily life. These include poor academic performance and behavior at school, poor relationship with peers and siblings, failure to obey adult requests, poor self-esteem, un-
derachievement and poor relationships with their parents. Behavioral treatments teach skills to children with ADHD that will help them to overcome their difficulties and reach their potential. Children with ADHD may need help in organizing their daily activities. ADHD children need consistent rules that they can understand and follow. They benefit from following the same schedule every day, including wake up, homework, dinner, bath time, playtime and bedtime. They need to have a set place for everything in their daily lives. Homework and notebook organizers can help, as can writing down every assignment, and making sure they bring home the needed books and school materials. Other aids are to schedule set times for the beginning and end of each activity, and to use charts as a visual tool to organize and motivate an ADHD child. Poor parenting or a chaotic home environment does not cause ADHD. However, a calm and supportive environment will help a child with ADHD to concentrate, whereas a noisy, messy environment makes it harder to focus. Using Behavior Modification Parents and teachers can help children with ADHD to improve their behavior using the techniques of behavior modification. Eventually, a child with ADHD can learn to use these techniques on their own to improve their interactions with other children. The key to success with behavior modification is to start with rules and goals that the child can achieve in small steps, apply the rules consistently, including interventions, and to closely monitor the child’s progress, modifying the rules and goals based upon the child’s progress. (For a more on the rules for successfully
The primary characteristics of ADHD are inattention, hyperactivity, and impulsivity. All children are sometimes restless, act without thinking and are inattentive. However, when these traits extend to poor interaction at home, in school and/or with peers, ADHD may be suspected. In such cases, it is important that a child receive a thorough examination and diagnosis by a qualiﬁed professional.
Helping a Child with ADHD In a Classroom Setting:
1. Create a safe environment for learning. 2. Provide the student with low distraction work areas. 3. Prepare the student for transitions. 4. Adaptations for a student with hyperactivity – make sure the student is always provided opportunities for physical activities. 5. Permit the student to play with manipulatives (such as a squeeze ball) if it isn’t too distracting. 6. Break the work assignments into short, sequential steps. 7. Support the student’s participation in the classroom. 8. Classroom and homework assignment adaptations. 9. Daily school-home report care – tool to help parents and teachers communicate regularly identifying target areas which are being addressed. 10. Behavior chart and/or rewards and consequences programs. 11. Praise the child publicly. 12. Speak to the child privately (NEVER in front of peers) concerning negative behaviors. Eidlisz
applying behavior modification techniques, see the article by Dr. Wakslak in the Treatment section of this issue - Editor.) Parents of children with ADHD need to work closely with their teacher to implement
a successful behavior modification program in school. Such programs are individualized according to the child’s needs, classroom resources and the teacher’s skills and preferences. Children with ADHD respond better
when they are encouraged and feel safe even when they make mistakes. Parental Techniques Programs teaching parents behavior modification techniques allow them to continue the child’s treatment in their own home. Parents need to provide their children with clear and consistent expectations, directions and limits. They should also employ proactive discipline methods that teach and reward appropriate behavior, while responding to misbehavior with measured alternatives such as a “time out” or “loss of privileges.” When applied consistently, such a system can help a child with ADHD to adopt a more acceptable behavior pattern. The parents of an ADHD child will also benefit by using stress management and relaxation techniques for themselves, helping them to respond more calmly when their child engages in unacceptable behavior.
Some children with ADHD respond better to stimulant medication while others do best with behavior therapy, but for most, a combination of the two is most effective. In the end, each family has to make treatment decisions based on what they think will be most effective for their child. Speak with your doctor and/or mental health professional for more information on ADHD, treatment options, and resources available to you and your family. Shoni Eidlisz, LMSW, is the Director of the Early Intervention Program for the OMNI Childhood Center. OMNI provides evaluations and therapy services for birth - 3 years old, preschool (ages 3-5) and school age children (ages 5-21). Omni Childhood Centers are at 1651 Coney Island Avenue and 18 Heyward Street in Brooklyn. For further information, please call (718) 998-1415.
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Breaking Through the Dyslexia “Iceberg”
Key Points * Dyslexia is an inherited neurological condition causing reading diﬃculties * The Orton-Gillingham Approach uses a 5-part multi-sensory technique * Other Dyslexia therapies are based, in part, upon Orton-Gillingham research
By Mrs. Leah David Your child is now 6 years old and entering first grade. She is bright and a real chatterbox. It is 3 months into the school year and you get a call from her teacher who is concerned, because your daughter is not keeping up with the class. Your daughter is having problems putting letters and sounds together. She is not learning to read. As a concerned parent you speak with your child’s pediatrician. You recall that your oldest son had the same problems with reading and even after you tried everything, he still didn’t do well in school. Your husband had
some trouble in school as well. Your doctor suggests that you seek an evaluation by a professional, and the evaluation shows that your child has the most common learning difficulty, known as Dyslexia. What is Dyslexia? Dyslexia is an inherited neurological condition that makes it extremely difficult to read, write, and spell —despite average or even above average intelligence. According to the International Dyslexia Association, it is characterized by difficulties with accurate and/or fluent word recognition, poor spelling and decoding difficulties. It can result in reading comprehension problems, and impede the growth of vocabulary and basic
knowledge. Children with dyslexia usually do not respond well to traditional reading programs. I often explain to parents that a child with Dyslexia has an “iceberg” blocking their progress. Once you break through that “iceberg,” learning becomes smooth sailing. Reading requires the eyes and brain to work together in complex ways. The eyes must focus on the printed word while the brain controls the movements of the eye across the page. In addition, the brain must understand how the words are put together
and how the letters sound. In processing words, the brain builds images and ideas, compares the new ideas to what is already known, and then stores these ideas in the memory. A malfunction in any part of the brain’s centers of vision, language or memory, or in the nerve cells that connect these centers, can result in dyslexia. People with dyslexia have brains that are wired differently. Imaging tests show that when people with dyslexia read, different parts of the brain are activated than in people without dyslexia. I like to explain this complex learning difficulty with a simple analogy. Imagine the brain is like the surface of the moon, filled with craters. When a typical child learns let-
ters, sounds and words, the brain is able to find the correct “crater” so that the information is remembered and can be recalled when needed. But in the brain of a child with dyslexia, the craters are not as deep, or the information isn’t stored in the right “crater,” so it cannot be easily retrieved when the child needs it to read, no matter how much help they may be getting from their parents or tutors. When their baffled parents ask me, “How can it be that the information their child learned on Monday is often forgotten by Wednesday?” I answer, “That’s Dyslexia!” How Do We Teach The Child With Dyslexia? Reading instruction for the child with Dyslexia must be specific, sequential and multi-sensory, spelling out every detail for reading, decoding and encoding (spelling). The professional dyslexia educator utilizes different sensory/motor systems to teach the building blocks of reading and develop new pathways to the various areas of the brain, which process language. The teacher starts from the basics, letter-by-letter and sound-by-sound. The rules of the language are taught and practiced repeatedly until the student can use them automatically, building a foundation to enable the child to develop effective reading skills. Many reading remediation programs, among them LiPS, Wilson, Slingerland, and PAF (Preventing Academic Failure) are based on the research behind the Orton-Gillingham Approach. Dr. Samuel Orton, a neurologist, developed this approach in the 1930’s after an extensive study of children with the language learning difficulties now associated with Dyslexia. Together with Anna Gillingham, a noted educator, they formulated a set of teaching principles and multi-sensory practices that is now known as the Orton-
Gillingham Approach. Orton-Gillingham uses the senses of touch, sight, hearing, and movement, to teach children how to read in a specifically ordered way. The Orton-Gillingham lesson, as defined by the Academy of Orton-Gillingham Practitioners and Educators, is a 1-hour, 1:1 session, child and teacher. The lesson is broken down into at least 5 parts designed to help the brain of the child with dyslexia absorb information in a different way. The material is covered methodically, making sure that the child has learned it thoroughly before moving on. For example, a child will learn the letter “A” by reading the sound, writing the sound, spelling the sound and saying the sound. Every time the child learns a new letter or a sound, it chips away at the “iceberg” that is blocking their path to reading, until enough of it is broken down so that reading becomes less strenuous. As a mother of a child with Dyslexia, and an Orton-Gillingham teacher, I have come to understand what these bright children need to succeed. Early intervention is the key! Left untreated these children will slip further behind their peers. If you notice that your child is struggling with reading, please have your child evaluated by a reading specialist. If testing reveals that your child is struggling with dyslexia, it is important to find a properly trained and experienced reading teacher who utilizes a multisensory, sequential and specific approach. Every child has the right and ability to learn to read. Make sure that your child gets the help they need. Mrs. Leah David, MS, is the Founder & Executive Director of Ohr HaLimud-The Multi-Sensory Learning Center, which utilizes the Orton- Gillingham Approach. Programs include a Bais Yaakov School for girl’s ages 7-14; an after school and Sunday tutoring program for boys and girls, and Orton-Gillingham Teacher Training Courses. She can be contacted at (718) 972-0170 or by e-mail at firstname.lastname@example.org.
EDUCATION The SEIT Teacher’s Role in Mainstream Classrooms
Key Points * SEIT Teachers are provided for qualiﬁed children as part of their IEP * A SEIT Teacher will come to your child’s school, preschool or playgroup * The SEIT Teacher coordinates service with a child’s parents, therapists and teachers
By Ilana Pasternak-Yeger Imagine your child’s first preschool experience. These are exciting days in both your lives! Until the teacher calls and begins to tell of the troubles your child is having in school… “Chaim doesn’t sit during davening and he doesn’t sing along with our davening songs. He often touches the children who sit next him, causing not only a huge disruption in class, but often creating a situation where the other kids exclude him during free play. When we do arts and crafts projects related to the parsha, he doesn’t answer the questions, which we review daily! He requires a lot of my individual attention to help him put his crafts together, and never remembers the steps the whole class was instructed to follow. My assistant and I give him as much help as we can, but there are seventeen other children in this class who need our help, too.
SEIT teachers target all ﬁve areas of a child’s development... When I try to talk to him one-on-one, all he does is stare at me blankly. We need to fix this situation. If not, Chaim will soon begin to realize he is not keeping up with the others and become even more withdrawn!” Today, parents of students with disabilities between the ages of three and five have a variety of educational options available to them. Under the 1990 Individuals with Disabilities Education Act (IDEA), these children may qualify for extended special education services, to help them successfully mainstream into neighborhood schools, daycare programs and playgroups. These services can take place during the child’s normal school day with little disruption to their
regular schedule, and one of the most helpful of them is SEIT (Special Education Itinerant Teacher). To satisfy the IDEA law’s requirement to provide special education services in the “least restrictive setting,” which means the most natural learning environment - a SEIT teacher will travel to your child’s school. If a child’s ability to function in the classroom is impeded upon by cognitive delays, behavior difficulties, short attention span, impulsivity or low frustration tolerance, SEIT services may be requested as part of the child’s Individualized Education Program (IEPs). Additionally, a SEIT teacher may be assigned to help a child diagnosed with Down Syndrome, PDD, Autism and Learning Disabilities participate in a mainstream classroom. SEIT teachers target all five areas of a child’s development: cognition, communication, social skills, physical/motor skills and adaptive skills. Children with learning disabilities can have an extremely hard time negotiating social situations, remaining seated during lesson time or simply understanding what is expected of them throughout the day. This is where the benefits of having a SEIT teacher shine! SEIT teachers also act as a coordinator for all of their student’s other therapists. They prepare lessons, are responsive to and “educate” parents, and consult with the student’s classroom teachers regarding their progress and areas of weakness. They also ensure that effective support for their student’s IEP carry over is being provided at home. SEIT teachers who obtain the lesson plans from classroom teachers ahead of time can pre-teach their students, developing picture books and simple crafts activities to make abstract information more concrete. If a child presents with behavioral issues or poor social skills, behavior modifications plans can be developed. The SEIT teacher can work with the student during free play to model appro-
priate social skills and behaviors. The teacher can develop a social skills curriculum that can be targeted throughout the day and even over the weekend. The SEIT, parents and teachers are constantly consulting with one another to discuss and analyze all issues and discrepancies in a child’s home/school performance. These meetings can also include a child’s therapists to discuss specific therapy techniques and to ensure that all educational goals are being met. The majority of SEIT sessions should happen in the classroom; however, working with a child outside of the classroom individually or in small groups can some-
times be beneficial as well, especially when looking to target specific IEP goals. The SEIT teacher’s goal is to embed instruction in the most natural way possible, allowing the student to succeed in school with a minimum of support, and using the routines of a regular classroom is the perfect setup to achieve this goal! Ilana Pasternak-Yeger, MS is a SEIT supervisor at The Auditory/Oral School of New York, which offers a comprehensive SEIT program servicing schools, playgroups and daycare centers in all five boroughs of New York City. Therapists are trained to target the cognitive, communicative and social needs of students, and specialize in working with students with central auditory processing disorders and those who are hearing impaired.
DIAGNOSIS Something Old and Something New: Gait Analysis
Key Points *Gait analysis is based upon the principles of stop-motion photography *Gait analysis is used to create a 3-dimensional picture of the body in motion *The results of gait analysis can be used for diagnosis, rehabilitation and in training for sports
By Dr. Ellen M Godwin When a horse gallops, do all four of its hooves leave the ground at the same time? That question was the subject of much speculation in the second half of the 19th century. Legend has it that in 1872, Leland Stanford, the former Governor of California and race horse owner after whom today’s Stanford University is named, wagered $25,000 that all four hooves do leave the ground, in a phenomenon called “unsupported transit,” and then set out to find a way to prove that he was right, by hiring one of the leading photographers of the era, Eadweard Muybridge. On June 11, 1878, Muybridge held a demonstration using an array of 12 highspeed cameras set up along a 20 foot-long section of racetrack, and triggered by the
Animated sequence of a race horse galloping. Photos taken by Eadweard Muybridge first published in 1887 at Philadelphia (Animal Locomotion).
horse’s hooves as they passed in front of the cameras. The series of photos taken that day of “The Horse in Motion” proved that all four legs of a galloping horse do leave the ground at the same time. Muybridge’s basic concept of stop-motion photography using multiple cameras is the basis of gait analysis, a diagnostic tool typically carried out in laboratories associated with universities, teaching hospitals and research centers. Therapists and physicians use gait analysis to identify the specific posture or movement-related problems of those who have suffered physical injuries or neuromuscular disorders such as cerebral palsy, spina bifida or Parkinson’s disease.
Gait analysis is also used to study orthopedic conditions such as in-toeing and the turning of the limbs, in order to prescribe specific orthotics or braces, and to check the effectiveness of the orthotics after they have been fitted to the patient. It is also used in planning orthopedic surgical interventions to lengthen or transfer the muscles, and to check the results after surgery. Gait analysis has also been used as a guide for training Olympic athletes, and to help players in sports such as golf and running to improve their performance. STUDYING HOW THE BODY MOVES Gait analysis involves the collection of data measuring the movement of the body in space (kinematics), using a 3-D motion capture system. Additional data is collected from force plates and then analyzed to understand the forces produced by the body’s various muscle groups on its joints (kinetics). A typical gait analysis lab has up to 8 computerized motion capture cameras positioned at all angles around a walkway or treadmill. Digital video cameras are also used to record the subject’s movements. A computer synchronizes and analyzes the data from the motion capture cameras and the force plates, to generate a 3-dimensional picture of the motions of the body parts over time. The cameras record infrared light signals from small active or passive markers attached to specific parts of the body. The passive markers are small balls covered with a reflective material, which reflect bursts of infrared light emitted by the cameras. The computer determines the time elapsed between each burst and the moment when the reflected signal reaches the cameras. It also determines the exact angles and velocities of the marked body parts. Using all that information, the computer generates a 3-dimensional kinematic picture of the motion. The active markers contain both infrared detectors and LED transmitters. When the
infrared burst is detected, the marker’s LED emits a uniquely-coded infrared signal of its own. This allows the computer to identify the data from each active marker instantaneously, and generate a 3-dimensional picture of the motion in real-time. Force-plates built into the walkway measure the ground reaction forces being generated as the subject walks or runs over them. Using the signal from the load transducers in the force-plates, the computer determines the forces being generated by each of the subject’s muscle groups, and the magnitude of the stresses on the joints. Some gait analysis labs also use dynamic electromyography by attaching electrodes to the subject’s skin to detect the electrical signals being generated by the muscles directly underneath. The computer then can determine the activation times of the muscles, and the pattern in which muscles are being activated. A gait analysis can also measure the amount of energy being expended during walking by the measurement of oxygen use or breathe analysis. While walking, the subject wears a small apparatus with a facemask (like a scuba diver wears), which analyzes the gases in the exhaled air. From this data, the amount of energy being expended by the body can be calculated. Such measurements on children who become exhausted quickly can be used to suggest energy-saving changes in their gait, which will give them more endurance. The energy calculation may also help to determine, for example, how quickly a child with a degenerative disorder is going into decline. Using the latest advances in biomechanical engineering, gait analysis can create a computer-generated model that will predict how a child’s walk would be altered if its muscles were lengthened. That model can then be brought to life on the screen using computer animation.
A gait analysis session generally takes up to two hours. Preliminary results are usually available by the end of the session, but a more thorough analysis of the data is usually required before a final report can be sent to the referring physician. Before scheduling a test in a gait analysis lab, parents should check to see if their child’s health insurance would cover the cost. It is not covered under government-paid IDEA services for children with disabilities, and coverage by private health insurance policies varies widely. YES, YOU CAN TRY THIS AT HOME Parents can carry out a simple gait analysis on their child in their own home, using a digital video camera. The camera should be set up in a fixed position in front of an unobstructed walkway about 20 feet long, and the child should walk back and forth in each direction about 20 times. Dressing the child in a minimal amount of clothing makes it easier to see the body movements. While the results will not be as thorough as a gait analysis done in a lab, your doctor or therapist may want to see the child’s motion in a more natural environment. Gait analysis is a fascinating amalgam of the principles of stop-motion photography, developed by Muybridge 130 years ago, and today’s cutting edge video, computer animation and biomechanical technology. It gives doctors and therapists a powerful tool with which to discover the root causes of the motion difficulties being encountered by their patients, and helps them to plan and evaluate corrective therapies and procedures. Ellen M. Godwin, PT, PhD, PCS, Director of the Human Performance Laboratory at Downstate Medical Center, has given presentations across the country on spasticity management, gait analysis and surgical planning in cerebral palsy and the use of BOTOX in children. Dr. Godwin is Adjunct Associate Professor in the Division of Physical Therapy at Long Island University.
Genetics and Hearing Loss By Tziona Bin-Nun Hearing loss can have many causes. Some are environmental, such as certain infections that the mother might contract during pregnancy (like CMV - cytomegalovirus) or infections in a newborn or older child (for example, meningitis), and some are genetic. Sometimes, hearing loss is due to a combination of environmental and genetic factors. In about 30% of babies with hearing loss, it is just one of several symptoms which are grouped together into a syndrome. In the other 70%, the babies do not have any other symptoms other then hearing loss.
We are just beginning to discover and identify which genes are responsible for genetic hearing loss. The GJB2 gene controls a protein named connexin 26, which is important to the proper functioning of the cochlea. The cochlea is the delicate part of the inner ear which transforms the sound waves, that have passed from outside the body through the outer and middle ear, into electrical impulses which then travel through nerves to the brain, which translates these sounds into meaningful stimuli. The cochleaâ€™s development in the fetus is controlled by a very complex set of instructions supplied by genes. A change or mutation in any one of these genes can result in hearing loss. A human being has approximately 30,000 genes, which are DNA sequences that provide the coded instructions to the body for the production of proteins. There are many different mutations in genes, which can cause hearing loss. The presence of a mutation in the DNA sequence of genes means that the code is incorrect and a protein might
be missing or non-functioning. Some of these mutations are recessive, meaning that only individuals who have inherited two copies of the abnormal gene (one from each parent) inherit a hearing loss. Hearing loss can be autosomal recessive. The hearing of those who inherit one normal and one abnormal recessive gene is not affected, but they are carriers, which means that they can pass the abnormal gene on to their offspring. In a family in which both parents are carriers of one recessive gene for hearing loss, each child born has a 25% chance of inheriting two abnormal genes and subsequently having hearing loss. That is why 90% of hearing impaired children are born to normal hearing parents. Some syndromes (groups of symptoms) are autosomal recessive as well, such as Usher (which affects vision as well as hearing), Pendred (which affects the thyroid as well as hearing), and Jervell and LangeNielson (which affects the heart as well as hearing). Hearing loss can also be due to an autosomal dominant gene, which means that even if only one parent has the abnormal gene, it can be passed on to their offspring. Since the gene is dominant, the parent who passes the abnormal gene on, and the child who receives it, will be affected, and have hearing loss, even if the copy of the gene they received from their other parent is normal. This means that if one parent has the dominant gene for Waardenburg syndrome, which includes hearing loss and several other anomalies (a white forelock, different colored eyes and strikingly blue eyes), and the other parent does not, each of their children has a 50% chance of inheriting the syndrome. But even when the dominant gene is inherited, the expressions of the syndrome may vary, and not all of the syndromeâ€™s traits are necessarily inherited. When a hearing-impaired child reaches marriageable age, the possibility that the child is carrying a hearing loss gene becomes
Key Points * Not all cases of hearing loss are due to genetic causes * 90% of hearing impaired children have hearing parentsn * Genetic testing can help to make intelligent shidduch decisions a serious concern in the process of selecting a mate. However, because of advances in our knowledge of the causes of hearing loss, as well as advances in genetics and the availability of genetic testing, in many cases it is possible to determine in advance the chances of a child with hearing loss resulting from a shidduch between a person with hearing loss and a person with normal hearing loss. A consultation with a geneticist will make it clear if the cause of one partnerâ€™s hearing loss is genetic or not, and the chances of passing it on to the next generation. If a non-genetic cause can be identified, then the offspring is not at risk. If the hearing loss is caused by an abnormal gene, then we can predict the chances of the hearing loss, as
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well as other symptoms (if the hearing loss is part of a syndrome), being passed on to the next generation based upon whether the abnormal gene responsible is autosomal recessive or autosomal dominant, and if it is recessive, whether or not it is present in the normal hearing person. That allows potential couples to make an intelligent, informed decision on the advisability of a shidduch, based upon an accurate assessment of the genetic risks involved. Knowledge is a powerful tool! Tziona Nin-Nun, M.S. CVCC/A, is a widely renowned audiologist and lecturer specializing in pediatric audiology, who has participated in several research projects and who maintains a large private practice. She has also been associated with the League for the Hard of Hearing, Beth Israel-Long Island College Hospital and Touro College.
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DIAGNOSIS Understanding Developmental Apraxia of Speech
Key Points * A child with Apraxia knows what he wants to say, but just can’t say it. * Children with Apraxia get easily frustrated because they can’t be understood. * Frequent repetition and parental support are keys to progress.
By Betty Aboﬀ, MA, CCC SL/P What is Developmental Apraxia of Speech? It’s a neurologically based speech disorder in children and is considered a motor planning problem. Learning speech is similar to learning how to drive a car. You must learn a sequence of steps and tasks, which at first, takes a lot of thought and concentration. But, over time, most children learn how to talk automatically, or without having to think about it, much as an experienced driver develops safe driving habits. A child with Apraxia can’t speak naturally because of some subtle brain impairment of unknown cause and nature. Some children have difficulty not only with pronouncing sounds in words, but also with voluntarily
making the movements needed to sequence sounds, syllables, and words. Children with Apraxia may also have other developmental delays including: oralmotor weaknesses (low muscle tone/inability to imitate various lip, tongue, and jaw exercises etc.), expressive language delays, fine motor or gross motor delays-usually related to motor planning problems. These children get easily frustrated as they try to say the words that others cannot understand, especially when taken out of context. Sometimes a child with Apraxia will reverse the order of sounds, leave some out, or add extra sounds when trying to pronounce a word. The first signs of Apraxia can appear in
PHYSICAL THERAPY & REHABILITATION SERVICES, P.C. 856 46th Street Brooklyn, NY 11220 Tel: (718) 435-7000 Fax: (718)-435-7066 www.Therapy-In-Motion.com We treat the following Diagnoses:
• MEDEK/NDT/Pediatric • Custom Foot Orthotic Intervention/Torticollis Evaluation/Fitting • Orthopedic and Sport • Balance/Coordination Injuries difſculties • Pre/Post Surgical • Postnatal Rehabilitation Rehabilitation • Low Back/Neck Pain • Posture Correction/Scoliosis • Carpal Tunnel Syndrome Treatment • Arthritis • Advanced Manual • Work Related Injuries Hands-on-techniques • Automobile Accidents • Geriatric Rehabilitation We Accept the Following Insurances: United Healthcare Aetna Oxford Cigna BlueCross BlueShield Magnacare Americhoice GHI Medicare HIP 1199 Health-Net US Family Worker’s Comp/No-Fault Languages Spoken: English, Yiddish, Spanish, Russian, Hebrew
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early infancy, with a baby that isn’t cooing or babbling. Another sign is a baby who is very “quiet” and whose vocal sound production is minimal and consists of very few consonants. The baby may be unable to babble normally (babbling is done by combining sounds in a repetitive manner) and may be slow to develop first words. Signs of Apraxia (as opposed to an articulation disorder) in an older child include inconsistencies in the child’s pronunciations of the same sound or word and a level of understanding of the language that is much higher than the child’s ability to speak. In a child who is already speaking, signs of Apraxia include: frequent vowel distortions, limited number of sounds in the child’s repertoire, and greater difficulty when trying to say longer phrases. Children with Apraxia also have difficulty with imitating and saying spontaneously more than one simple syllable, difficulty with the correct voicing of a sound (i.e. “p” for b” and visa versa), difficulty with prosody (melody and intonation), struggle and groping behaviors, and unusual movements of the tongue, lips, and jaw as the child tries to produce sounds and coordinate his articulators (parts of the body involved in producing vocal sounds). The result is that the Apraxic child has difficulty making himself understood due to the inconsistencies and multiple errors in his speech. Such a child needs to be evaluated by a licensed Speech-Language Pathologist, who will assess the child’s muscle development, speech mechanism, breath control, voice intonation patterns, ability to produce sounds and sequencing of sounds in words. Children will not “grow out” of Aproxia on their own. It is important to begin intensive speech therapy, which depending on the severity of the condition, may range from 2 to 5 sessions a week. Short and frequent therapy
sessions are more effective than longer but more infrequent sessions. It is important to start therapy when the child is still very young because his difficulty in producing speech and being understood by others may lead to academic and social difficulties when he reaches school age. Therapy focuses on improving the child’s ability to imitate various vowels and consonants and develops the ability to sequence consonant and vowel combinations into multi-syllabic combinations, words,
Oral vs. Verbal Apraxia Oral Apraxia is difﬁculty controlling those muscles required for speech. A child with Oral Apraxia may also encounter diﬃculties with nonspeech activities, such as blowing or imitating oralmotor movements. Verbal Apraxia is diﬃculty coordinating the tongue, lips, and jaw in the correct positions to say syllables and words. There is usually nothing wrong with the muscles of the tongue, lip, and jaw, and these children know what they want to say, but they just can’t say it. The child’s brain cannot manipulate the tongue, lips, and jaw correctly to produce the words. A child may have oral, verbal or a combination of both types of Apraxia. Aboﬀ
DIAGNOSIS phrases, and ultimately sentences. The therapy involves asking the child to imitate syllables of increasing difficulty and to re-
peat them until he can consistently produce the targeted consonant and vowel combinations correctly. Therapy also involves using a multi-modality approach, which includes auditory cues (telling the child verbally how to produce the sound), visual cues (using pictures), and tactile cues (touching the parts of the face or mouth to physically show the child how to produce the desired sound).
Children receiving therapy for Apraxia will, over time, learn to use understandable speech and language to communicate their wants and needs. Some therapists also may also use a lot of oro-motor exercises, which increase strength and the mobility of the articulators. For the more involved Apraxic child, there are assisted devices such as PECS (Picture Exchange Communication System). It uses familiar/common pictures pared with words, in a small book that the child carries and uses when he wants to communicate. Communication boards or electronic assisted devices are also recommended for temporary use, until the child develops more sounds/ words in his vocabulary, and will not diminish the child’s ability to develop verbal speech. Cueing and physical prompting have also been used and adapted, depending on the needs and tolerance of the apraxic child. The use of an intensive structured
therapy approach called “Prompt” (Prompts for Restructuring Oral Muscular Targets, which was developed by Debra Hayden) has also led to good results. “Prompt,” which is being used by many therapists, incorporates intensive oral-motor therapy, multi-sensory cueing (touch, pressure, placement, auditory, visual cues), and physically manipulating the muscles to produce the targeted sounds. (See article on Prompt Therapy on page 56.) A supportive home environment and a commitment by the child’s parents to frequent practice at home of the same syllable drills the child is working on in therapy, are keys to progress. The more often the child practices making the same sounds or sound combinations, the quicker the motor plan will become a habit and easier for the child to say. Positive reinforcement from the child’s parents in a supportive and encouraging home environment is essential. It is
important to avoid criticizing or correcting the child’s speech. As long as the parent understands what the child meant to say, the parents should repeat it, correctly, so that the child can hear how it should sound and also know that he was understood. Parents should praise all sounds and words that the child verbalizes correctly, and when the child makes a verbal error, model the correct production for the child to imitate. Children with Apraxia in therapy usually make slow but steady progress, but the commitment of parents to devote time for repetitive practice with their child is essential for maintaining the progress achieved!! Betty Aboff is a licensed Speech-Language Pathologist specializing in evaluations and therapy for children ages birth to five. She is Speech Supervisor with the Whitestone School for Child Development, a special ed preschool in Queens, and Kinderkare, an EI agency in West Hempstead. She has almost 20 years experience in the field. You may reach her at 516-565-0189 or at email@example.com.
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Your Child Deserves the Best! 41
Prader-Willi Syndrome By Stephen Glicksman, Ph.D. Every cell of the human body has 23 pairs of chromosomes. These chromosomes carry within them every bit of information about what makes us who we are, physically: The color of our hair, the color of our eyes, our gender, whether we will be innately talented in sports or music, our learning styles, which diseases we might be prone to develop, the limits of our potential height and weight... even certain personality traits appear to be coded within our chromosomes. Every once in a while, something unexpected happens to a chromosome that can have an impact on the development of a child. Sometimes a piece of a specific chromosome is missing; sometimes there is too much of a different chromosome. Having an extra 21st chromosome, for example, causes a person to have Down Syndrome. Missing a little piece of chromosome 15 is what causes Prader-Willi Syndrome.
Prader-Willi syndrome is a condition effecting approximately one out of every 15,000 people. It is seen equally in boys and girls, from all races, religions, and socio-economic groups. People born with Prader-Willi Syndrome are usually very short, have low muscle tone (that means they are somewhat “floppy”), behavioral issues, and learning challenges ranging from learning disabilities
Key Points * Children with Prader Willi are very short, usually mildly retarded, and always hungry. * Prader Willi is the result of chromosome damage. * These people need constant supervision to keep them from eating themselves to death
in people with normal IQs to profound mental retardation (most people with Prader Willi Syndrome have mild mental retardation). The most striking feature of Prader-Willi Syndrome, however, is an insatiable appetite. This does not mean that people with PraderWilli Syndrome are “really hungry;” it means
A person with Prader-Willi syndrome is missing a piece of chromosome 15 they are “ALWAYS HUNGRY”. Because of their genetic abnormality, people with PraderWilli Syndrome simply never feel satiated. This is coupled with the fact that people with Prader-Willi Syndrome actually need fewer calories to survive (in other words, their metabolism is slower than normal). Put these two facts together and you have the potential for life-threatening obesity. In fact, Prader-Willi Syndrome is the number one known genetic cause of life-threatening obesity. Most people with Prader-Willi Syndrome will require constant and lifelong supervision in a controlled environment due to their insatiable appetites and behavioral challenges. In other words, they require strict supervision and behavior management to keep them from literally eating themselves to death. There is no known cure for Prader-Willi Syndrome, but there are many ways to treat the characteristics of the disorder. Growth hormones can help people with Prader-Willi reach their full height potential. Special education can help those affected to overcome their learning challenges, and psychological interventions and medication can assist in treating the emotional consequences of the condition. A strict “food security” program must be put into place to teach children
with Prader-Willi when it is okay for them to eat and when they must stop eating, since their bodies will never send them the typical physiological signals that they are “full.” And, the continued love expressed by family and friends can show people with Prader-Willi that they are cared for and accepted, despite the constellation of challenges created by their condition. Research into treatments and a cure for Prader-Willi Syndrome, are currently underway as public awareness of the condition continues to grow. Currently, House Resolution 1386 is before Congress. The bill would designate the month of May as “National Prader-Willi Awareness Month”, to
help in the effort to educate the public about the condition and to secure additional private and federal funding for research. Everyone who wants to see this happen should contact their representative in Congress and urge them to support H.R. 1386. Dr. Stephen Glicksman is a Developmental Psychologist at Women’s League Community Residences, a life-long social services agency meeting the needs of children and adults with intellectual and developmental disabilities and their family. For more information on Women’s League’s array of services, please call 718 853-0900.
For more information on Prader-Willi Syndrome, contact the Prader-Willi Syndrome Association (USA) at 1-800-926-4797 or www.pwsausa.org
DIAGNOSIS Are Chromosome 18 Abnormalities a Shidduch Risk? By Dr. Stuart Ibel
Key Points * Most chromosomal abnormalities are not passed on to the next generation * Chromosomal abnormalities occur in 1 out of every 180 births * Chromosome 18 abnormalities are the third most common of such disorders
In the Jewish community, the concern that physical, developmental, and mental disorders can be inherited has had a profound effect upon the shidduch (matchmaking) process. It has prompted families to hide the fact that any of their members have such a disorder out of fear that it will cause an existing match to be called off, or cause a family member to be rejected, on that basis alone, as a potential candidate for a match.
of one may be missing and the other half duplicated (isochromosomes) and other variations such as rings, insertions and inversions. Collectively, all of these abnormalities occur in approximately 1 in every 180 births. When one of these changes in the usual configuration of the chromosomes occurs at conception, the genetic make-up of each cell in the body will be affected, which may or may not lead to various medical and devel-
It is true that there are chromosomal disorders that are inherited. These include Fragile X syndrome, which is the second leading cause for mental retardation, and an inherited disorder that is of particular concern in the Ashkenazi community -- Cystic Fibrosis, which is a life shortening, childhood-onset disorder. But most other chromosomal disorders, such as Down syndrome, are not inherited. They occur, “de novo” or spontaneously, due to a one-time change at conception, whose cause has not yet been determined. A chromosomal abnormality results from an unusual change in the number or arrangement of the chromosomes in each cell of the body. A piece of the chromosome may be missing (deletion), repeated (duplication), broken off and attached to another chromosome (translocation). There can be an extra copy of a chromosome (trisomy), or one of the pair may be missing (monosomy), half
opmental problems. In some cases, a parent may carry a chromosome abnormality that is passed on to his or her child. However, in most cases, chromosome abnormalities are not inherited from a parent. Rather, they were changes that were present or occurred at conception. Chromosome 18 abnormalities are the third most common chromosomal abnormalities after Down syndrome and Fragile X syndrome. There are five subtypes of chromosome 18 disorders, and none of them are inherited from parents. Briefly, the five subtypes are: 18p-, 18q-, tetrasomy 18p, trisomy 18 and ring 18. The effects of these five conditions vary widely: In the 18p- subtype, there is a missing piece of the short, or “p” arm of the chromosome. It has very severe affects on all aspects of development of the brain, organs and their various functions. The 18q- subtype has
a missing piece of the long arm or “q” part of the chromosome. The effects of this disorder are similar to that of the 18p- variant, except that with this abnormality the child may have average or even above-average intelligence. With the Ring 18 subtype, the chromosome forms a ring, which results in material being lost from both the p and the q arms. The tetrasomy 18 variant, which has not yet been studied extensively, involves an extra 18th chromosome. Children with this abnormality have difficulty sucking or swallowing. They frequently vomit after feeding and typically exhibit low to moderate mental retardation. Finally, there is Trisomy 18, also called “Edward’s syndrome,” which is the most severe of the five variants. Children with this abnormality usually don’t live past one year of age. Other genetic mutations, which affect growth and development, but which are not inherited, include Turners syndrome and Williams syndrome. For those interested in these abnormalities or syndromes, check the websites supported by organizations dedicated to these conditions, such as www. chromosome18.org, www.turnerssyndrome. org, www.williams-syndrome.org, etc. The website for the National Institutes of Health, nih.org, is another excellent source of information on chromosomal abnormalities and other genetic disorders. While chromosome 18 abnormalities, like many other chromosomal disorders, can have very serious consequences, including physical, developmental or psychological disorders, they are not inherited, and this should be considered before putting a family with an affected member in “medical cherum.” Stuart Ibel, PhD, is a NYS Licensed Psychologist and Board Certified Behavior Analyst. He is the Program Director of Challenge Early Intervention Center and maintains a private psychology practice in Brooklyn, NY.
Basic Facts on Genes and Chromosomes Our bodies are made up of organs composed of many diﬀerent types of specialized cells: heart, liver, muscle, nerves, etc., These specialized cells and the organs which they comprise were created and function in accordance with a set of coded biological instructions contained within the genes and chromosomes of the sperm cell and egg from which each person was conceived. Taken together, the 20 to 25 thousand genes in the human genome comprise our biological heritage, which, except for identical twins, is unique for every human being. The genes are contained in tightly wrapped, string-like structures called chromosomes in the nucleus of every human cell. If a chromosome were to be unwound, it would be six miles long! The genes in the chromosomes govern the growth and development of every cell in the human body, including the particular characteristics, which make each person, except for identical twins, biologically unique. Every human being has 46 chromosomes in each cell, arranged into 23 pairs. We inherit one copy of each pair from our mother and the other from our father. The ﬁrst 22 pairs are arranged according to size. The 23rd pair is the chromosome, which determines the gender of the child. In females, the 23rd pair is made up of two “X” chromosomes. In males, the pair is made up of an “X” and a “Y.” Ibel
Insight Into Selective Mutism By Nina Rosengarten MS, CCC-SLP As I observed 5 year old Leah in her classroom, my heart broke. It was center time and several groups of children were engaging in different areas of play. The sweet sound of chatter and laughter filled the room, radiating from all the children, but not Leah. Leah sat among her peers motionless –her body stiff, a blank stare in her eyes, completely detached from all those around her. Not a single sound uttered, no gestures made. Leah was suffering from Selective Mutism, a complex childhood anxiety disorder characterized by a child’s inability to speak in select settings and environments. I had spoken to Leah’s parents who turned to me in despair because their 5-year-old
Common Characteristics Some of the more common characteristics displayed by selectively mute children include: • Mutism in at least one setting • Blank facial expressions • “Frozen” appearance • Diﬃculty initiating and responding non verbally • Slowness to respond • Heightened sensitivity to surroundings • Excessive tendency to worry and have fears • Intelligent, perceptive and inquisitive • Introspective and sensitive Rosengarten
Key Points * Selective mutism is an anxiety disorder that is often misdiagnosed * Left undiagnosed and untreated, selective mutism can damage a child for life * With these children, it is important to encourage every form of communication
daughter, who filled their home with endless banter, infinite questions and priceless giggles, didn’t utter a word to anyone outside of their home. No teachers, doctors, waiters or fellow train passengers ever heard her utter a single sound. As a speech language pathologist, I feel that it is my duty to enlighten and educate our community regarding this prominent, often misunderstood and unrecognized disorder. According to the American Academy of Child and Adolescent Psychiatry, Selective Mutism is said to affect approximately 7-10 of every 1,000 children in the United States. This rate is comparable to other disorders such as depression, and is higher than that for autism. It is difficult to determine the prevalence of Selective Mutism because of the lack of knowledge and awareness of the condition on the part of both doctors and school officials. The silence of selectively mute children is commonly misdiagnosed. It is often attributed to basic shyness and perceived as something that will dissipate with age. Sadly, many children are actually punished for their refusal to speak, while others are placed in special education classes notwithstanding the fact that they do not exhibit any academic deficiencies. A majority of selectively mute children have severely inhibited temperaments. Compared to the “typically” shy or timid child, the selectively mute child falls at the extreme end of the spectrum. As a result, the child, who speaks freely at home, is non communicative in settings outside of the home, including school, the doctor’s office, restaurants and the like. Interestingly, these children are generally well liked by their peers, who often look to help and befriend them despite their inability to verbally communicate. Selectively mute children are generally diagnosed between the ages of 3 and 8.
Given that their developmental milestones are within normal limits, coupled with the fact that their interactivity within the home is considered typical, it is not until these children begin their formal schooling – where they are expected to perform, interact and speak – that their disability becomes evident. It is vitally important for all teachers and professionals working with children in our community to open their eyes, enhance their awareness of the symptoms of Selective Mutism and become proactive in its diagnosis and treatment. We cannot allow these children to fall through the cracks, by assuming that the child is merely shy and will ultimately outgrow the condition.
Sadly, many children are actually punished for their refusal to speak... Early diagnosis allows these children to receive the treatment they need to develop proper coping skills and overcome their anxiety. Permitting them to go undiagnosed can harm the child suffering from Selective Mutism for life, subjecting them to severe academic, social and emotional repercus-
sions. If a child were physically ill, we would immediately take them to the doctor in order to get them the medical attention they need. Similarly, we must not neglect the selectively mute child who suffers in silence and requires proper therapeutic intervention! In seeking proper treatment, parents need to turn to speech language pathologists and psychotherapists and/or psychiatrists who are familiar and well versed with this disability. In order to ensure success, it is essential
that the professionals work together with the child, the parents and the teacher. While putting together a successful treatment plan for selectively mute children, it’s important that parents, teachers and professionals bear in mind the following. First, every form of communication exhibited by the child, no matter how trivial, must be recognized, reinforced and rewarded. From the slightest gesture to the most elaborate conversation, each step the child takes towards communication is vital and must be acknowledged as such. Additionally, the child should never be penalized for failing to speak, nor should bribery be used to encourage speech. Finally, in order to maximize efforts, use particular settings or envi-
ronments in which the child is more at ease. Some studies suggest that treatment plans include a combination of medication and proper therapy. Selective Mutism is an anxiety disorder, so the medications prescribed include very small doses of Paxil, Prozac, Celexa, Luvox or Zoloft, which have proven to be successful in the treatment of anxiety disorders. They are believed to take the “edge off,” thereby lowering anxiety and increasing the child’s ability to respond positively to therapy. The decision to medicate is ultimately a personal choice, to be determined on a case-by-case basis by parents and therapists working together. My personal belief is that medication should be considered only as a last resort, after therapy alone has failed to demonstrate significant progress. In Leah’s case, medication was not necessary because of her positive response to intensive speech therapy. Ultimately, the silent
withdrawn child I first met was completely transformed into a most sociable, outgoing and animated young girl. It is time for the entire community to become more aware and proactive to end the ordeal of children suffering from Selective Mutism. As one child suffering from this disorder described it to Dr. Elisa Shipon Blum, “When I try to speak, my bones feel like glass, my skin feels like paper and my lips are glued shut.” No longer may we permit them to suffer in silence. Nina Rosengarten is a Speech Language Pathologist with a private practice in Brooklyn, NY. In addition, she works for the Department of Education, treating school aged children with various disorders and disabilities, including Selective Mutism. She also works with infants and toddlers from birth to age 3. She can be reached at (718) 692-0430 or at nrosengarten@aol. com. All comments or questions regarding this article are welcome.
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Are Your Child’s Toys Hazardous?
Key Points * Loud toys can permanently damage a child’s hearing * Toy industry compliance with federal noise standards is voluntary and not uniform * If a toy is too loud for you, it is probably too loud to be safe for a child
By Sarina Roﬀé Mommy, can you buy me this toy? It’s so easy for us to buy the toys that our children ask us for, but even some popular brand-name toys could endanger the health of our children Sometimes the danger comes from the very aspects that make the toy so attractive. For example, we have learned that the bright colors which make some imported toys attractive to the eye are due to lead-based paint, which pose the danger of permanent
brain damage when the child inevitably puts the toy in his mouth. Toys with small, removable pieces can pose a potentially lethal choking hazard, but even more dangerous are toys with small magnetic pieces, which can cause serious internal damage if swallowed. There is also a significant risk that seemingly innocent but excessively “noisy” toys can cause permanent damage to a child’s hearing. Some of these risks have been widely recognized. For example, toys with small parts, which pose a choking hazard, generally carry explicit warnings on the package against giving them to children below a recommended minimum age. But other threats are hidden or may not become apparent until after the toy enjoys widespread use. A few years ago, a battery-operated “hungry” Cabbage patch doll made headlines
when it had to be taken apart to remove it from the scalp of a seven-year-old girl. It seems the doll had started to chew on her hair and would not let go. This shows that sometimes the unique aspect of a new toy that makes it “cute” or attractive can also make it potentially dangerous. There is also a hidden danger from noisy toys. Children love to hear the “bang” when they pull the trigger on a toy gun, or loud music when they play a toy instrument, but excessively loud noises can permanently damage their hearing. The problem is even more serious for very young children, who hold their toys very close to their ears. Prolonged exposure to loud noises will eventually damage the tiny hair cells inside the cochlea of the inner ear. These hair cells play a vital role in translating the sound waves entering our ears into the nerve impulses that our brains recognize as speech, noise or music. Once those hair cells are damaged by excessive noise, the result is permanent hearing loss. Exposure to excessive noise is the leading cause of hearing loss in over 28 million Americans. Hearing loss among young people is growing at an alarming rate, in part due to the headphones on portable music players being played at dangerously high volume, but also due to exposure to excessively noisy toys. According to a 1998 study published in the Journal of the American Medical Association, almost 15 percent of children ages 6 to 17 show some signs of hearing loss. What’s Too Loud? Sound intensity is measured in units called decibels (dba), but it is not a linear scale. A difference of plus or minus 3 decibels represents a doubling or halving of sound intensity. An increase of 10 decibels reflects 10 times more sound energy, and 20 decibels a 100-fold increase. Normal conversations are conducted at levels between 50 to 60 deci-
bels. Loud street and traffic noises can reach levels of between 80 to 90 decibels. The federal Occupational Safety and Health Administration, the American Academy of Pediatrics and the National Campaign for Hearing Health have all set 85 decibels as the upper limit for safe levels of noise over an extended period of time. Above that level, prolonged exposure will result in permanent hearing damage, and the louder the noise level, the more quickly permanent damage will be done. According to the Toxic Noise Guidelines set by the National Campaign for Hearing Health, exposure to noise above 85 decibels over an 8-hour period puts one at risk for some permanent hearing loss. At 90 decibels, the time limit for safe noise exposure is reduced to 2 hours. At 100 decibels (the typical noise level of a jack hammer), continuous exposure for 15 minutes risks hearing loss. At 110 decibels, exposure for more than 2 minutes is unsafe, and any exposure to noise above 130 decibels risks permanent hearing loss. The federal guidelines set last year for the Consumer Products Safety Commission by the American Society for Testing and Materials reduced the maximum permissible noise level for toys to reflect the current understanding of the danger to children’s hearing. The maximum continuous noise made by close-to-the-ear toys was set at 65 decibels, and, for hand-held, tabletop and crib toys, 85 decibels. For brief or impulse sounds, the maximum noise level is set at 95 decibels for close-to-the-ear toys, 115 decibels for toys such as rattles, and 125 decibels for cap guns and similar toys. However, compliance with these guidelines on the part of the toy industry is still only voluntary, and the danger that toys commonly found on the market today exceed safe noise standards is very real. In late 2006, the Sight and Hearing Association and researchers from the University
of Minnesota tested 15 popular toys taken from retailers’ shelves, and found that 12 of them generated more than 100 decibels of noise. All 15 generated more than 90 decibels when measured directly at the toy’s speaker. Three talking books, meant for children as young as 18 months, generated more than 110 decibels, loud enough to cause permanent hearing damage within 2 minutes. A study conducted by researchers at the University of California at Irvine, in December 2007, eight months after the new federal noise guidelines were adopted, found that 15 out of 17 popular brand name toys generated at least 90 decibels of noise, and 6 of the toys, 100 decibels or more. “Noise-induced hearing loss is cumulative. It doesn’t typically happen from one event; it gradually happens over time. That’s why it’s important to start protecting hearing at a young age,” the Sight and Hearing Association advises parents, and offers these practical tips when shopping for children’s toys: 1. Listen to a toy before you buy it for a child. If it sounds loud to you, then it’s certainly too loud for the child and potentially dangerous to the child’s hearing. 2. Report excessively loud toys to the federal Consumer Product Safety Commission. 3. Put masking or packing tape over the speaker on a loud toy to help reduce the volume, and if it’s still too loud, remove the batteries. Parents should also exercise similar caution and preview the noise level of any older “hand-me-down” toys, made prior to the adoption of the new noise standards, before accepting them or turning them over to their children to play with. Sarina Roffé is an award-winning journalist, frequent contributor to Jewish publications and a member of Brooklyn’s Syrian Jewish community.
The Graying of Our Mentally Challenged
Key Points * The elderly developmentally disabled population will double in 20 years * They generally share the special needs of the rest of the elderly population * Our community institutions have not yet begun to come to grips with the challenge
By Devora Thau, MHCA, LNHA In the world of nature, there are some tides that rise dramatically. The sea is a turmoil of gigantic waves; tsunamis and tidal waves can destroy huge areas of land and population in the shortest spans of time. Other tides rise quietly, creeping forward over miles of mud and sand and cause no obvious disturbance. Although their advance may hardly be noticed, they are nonetheless powerful and persistent.
The rising tide of dementia and Alzheimer’s is of the latter, quiet kind. For many years, its prevalence has been slowly but steadily increasing, and this is likely to continue for years into the near future. Today there is a far greater proportion of people moving into the older age range and facing the diseases of the elderly. The population
that has heretofore been mostly ignored during this time frame is that of the mentally retarded and developmentally disabled (MRDD) population. Text books from the 1970s state that this population does not live past their early twenties. That is no longer true. With improved medical technology and a higher quality of care for the MRDD population, people are living longer, many into their sixties and seventies. This change in demographics has resulted in an increase in Alzheimer’s disease, a previously unheard of diagnosis for the MRDD population. This demographic wave presents new challenges and issues to providers in the MRDD setting. It had always been assumed that mental retardation and dementia were basically synonymous. Research and clinical practice have proven otherwise. The patient who was diagnosed at an early age with either mental retardation or developmental disabilities is not immune from the diseases of the elderly; in fact, quite to the contrary, they often display these symptoms at an earlier age and require aggressive treatment with new modalities to maintain their level of independence, which was achieved through great personal efforts. The Office of Mental Retardation and Developmental Disabilities (OMRDD) is well aware of this rising crisis and the lack of proper preparation for this impending challenge.
They are formulating a Task Force on Aging to attempt to quantify the problem and analyze various possible solutions Research data projects that the “graying” MRDD community will nearly double in size to 1.2 million by 2030 when the last of the baby boomer reaches age 60. It is important to recognize that the majority of MRDD people (60%) live with their families, and in one quarter of these households, the primary caregiver is 60 or older. The aging and developmental disability communities share a number of common concerns (see sidebar). Many states have started programming for this newly aging population with excellent programs available. Texas and Illinois have started programs but New York State has yet to do so. There is no programming available currently for this population in the Orthodox community. What is needed, and what is now being developed, is a two-pronged approach: first, to develop a model home for placement that can then be duplicated by other agencies; second, to educate staff and the community-at-large about treatment modalities. By planning strategically now, we can be prepared for the foreseeable challenge as the demographics continue to change. The tide is rising, but with proper planning and preparation, the needs of our graying mentally challenged population will not be catastrophic. We can respond in a professional manner with the necessary training and education to achieve a successful transition. Devora Thau, MHCA, LNHA, is the director of Mishkon, a division of the Jewish Board of Family and Children’s Services, which provides residential support and community services for developmentally disabled people and their families. For more information, call (718) 851-7100.
Typical Needs of Our Aging Mentally Challenged The later life concerns of individuals with developmental disabilities are essentially the same as those of the general elderly population: • Maintaining health and function through medical research and improved access to health care and health promotion activities • Developing more eﬀective models of dementia care including group homes in the community • The ability to age in place in the community by providing supports and services to caregivers as well as care receivers • Reducing disincentives to work such as the stringent asset and income limits for Medicaid eligibility • Meaningful retirement activities that enable the elderly to contribute to their communities • Ensuring elderly and disability-friendly communities by greater use of environmental modiﬁcations and assistive devices Thau
TREATMENT DIR/Floortime: Turning Therapy Into Child’s Play Based upon an interview with Serena Wieder, Phd.
Key Points * DIR/Floortime emphasizes parent-child interactions & family relationships * DIR is a roadmap integrating all aspects of a child’s development * Floortime focuses on a child’s initiative and intent, encouraging emotional and cognitive development
By Yaakov Kornreich Do you know a child on the autism spectrum? When young, he or she may not respond to his name, or look at you. Sometimes he is very sensitive to sounds and touch. Other times he does not even notice what is going on around him, or is preoccupied with repetitive interests, or is alarmed by any changes. Often, he is not assessed
and relating and communicating with others. Recent discoveries in neuroscience indicating that autism is a complex processing disorder involving poor interconnections between different parts of the brain support the DIR model of autism conceived many years ago. DIR believes “affect,” that is, subjectively experienced emotions in the autistic child and
the child’s six basic building blocks (selfregulation and joint attention, engagement, two-way communication, complex social problem solving, creating symbolic ideas and abstract thinking), the “I” (individual differences in sensory and motor processing), and the ‘R” (the family’s care-giving relationship patterns). Taken together, DIR presents a comprehensive picture of the child’s development. Floortime is a treatment method as well as a philosophy for interacting with children, adolescents, (and adults!). It involves meeting a child at his current developmental level, and building upon his particular set of
strengths. Its objectives are to build healthy foundations for the child’s social, emotional, and intellectual capacities rather than focusing on specific skills and isolated behaviors. It harnesses the power of a child’s motivation; following his lead, engaging in warm but persistent attempts to engage his attention and discovering his interests and desires in interactions through “affect” cues (such as emotional tone of voice, pacing, gestures which alert attention and heighten emotions to engage the child’s feelings and ideas). By entering into a child’s world, we can help him or her learn to relate in meaningful, spontaneous and flexible ways. Floortime
Interborough Developmental and Consultation Center Services for Children, Adolescents and Adults Including: until someone notices he is late to start talking. While growing up, he is missing the fun of interacting and sharing the pleasure, excitement and discovery of relating and communicating as he discovers the world around him and his own abilities. Today it is estimated that one in 150 children has an autism spectrum disorder (ASD), making it more prevalent than any other childhood disorder. Autism is not a single, specific deficit with a well-defined cause. It is a complex biological/neurological disorder, which involves many of the brain’s functions. It impacts a child’s development, including their capacity for learning, self-regulation, self-awareness,
the affect cues received from others, can help to make these missing connections. The best results come from recognizing ASD early and treating it intensively. This requires understanding each child’s unique profile and then custom tailoring a comprehensive intervention program to help each child realize his or her potential. DIR/Floortime begins with an analysis in which each child’s strengths and weaknesses are compared to a theoretical model for child development, developed through clinical research based on observations of hundreds of different children over many years. DIR focuses on three components; the “D” (for development), which evaluates
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TREATMENT DIR/Floortime: Turning Therapy Into Child’s Play is only one component of a comprehensive program, which also includes a wide variety of sensory-motor exercises, semi-structured activities, therapies, play dates, regular or special education, bio/medical interventions and family support. It also may use, when indicated, other techniques, including visual strategies and behavioral interventions. Parents and professionals in the field throughout the United States and in 80 countries around the world, including Israel, are now using the principles of diagnosis and treatment developed by the DIR/Floortime model.
What is Autism “Autism is not primarily a disorder of social interaction, but a global disorder aﬀecting how the brain processes the information it receives. . . especially when the information becomes complicated. . . Functional Magnetic Resonance Imaging (fMRI) studies [of children with Autism] show abnormalities in the neurological wiring through which brain areas communicate. . . have diﬃculty performing complex tasks that involve brain areas working together. . . diﬃculty understanding complex ﬁgures of speech, like idioms and metaphors.” - Dr. Nancy Minshew, Professor of Psychiatry and Neurology, the University of Pittsburgh, and Director of the Collaborative Program of Excellence in Autism (CPEA), funded by the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development Wieder
GUIDING A CHILD’S EMOTIONAL DEVELOPMENT It is never too early or too late to start applying the DIR/Floortime model. A very young child spontaneously communicates through gestures, vocalizations and visual clues, and that communication is emotionally (affect) driven. When a child wants something, he expresses that desire through a signal, which could be a cry, a look or a gesture, and reacts to similar signals from those with whom he is interacting. Over time, these interactions guide the child’s emotional development, affect the child’s interests and behaviors, and redefine the child’s potential. The DIR/Floortime model identifies the six core developmental stages and processes in a child’s early life. In older children, the DIR/Floortime method develops higher levels of communications and thinking, such as complex problem solving and sequencing abilities, using individually tailored activities, which follow the child’s, own interests, and provide opportunities for new learning. The children are encouraged to use their toys and “play acting” as symbols for emotional expression, and as a laboratory in which they learn, by discovery, how to deal with their emotions, relationships and understanding of the real world. For children approaching school age, DIR concentrates on activities designed to
work on any underlying difficulties the child may have in the sensory- motor areas, to help prepare the child to be able to process, execute and perform satisfactorily in the typical or special education school classroom environment. Floortime involves parents and other family members in the child’s therapy through their participation in spontaneous symbolic (conversations, play, drama, art, etc) and sensori-motor activities. The parents are far more than just case managers for their child. They become full partners in the therapy by providing learning and problem-solving experiences for their children.
Dr. Serena Wieder delivering a presentation on DIR/Floortime at a HASC-sponsored seminar in Brooklyn in September. Dr. Serena Wieder is the co-developer of the DIR®/Floortime™ model with Dr. Stanley Greenspan. Dr. Wieder is the co-founder of the Interdisciplinary Council on Developmental and Learning Disorders, Director of the DIR® Institute and CEO of the ICDL Graduate School offering the first Ph.D. program in Infant Mental Health and Developmental Disabilities. She co-authored The Child with Special Needs and Engaging Autism. She can be reached at firstname.lastname@example.org. See www.icdl.com for further details and resources.
LESSONS LEARNED IN THE SUKKAH On a recent trip to Israel, Dr. Wieder visited a program based on the DIR/Floortime model for children from religious families with Pervasive Developmental Disorder (PDD). She observed a video in which the children, who typically did not speak and had trouble interacting with others, were able to cooperate in building a play Sukkah in their classroom. Here was an educational experience, which they found to be relevant, meaningful and charged with emotions. They knew the importance of the Sukkah in their family life. The idea excited their imaginations and motivated them to overcome their social challenges and sequencing diﬃculties to interact and cooperate with one another. In the process, they achieved many of their developmental goals as a natural outgrowth of their enthusiastic, emotionally driven play. They initiated the idea and used their motor, spatial, sequence and language abilities to problem-solve together. They imagined that the Sukkah was broken and played at ﬁxing it. They also emulated the Sukkah’s real-world uses, pretending to make kiddush and wave the lulav and esrog. This play Sukkah was an example of the Floortime method at its best in a small group. It used the children’s natural enthusiasm for imaginative and constructive play to advance the development of complex thinking and problem solving, and gave them new opportunities to learn in self-initiated and intentional ways. Kornreich
Avoiding Failure With Behavior Modiﬁcation
• Changing behavior is merely a matter of motivation • Goals must be achievable and the rewards applied consistently • Results must be monitored over time
By Rabbi Dr. Chaim Wakslak Behavior Modification is a technique that has been used successfully by parents, teachers and psychologists in a variety of settings. The basic premise of Behavior Modification is that observable and measurable behaviors are good targets for change, and that behavior follows a set of consistent rules. Consequently, methods can be developed for defining, observing, and measuring behaviors, as well as designing effective interventions. Reinforcers are consequences that strengthen appropriate behavior. Negative reinforcers are consequences that weaken appropriate behavior. Finally, the behavior modification technique assumes that all children function more effectively when confronted with the right set of consequences. Implementing an effective behavior modification program is a step-by-step process: • The problem behavior must be identified and defined, usually by count or other observable description. • Design a way to change the behavior. • Identify an effective reinforcer. • Apply the reinforcer consistently in order to
Modification program: 1- Not considering whether the individual can consistently suppress an undesired behavior, even if they are highly motivated. In such a case, introducing contingencies is only likely to distress the individual and lead to further behavioral problems. Individuals specifically diagnosed with regulatory disorders (such as Tourette’s, OCD, inattention, mood disorders) will inherently have a limited ability to regulate behaviors and mood, even if they are highly motivated. 2- Designating “reinforcers” or “rewards” without determining whether they are effective rewards for that child or student. While something may seem to someone else like it should be “reinforcing” or usable as a reward, one should not assume that the subject feels that way as well. It is always advisable to ask the individual what they think would work for them. 3- Trying to deal with too much at one time. Individuals with multiple diagnoses often have a number of problems, but you are unlikely to be successful if you try to tackle too many symptoms or behaviors at once. Prioritize. 4- Not having a discrete response. Some processes, like “attention” or “cooperation” can be difficult to define. If you want to increase a person’s “on-task time” or a “cooperation behavior,” make sure that you have a clearly defined “response” that can be measured and rewarded. 5- Inadequate analysis of the baseline behavior pattern, resulting in setting the wrong goals and contingencies. Many parents and teachers are too quick to attempt “behavior modification” techniques, without first ascertaining that the desired pattern of behavior is attainable or sustainable, or understanding what motivations may be driving it. An example of such an error is set-
To be more certain of success, you should provide the reinforcers immediately... shape or change behavior. Behavioral therapists predicate their approach on the assumption that behavior modification techniques never fail. If the desired change of behavior is not achieved, it is because the technique was either applied inefficiently or inconsistently. In order to better understand the process, it is helpful to identify some of the more frequent and significant causes of a failed Behavioral
ting a time span (like 20 minutes) to earn a reward without first making sure that meeting a 20-minute time span is even remotely within the individual’s current abilities. 6- Failure to use immediate reinforcers at the outset of the program. The most effective way to shape or increase a desired behavior is to reinforce it every time it occurs and to make that reinforcement immediate. A common mistake made by teachers and parents is to tell a child, “If you’re good today in school, you’ll get a reward when you get home.” or “If you earn [x] number of points every day this week, you’ll get [this great reward] on Friday.” To be more certain of success, you should provide the reinforcers immediately or very soon after the behavior occurs. 7- Failure to review the effectiveness of the reinforcers over time, and change them as necessary. A reward, which may motivate a child on one day, might not interest them the next. If you rely on the same one or two reinforcers for too long, you may find that the child’s behavior starts to deteriorate when he loses his motivation. 8- “The plan worked, so we can stop it!” If the child exhibits the desired behavior (or inhibits the undesirable behavior) while the behavior modification plan is in place, don’t assume that the desired behavior will continue if you stop the plan. If your plan appears to be succeeding, you might try to systematically and gradually introduce longer delays before reinforcers are delivered to see whether the behavior deteriorates. If it remains satisfactory, you can then try to
gradually eliminate the reward entirely. 9- Asking the parents to provide rewards at home for school-based behavior.
The problems with such approaches are threefold: (1) it introduces a delay in providing or delivering the reward, (2) it keeps the parents as the main “players” when we want the child to see the teacher as being reinforcing, and (3) even parents who mean well often fail to follow through, thereby decreasing the effectiveness of the plan. From these negative examples, we can infer how the four basic principles of a behavior modification plan, which we cited at the top of this article, should be implemented in practice. The keys to success are effective design, consistency in application, and continuous monitoring of the plan’s effectiveness. Rabbi Dr. Chaim Wakslak is a Clinical Psychologist and serves as the Clinical Director for HASC Center, a Brooklyn-based organization which provides residential, employment, day hab and other services for adults and children with developmental disabilities. Rabbi Dr. Wakslak is also the Rav of the Young Israel of Long Beach.
Understanding Muscle Tone
• Low muscle tone is a lifelong condition • Children with low muscle tone may need additional help as they grow • Children with low muscle tone will beneﬁt from constructive play
By Dr. Ephraim Yablok
Let us consider the following scenarios:
Aaron is eight months old. During a well-visit with his pediatrician, his mother expresses the following concern: “Aaron seems so floppy. When I’m holding him, he just ‘hangs there’, and when he’s placed in a sitting position, he droops forward and must be supported.”
When Mr. Kaplan takes his 5-year-old daughter Sara to the playground, he notices that she doesn’t move around as easily as other children her age. “Sara seems to tire easily when climbing or after walking just a few blocks”, he tells his wife. “She also seems hesitant and unsure when going down steps, and always holds the railing tightly for support.” His wife then mentions this to her neighbor, a physical therapist, and asks if she should have her daughter evaluated. Both Aaron and Sara are exhibiting symptoms of “low muscle tone.” There has been some confusion over what exactly muscle tone is because the word “tone” is used to describe different things in different contexts, by both clinicians and “lay-people.” For example, the term “toning up” is used in reference to exercises people do at the gym. The “muscle tone” of a newborn baby is one of the five parameters that comprise the Apgar score which is used to measure the baby’s health. In addition, some clinicians use the word “tone” to indicate the level of “stiffness”
felt in a muscle. Finally, weak musculature is said to exhibit “low tone” when it appears “flabby.” In physical therapy, muscle tone is a measure of how well our muscles, even when at rest, help our bodies to maintain their posture against the force of gravity. Muscle tone provides support for our movements against the pull of gravity, yet still allows for flexibility and freedom of movement. An individual’s level of muscle tone will remain constant throughout their life, unless they suffer neurological damage, such as a stroke or a malignancy that affects their brain or central nervous system. As young children grow, their muscle tone serves as the foundation upon which they develop strength and control over their movements. A person with relatively low muscle tone often needs to give more thought and effort to certain movements which a person with higher muscle tone would be able to do instinctively.
It is important to distinguish between muscle tone and muscle strength. Muscle strength is the capacity for exertion and endurance, or the ability of the muscle to generate or resist force. It is often a function of how much exercise the muscle receives, and
is completely independent of an individual’s muscle tone. A person can have low muscle tone yet still develop substantial strength, and visa versa. Cases of abnormally low or high muscle tone are almost always associated with a particular syndrome or neurological deficit.
There has been some confusion over what exactly is muscle tone. For example, people who have Down syndrome display excessively low muscle tone, known as hypotonia, which causes them to exhibit “stooped” posture, excessive range of motion in their joints, and difficulty with certain movements, such as standing up from a seated position on the floor. People who have cerebral palsy or similar neurological conditions often display particularly high muscle tone, referred to as hypertonia, which often causes decreased range of motion and movements or postures that are stiff and poorly controlled. This is different from spasticity, which is another type of neuromuscular impairment related to movement. But even in the rest of the population, the level of muscle tone can vary widely. An infant or developing young child whose muscle tone is at the low end of the “normal” range will not get the same level of internal postural support when learning new movements and skills that a child with higher muscle tone would receive. As a result, the child with lower muscle tone may have to work harder and learn to use extra muscle groups and energy to compensate. At the age of 8 months, Aaron in case 1
should already have excellent head support. The “floppiness” in his joints that his mother complained of and his inability to maintain an erect sitting posture are signs of low muscle tone. He would benefit from a physical therapy treatment focused on strengthening and improving the balance of his muscle activity as well as his endurance. A similar explanation accounts for young Sara’s difficulty in performing ageappropriate skills in case 2. Because of low muscle tone, she tires quickly when walking and must work hard to support her posture. She is cautious and holds on tight to the railing when going down steps because she needs more external support to compensate for insufficient internal support. As Sara matures, she will become more confident and capable as her muscles become stronger and she becomes more aware of how to best perform certain activities. Until then, she may need to take breaks during physical activity more often than other children her age. She may also need more support and encouragement, as well as occasional assistance from her parents, when engaged in more challenging physical activities. There is nothing we can do to change a child’s muscle tone. However, it is important for parents, caregivers and professionals to recognize that what’s best for any child is regular, daily, age-appropriate play and interaction. Often, when an infant or child appears to be developing at a slower rate, a simple change in their routine that exposes them to stimulating play activity will set the stage for healthy function for years to come. Ephraim Yablok, MS, PT, DPT is a pediatric physical therapist licensed in New York and New Jersey who treats and consults for children of all ages in both the home and school settings. He is a certified Cuevas MEDEK Exercises Level 2 practitioner. He maybe contacted at (347) 446-6966 or via email at: reyablok@ verizon.net.
TREATMENT I RememberWhen….” Every Time We Read
• Short term memory is crucial to reading ﬂuency • Building memory skills early will help young children to read later • Teach children memory techniques to help them in later life.
By Leah Donn
omeone is reading the special Kaddish at a siyum… The unfamiliar words cause him to read slowly and laboriously…. hen you are trying to decipher a word on your fourth grader’s spelling homework, and recognize the fragment… “___stomer”… you easily reconstruct the rest of the word … ou patiently help your child to decode the word Mayflower in his history book. He turns the page and comes across the same word – but fails to recognize it…
These scenarios illustrate the impact that memory has on reading ability. Fluency in reading is largely a product of the vast store of memorized words that we have accumulated over time. People read the words of an unfamiliar Kaddish more slowly than those of Ashrei because we do not recite that Kaddish frequently and cannot easily retrieve them from memory. The vast majority of our reading is effortless because we are merely retrieving familiar words already firmly embedded in our memory. When we have to decode new words, such as those in a medical
textbook, our reading becomes much more halting. That is also why it probably took your brain only a few seconds to identify the fragment of the word customer… Typically, when a child decodes a word like Mayflower it is immediately stored in his memory to be retrieved at a later time. But the child without efficient memory needs to do more than just read a word once in order to store it away for easy access later. The child may require multiple repetitions, additional time looking at and focusing on the word, tracing it, or writing it in different contexts in order to imprint it indelibly in his memory for quick retrieval the next time it is encountered. It has been widely assumed that children who encounter difficulty reading suffer from specific processing deficits, particularly in phonological coding. Research suggests, however, that deficits in working and shortterm memory also contribute significantly to reading difficulties, and that the efficient use of memory skills can help even a child with a deficit in phonological awareness to learn to read at satisfactory levels (Swanson & Howell, 2001). Until recently, reading disabilities had been recognized in most children until after they had entered school and experienced failure in the classroom, frequently accompanied by a negative impact on the child’s self-esteem and confidence. However, the correlation between memory deficits and reading disabilities suggests that children at risk for reading disabilities can be identified before experiencing failure in the classroom. Once a memory deficit is identified, early intervention may help prevent or reduce the severity of subsequent reading difficulties.
The Value of Memory Games
A variety of techniques can help even very young children to address their deficits in memory. Parents and teachers of Pre-K and Kindergarten classes should include memory building activities and games in their prereading activities. The curriculum for older children should also emphasize building a repertoire of memory skills. Requiring children to memorize short poems, songs and other relevant, age-appropriate material (i.e. months of the year for younger children) is an excellent way to increase their memory skills. Just as one learns how to read by reading, one learns to remember by memorizing. Games that challenge a child’s memory skills are also very useful. One favorite is to collect various items in a box, let the child look at them for a minute or two, and then challenge the child to remember them all after they have been removed from view. The game teaches children association skills (how to group items by color, function etc.) and the power of verbal rehearsal (reauditorization). Teaching children other common memory building techniques, such as mnemonics, acronyms (ROY G. BIV for the colors in the rainbow) and acrostics (My very educated mother just served us nectarines, for the order of the planets) makes the process of imprinting key information in their memory more enjoyable. Improving a child’s memory skills aids reading in many ways. It makes the retrieval of stored words and phrases more efficient, and improves decoding ability, vocabulary development, fluency and comprehension. Improving a young child’s memory will also help to improve their focus and ability to retain information throughout their later life. When parents, classroom teachers and reme-
diation specialists provide early intervention and make it a priority to develop strategies for remembering and recalling, they will help these children improve their reading ability, and give them the lasting memory of early educational success. Leah Donn, M.S.Ed is a special educator and reading specialist. She is an instructor at Sara Schenirer’s Institute for Special Education, as well as coordinator of their Adult Education Program.
diagnostic checklist Here is a diagnostic checklist (Catts, 1997) which can be used to detect memory deficits in children as early as Pre-1-A or the first grade: •Experiences problems learning the names of people or places • Has difficulty remembering the words to songs or poems •Has problems learning a second language •Cannot retrieve a specific word or uses words lacking specificity (e.g. “stuff ”, “thing”) •Speech is hesitant, filled with pauses or vocalizations (e.g. “um”, “you know”) •Has a problem remembering/retrieving verbal sequences (e.g. days of the week) No single indicator is conclusive, but the more of these indicators that are present, the more likely it is that the child may be suffering memory deficits that could lead to difficulties in learning to read.
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TREATMENT Key Points
• Kinesio tape can relieve pain, enhance drainage, and correct misalignment • Kinesio tape is economical and easy to apply • Kinesio tape feels like human skin to the wearer
By Yitty Rimmer The first time I heard of Kinesio Tape, I was very skeptical that a “band aid” could improve muscle function. Logically, and as an occupational therapist, I just couldn’t come to terms with this idea. Then, four years ago, a colleague at the agency where I was employed at the time, took the two-day pediatric course and was hooked. Soon, she was walking into the office every day with rolls of colored bandages, cutting them to different sizes and fitting them on the children she was treating. We were all amazed at their positive effects on postural alignment, and how they improved finger and hand positioning for fine motor tasks, such as writing with a pencil. I was intrigued. To the chagrin of my husband, just two weeks before Pesach, I enrolled in a Kinesio Taping course. Since then, I have applied Kinesio Tape to many children, and have seen overwhelmingly positive and immediate results. As an occupational therapist, I often use Kinesio Tape with children who have difficulty maintaining a correct, mature, “tripod” grip of a pencil in their hand, but who are capable of initiating the tripod grasp and hold. I apply the tape in such a way that it creates an open web space in the child’s palm, and then use another piece of tape to pull the thumb into the correct bent position to hold the pencil. (See photo above) Children use the tape as a cue as to where to position their fingers, and rely on the support it gives them during writing assignments. Many children are willing to wear the tape for a few days at a time, extending the benefits of their therapy sessions to writing situations at home and in school. The tape even works with children who suffer
from sensory integration dysfunction, and who tend to resist other forms of tactile repositioning. The tape can be adjusted to provide a steady, deep pressure that these children find to be calming. Kinesio Tape is available in four different colors, including beige, bright blue, red-
dish pink, and black. However, most school age children prefer the beige tone because it blends in with their skin, although, I did have one boy who insisted on wearing bright blue. There are four major physiological effects in the use of Kinesio Tape. It relieves pain or abnormal feeling on the skin and muscles. The tape can be applied to the skin in a way that takes off pressure off the painful area, relaxing muscle tension and improving blood flow. It supports the muscle during movement. When placed along the line of the muscle, the tape applies pressure to support the muscle while it moves. It improves the contraction of a weak muscle, reduces muscle fatigue and increases active range of motion. It removes congestion of lymphatic fluid or hemorrhages, reducing swelling under the skin. When Kinesio Tape is applied, it promotes lymphatic drainage by raising the skin directly underneath, allowing excess
fluid to move to other areas and decreasing pressure in the clogged area. Improving fluid circulation also reduces excess heat and chemical substances in the tissue, as well as reducing inflammation and pain in nearby skin and muscle. The fourth benefit of Kinesio Tape is that, when placed over a joint, it can correct misalignment and allow the joint to be manipulated to move more correctly. Compared to other forms of therapy, Kinesio Tape is economical and easy to apply. The usefulness and versatility of Kinesio Tape is due to its unique physical characteristics. It is elastic enough to be stretched up to 130-140% of its original (resting) length. The thickness and weight of the tape is approximately the same as that of human skin, so that it does not “feel” very different to the wearer. It is attached with 100% acrylic, heat-sensitive adhesive for 3 or 4 days at a time, and can be worn in the shower. In fact, there is special type of Kinesio Tape designed for use by professional athletic swimmers. The tape has no medicinal properties, and contains no latex. However, some children have exhibited an allergic reaction to the tape itself, and children who are fair skinned, freckled or red-haired may find that application of Kinesio Tape may turn their skin red. Some therapists test their subject’s response by applying the tape to a small patch of skin in a sensitive area, such as on the stomach or neck, a week before applying it to the intended area. Others will apply a thin coat of milk of magnesia to the skin before applying the tape. The bottom line is that, as strange as the concept may sound, Kinesio Taping actually works. If your child’s therapist suggests
applying Kinesio Tape, you and your child have little to lose by giving it a try, and there is a very good chance that you will be pleasantly surprised by the results. Yitty Rimmer has a Masters in Occupational Therapy from New York University. She currently has her own private pediatric practice in Brooklyn, NY.
An Innovation from Japan Dr. Kenzo Kase invented Kinesio Tape in Japan in 1973. He believed that muscles and other tissues could be treated by outside assistance, other than surgery and/or hospitalization. After extensive experiments with all types of bandages and surgical tapes in use at that time, he decided to develop a new type of elastic tape to get the desired results. At first, his tape and method were used exclusively in clinical rehabilitation settings. The breakthrough in its acceptance came when Dr. Kase’s tape was used by the Japanese National Volleyball Association players in the 1988 Olympic games. After that, its use gradually spread to every professional sport in Japan. In 1995, Kinesio Tape was introduced to the United States by the National Athletic Trainers Association. Two years later, physical therapists in the US began using it as well. In 2001, Medicare officially approved billing for Kinesio Tape therapy. Today, 75% of Kinesio Tape applications in this country are for non-athletic cases.
TREATMENT Key Points
• Art has therapeutic value for children with disabilities • Art encourages children to express themselves • Doing art with your child can be an enjoyable experience By Ellen Metrick
Using Art to Unleash a Childs Creativity Art has many virtues and contributes in many ways to our lives. Its therapeutic value has been extensively explored and confirmed. Under the right circumstances, art has the ability to heal, transcend, and transform. It engages the right side of the brain, stimulates our creativity and prompts us to use our intuition. Art can also level the playing field for children with disabilities by enhancing and refining, important skills. Art is a tool that can help children who have disabilities to achieve all sorts of goals and strengthen abilities that are building blocks of learning and development. These include:
Hand-eye coordination: When children color in the lines of a coloring book, they are using their hands and eyes cooperatively. Fine tuning this coordination assists them in performing everyday tasks, such as tying shoes and eating with utensils. Fine motor skills: As children mold shapes using play dough or other molding mediums, they are strengthening the muscles in their hands and learning how to use their fingers independently. Working with these materials helps children to acquire the manual dexterity they need for such tasks as buttoning and zipping up their clothes.
Color recognition: Painting allows children to discover the world of color and explore the art of color mixing. Children learn to recognize colors that will later cquire other meanings for them, such as red for stop, green for go. By mixing colors, they learn about the relationship of cause and effect – by mixing red and
blue to make purple. This not only enables them to see what happens, but also serves to empower them. These young artists then learn that they have control over their environment and have the ability to change it.
Sequential thought: As children make a necklace out of beads, they can practice order. By placing beads in a sequential order, such as green, yellow, green, yellow, they are working on AB patterning – a premath skill.
Matching: Matching gives children an opportunity to learn about similarities and differences. Children can make up their own matching games by using different stamps and colored ink.
Visual acuity: Color-by-number sets can help children focus on the fine details of the picture. This practice helps hone skills that are needed for proficient literacy. Freedom of expression is another, “softer” component of art. It teaches children that everything is acceptable and helps to develop their potential for wonder. Children who may be apprehensive about verbalizing their opinions, whether because of shyness or an underlying disability, can find freedom through various artistic media. They do not have to keep their viewpoints bottled up. They can be released, heard and understood through art. In addition to the other benefits of art, it is also fun and it engages. Gratefully, it is one medium where there is no right or wrong answer.
So put on some old clothes, clear the kitchen table, turn on some inspiring music and unleash the captive artist in your kids and yourself. Ellen Metrick is the Chief Toy Evaluator at AblePlay™ a toy rating system, reviewing resource and website at www.ableplay.org that provides comprehensive, independent ratings and reviews on toys for children with special needs. AblePlay was developed to help their parents, special educators, therapist and caregivers choose the most beneficial and appropriate toys. AblePlay is the latest initiative of the National Lekotek Center, a nonprofit authority on play and children with disabilities.
Enriching Creative Play In working with kids with special needs, the toy specialists at AblePlay, have developed these guidelines to help enrich the experience: 1. Prepare an area where children can feel free to make a mess and spread out 2. No right or wrong (it’s OK to draw outside the lines) 3. Allow time for the creative process to evolve – be patient 4. Encourage, praise and display these creations and artistic expressions and create a gallery (that’s what refrigerator doors are meant for) 5. Finally, get involved in making art yourself. Kids learn more from example, and you might enjoy it more than you realize. Metrick
TREATMENT PROMPT Therapy Succeeds Where Others Fail By Megan Petrizio-Randall M.A., CCC As a speech pathologist, I have used traditional articulation therapy with both the typically developing population and students with special needs such as those with Autism Spectrum Disorder. These methods include utilizing visuals (usually flash cards) to help the student, through repetition, to produce the target sound as it appears in different positions within words. While proven successful with typically developing, cognitively intact students in alleviating their speech difficulties, these methods have delivered mixed results when employed on students with special needs who have more severe difficulties with auditory and visual input. If their additional impairment interferes with
their ability to understand and benefit from traditional therapy, I often will use PROMPT therapy, which is gaining wider acceptance as an effective treatment for special needs children. PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. It was developed in the late 1970’s by Debra Hayden, a speech pathologist who designed it specifically for populations that experience difficulties with auditory and visual input. It involves physical input to the lips, jaw, and base of the tongue to help students prepare for speech. Prompt has evolved into multi-dimensional approach that includes physi-
cal sensory skills, cognitive/linguistic and social emotional components. Because the treatment, planning and precise prompt techniques used in PROMPT Therapy must be custom tailored for the specific needs of each student, speech pathologists undergo a special 3-part course of training to learn how to implement it properly. In my experience, working with students with severe difficulties, the extra effort has been worthwhile. PROMPT Therapy has proven successful where traditional speech pathology techniques failed. All aspects of the student’s communication benefit from PROMPT Therapy’s comprehensive methods. PROMPT methodology also helps those
students whose speech production was limited to produce more vocalizations and allow their parents to see that their child is able to produce speech despite significant impairments. For students with special needs, PROMPT Therapy has proven successful where traditional speech pathology techniques fail. Megan Petrizio-Randall is a speech pathologist and audiologist licensed in New York State and California. She works at the Reach for the Stars Learning Center in Brooklyn, NY.
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TREATMENT Time to End the Stigma of Orthotics
• Orthotics are often an eﬀective alternative to surgery • Orthotics are lighter, more comfortable and attractive than they used to be • Parents harbor fears that a child with orthotics will be stigmatized
By Rochelle Silberman As an orthotist, I feel blessed to work in a profession that is so close to my heart. The joy I see in a patient’s eyes, when his treatment is successful, his body is repaired, and mobility is improved, brings me a unique sense of satisfaction. Part of this is, no doubt, due to my personal introduction to the field at a very young age. I was born with congenital hammertoes.
of some kind today. Short-term braces are often used for those awaiting surgery on their neck or back, which can be caused by severe trauma from a car accident or a job-related injury. Simple braces can be purchased readymade, off the shelf, but for more complex cases, a custom-made device must be made by an orthotist. Another common use for orthotics is for babies who suffer from plagiocephaly, which is a head deformity in which the skull grows flat, and which has become much more common since the “Back to Sleep” campaign was introduced in 1992. An orthotic helmet is used to correct the damage done to a baby’s head, because it has spent so much time lying on its back to guard against SIDS. Much has changed during the 26 years since I completed my training and became an orthotist. At first, I could only offer many of my patient’s cumbersome, heavy metal braces, which were both unsightly and very uncomfortable to wear. Many considered them to be “barbaric,” and, looking back, I would have to agree. Thank G-d, that is no longer the case. Today, when an apprehensive child and his or her parents come to my office fearing the worst, I am pleased to show them my repertoire of colorful, lightweight and relatively comfortable braces sporting such kid-friendly names such as “bunny” and “froggy.” This often succeeds in winning over the child, who is eager to feel and function better. It is the parents, who still associate today’s orthotics with the ugly braces of an earlier time, who are more likely to resist orthotic treatment. They often express their concern, despite my reassurances, that their child’s orthotic “will show,” or “that people will talk.” Even though they do want their child’s problems corrected and mobility improved, they
The name orthotics derives from the Greek word “ortho,” meaning straight or correct. My toes just would not straighten. That was not a big deal to anyone else, but to me, it was a nightmare. My parents schlepped me from shoe store to shoe store, but my notso-dainty feet would not fit into shoes of any size. In desperation, my parents finally took me to an orthotist on the far end of Long Island who was able to help me. In his office, I watched him carefully while he fabricated out of plaster the device that ultimately allowed me to walk and run properly. I decided right then and there that I would someday help others the same way that he had helped me. Orthotics and braces help straighten musculoskeletal deformities and other abnormalities in a person’s body. An orthotist can provide something as simple as a custom-fitted shoe insert to correct flat feet, to the challenge of crafting devices to correct skeletal damage in patients due to a stroke or spinal cord injury. Orthotics can also help babies and children suffering from congenital conditions, birth defects such as spina bifida or cerebral palsy. Millions of people are wearing a brace
often don’t realize that the limp or physical abnormality which will result if treatment is forgone, would be far more noticeable than the orthotic which I would provide, and which, over time, will correct the problem permanently. Nevertheless, many parents postpone their child’s orthotic treatment unnecessarily. During this time, their child’s condition can worsen; often resulting in the child having to spend more time in the brace than if it had been applied immediately. “Sari” (not her real name) was one such mother. When she first brought her fiveyear old son, “Danny,” to my office, he was slumped in a wheelchair. His slight body had a severely twisted foot, which made vigorous physical activity no more than a dream for the pre-schooler. Danny’s doctors said that his foot could be corrected through surgery, but before putting him under the knife, they suggested that his mother first consider a less invasive option, such as an orthotic. Sari, of course, wanted only the best for her son, but her fear of others’ scorn initially overrode her motherly concern. At first, she refused to have Danny outfitted for an orthotic. Only after several weeks of debate and indecision did she finally agree to the procedure. Within the first month, Sari and Danny had adapted and barely noticed that he was wearing an orthotic device. When his treatment was complete, a year later, Danny had been transformed into a totally normal, running, jumping, rambunctious little boy, with no side-effects or noticeable deformities. Danny’s case is far from unique. Today’s lightweight, more comfortable, attractive and effective orthotics are an attractive alternative to far more drastic treatments to correct many childhood deformities and improve quality of life.
Old technology vs. new technology
Parents need no longer fear that the use of orthotics will subject their child to bullying from their peers or gossip by adults. Just as advances in treatment have eliminated the stigmas that once were attached to learning disabilities, speech impediments, and other special needs, so it should be with orthotics. It is time for our community to accept their use, as routinely as we accept eyeglasses for our children who need them, without stigma or shame. Rochelle B. Silberman is an orthotist specializing in pediatrics. She’s been designing and fabricating orthopedic and neurological braces for over 25 years. For more information, you can contact her at Kidi-Splint (718) 493-1611
TREATMENT Pilates Strength Training for Children With Cerebral Palsy
• Children with cerebral palsy can beneﬁt from strength training • Pilates strengthen trunk muscles • The training can improve a child’s ability to stand, walk and play
By Avi Kleinman Strength training for children has long been discouraged, because of the belief that a child’s muscle would not respond as an adult’s, and that it might even prove to be harmful. Recent investigations, however, have shown that children do benefit from strength training if it is performed properly. Still, it was not utilized for children with Cerebral Palsy or similar neurological conditions
Strength training and/or Pilates is a proven and effective means for fear that it would only increase muscle tightness, and other reasons. However, the positive effects of strength training - using weights and resistive exercises - with children with Cerebral Palsy and similar neurological conditions has already been demonstrated by continuing in-depth studies. Many innovative therapists have already started to use strength training with children by employing weight machines, pulley systems, cable columns, ankle weights (if a child has progressed to these points), in a similar fashion as adults. Some therapists have taken this approach one step further by incorporating Pilates exercises into their strengthening program. These exercises were created by Joseph Pilates in order to lengthen and strengthen muscles while creating greater flexibility. The method focuses on strengthening the “core” postural muscles through the use of a variety of positions and activities. While the level of strengthening varies, even at lower levels, Pilates involves a very aggressive form of trunk strengthening. Implementing a strength-training program for any child is not as easy as joining the local gym and hopping on a machine
(it should not be that easy for adults, either). The resistance has to be monitored and raised very carefully, not only to maximize the results, but also to prevent injury. Pilates exercises can be particularly difficult and cause injury if their progression is not closely monitored and calibrated. Strength training is defined as moving a muscle against resistance. Often, just moving a child’s ankle up and down along with them qualifies as “strength training” if it is a challenge to those muscles. With children we have to plan a strength training program in longer terms than one planned for adults – even though increased muscle strength can be achieved and demonstrated as early as a few weeks. With children, it has to be performed at a slower pace and requires a lot more supervision and assistance. This process can become tedious at times, but the improvement will be demonstrated by the improvement of the child’s function as well as muscle strength. The focus of Pilates on strengthening the “core” is based on familiar concepts of physical therapy. Everyone needs a strong trunk to help move our arms and legs. If, for example, our trunk is weak, our legs would have to pick up the slack, requiring more work. However, most treatment techniques do not address the strengthening of the core as intensively as Pilates. As a Pilates program progresses, it includes many challenging positions and movements, but with children, it often starts with movements on a mat, and gently moving their back up and down. Over the course of months and years, the benefits from improved strength – whether it is better posture or stronger ankles – should carry over into a child’s balance, walking, stair climbing and other facets of their lives. What may start as assisting a child’s ability to move a foot will progress to moving it against a 10 pound weight. As the
amount of resistance is increased, the results should soon become evident in a variety of activities. Strengthening a weak calf muscle will allow children to “catch” themselves and not fall down when they try to stand-alone. Strengthening a weak abdominal muscle will help a child’s sitting posture. All children need good posture and strong muscles, but children with Cerebral Palsy and similar neurological conditions need them more than most others. Many methods of physical therapy are needed to maximize these children’s potential. Strength training and/or Pilates is a proven and effective means to improve these areas, leading to improved function in the areas of standing,
walking and playing. It can be used in concert with other techniques and therapies, and is gaining popularity due to its scientifically demonstrated benefits. All this proves that sometimes, “the next great therapy” can be the broadened application of an old, established, but underutilized therapy. Avi Kleinman, MSPT practices pediatric and orthopedic physical therapy with offices in Flatbush, Boro Park and the 5 Towns, and works with Tali Berkovich, MA, who practices Pilates in conjunction with early childhood education. They can be reached at 718 627 8100.
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TREATMENT Children With Autism and Sports A Home Run!!!
â€˘ Sports can help autistic children break down social barriers with peers â€˘ ABA methodology can be used to teach sports to autistic children â€˘ Sports can open doors and create opportunities for success
By Jared Wasserman Great grades...check! High reading scores...check! Independent and isolated play skills...check! Following instructions...check! Knows every rule of a game or particular sport...check! Can identify every player on his favorite team and their uniform number...check! Has the ability to follow the rules of sports in a social situation with his peers...incomplete! For the past ten years I have worked as a special instructor. I have provided services using the methodologies of Applied Behavioral Analysis (ABA), a methodology used to help teach new behaviors by correcting and reinforcing appropriate behaviors. When working with children with Autism Spectrum Disorders, ABA breaks down the components of a childâ€™s development into teachable steps by finding the motivation a learner needs to succeed with the goals which have been carefully planned for them. Over the years many parents have asked what else they can do for their child who has been diagnosed with one of the Autism spectrum disorders, in addition to the Special Instruction, Occupational Therapy, Physical Therapy, and Speech and Language Therapy. These are the services which are commonly specified in the childâ€™s Individual Education Program (IEP) to help reach important developmental milestones and prepare them for lifeâ€™s many challenges. One answer is something I discovered working with a 10-year-old boy with High Functioning Autism, many of whose skills were almost indistinguishable from his peers. He read on grade level, his math skills were above grade level, in yeshiva he memorized all the parshiyot and was able to repeat them verbatim when asked. Yet his parents were still unhappy. â€œHe still is different then all the other kids on the block. He really has no friends,â€? they complained, and, most of all, â€œHeâ€™s just really immature for his age. That is why he likes playing with Thomas toy trains.â€? After giving it some thought, I decided
to help this boy bridge his social gap with his peers by introducing him to baseball, one of the sports that most boys like to play. I decided to use one of my studentâ€™s strengths, his ability to memorize almost anything he read. I taught him the rules of baseball. I had him reading about and watching baseball. We went to a store as a field trip to buy him a glove, a baseball bat and a baseball. This gave him the motivation to actually play. We started with running drills that were fun and encouraged him to want to do more. Next I taught him, step-by-step, how to hit the ball with the bat, how to catch and how to pitch. After a few one-on-one practices sessions, we decided to practice on this boyâ€™s block, in front of his peers, and as I had hoped, soon some other boys his age asked if they could join. I wound up coaching all the boys that day. My student not only enjoyed himself, but he also took pride in his play, and having the other boys asking him when he could play with them again. The key to this success was the use of the ABA model in breaking down the rules and methods of playing baseball into small steps, reinforcing his motivation to play, and then generalizing his playing skills once he learned the basics. It was then that I recognized the need to use the model of ABA as a teaching method for all sports to children on the autism spectrum. Teaching sports skills does not necessarily require the teacher to play the game. It means instilling the basic sports skills, confidence (â€œI can do itâ€?), and joy of playing a game. Many of my students start off with almost no sports background and must be taught the most basic behaviors such as learning to pay attention to the sound of a whistle and then to react accordingly. I have all the students stand in a line facing in the opposite direction from me, and when I blow the whistle, they must quickly turn around. They must then track a ball that I have just rolled to either them or one of their peers. This helps them make connections between
their mind and their muscles, and it trains them to be at full attention. We then move on to the skills involved in catching a ball. At every step, I constantly go back to the original skills and build upon them. This gives them many opportunities to be reinforced and to master the skills I have taught them. Sports skills build a tremendous amount of confidence within a child, but lots of repetition and reinforcement is essential, very much like the protocols used to a teach a child reading, math and appropriate behaviors. From a social standpoint, teaching a child sports is one of the best ways to help him break out and create new social opportunities for himself. 6KHLQGHO-HDQQH :DUPDQ (;(&87,9(',5(&725
The conventional wisdom is that it is necessary to teach special skills to children on the autism spectrum, but I believe that teaching these children basic sports skills can create opportunities and open up doors for them that have never been imagined. A child on the autism spectrum who has learned basic sports skills has the keys to many future social opportunities, and those opportunities create success. HOME RUN!!!!!!!!! Jared Wasserman has been teaching children with special needs for the past 12 years. He holds a Masters of Science in Special Education and Advanced Certificates in School and District Administration. His specialty and joy is working with young children diagnosed with Autism Spectrum Disorders. He is currently running 1-2-3 â€œLETâ€™S PLAYâ€? social skills program in Brooklyn. He can be reached at Email- email@example.com or 917-299-4596.
Simple Homemade Therapy Tools By Ilene Klass Days, weeks, and months are spent planning the perfect birthday or holiday gift. Numerous trips to the store are made, an exorbitant amount of money is spent, and the anticipation of giving this gift builds by the day. All this effort is made to find the perfect gift that will keep your child entertained and happy, while hopefully building educational knowledge and skills. Most of all, it is designed to light up your child’s face with happiness and excitement when the gift is opened. What is the end result? The child squeals with delight as she plays with the empty box for hours, using it as a fort, playhouse, police station, etc, while the toy it contained is virtually ignored. The moral of this story is that sometimes the best toys are found in one’s own home, or can be made using simple household items. This is not to devalue the toys that are sold in stores. Our point is that most things can have a therapeutic value if you can simply identify a purpose and utilize them correctly. This is especially important for those children who currently receive therapy services in their homes. With the current funding cutbacks to therapeutic services, most children receive therapy sessions only 1 to 2 times a week for thirty minutes. Though these therapy sessions are of great value, it is vital for parents to carry over the skills learned during therapy sessions to the child’s everyday life. Practice between sessions is essential as it helps the child integrate the skills taught, to the point that they become routine and automatic. This article offers parents some suggestions for things they can do with their child to learn, practice, and refine developmental skills with common items found in most households. These activities can also be utilized by therapists as Families As Partners (FAP) calendar activities.
Crazy Bones Though the creators of Crazy Bones did not design them to be a therapeutic toy, in actuality, they have surprising therapeutic value. It’s how they are utilized that truly defines them. Crazy Bones are inexpensive and readily available. They can be sorted by color, categorized, and used to practice identifying same and different items. • When played as intended, the child flicks the Crazy Bones. From a therapy point of view, this provides practice with opposition (touching one finger to another) of their thumb and index finger. This incorporates finger isolation and fine pincer grasp (opposing thumb and index finger), which is vital for daily tasks such as opening/closing buttons during dressing.
• Crazy Bones can be hidden in a bin of rice, sand, barley, lima beans, etc, challenging the child to dig inside to find them. (See Sensory Experiences) • Crazy Bones can be hidden in the home and a game of hot and cold can be played to find the hidden one. • Crazy Bones can be used as kugelach or jacks to develop better hand eye coordination. • Crazy Bones can be set up as an obstacle course for match• An empty coffee can with a small hole in the cover can be used to push the Crazy Bones through with or with- box cars or toy trains to naviout resistance (depending on the size of the hole), to gate around for visual motor facilitate hand strength, grasping and releasing skills. and motor planning fun. These are only a few suggestions for the use of Crazy Bones, but with a little creativity, the possibilities are endless.
L e a r n i n g i n t h e Tu b The bathtub is a great place to have fun with your child while simultaneously teaching a life skill, and caring for your child’s hygiene. Here are some ideas for fun therapeutic activities at tub time: • Foam Soap can be found at Walmart and pharmacies. It is the consistency of shaving cream, but safe and non-irritating to the skin. Foam can be smeared on the bathroom walls, where the child can practice scribbling, coloring, forming letters and number, while simultaneously getting a unique sensory experience. Allowing children to spray the foam themselves improves finger isolation and strength. The best part is that the foam is easily cleaned off the wall by little hands wiping in large arcs of motion, which improves upper extremity strength, endurance, and helps build stability of the shoulder girdle muscles that are needed for writing, cutting, and other hand tasks. • A variety of sponges, washcloths, and scrubbies can be squeezed to improve hand strength while at the same time offering sensory input. The more varieties the better. Try thick washcloths, thin ones, and small and large sponges. Squeeze the water into funnels and cups. Try to fill a cup to the top with water squeezed out from the sponge. • Spray bottles are great for hand strengthening when the trigger is squeezed. The spray bottle can be used together with the foam soap, to spray the foam off the bathroom wall. Food coloring can be added to the water in the bottle for more fun and visual input. The color doesn’t stain tile walls (but it will stain un-tiled walls). • Soap crayons are readily available and inexpensive. Imagine learning to scribble and form shapes, letters, and numbers on the tile wall while in the bath and having fun! This is much more fun than sitting at a table to practice writing. • Soap finger paint is a blast for children and adults alike. Many children who are tactile defensive (don’t like to touch certain textures) and won’t touch finger paints in school, will be more willing to do so where they can easily wash it off if it becomes noxious and overwhelming. Placing one fingertip into each color, encourages isolated finger use, and is great for color identification. • Measuring cups are great tools for filling/dumping, and learning about measurements and fractions. How many ½ cups do you need to fill a 1-cup measure? Follow a pretend recipe in the bathtub, to make pretend bathtub cakes using verbal or written directions. • Young children love to watch water flowing through a funnel, especially if the water is colored by tub tints mentioned earlier.
TREATMENT Sensory Experiences Sensory experiences are a very important part of a child’s development and can be offered easily by using everyday items. Here are some suggestions. • A sensory bath can be done using a variety of materials. They can be placed into a large bin with a cover, large enough and deep enough for the child to play without having to worry about excessive spillage. Some suggestions include using rice, beans, sand, water, cornhusks, or dried corn cobs (found at a pet store). A handheld broom and dustpan can be purchased at a 99 cent store and left in the bin for easy clean-up. Bury hands and feet and make it “rain” rice over their hands, arm, feet, etc. • Funnels and sieves can be used for dumping and filling fun. • Sand toys can be used with rice if the holes are large enough for the rice to flow through. • White rice can be easily colored by adding a small amount of food coloring to the rice and mixing it up. Make many colors of rice and add them together for multi-colored fun. Have them pick out pink rice, blue rice, etc. for fine motor control and color discrimination. • Hide small objects and toys in the rice, sand, etc. Have the child find the objects and match them to pictures of the objects, or sort them by category. Count the objects found and do simple math examples by throwing some of the objects back in the rice. • Have the child squeeze a handful of rice in their hands for hand strengthening. • Use shovels and other tools for digging fun for children who are slow to touch the sand or rice. Slowly they will begin to use their hands. • Soap crayons are readily available and inexpensive. Imagine learning to scribble and form shapes, letters, and numbers on the tile wall while in the bath and having fun! This is much more fun than sitting at a table to practice writing. • Soap finger paint is a blast for children and adults alike. Many children who are tactile defensive (don’t like to touch certain textures) and won’t touch finger paints in school, will be more willing to do so where they can easily wash it off if it becomes noxious and overwhelming. Placing one fingertip into each color, encourages isolated finger use, and is great for color identification.
The Home Obstacle Course Gross motor skills can also be practiced in the home using common household objects. Here are some easy suggestions. • Place a line of masking tape on the floor and have the child jump, hop, or gallop over the line. Walk on the line like a tightrope walker. Use your imagination. There are endless opportunities for gross motor movements with a simple line of masking tape. • Have the child jump over objects; some high, and some low • Make an obstacle course in the home. Use direction words such as crawl under the chair, around the coffee table, and over the bed. It’s a great way to foster motor planning and practice directional words such as over, under, in between, etc. Have the child practice walking, crawling, scooting, crab walking, bear walking, etc. • Make homemade stepping-stones out of items such as buttons, placemats, carpet squares, or cut out footprints from colored paper. Have the child step, jump or hop from one to the other. Lay a blue sheet down and tell the child not to fall in the pretend water. Make a game out of who can step on the most stones without falling in the water.
Beading and Threading Exercises Stringing/lacing is an important developmental skill and can easily be practiced in the comfort of your own home with everyday objects. Here are some suggestions: • Objects that can be used for string are limitless and a string in and out around the plate. It can also be laced can include, a skinny wood dowel, pipe cleaner, lanyard, around the plate and through the other side. See if your shoestring licorice, shoestring with long plastic piece, child can identify mistakes made and whether they can regular shoelace, yarn, dental floss and thread. self correct. • Objects that can be used for stringing are equally limitless and can include, cut straws, pasta (such as tubetti, ziti, ditaliano, wheels, etc), Froot Loops, Cheerios, Applejacks, buttons (large and small with two or four holes for more difficulty) • A variety of mediums can be used as the lace when beading and can be utilized in order of skill difficulty. Proceed in this order to facilitate proper skill acquisition. • Punch holes in a paper plate and have the child lace
It is important to keep in mind that a child’s work is his play, and he must play in order to learn, practice, refine, and integrate the skills needed for everyday tasks. It is important to offer as much opportunity in a loving, safe, and non-threatening environment. These activities should be set up to ensure success for the child. That is not to say that we shouldn’t challenge them, because challenging is how we learn. Just be sure that initially, they can be successful in order to build their selfconfidence to try the harder tasks. Remember, the more fun the task, the less children will resist and the more they will learn. And you don’t need to break the bank to do so. Parents need to consult with therapists on these activities to ensure maximum benefit to the child. Chaya (Ilene) Klass, MS, OTR/L is an occupational therapist currently treating children age birth to eleven. She can be reached at (347) 631-4512
PRODUCTS From the Reviewers
The world of special needs children has grown tremendously over the past few years. New diagnoses, new therapies and a whole range of new products to make life a little bit easier. It’s hard to know which product is best for your child and their specific needs. That’s where we come in with our unique product section. Therapists in the field have reviewed all of the items in these reviews. We hope you enjoy, Ilene (Chaya) Klass, Megan Petrizio, Helene Wasserman To be included in future issues or to make suggestions, please contact Ilene Klass at firstname.lastname@example.org.
A major breakthrough for 5 million kids. New for attention deficits: Cogmed Working Memory Training TM • Improved attention • Better complex reasoning skills • Better academic performance • Five week, home-based training Available in Long Island and Brooklyn only at LICCT, please call 516-922-2430 for more information. cogmed.com
V-Motion Finally, a video gaming system that can effectively be used by young children ages 3-7 and children with disabilities. The new craze of the Nintendo Wii Gaming System has everyone running to the store, but for young children and children with disabilities, the V-motion may be a better fit. The V-Motion video gaming system utilizes a multi-sensory approach to learning that impacts different areas of the brain at once, through visual animation, auditory instructions, music, and positive verbal reinforcement. The cordless game controller uses gross or fine motor movements depending on the setting used. The motion sensor setting can be used when sitting or standing and accurately responds to the child’s right, left, up and down movements, which then correlates to the movement of the character on the screen. The oversized joystick setting is great for little hands or for children with fine motor difficulties, because it utilizes a gross grasp pattern. The controller can also be set for specific right and left hand dominancy. The V-Motion games called Smartridges include well-loved characters like Spiderman, Dora, Thomas the Tank Engine, Wall-E and others. Each game has different levels of play that can be used to teach various educational concepts for learners of different levels. As each board is completed, a new concept is taught and generalized to the next level. What’s truly great about this system is that the physical motion required by the child helps reinforce leaning, while effectively keeping them focused on the task at hand. This is especially helpful for children who have difficulties with focus and attention, such as children with autism spectrum disorders, ADD, ADHD, and a multitude of other learning and developmental disabilities. Children can learn numerous educational concepts that may have otherwise been difficult to conceptualize and integrate and all while they think they are just having fun. Games can be played individually or with multiple players, which encourage reciprocal conversation, socialization, turn taking and game etiquette. A second game controller can also be purchased separately allowing more than one person to play at the same time. The gaming console and joystick are available in blue and pink and are made durable enough to withstand hours of play and learning. This gaming system also comes with a USB V-Link that allows parents to connect online and track their child’s progress. Additionally, this feature enables you to obtain bonus game packs as your child completes various tasks. V-Motion has taken the fun and mind building to a whole new level.
Therapeutic Benefits: • Improves hand eye coordination and visual motor skills, which is the ability to coordinate visual information and execute the proper motor movements to complete the task. • Provides leisure, play skills, socialization, reciprocal conversation, turn taking, coping skills, and game etiquette.
• Educational growth on appropriate skill level • A multi-sensory approach to learning including tactile (touch), vestibular (movement), auditory (sounds) and visual input that appeals to various learning styles. • Encourages gross and fine motor movements • Improves visual perceptual skills, which is the ability of the brain to accurately interpret information coming in through the eyes. • Motor planning, which is the brain’s ability to conceive, organize, and carry out a sequence of novel actions.
• Improves focus and attending skills. • Improves reinforcer effectiveness, which encourages persistence at tasks perceived as difficult.
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PRODUCTS Foam Tummy Scooter Board: The Cadillac of scooter boards is beautifully constructed of a high density, durable foam making scooter board activities more comfortable and inviting for children of all ages. Proper hygiene is insured by simply wiping down the board with a wet cloth. Scooter boards can be used in sitting or prone (on their stomach) positions and provide a variety of therapeutic benefits including improved gross motor skills, coordination, muscle tone, strength, endurance, visual motor skills, motor planning and more. Wrist and ankle weights can be used for increased proprioceptive and pressure sensation. Children will have hours of fun riding the scooter in all directions as well as turning in circles, pushing off walls, ride down ramps, crashing into pillows and more. The Scooter board is great for controlled sensory input, especially with the small tactile bumps already built in. It features non-marring rubber swivel casters, which easily glide across most surfaces and provide a smooth, comfortable and exciting ride. It’s a wonderful way for children to receive therapeutic benefits while having loads of fun. The Scooter board is available in a variety of sizes and features and is offered at an extremely reasonable price. This is a must have for therapists and parents alike.
Therapeutic benefits: • Motor planning, which is the brain’s ability to conceive, organize, and carry out a sequence of novel actions. • Improving muscle tone, body strength and endurance. • Sensory input including vestibular (the body’s position in space, registered through the fluid in the ear canal), proprioceptive (pressure on the body that is registered by the joints and muscles), and tactile (sense of touch) input. • Gross motor skills involving the movement of the large muscles of the body (i.e. jumping, walking, etc.) • Coordinating the body’s ability to move in a coordinated and fluid manner.
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PRODUCTS Learn To Dress Monkey
Alex the monkey is an invaluable tool to help young children, ages 18 months and up, learn dressing skills and more. His brightly colored clothing, variety of textures, and plush huggable body makes Alex appealing for children to play with, while simultaneously providing a wide range of sensory exploration. Alex is 22 inches long, and has real removable clothing that helps children learn, practice and master self-care dressing. Children can put on and remove Alex’s shirt, overalls, socks and shoes, as well as learn to lace and tie shoes. His buttons, zipper, loop, Velcro fastener and buckle are large enough for little hands to manipulate. Alex also comes with a removable Velcro banana and sound disc, which is activated by pressing on his pocket. This versatile and functional toy is lightweight, allowing children to take him with them. Alex provides hours of fun filled play while subtly teaching children to dress themselves from head to toe.
Therapeutic Benefits: • Hand eye coordination, which helps children effectively use their hands and eyes together in a coordinated manner. • Fine motor skills, which improves the strength and dexterity of the small muscles of the hand including grasp patterns such as pincer, tripod, and fisted grasps. • Problem solving skills which includes analyzing the task, breaking it down into small and manageable steps, and forming the best strategies to complete the task in the most effective manner. • Sensory exploration including visual (vision), tactile (touch) and auditory (hearing) stimulation. • Imaginative and pretend play • Activities of Daily Living (ADL’s) which are self care skills such as dressing, feeding, grooming etc. that are part of our daily routine.
Kubit2Me Kubit2me is a new and innovative way for kids to make therapeutic gains while simultaneously having loads of fun. No spinner, dice, or playing pieces are needed. Just toss the furry colorful cube with built in pockets, remove a card, and the fun begins. Each pocket holds cards on various topics to make learning fun and exciting. It even comes complete with rewards that can be placed in the built-in prize holder so children can get immediate positive reinforcement. Kubit2Me is available in three age levels, and bonus boxes can be purchased separately for other age and cognition levels. The Lil’Scholars All About Me bonus box, geared for children ages 3-6, comes complete with cards and game ideas that focus on letter and word recognition, sequencing, body parts and emotions. The Kubit2me Now You’re Talking edition targets ages 10 and above with thought provoking questions that encourage communication, socialization, and self-expression. Game questions focus on beliefs, opinions, relationships, and memories – all topics that affect our everyday lives. Practicing social skills such as communication, turn taking and respecting other’s time to speak are only a few of the applications. Kubit2me can be played in small or large groups and combines physical play with, hand eye coordination and overall learning in a fun and non-competitive way. The soft and fuzzy hair makes it easy for little hands to grasp and adds a terrific tactile sensory component. The playing cards store easily in the built-in pockets. This tool can be used by a variety of professionals including social workers, speech pathologists, occupational therapist, teachers and youth counselors and can be a great therapeutic tool!
Therapeutic Benefits: • Socialization, self-expression, and communication • Sensory regulation and modulation, which is the brain’s ability to receive, process, and make sense of sensory input coming in via the five senses as well as the body’s muscles and joints. • Improves hand eye coordination and visual motor skills, which is the ability to coordinate visual information and execute the proper motor patterns to complete the task.
Autismsuperstore.com $24.99 Kims Cup This handy, affordable one of a kind therapeutic toy is so simple, yet extremely practical and functional. The plastic cup with a handle also has two twist-on lids with different sized holes and a slot to allow for the insertion of dowels, sensory critters, pegs, chips, beans and pegs. Each object requires a different grasp pattern and varying amounts of pressure to drop through holes into the container. This is useful when working on fine motor skills to help develop and refine the small muscles of the hand which are vital to basic everyday skills like dressing, eating, writing, cutting, typing, etc. Just give the child a sensory critter to hold, while simultaneously picking up and inserting the small objects into the cup to develop both sides of the hand and promote in-hand manipulation skills. Kim’s Cup is also a great toy for early learning concepts such as cause and effect; it encourages the use of both hands together in a coordinated manner and provides visual and auditory sensory input when shaken. Kim’s Cup is a lightweight and portable therapy tool that is easily taken from place to place to the therapy room, house, or school. A must have for all therapist! Pocket Full Of Therapy
Therapeutic Benefits: • Develops fine motor skills including various developmental grasp patterns, isolated finger use, and both sides of the hand. • Improves hand eye coordination and visual motor skills, which is the ability to coordinate visual information and execute the proper motor patterns to complete the task. • Provides sensory input including tactile, visual, and auditory input.
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Novenops: Novenops are cards that help develop a student’s ability to understand basic elements of grammar. They come in a set and can be played as a game that will continuously reinforce sentence structure concepts. The cards not only address grammar, but also reading and writing skills. It is a fun game to play and students often enjoy exchanging turns and sharing laughs throughout the experience. Initially, the therapist shuffles the deck and distributes five cards to each player. After the remaining cards are placed face down on the game board, the first player puts a noun card on the first noun position on the game board. The next player must draw a verb card. Finally, a phrase card is played and the player forms a noun + verb + noun sentence or NOVENOP. The player who places the phrase card may read the often funny NOVENOP aloud. The game continues until players run out of cards.
Therapeutic Benefits: The Novenop card set is a relatively inexpensive and fun tool to use with students working to improve their grammatical skills. It not only addresses goals focused on expressive and receptive language skills; it also allows for work in the pragmatic (social) skills area with the facilitation of turn-taking, joint attention, and topic maintenance. This is a fun and engaging material to use with students who need improvement in grammar and pragmatics.
Help children face sensory challenges with these fun activities! Includes 35 beautifully illustrated cards with over 100 activities for parents and teachers who are looking for some great sensory games using common objects found in the home and school. The purpose of each activity is labeled as it relates to sensory integration, eg. tactile, auditory, crossing midline, heavy work/proprioception, etc. Includes 7 categories with 5 cards each; the categories are Play, Eat, Make, Move, Draw, Splash and Shape. Includes additional cards with How to Use the Activities and a Glossary of Terms.
Therapeutic Benefits • Great for carryover of sensory integrative therapy by both the parent and teacher • A great tool to have handy for engaging children in fun sensory activities.
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Weighted Compression Vest: This well constructed, durable weighted vest combines both compression and weight resulting in deep pressure (proprioceptive input) or a “deep bear hug” for children who have difficulty maintaining a calm, attentive state, display stereotypic behaviors (i.e. hand flapping, twitching, etc.), are hypersensitive to sensory input, have difficulty maintaining attention, or appear clumsy and uncoordinated. The deep pressure assists the child to self-calm and relax, allowing the brain to adequately process incoming sensory input. Weights are safely positioned in pockets located inside the vest, and can be easily added or removed. Velcro closures on the sides and shoulders allow for maximum comfort, easy sizing, and quick removal. Vests are designed with a soft mesh material on the sides to increase airflow and overall comfort, and can be worn inside or outside of everyday clothing. The vests are cold-water machine washable when weights are removed. Vests sizes S-XXL include two 1/2-pound weights and four 1/4-pound weights for a total of 2 pounds. The XS vest includes four 1/4-pound weights for a total of 1 pound. Finally, one vest that combines both compression and weight in one! A real value and a must have for therapists and parents.
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• Sensory regulation and modulation, which is the brains ability to receive, process, and make sense of sensory input coming in via the five senses, as well as the body’s muscles and joints. • Provides calming and organizing deep pressure to help children remain calm, attentive, and organized.
The Z-Vibe is a tool designed by a speech-Language pathologist that uses gentle vibration to provide controlled sensory stimulation to the face, mouth structures (palate, tongue, gums, cheeks, etc.) and throat. It is used to improve oral motor, muscle tone and sensory tolerance in the mouth. The Z-Vibe has been very successful in promoting lip closure for eating, sucking, speaking, articulation, drooling, and to improve swallowing. The vibratory sensory input provided by the Z-Vibe is also helpful for picky eaters whose aversion to various food textures results in a limited diet. The FDA approved Z-Vibe is constructed with durable, textured, aluminum and sturdy, medical grade, latex free plastics. Due to its convenient small size (its about as large as a ball point pen) it is perfect for therapists and parents to use throughout the day. Only a speech or occupational therapist or a parent who is under the supervision of a therapist should use the Z-Vibe. While the Z-Vibe is sold with one probe tip, there are a variety of other tips available for purchase, which provide a range of sensory stimulation and serve specific therapeutic functions including feeding, biting, tongue movements, and even writing. The Z-vibe handle can be used to stimulate the swallowing reflex, tongue retraction, lip closure, as well as stimulation to the facial muscles. The probe or mini tip can be used for stability and jaw movements, tongue movements, food retrieval, tongue thrust, as well as tongue, lip and cheek strength and awareness. The fine tip can be used for tongue movements as well. The prefer tip is helpful for sucking action and lip closure, as well as cheek, lip, and facial awareness and stimulation. The spoon tip comes in a soft and hard version and is used to provide oral stimulation during feeding to aid in sensory tolerance to the mouth. The pencil tip provides controlled vibration to the hand. The child gets the desired sensory input without any effect on their written work. Older people can also benefit from the therapeutic effect of the vibrations in their hands. Each of the tips screws easily into the handle and can be changed or replaced.
Therapeutic benefits: â€˘ Provides controlled sensory input to the face, mouth, and neck that improves overall strength, muscle tone, and sensory tolerance resulting in decreased drooling, improved articulation, improved feeding and decreased food aversions. â€˘ The Z-Vibe pencil improves writing skills and provides controlled sensory input to the hands thereby reducing fidgeting and selfstimulatory behaviors.
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How To Draw 101 things that go: This highly entertaining book is part of the “How to Draw” series of books, which consists of how to draw animals, funny people and monsters. Each page illustrates easy step-by-step instructions that are broken down into smaller, more manageable steps to teach children how to draw. The drawing is broken down into 6 boxes. The child advances from the first box to the 6th box, which is the completed drawing with no erasing or going over an outline afterwards. They simply copy what’s there as they move from one box to the next till the picture is completely drawn. This is a fun and exciting way for children to work on visual motor skills and near point copying, a writing skill needed in our daily life (copying a recipe, homework from the blackboard, or an address and phone number from a phone book). Amongst the 101 drawings you can copy in this particular book are a submarine, yacht, forklift truck, Rolls Royce, bulldozer, bus, fire engine, tractor and more. This book is well worth the purchase price, and is a wonderful tool for parents and therapists alike.
Therapeutic Benefits: • Improves hand eye coordination and visual motor skills, which is the ability to coordinate visual information and execute the proper motor patterns to complete the task. • Near point copying, which is the ability to copy text, or design accurately from a source placed to the side or in front of the individual (i.e. copying spelling words from a textbook to the child’s loose-leaf, etc.) • Hand eye coordination and visual motor skills, which is the ability to coordinate visual information and execute the proper motor patterns to complete the task.
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Chewy Tubes As a professional working with clients who demonstrate oral motor deficits, there are some items we consider essential; the chewy tube is one of them. Chewy tubes are innovative non-food oral motor tools designed to provide a resilient, chewable surface for practicing biting and chewing skills. Clinicians may select to use chewy tubes in therapy sessions in order to address an initial oral motor skill, or for rehabilitation of the jaw following a trauma or stroke. Therapists can also use the chewy tubes to treat children who seek additional proprioceptive input into the jaw or enjoy biting on chewy tubes. Chewy tubes vary in texture depending on a client’s needs and are latex free, lead free and do not contain PVC or phthalates. Chewy tubes can be used as tools to address oral motor concerns of students who demonstrate difficulties with strength, coordination, sensitivity, and awareness of their oral motor structures (e.g. lips, jaw, and tongue). Some chewy tubes can be used as an oral motor strategy to help people increase strength and coordination of their jaws for feeding and speech production. Chewy tubes can also be used to increase sensory integration for a student who is a picky eater and does not tolerate certain temperature or textured foods. Overall, chewy tubes can be used with children and adults with Autism, cleft palate, Down syndrome, traumatic brain injury, and many others. Chewy tubes should always be used with supervision and parents should follow the recommendations of their therapist or caregiver for using chewy tubes.
Therapeutic Benefits • • • •
Increases sensory regulation and awareness of oral motor structures Allows for increase in strength and coordination of the jaw Allows for increased proprioceptive input to clients Increases coordination of jaw
Chewytubes.com - Price varies $7.00 to $10.00
Perfect as a computer table or desk top Easy push button height adjsutment Adapts to any wheelchair size Angle Adjustable top from 0 to 90
used in combination with the
Jaw Rehabilitation Program provides a powerful tool for developing biting and chewing skills. For more information call
Speech Pathology Associates, LLC at 207-741-2443
or visit us on the web at
Central Design 732-942-0746
by R.E.A.L. Design
TM e l C e o n h vert-able Tab T
Key boards Pals: Finally, a typing tutor program that’s geared for not just for children of all ages, but special needs children as well. Using interactive puppetry, exciting scenery, and cute songs, Keyboard Pals helps children learn to type. What’s unique about this program is its use of mnemonics (memory tricks) to help children remember which key is where on the keyboard. Each letter has its own house in Keyboard Town. The home keys A, S, D, F, J, K, and L, have names and live in a house on Home Key Street, with those characters going to visit either uptown or downtown. For example, A is for Amy who lives on Home Key Street and goes downtown to visit the zebras (for the letter Z) or uptown to visit Qwert (for the letter Q) who asks lots of questions. Each letter is taught individually, slowly building up to words as the letters are taught. An interactive hand visually demonstrates how the child’s hand should move in order to press the correct key while simultaneously using auditory directions. Thus, whether your child is a visual or auditory learner, this multi-sensory approach improves the probability of their success. The program also includes coloring pages, games, and stickers to reinforce skills already taught. Additional features include the ability to pace your child at one that is comfortable for them, by allowing the parent/teacher to begin the session where they last left off, or go back and review the previous session or one where the child needs reinforcing. Background colors can be modified to allow individuals with visual disturbances to be successful. Key Board Pals has inactivated the backspace and delete button so the child doesn’t lift their hands off keyboard. This helps to limit distractions and create a stress free environment. This low pressure, positive experience will make learning to touch type fun and exciting, and foster feelings of success in the child. Finally, some children who have difficulty writing find it hard to keep up as the writing requirements for school increases. Touch-typing allows the child to concentrate on what he is actually writing instead of focusing all their energy on the physical act of putting pencil to paper. As for the child who finds it hard to learn to touch type, this program helps by giving a simple yet effective way to learn and remember where the letters are located on the keyboard, in a positive manner that fosters success. • Improves hand eye coordination and visual motor skills, which is the ability to coordinate visual inforTherapeutic benefit: mation and execute the proper motor patterns to complete the task. • A multisensory approach to learning how to touch type • Improves focus and attention to task by making learning interesting, pleasing to the senses, and • Opportunities to reinforce what’s learned that cater to a variety of learning styles. • Makes learning fun and easy to learn thus allowing better written expression for those who have facilitates successful outcomes. • Ability to modify the background colors assists individuals with visual difficulties difficulty with writing. • The slower pace allows individuals poor motor planning, slow processing speed and other deficits be • Can effectively help young adults learn to touch type, opening up more vocational opportunities. successful.
Central Design 732-942-0746
Our New Cd-rom Teaches Typing To Children With Learning Differences Using Puppets, Humor And Music. Keyboard Town PALS has put together an outstanding creative team to produce our software package. These professionals come on board with years of experience in children's educational programming. Several members of our crew were part of the EMMY AWARD-WINNING MISTER ROGERS' NEIGHBORHOOD.
ce, at their own pa Students learn ent . m on vir en e re in a stress-f
For more information call
1-866-200-8881 or visit us at
www.keyboardtownpals.com “Keyboard Town PALS is the missing link that leads to creative writing”. Stephen Phillips, Director of Children's Health Education Foundation/ Health Corps
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Tech4Everyone While we all agree that advancements in technology can be of great benefit to those with special needs, many programs cater to those with a specific level of ability. As the diagnosis of autism increases and the need to find mechanism to reach the population grows, organizations are turning to innovative and new approaches. A powerful new tool is the computer empowered with the Tech4everyone special needs station. The T4E Computer station enables adults and children with learning disabilities, autism, emotional and behavior problems, multiple disabilities, as well as cognitive and communication difficulties to fully utilize and enjoy the excitement, stimulation and learning potential that the computer has to offer. The Tech4everyone computer station is an assistive workstation; complete with its own unique specialized windows environment and software that was designed specifically for the special needs population. This allows anyone, no matter what his or her functioning level is, the ability to benefit from a computer. With that in mind, it can be purchased with an adaptive keyboard, mouse, track ball, and a touch monitor. For those with very little mobility, scanning mode is available. The wonderful thing about the software developed by Tech4Everyone is that can be individualized for each client or student in the program and that it tracks its usage. Each student accesses his own individualized system by simply clicking on his or her own face. The personalized interface has simple visual and auditory cues to help him/her access the different types of software available for use. The Tech4everyone Computer station builds daily living skills, math and literacy skills, cognitive and social skills. Other software applications and the web can be integrated. Through the combination of a dedicated personal learning environment, teacher empowerment tools that control and monitor user’s activities, digital tools which utilizes the power of photography as a teaching tool, software appropriate for each student’s level and abilities - Tech4everyone has harnessed the power of the computer and has transformed it into a successful learning tool.
Therapeutic Benefits: • • • • •
Enables the developmentally disabled to use the computer independently Real Early life skills through the T4e skills videos such as buttoning, buckling, lacing and more Memory enhancement skills Activities to enhance memory, gross motor control, visual perception and cause and effect. Social integration skills
• Cognitive strengthening and enhancing activities • Self esteem enhancements from acquiring new skills • Enables the integration of valued outcomes and IEPS with the activities being done n the computer • Provides usage tracking tools enabling an organization/school to monitor that the computer is being used in the most beneficial way.
Call for Pricing
Past Issues of
Now Available 1
U I L D I NG L OCKS
SPECIAL EDUCATION SUPPLEMENT
To Purchase Copies Email request to firstname.lastname@example.org 71
MICHAEL I. INZELBUCH ATTORNEY-AT-LAW s )%0 $EVELOPMENT s $UE 0ROCESS (EARINGS s 3PECIAL %DUCATION 3ERVICE 0ROCUREMENT
“Every child deserves a free and appropriate education at the school district’s expense” 0HONE &AX -EMBER .* .9 "ARS
General Listing of Services - Organizations Compiled by Moshe Klass Editor’s Note: The listing below is intended to serve as a starting point for family members, professionals and care givers seeking programs, institutions and service providers designed for special needs individuals and their families within the Jewish community. Building Blocks does not speciﬁcally endorse any of those listed. Readers are urged to contact them individually for more information. You must make your own determination as to whether the services and programs they oﬀer are appropriate for your speciﬁc case. While a lot of time and eﬀort was devoted to this list, it is in no way perfect or comprehensive. Most of the information was compiled from organizations and agencies that opted in by sending information. There are no advertising requisites for this. It is completely free. We started with a master list by organization in alphabetical order with full information, followed by a list of private practices. The remaining pages are by category, with limited information.
AHRC New York City Address: 83 Maiden Lane, NY, NY Phone: 212-780-2500 Contact: Central Receptionist
Aim High Children Services
When Tutoring Fails Our Orton-Gillingham Approach helps your child succeed! As a child struggles unsuccessfully to read, his or her confidence, self-esteem, social skills and emotional health suffer as well. At Ohr Halimud we find the cause of your child's difficulty and we correct it. Find out how this proven program will teach your child to read and succeed! Call for details about our “Operation Read” special grant program for children ages 7-9. Every child has the right and ability a learn to read! Don’t you agree?
Address: 202 Foster Ave, Brooklyn, NY 11230 Phone: 718-853-1750 Services: Seit, Evaluations, integrated classrooms, ABA special education therapists
Asperger Syndrome High Functioning Autism Association (AHA) Address: PO BOX 916, Bethpage, NY 11714 Phone: 516-470-0360 Contact: Pat Schissel - President Services: Support & information for families, individuals & professionals affected by Asperger Syndrome, High Functioning Autism & Pervasive Developmental Disorders.
The Auditory Oral School of NY Address: 3623 Ave L, Brooklyn, NY 11210 Phone: 718-531-1800 Contact: Pnina Bravmann - Program Director Services: A DOE funded preschool program offering self contained & integrated classrooms focusing on the development of auditory, cognitive and social skills in hearing impaired & language delayed students. Provides SEIT & related services.
Blanche Kahn Family Health Center REGISTRATION OPEN Orton-Gillingham Teacher Training CALL FOR APPLICATION
Address: 1221 E. 14th ST, Brooklyn, NY Phone: 718-434-4600 Contact: Mrs. Fireman - Clinic Administrator
Board of Jewish Education of NY (BJENY) Address: 520 8th Ave, 15th Floor, Brooklyn, NY 10018 Phone: 646-472-5300 Contact: Dr. Jed P. Luchow - Director of Special Education Services: Advocacy, AJSE (Association of Jewish Special Educators), Annual Parent Empowerment Conference & Resource Fair, Assistive Technology, JPAC (Jewish Parent Advocate Coalition), Project SIR: Success In Reading for Early Literacy, Workshops for Professionals & Workshops for Parents.
Bright Smile Center Address: 1 051 59th ST, Brooklyn, NY Phone: 718-437-5774 Contact: Mrs. C Glick
Brooklyn Community Management Address: 2555 Nostrand Ave, Brooklyn, NY 11210 Phone: 718-951-8800 Contact: Chuck Services: Neurological, sensory integration, internal medicine, podiatry pain management, arthritis, post surgical physical therapy, OT, aquatic therapy, speech language pathology counseling.
CAHAL Address: 540-A Willow Ave, Cedarhurst, NY 11516 Phone: 516-295-3666 Contact: Naomi Nadata - Program Director Services: Special Education classes for children with Learning Disabilities from Kindergarten through High School in 11 Yeshivas in the 5-Towns, Far Rockaway & Greater Nassau County.
RESOURCES DIRECTORY General Listing of Services - Organizations continued
Thivierge &Rothberg p.c. ATTORNEYS AT LAW
Camp Ahuvim Address: 1160 E. 8th ST, Brooklyn, NY 11230 Phone: 718-724-4283 Contact: Shlomo Kertzner - Director Services: Camp for boys with Autism located in the Catskills.
Chai Lifeline, Inc Address: 151 W 30th ST, 3rd Floor, NY, NY 10001 Phone: 877-CHAI LIFE Contact: Rabbi Mordechai Gobioff - Director of Client Services Services: Provides family-focused, emotional and social support services to children with serious medical illnesses and their families. Programs include tutoring; counseling for ill children, siblings & parents; insurance advocacy; medical referrals; Big Brothers & Sisters; recreational activities & more.
Challenge Early Intervention Center Address: 649 39th ST, Brooklyn, NY Phone: 718-972-0880 Contact: DR Ibel - Clinical Director Services: Full array of Early Intervention services including ABA.
Comprehensive Kids Developmental School Address: 99 Essex ST, NY, NY 10002 Phone: 212-566-8855 ext 308 Contact: Arthur German - SIET Coordinator Services: ABA SEIT services, Center & home based services, CPSE, OT, PT, RSA provider, SEIT, Special Ed. school.
Eis Laasois Address: 22 Middleton ST, Brooklyn, NY 11206 Phone: 718-303-9400 Contact: Mr. Weiss - Administrator Services: Pre-School special education & Early Intervention Home & Center based.
Friendship Circle of Brooklyn Address: 792 Eastern Parkway, Brooklyn, NY 11213 Phone: 718-907-8852 Contact: Chayle Eckhaus - Program Coordinator Services: Pairs local teen volunteers & children with special needs for weekly visits & outings.
Hand in Hand Development, Inc. Address: 465 Grand ST, 2nd Fl, NY, NY 10002 Phone: 212-420-1999 ext 149 Contact: Leah Esther Lax - Director Services: For children with Autism Spectrum Disorders or serious behavior management issues. EI, CPSE, Speech Therapy, PT, OT, Nutrition Therapy, Vision Therapy, Counseling & Psychological Services, Sensory Gym. Parent Child group, Parent/ Caregiver Support group, & Service Coordination.
Ha’or Beacon School Address: 2884 Nostrand Ave, Brooklyn, NY 11229 Phone: 718-951-3650 Contact: Goldy Hirsch-Program Director
Address: 1070 E. 17th ST, Brooklyn, NY Phone: 718-986-7648 Contact: Leah Hirth - Executive Director Services: Medicaid Waiver, Medicaid Service Coordination, Vocational Training. Clinical Services (age 21+): Evaluation & Therapy, Speech Therapy, OT, PT, Counseling, and Psychology.
HASC Creative Business Resources Address: 1566 38th ST, Brooklyn, NY 11218 Phone: 718-853-0900 Contact: Perela Mayer - Coordinator Services: Provides pre-employment training, job placement & ongoing job coaching for individuals with learning or developmental disabilities.
FAX. 212-397-6361 Christina D. Thivierge (Fax) 646-607-9827
Randi M. Rothberg (Fax) 646-607-2752
S. Pollak Audiological: Audiological evaluations for all ages, from newborn through adulthood. State of the Art, competitively priced hearing aids for all ages. Highly experienced and professional audiology staff Accepting most insurances Two locations: S. Pollak Audiological 1263 Ocean Parkway 463 Bedford Avenue Brooklyn, NY 11230 Brooklyn, NY 11211
Therapy for Kids OT, PT, SLP, LLC We provide
Harmony Services Address: 813 Quentin RD, Brooklyn, NY 11223 Phone: 718-787-4412 Contact: Moshe Wangrofsky - Program Director Services: Offers in school counseling, parent training, teacher training, remediation services, tutoring & psycho-educational evaluation.
140 BROADWAY • 46TH•FLOOR 211 West 56th Street Suite 30K New York • New York • 10005 10019 Tel.212-397-6360 TEL.212-397-6360
• Camp HASC - Sleep-a-way Camp Address: 5902 14th Ave, Brooklyn, NY 11219 Phone: 718-490-5361 • Camp Hasc - Day Summer Program Address: 6220 14th Ave, Brooklyn, NY 11219 Phone: 718-686-5930
Occupational Therapy Physical Therapy Speech/Language Therapy Counseling Services Evals/Therapy an indoor/outdoor Sensory Gym We utilize Therapeutic Listening Programs, Brushing Programs, Yoga Programs, Handwriting Without Tears Program, Cooking/Baking Programs.
are We n till ope p.m. 9:00
We accept private pay, RSA, CPSE-Preschool Contracts. SIPT Certified-sensory integration. For information call
Park in on si g te
68-68 Main St. Kew Gardens Hills 73
RESOURCES ďšş DIRECTORY
Are you Concerned that your child cannot read, write, or communicate effectively when necessary - socially or academically?
CLASSES ARE NOW FORMING
at the CENTER for ALTERNATIVE TEACHING
General Listing of Services - Organizations continued
A Division of S.O.S.
Utilizing advanced methods that accelerate comprehension and retention.
If he cannot learn the way we teach, we had better teach the way he can learn â€? Robert Burns
AN INVESTMENT OF A LIFETIME If your child is not attending or beneďŹ ting from the teaching methods oďŹ€ered at their school, classes are now forming in a highly productive and relaxed environment conducive to the joy of learning and development - Filling the void in our conventional teaching systems and methods - utilizing your childâ€™s multi-intelligences. t&EVDBUJPOBMBOE4PDJBM4LJMMT&WBMVBUJPOTt4PDJBM4LJMMT$PBDIJOH t3FBEJOHt8SJUJOHt"SJUINFUJD t(FOFSBMMBOHVBHFBOE$PNNVOJDBUJPO4LJMMT t1SJWBUF4FTTJPOTBWBJMBCMFPOBMMHSBEFMFWFMTJO)FCSFXBOE&OHMJTISFBEJOH t1SF"#PZT(JSMT3FBEJOH3FBEJOFTT$MBTT1SFQBSBUJPOGPS(SBEF t1SFQBSBUJPOGPS/:4UBUF&OHMJTI-BOHVBHF"SUT BOE.BUI&YBNT t3FHFOUTBOE$MFQ5FTU1SFQBSBUJPO t"EWPDBUFGPSQSPQFS4DIPPM1MBDFNFOU
Private sessions are now being oďŹ€ered for young adults (Shidduch age and up) with low level comprehension and communication abilities, for life preparedness.
Pediatric & Adult Care Neurological Orthopedic Sensory Integration Internal Medicine Podiatry Pain Management Arthritis Post Surgical Physical Therapy Occupational Therapy Counseling Aquatic Therapy in our new pools Speech & Language Pathology
Dr. Jack Kabariti, M.D.F.A.A.P Medical Director
Call for an appointment
(718) 951-8800 Most Insurance Plans Accepted 2555 Nostrand Ave. (Bet. K & L) Brooklyn, NY 11210
HASC continued â€˘ Gan Ezra Early Intervention (Monsey) Address: 201 Route 306, Monsey, NY 10977 Phone: 718-851-6100 â€˘ HASC Center Inc Address: 5601 First Ave, Brooklyn, NY 11220 Phone: 718-745-7575 Contact: Tzippy Friedler - Intake Coordinator Services: Boro Park, Flatbush, WIlliamsburg, Crown Heights - Residential Services, DayHab - Mixed & Separate; In Home ResHab, MSC, Work Readiness, Pre- Vocational, Supportive Employment. After School & Sunday Programs for Autistic Children, Family Health Center. â€˘ Preschool Program Address: 1311 55th ST, Brooklyn, NY Phone: 718-851-6100 Contact: Julie Ben-Zvi - Program Director Services: EI home-based & center-based, Preschool, SEIT & RS services & evaluations. Services in English, Hebrew, Yiddish & Russian; After school program, parent support groups & professional development. â€˘ Remsen Location Address: 555 Remsen Ave, Brooklyn, NY 11236 Phone: 718-495-3510 Contact: Stacy Zeitz â€“ Program Director â€˘ School Age Program Address: 6220 14th Ave, Brooklyn, NY Phone: 917-710-5196 Contact: Chaya Shandel Mandel - Program Director â€˘ Woodmere Location Address: 321 Woodmere Blvd, Woodmere, NY 11598 Phone: 718-853-9700
A Helping Hand Address: Brooklyn, NY Phone: 718-435-7464 Services: SEIT services with experienced therapists. Pre-school & students under Pendency.
Human Care Services Address: 1042 38th ST, Brooklyn, NY 11219 Phone: 718-854-2747 ext. 245 Contact: Chaya Mandelbaum - Intake & Development Services: Group homes, DayHab program, Personalized ResHab, MSC, Respite, Sunday morning program, Family Education and Training, Family Reimbursement.
Ichud Mosdos Hachinuch of Brooklyn Address: 1583 40th ST, Bklyn, NY 11218 Phone: 718-854-2400 Services: Self-contained Special Ed classes within mainstream schools.
Imagine Academy for Autism Address: 1465 E. 7th ST, Brooklyn, NY 11230 Phone: 718-376-8882 Contact: Mindy Jerome - Executive Director
IncludEd Educational Services Address - Cedarhurst Location: 445 Central Ave, Suite 111, Cedarhurst, NY 11516 Phone: 516-374-3377 Contact: Morton Kramer - Executive Director Address â€“ Kew gardens Hills Location: 68-45 Main ST, Kew Gardens Hills, NY 11367 Phone: 718-263-5437 Contact: Toby Teichman â€“ Director Services: Preschool Special Education Service including evaluations, Integrated classrooms, SEIT, Speech, OT, PT & Counseling services.
The Institute for Special Education of
Sara Schenirer Address: 4622 14th Ave, Brooklyn, NY 11219 Phone: 718-633-8557 ext 16 Contact: Leah Donn - Program Coordinator Services: Weekday morning and/or evening classes. Graduate program for women.
Jewish Board of Family & Childrenâ€™s Services (JBFCS) â€˘ Boro Park office Address: 1273 53rd ST, Brooklyn, NY 11219 Phone: 718-435-5700 ext 209 Contact: Faye Wilbur - LCSW Director Services: Parenting groups for mothers ongoing & group forming for fathers, socialization groups for children in regular classes & special education programs. Individual, couple & family counseling addressing among other things the impact of having a person in special education in the family.
RESOURCES DIRECTORY General Listing of Services - Organizations continued JBFCS continued • Child Development Center Address: 120 West 57th ST, NY, NY 10019 Phone: 212-632-4733
• Mishkon Address: 1358 56th ST, Brooklyn, NY 11219 Phone: 718-851-7100 Contact: Devora Thau - Director, MHCA, LNHA Services: Wide range of residential & community support services for developmentally disabled people & their families. Provides educational, medical & therapeutic care in warm, home-like settings sensitive to religious & cultural needs of Orthodox Jewish residents. Offers Medicaid Waiver & Respite care programs as well as parent education. • Manhattan Office Address: 120 West 57th ST, NY, NY 10019 Phone: 212-632-4529 Contact: Bonnie Chernin
Jumpstart Early Intervention Program Address: 3915 15th Ave, Brooklyn, NY 11218 Phone: 718-853-9700 Contact: Tzirel Winograd - Program Coordinator Services: Provides Comprehensive evaluations & home-based therapy for infants & toddlers who are experiencing delays.
The New Seminary Address: 2600 Ocean Ave, Brooklyn, NY 11229 Phone: 718-769-8160 Contact: Rebbetzin Sora F. Bulka, Dean and Rabbi Yeshaya Levy, Dean Services: The New Seminary, in association with recognized major universities, offers a program where students are provided the education and training they need towards earning their Bachelor and Master degrees, including the fields of: Education/Special Education/Early Childhood/ Therapies/Social Work.
Ohel Bais Ezra Address: 4510 16th Ave, Brooklyn, NY 11204 Phone: 718-851-6300 Services: Housing, Foster Care, Outpatient Counseling, Medicaid Service Coordination/ Life Coach; At-home ResHab; Respite; Sunday Recreation Programs; Summer Camp Programs; After School Programs; Shabbaton Programs; Shabbos Bnos Programs; Day Hab Programs; Residential Services. Recreation & respite programs for children with autism & other developmental disabilities.
Ohr HaLimud Address: 1681 42nd ST, Brooklyn, NY 11204 Phone: 718-972-0170 Contact: Leah David - Executive Director Services: Bais Yaakov for Girls with Dyslexia, after school tutoring Center for Boys & Girls.
Kulanu Address: 68 Washington Ave, Cedarhurst, NY 11516 Phone: 516-569-3083 Contact: Jonathan Cooper, LCSW - Director of Inclusion & Community Support Services Services: Community based recreational, educational, referral, information & support program for children & families in need of services for children with special needs.
Omni Childhood Center Address: 1651 Coney Island Ave, Brooklyn, NY 11230 Phone: 718-998-1415 Contact: Sheila Selig Services: Special Ed, Speech, Occupational Therapy
is a school located in Deal, NJ
servicing students with individual learning needs, who are not thriving in the mainstream setting. SEAD provides small classes with highly qualified staff to maximize each students potential with mainstreaming opportunities in the local community schools. For more information please call 732-460-1700
Your Children Deserve the Best Make Sure They Always Qualify for What They Deserve Supplemental Needs Trusts Special Estate Planning (k’halacha) Medicaid Planning /Eldercare Law
Law Offices of David D M. Schlachter er www.LawDMS.com 973 272-4768 718 377-1356 2245 Passaic Ave, Passaic NJ 070555
Masters in Special Education Classes offered Sundays in Brooklyn ■ ■
State-Certification Early Childhood and Childhood Tracks Available
Registration Dates Jan 11th ■ 11:00am Jan 15th ■ 7:30 PM Montauk Intermediate School 4200 16th Ave. • Brooklyn, NY 11204
Classes start on Feb 1st. Order your registration packet today!
On Our Way Learning Center Los Niños Services Address: 535 8th Ave. 2nd Floor, NY, NY 10018 Phone: 212-787-9700 Contact: Scott Mesh, Ph.D. - Executive Director Services: EI, OT, PT, ST, Evaluations, Parent Training, Group Program.
Address: 264 Beach 19th ST, Far Rockaway, NY 11691 Phone: 718-868-2961 Contact: Evaluation/Intake Coordinator Services: Special Ed classes, OT, PT, ST, Evals, Counseling, Parent Workshops.
718.376.0974 ext. 1213 877.RING.TTI
Guidance you can trust!
RESOURCES DIRECTORY General Listing of Services - Organizations continued Otsar Early Childhood Center Address: 779 East 49th ST, Brooklyn, NY 11203 Phone: 718-946-1413 Contact: Ann Brand - Director
Special Care for Families & Children’s Services Address: 1421 E. 2nd ST, Brooklyn, NY 11230 Phone: 718 252 3365 Contact: Miriam Kaufman - Executive Director Services: MSC, in home residential habilitation, respite, environmental modification.
P’Tach-Parents for Torah for All CHildren Address: 1428 36th ST, Suite 211, Brooklyn, NY 11218 Phone: 718-854-8600 Contact: Rabbi Burton Jaffe - National Director Services: Special education organization geared at mainstreaming children with learning differences into regular classes.
Special Education Academy of Deal (SEAD) Address: 1 Meridian Rd, Eatontown, NJ 07724 Phone: 732-460-1700 ext. 116 Contact: Mashy Guterman - Educational Director Services: Children with learning, behavioral or neurological challenges. Special Ed School for Preschool & Elementary aged children.
Reach for the Stars Address: 3300 Kings Highway, Brooklyn, NY 11234 Phone: 718-677-0797
Resources for Children with Special Needs, Inc. Address: 116 E. 16th ST, NY, NY 10003 Phone: 212-677-4650 Services: EI, CPSE, Advocacy, Professionals & Parent Training. Online database & directory. After School Programs, Support Groups, Recreational Services.
Shema Kolainu – Hear Our Voices Address: 4302 New Utrecht Ave, Brooklyn, NY 11219 Phone: 718-686-9600 Contact: Suri Gruen – Executive Director, Gili Rechany – Educational Director Services: Center Based Services. Provides quality ABA & therapy programs for children with autism. Pre-School Age & School-Age, After school Related Services 3-8pm. Home based programs. Parent/Caregiver Workshops- Designed to support the needs of parents & caregivers. EI Program. Evaluations, ST, PT, OT & Special Instruction. SEIT Program An individualized educational program for children ages 3-5. CPSE Evaluations. MSC - Ages 3-21. ResHab - Ages 3-21.
Step by Step Infant Development Center Address: 1049 38th ST, Brooklyn, NY 11219 Phone: 718-633-6666 Contact: Chava Halberstam Services: Evaluations & Therapy: Special Instruction, OT, PT, Speech, Counseling, Nutrition, Parent-Child Group, Parent Training, Aqua Therapy, Audiological, ABA, Service Coordination.
Strivright Address: 3623 Ave L, Brooklyn, NY 11210 718-531-1800 Contact: Pnina Bravmann - Program Director Services: EI agency providing high quality centerbased & home-based educational & related services to all children presenting with developmental disabilities with a specialty catering to language delayed & hearing impaired children. Parent infant & toddler educational/support groups are offered to parents of hearing impaired children.
TAFKID Address: 977 East 17th ST, Brooklyn, NY 11230 Phone: 718-252-2236 Contact: Juby Shapiro
The Shield Institute/JBFCS Address: 39-09 214th Place, Bayside, NY 11361 Phone: 718-269-2012
RESOURCES DIRECTORY General Listing of Services - Organizations continued Therapeutic Resources Address: 36-36 33rd ST, Suite 500, Long Island City, NY 10012 Phone: 212-529-9780 Services: ABA services for both EI & SEIT, EI & SEIT services, evaluations for EI
Therapy for Kids Address: 68-68 Main ST, Flushing, NY 11367 Phone: 718-793-5202 Contact: Judy Avigdor - Director Services: Provides OT, PT, & SLP services to children, 3-21 years old. Indoor & outdoor sensory gym. Parking on site. Open till 9PM. Hebrew, Russian, Yiddish, & Spanish speaking therapists.
TTI Address: 4435 18th Ave, Brooklyn, NY 11204 Phone: 718-376-0974 ext 1213 Services: A state accredited masters program offered on Sundays in a choice of either the Early Childhood or Childhood tracks. For women only.
Yachad/The National Jewish Council for Disabilities (NJCD) Address: 11 Broadway, 13th floor, NY, NY 10004 Phone: 212-613-8229 Contact: Dr. Michael Orgel - Coordinator of Family Services Services: Inclusive programming in NY, NJ & 14 cities nationally. Summer programs. Our Way - a special program for the deaf & hard of hearing. Vocational services, resource center for families.
The Yaldeinu School Address: 1600 63rd ST, Brooklyn, NY 11204 Phone: 718-851-0123 Contact: Bluma – School Director
Yedei Chesed Address: 48 Scotland Hill, Monsey, NY 10977 Phone: 845-425-0887 Contact: Tova Pollen Services: Developmentally disabled & their families. Advocacy, Camps for Special Needs, Day Hab, EI, Family Care, Group Homes, Medicaid Waiver Provider, Respite, ResHab.
Marilyn C. Agin, M.D. Developmental Pediatrician & Physiatrist 79 Laight St., #1A New York, N.Y. 10013 Tel. 212-274-9180 Fax. 212-219-3688 E-mail: email@example.com
FRISHMAN & FABER Attorneys & Advocates for the Special Family
*Special Education Advocacy from Birth through Age 22; *Transition Planning & Advocacy; * School Discipline Matters; *Estate Planning, Supplemental Needs Trusts & Guardianship 83 South Bedford Road Mount Kisco, New York 10549 914.241.3680 www.frishmanfaber.com
Women’s League Community Residences, Inc. Address: 1566 38th ST, Brooklyn, NY 11218 Phone: 718-853-0900 Contact: Hindy Roth - Intake Coordinator Services: Residences for children & adults with developmental disabilities. Provides Medicaid Service Coordinators who access medical, financial & educational services for individuals with developmental disabilities living at home with their families. Medicaid Waiver, Res-Hab.
Yeshiva Bonim Lamokom Address: 425 E. 9th ST, Brooklyn, NY 11219 Phone: 718-693-9032 Contact: Tali Abramzon
Yeled V’Yalda Early Childhood Center Address: Brooklyn, NY 11213 Phone: 718-686-3700 Contact: Mina Sputz Services: ABA therapy, Counseling, EI therapy services & service coordination for ages 0-3, CSE, Feeding therapy, Multidisciplinary evaluations & CPSE, OT, PT, Sensory Integration, SEIT, Speech & Social Skills training.
Yeshiva Tehila L’Dovid Address: 1714 E. 17th ST, Brooklyn, NY 11229 Phone: 718-645-0028 Contact: Rabbi Kranczer Services: Special Ed school for boys with learning disabilities.
Yeshiva Education for Special Students Address: 147-37 70th Road, Flushing, NY 11367 Phone: 718-268-5976 Contact: Rabbi Yaakov Lustig, M.S. – Director Services: Self-contained classes with mainstreaming opportunities available. Serving children with learning disabilities, processing difficulties, language delays & attention issues.
RESOURCES BOOK REVIEW General Listing of Services - Private Practises 123 Let’s Play
FRISHMAN & FABER
Address: Bergen Beach, NY Phone: 917-299-4596 Contact: Jared Wasserman Services: Teaches & reinforces appropriate social skills. It is designed to supplement a child’s typical education & therapy sessions.
Address: 83 South Bedford RD, Mount Kisco, NY 10549 Phone: 914-241-3680 Services: Attorneys & Advocates for the Special Family. Special Education Advocacy from Birth - Age 22; Transition Planning & Advocacy; School Discipline Matters; Estate Planning, Supplemental Needs Trusts & Guardianship.
Marilyn C. Agin, M.D.
Free Services for Very Young Children * Evaluations * Unique Integrated Classrooms * Special One-on-One Teachers [SEIT] * Speech, Occupational & Physical Therapies * Counseling * Service Coordination * Transitional Services 516 374-3377
Chaim Sender, LCSW & Associates Child, Adolescent & Adult Psychotherapy
English and Yiddish 1802 Avenue K Brooklyn, NY 11230 718-677-0095
Address: 79 Laight ST, #1A, NY, NY 10013 Phone: 212-274-9180 Contact: Marilyn C. Agin, M.D. Services: Developmental Pediatrician & Physiatrist
Kids in Shape Address: 1336 50th St., Bklyn, NY 11219 Phone: 718-435-6906 Contact: Alyssa & Andres Kallenos Services: OT & Pediatric/Child Physical.
Law Offices of Lauren A. Baum, P.C. Address: 307 East 53rd St, Suite 501, NY, NY 10022 Phone: 212-644-4414 Contact: Lauren A. Baum Services: Representing students with special needs in all matters.
Das Center Address: 302 Twin Oaks Dr, Suite B, Lakewood, NJ 08701 Phone: 732-272-8509 Contact: Mrs. Chanie Monoker - Educational Assessor & Interventionist Services: Specializes in differential diagnosis for school aged children. Offers professional development workshops for teachers.
Dr. Karen G. Lyman, PT, DPT Address: 22 Fawn Drive, Livingston, NJ 07039 Phone: 973-220-4454 Contact: Dr. Karen G. Lyman, PT, DPT
Metro SportsMed Contact: Jill Sheinberg Phone: 718-369-8000 Address – Location 1: 4911 13th Ave, Brooklyn, NY Address – Location 2: 44 Lee Ave, Brooklyn, NY Address – Location 3: 263 7th Ave, Brooklyn, NY Address – Location 4: 1309 Ave J, Brooklyn, NY Services: PT and OT services
Michael I. Inzelbuch Esq. Educational Advocacy Services Address: 1359 Coney Island Ave, Bklyn, NY 11230 Phone: 718-252-6682
Family Physical Therapy of NY Address: 3036 Ave U, Brooklyn, NY 11229 Phone: 718-732-FTNY (3869) Contact: Rami Abelson or Stavros Karoutsos Services: Providing PT, OT, ST for the pediatric & adult populations. Also offering counseling as well as SEIT. P3/P4 services.
Address: 555 Madison Ave, Lakewood, NJ 08701 Phone: 732-905-0325 Contact: Michael I. Inzelbuch - Attorney at Law Services: IEP Development, Due Process Hearings, Special Education, Service Procurement.
Miracles in Communication Address: 1029 Teaneck Rd, Suite #4, Teaneck, NJ 07666 Phone: 201-837-6060 Contact: Joanne Hinchman-Giuffre, M.A. CCCSLP – Director Services: Specializing in motor speech & language therapy with prompt.
RESOURCES DIRECTORY General Listing of Services - Private Practises continued S. Pollak Audiological Address - Location 1: 1263 Ocean Parkway, Brooklyn, NY 11230 Phone: 718-421-2782 Address – Location 2: 463 Bedford Ave, Brooklyn, NY 11211 Phone: 718-782-2808 Contact: Shirley Pollak, AuD., CCC-A Services: Audiological evaluations for all ages, from newborn through adulthood.
S.O.S. (Strategies for Optimum Student Success) Address: 1542 E. 19th ST, Brooklyn, NY Phone: 718-382-5437 Contact: Rifka Schonfeld Services: Valuations, social skills coaching, academic remediation & enrichment on all grade levels in secular & Hebrew Studies. Language & communication skills for young adults with low level comprehension & communication abilities for life preparedness. Advocate for proper school placement.
Law Offices of David M. Schlachter
307 East 53rd Street, Suite 501 New York, New York 10022 Phone: (212) 644-4414 Facsimile: (212) 644-8470 Email: LBaum@NYSpecialEdLaw.com Representing Students with Special Needs in All Matters under the IDEA and Section 504 of the Rehabilitation Act
Therapy-In-Motion Address: 856 46TH ST, Brooklyn, NY 11220 Phone: 718-435-7000 Contact: Dr. Abe Kopolovich, MS DPT Services: EI, PSE, RSA, Medek, orthopedic injuries
Thivierge & Rothberg, P.C., Attorneys at Law Address: 140 Broadway, 46th Floor, NY, NY 10005 Phone: 212-397-6360 Contact: Christina D. Thivierge, Esq. & Randi M. Rothberg, Esq.
3521 Avenue S, Brooklyn, NY 718.336.3832 • Physical Therapy • Occupational Therapy • Speech Therapy
assists families whose children have been diagnosed with a variety of disabilities and special needs.
Stutter Haven Address: 2723 Ave. R, Brooklyn, NY 11229 Phone: 718-375-5444 Contact: Batsheva Sheps
Services provided by TAFKID include:
D Family Support Services & Information D Educational Advocacy D Individual Case Consultation D Referrals to Doctors, Therapists,
To be included in the next issue, email a request for a listing form firstname.lastname@example.org
Join us for our Next Exciting Edition of Building Blocks in May-June 2009
Law Offices of Lauren A. Baum, P.C.
Address: 245 Passaic Ave, Passaic, NJ 07055 Phone: 973-272-4768 718-377-1356 Contact: David M. Schlachter Services: Supplemental Needs Trusts. Special Estate Planning (k’halacha). Medicaid Planning /Eldercare Law.
i uo ld i ng l cks
A SPECIAL EDUCATION MAGAZINE MAY - JUNE 2009
Schools and Government Programs
D Parent Matching D Family Recreation Programs D Parent Training and Meetings D Guest Lecturers D Community Sensitivity and Training D Informational Publications D Pediatric Equipment Lending Program D Tape/Video Lending
For more information contact Moshe Klass at email@example.com or 718-330-1100 ext. 352.
is a not-for-proﬁt organization services are free of charge to all families. For more information call TAFKID at (718) 252-2236 or e-mail: firstname.lastname@example.org
Listings by Catagory
Editor’s Note: In this section are providers of services by category with only the names of the various organizations, services and practitioners. For more detailed information, turn to the general listing starting on page 72.
EARLY INTERVENTION : BIRTH – AGE 3 AHRC NY Challenge Early Intervention Center Das Center Eis Laasois Family Physical Therapy of NY Hand in Hand Development, Inc. HASC Early Intervention (Boro Park) HASC Gan Ezra Early Intervention (Monsey) HASC – Remsen Ave HASC Woodmere Jumpstart Early Intervention Program Kulanu Los Niños Services Dr. Karen G. Lyman, PT, DPT Metro SportsMed Omni Childhood Center On Our Way Learning Center Otsar Early Childhood Center Resources for Children with Special needs, Inc. S. Pollak Audiological Shema Kolainu – Hear Our Voices Step by Step Infant Development Center Strivright The New Seminary Therapy-In-Motion Yedei Chesed Yeled V’Yalda Early Childhood Center
Day Hab/Vocational AGE 18+ Creative Business Resources/A Division of Women’s League Harmony Services HASC Center Inc Human Care Services Jewish Board of family & Children’s Services Kulanu Ohel Bais Ezra OTSAR Family Services S. Pollak Audiological S.O.S. (Strategies for Optimum Student Success) Stutter Haven The Shield Institute/JBFCS Yachad/The National Jewish Council for Disabilities (NJCD) Yedei Chesed Yeshiva Bonim Lamokom
SCHOOL AGE 5+ 123 Let’s Play
The Auditory Oral School of NY
Omni Childhood Center
Brooklyn Community Management
P’Tach-Parents for Torah for All Children
Reach for the Stars
S. Pollak Audiological
S.O.S. (Strategies for Optimum Student Success)
SEAD – Special Education Academy of Deal
Family Physical Therapy of NY
Shema Kolainu – Hear Our Voices
Ha’or Beacon School
Special Education Academy of Deal (SEAD)
HASC School Age Program
Hebrew Academy for Special Children
Therapy for Kids
A Helping Hand
Ichud Mosdos Hachinuch of Brooklyn
Yachad/The National Jewish Council for Disabilities
Imagine Academy for Autism
Jewish Board of Family & Children’s Services
Yeled V’Yalda Early Childhood Center
Dr. Karen G. Lyman, PT, DPT
Yeshiva Bonim Lamokom
YESS - Yeshiva Education for Special Students
Miracles in Communication
Yeshiva Tehila L’Dovid
PRESCHOOL AGES 2.9-5 123 Let’s Play Aim High Children Services The Auditory Oral School of NY Bright Smile Center Brooklyn Community Management Comprehensive Kids Developmental School Das Center Eis Laasois Family Physical Therapy of NY Hand in Hand Development, Inc. HASC Gan Ezra Early Intervention (Monsey) HASC Remsen Ave HASC Woodmere Hebrew Academy for Special Children A Helping Hand Imagine Academy for Autism IncludEd Educational Services Jewish Board of Family & Children’s Services Kulanu
Dr. Karen G. Lyman, PT, DPT Metro SportsMed Miracles in Communication Omni Childhood Center On Our Way Learning Center Otsar Early Childhood Center Reach for the Stars Resources for Children with Special needs, Inc. S. Pollak Audiological S.O.S. (Strategies for Optimum Student Success) SEAD – Special Education Academy of Deal Shema Kolainu – Hear Our Voices Special Education Academy of Deal (SEAD) Stutter Haven Therapy for Kids Therapy-In-Motion Yeled V’Yalda Early Childhood Center Yeshiva Tehila L’Dovid
Listings by Catagory Evaluations/Therapy Services 123 Let’s Play Aim High Children Services The Auditory Oral School of NY Blanche Kahn Family Health Center Bright Smile Center Brooklyn Community Management CAHAL Comprehensive Kids Developmental School Counter Force Das Center Eis Laasois Family Physical Therapy of NY Hand in Hand Development, Inc. HASC Center Inc Hebrew Academy for Special Children IncludEd Educational Services Jewish Board of Family & Children’s Services Kids in Shape Los Niños Services Dr. Karen G. Lyman, PT, DPT Metro SportsMed Miracles in Communication
Individual/Family Support & Information Asperger Syndrome High Functioning Autism Association (AHA) Board of Jewish Education of NY (BJENY) Counter Force Friendship Circle of Brooklyn Harmony Services HASC Center Inc Hebrew Academy for Special Children Human Care Services Imagine Academy for Autism Jewish Board of Family & Children’s Services Kulanu Ohel Family Services Otsar Early Childhood Center P’Tach-Parents for Torah for All CHildren Resources for Children with Special needs, Inc. S.O.S. (Strategies for Optimum Student Success) Shema Kolainu – Hear Our Voices Special Care for Families & Children’s Services Step by Step Infant Development Center Strivright TAFKID Women’s League Community Residences, Inc.
Omni Childhood Center On Our Way Learning Center Otsar Early Childhood Center S.O.S. (Strategies for Optimum Student Success) Shema Kolainu – Hear Our Voices Step by Step Infant Development Center Stutter Haven Therapy for Kids Therapy in Motion Yeled V’Yalda Early Childhood Center Yeshiva Education for Special Students
Special Education Training The Institue for Special Education of Sara Schenirer The New Seminary TTI
Medicaid Waiver Brooklyn Community Management Harmony Services HASC Center Inc Human Care Services Jewish Board of Family & Children’s Services Ohel Bais Ezra Shema Kolainu – Hear Our Voices Special Care for Families & Children’s Services Step by Step Infant Development Center Women’s League Yachad/The National Jewish Council for Disabilities (NJCD) Yedei Chesed
Respite Friendship Circle of Brooklyn HASC Center Human Care Services Imagine Academy for Autism Jewish Board of Family & Children’s Services Kulanu Ohel Bais Ezra Otsar Family Services Special Care for Families & Children’s Services Step by Step Infant Development Center Yedei Chesed
Advocacy Asperger Syndrome High Functioning Autism Association (AHA) Law Offices of Lauren A. Baum, P.C. CAHAL Counter Force Ease Advocates FRISHMAN & FABER IncludEd Educational Services Michael I. Inzelbuch Esq. Resources for Children with Special needs, Inc. S.O.S. (Strategies for Optimum Student Success) Law Offices of David M. Schlachter TAFKID Thivierge & Rothberg, P.C., Attorneys at Law Yachad/The National Jewish Council for Disabilities (NJCD) Yedei Chesed
Camp Camp Ahuvim Camp Hasc Friendship Circle of Brooklyn Harmony Services Jewish Board of Family & Children’s Services/Camp Mishkon Kulanu Ohel Bais Ezra OTSAR Family Services Yachad/The National Jewish Council for Disabilities (NJCD)
RESOURCES PLACES TO GO Wheelchair-Accessible Attractions Within 50 Miles of New York City Compiled by Avi Sacks Wheelchair-Accessible Attractions Within 50 Miles of New York City Compiled by Avi Sacks This list was compiled in April, 2008. You are strongly advised to call in advance to confirm availability, times and prices. Listed prices do not include tax. Some discounts may be available. Please use discretion. Some listed activities or attractions may not be appropriate for people with certain disabilities. For a listing of other places of interest in the NY, NJ, CT and PA region, visit http://www.fieldtrip. com Tours of Famous Places Around New York City Federal Reserve Bank 33 Liberty St (212) 720-6130 Admission: Free A brief explanation of the Federal Reserve System Gracie Mansion Tours 88th St & East End Ave (212) 570-4751 Hours: Wed 10AM, 11AM, 1PM & 2PM; Admission: Adults- $7, Srs - $4, Students- free. Group tours are also available Tours of the Mayors official residence Must have a reservation - no walk ups Lincoln Center 150 W 65th St (212) 875-5350 Admission: Adults-$15, Srs and students-$12 1 Hour tour of major theaters such as the Metropolitan Opera House & Avery Fisher Hall (wheelchair accessible, should make reservation ahead of time) Madison Square Garden 4 Penn Plaza Bet. 31st and 33 rd St (212) 465-6000 Admission: Adults-$17, Kids-$12
NBC Studio Tour 30 Rockefeller Plaza 49th St (212) 664-7174 Admission: Adults-$18.50, Kids-$15.50, No kids under 6 Fascinating T.V. Studio tours, top of the rock as well as Rockefeller center Statue of Liberty (212) 363-3200 Admission: Adults$12, Kids under 12-$5 Observation deck is not wheelchair accessible Yankee Stadium Tour 800 Rupert Place (718)-946-3868 Admission: Adults-$20, kids 14 & under & Srs 60+ $15 Classic Tour lasts about one hour includes: Discussion of Yankee history , Field access, Dugout visit area, Press Box, Monument Park, Clubhouse Famous Attractions in New York City Chelsea Pier Sports Complex 23rd St and the Hudson River (212) 336-6666 Admission: Adult- $12.50, Srs- $10 Prices: Skate Rental- $7, Helmet Rental$3.75, group prices available Hours: M–F 9am- 5pm, $8 per person, per game , Sun 9am-5pm, $9 per person, per game Thirty acre indoor and outdoor sports village, featuring golf driving range, ice skating, batting cages and bowling, skating Circle Line Pier 83, W 42nd St, NYC (212) 563-3200 (212) 563-3200 Hours & Admission: Call for information Year Round narrated sightseeing cruise, different cruises starting at 75 minutes, 2 hours & 3 hours.
Empire State Building 350 5th Ave &34th St (212) 736-3100 Admission: Adults- $18.45, Youth 1217-$16.61, Kids 6-11-$12.92, 5 & under free 1050 Feet above Manhattan. 86th Floor observatory FAO Schwartz 767 Fifth Ave (58th St.) (212) 644-9400 Admission: Free Elaborate toy store Hayden Planetarium at the Museum of Natural History 81st St & Central Park West (212) 769-5100 Admission: Adults- $15, Child under 12- $8.50 (includes Museum Admission fee) Very good Space Show. Check schedule for special programs New Roc City 33 Lecounte Place (914) 637-7575 New Rochelle, NY Hours: 11 AM - Midnight Arcades, rides, go karts, mini-golf, bowling, ice skating, bumper cars. New York Waterway W 38th St &12th Ave (800) 533-3779 Hours & Admission: Call for information Tour of New York’s harbor. Sailing yearround, features views of the Manhattan skyline, the Statue of Liberty, Ellis Island, South Street Seaport, the Brooklyn Bridge, the UN, the Chrysler Building, and the Empire State Building Plaster Play 122 Ave J (718) 951-1444 Admission: $5 per project Create a project; paint it your way by plaster play!
Sky ride Empire State Building 350 5th Ave (888) 759-7433 Admission: Adult- $29.50, Youth $22.50, Child- $16, Seniors- $22.50 An awesome virtual aerial tour of New York City that sends you on a ride around, above and even below all that the City has to offer. . . from the comfort of a specially equipped, motion-simulated, big screen theater seat. Sony Wonder 56th St & Madison Ave (212) 833-8100 Admission: Free A free technology museum for all ages Staten Island Ferry South Ferry - southern end of Manhattan (718) 815-Boat (2628) Admission: Free 25 Minute Ride goes past Statue of Liberty and other sites. The Beast by Circle Line Pier 83, W 42nd St & 12th Ave (212) 563-3200 Admission: Adults- $19, Kids 12 & under- $13 “The Beast” races through New York harbor at 45mph. It’s a roller coaster, a water ride and 30 minutes of high-speed cruising all in one! Quick stop at the Statue of Liberty for a close-up photo.
White Post Farms 250 Old Country Road Melville, NY 11747 (631) 351-9373 ext 72 Prices: Pony Rides- $5 per ride (60 lb. limit) Individual Feed Cones- $1 ea. Milk Bottles for sheep & goats- $1.50 ea. Souvenir Feed Pail with 6 feed cones$5 ea. Train Rides- $2 per ride Admission: $8 Very large Petting zoo, sand park, pony rides great place
RESOURCES PLACES TO GO Other Enjoyable Activities The Aviator Located on Flatbush Ave, Just South of Belt Parkway, Exit 11S. Brooklyn, NY (718) 758-7500 Admission: Adult- $8, Kids-$6 Skate Rental: $4.50 Enjoy ice skating and rock climbing in this new indoor facility!
Battleview Orchards 91 Wemrock Rd Freehold, NJ (732) 462-0756 ALWAYS CALL to confirm dates, supply and weather before traveling a distance. Price: $1.15 per lb Apple picking Bowling-Gil Hodges Lanes 6161 Strickland Ave Brooklyn, NY (718) 763-3333 Bowling and Arcade Games
Fun Station USA 3555 Victory Blvd Staten Island , NY (718) 370-0077 Hours & Admission: Call for information Indoor Family Amusement Park - Rides, Laser Tag, Simulators, Batting Cage, Basketball Court, 3 Stories Maze, Bowling and Arcade Games 2 Hours Unlimited Rides
Bowling-Melody Lanes 461 37th St Brooklyn, NY (718) 832-2695 Bowling and Arcade Games
Active Kidz 210 Forest Dr East Hills, NY (516) 621-6600 Prices: Adventure maze- $10, Toddler area- $4, Rock Climbing- $15, Combination of Rock climbing and the Adventure Maze- $20, Laser Tag- $7.75 Children’s indoor playground and athletic facility which includes; laser tag, rock climbing, and an adventure maze. It is a great place for children under 12. Call in advance for open play hours. A Day in a Brooklyn Trolley Prospect Park Brooklyn, NY (718) 965-8967 Admission: Free Tour Brooklyn’s 526-acre green heart, Prospect Park, by old-fashioned trolley. The free “Day in Brooklyn” trolley runs noon to 6pm weekends and holidays, making a leisurely circuit of the park with stops at the restored Victorian carousel, the Prospect Park Wildlife Center, the Brooklyn Botanic Garden, Grand Army Plaza and the Brooklyn Museum of Art, and connection to the Brooklyn Children Museum’s free trolley.
Brooklyn Indoor Sports 800 3rd Ave Brooklyn, NY (718) 965-0004 Prices: $5- 3 tokens - $10-7 tokens, Basketball Court- $5.00 per person for 30 minutes, Arcade games-4 tokens for $1.00 Central Park Carousel 64th St NY, NY (212) 879-0244 Carousel Flushing Meadows Park Queens, New York (718) 760-6565 Sports, theater, museum.
Imagine That 4 Vreeland Rd. Florham Park, NJ (973) 966-8000 Admission: Adults-$7.95, Kids-$9.95 This museum for 3- to 10-year olds features more than 35 interactive exhibits that are there for kids to use as well as see. No strollers allowed Jamaica Bay National Wildlife Refuge Floyd Bennet Field Brooklyn, NY (718) 318-4340 Admission: Free but call first Wildlife, Trails & Gardens Great place to observe nature.
Bowling-Maple Lanes 16th Ave and 60th St Brooklyn, NY (718) 331-9000 Bowling and Arcade Games
Brooklyn Botanical Gardens 900 Washington Ave Brooklyn, NY (718) 622-4433 Admission: Adults $8, Srs-$4, Students12+ with valid IDs $4, Kids under 12Free Tuesdays- Free A 52 Acre urban oasis with specialty gardens
Admission: $37 a person - for 45 minutes No children under 11 Horseback riding
Historic Richmond Town 441 Clarke Ave Staten Island, NY (718) 351-1611 Admission: Adults- $5, Srs-$4, Kids-517 $3.50 SI Historical Society Members and children under 5- FREE A living history village & museum complex. Explore the diversity of the American experience in Staten Island & its neighboring communities, from the colonial period to the present Horseback Riding (Jamaica Bay) 7000 Belt Pkwy Brooklyn, NY (718) 531-8949
Liberty Science Center 251 Phillip St Jersey City, NJ (201) 200-1000 Hours & Admission: Call for info. Hundreds of hands on exhibits New York Hall of Science Flushing Meadows Corona Park (718) 699-0005 Hours: Closed Mondays, Tue-Thu 9:30am–2pm, Fri 9:30am–5pm (free 2–5pm), Sat & Sun 10am–6pm (free Sun 10–11am) Admission: Adults-$11, Kids 17 & under-$8 Hands on Science and technology exhibits. Visitors can explore more than 160 interactive exhibits, hands-on science and technology exhibits Paddle Boats Prospect Park off of Ocean Ave (718) 965-6545 Admission: $12.50 an hour plus $10 refundable deposit Paddle boating Plaster Gallery 2827 Coney Island Ave Brooklyn, NY (718) 769-8500 Pick out a piece of plaster and paint to your liking
RESOURCES PLACES TO GO Puppet works 338 Sixth Ave Brooklyn, NY (718) 965-3391 Admission: Kid-$7; Adult-$8, GROUPS of 20 or more, $5 per person NO CREDIT CARDS ACCEPTED Puppet theater performances based on classic children’s stories and fairy tales Must call for reservations
Swedish Cottage Marionettes 830 5th Ave (Central Park W Ave bet 79th St & 80th St) NY, NY (212) 988-9093 Call for reservations Admission: Adults- $8, Kids $5 Puppet theater performances Salt Marsh Nature Center 3302 Ave U (Marine Park) Brooklyn, NY Admission: Free One of Brooklyn most beautiful hideaways Zoos and Aquariums Adventure Aquarium 1 Aquarium Dr Camden, NJ (856) 365-3300 Admission: Adults-$18.95, Kids (2-11) -$14.95, 2 & under - FREE Come explore nearly 200,000 square feet of sharks, hippopotamuses, free-flying birds and sea life from around the world. Alley Pond Environmental Center 228-06 Northern Blvd Douglaston, NY (718) 229-4000 Admission: Free Nature Trails, aquarium, mini zoo
Atlantis Marine World 431 E Main St Riverhead, NY (631) 208-9200 Admission: Adults 12-61- $21, Kids 3 – 11- $18, Srs 62+- $18, Under 3- Free A voyage of undersea discovery. From shark dives to snorkeling, boat tours to salt marsh explorations, a giant octopus to the Western hemisphere’s largest all-living Coral Reef display
Prospect Park Wildlife Center 450 Flatbush Ave (718) 399-7339 Admission: Adults-$6, Children-$2, Srs-$2.25 Local zoo. Very pleasant Queens Wildlife Center 53-51 111th St Flushing, NY (718) 271 -1500 Admission: Adults- $6.00, Under 12$2.00, Srs- $2.25 Animals exhibits in their natural setting.
Bronx Zoo 2300 Southern Blvd Bronx, New York (718) 220-5100 Admission: Adults-$15, Kids-12 & under-$11, Srs-$13 Under 2-Free, Weds. admission is donation Largest Urban US Zoo includes Jungle road
Staten Island Zoo 614 Broadway Staten Island, NY (718) 442-3174 Admission: Adults: $7, 60+ $5, Kids 3-14- $4, 3 and under- Free Wed 2pm-4:45 pm admission free, donations welcome. Excellent small zoo
Central Park Zoo 830 5th Ave & 64th St (212) 861-6030 Admission: Adults-$8, Srs-$4, Kids 3–12-$3, Under 3 Free Home to Polar Bears, Penguins and monkeys
Turtleback Zoo 560 Northfield Ave West Orange, NJ (973) 731-5800 Admission: Adults- $6, Srs-$3, Kids (2 -12)-$3 Very large nice zoo
NY Aquarium Surf Ave & W 8th St Brooklyn, NY (718) 265-FISH (3474) Admission: Adult- $13, Child (3–12)-$9, Srs-$10, Groups*- $6 *To receive the group rate, you must make a reservation at least two weeks in advance of your group’s visit. Please call 718-741-1818 NY’s famous Coney Island aquarium
Van Suan Park 216 Forest Ave Paramus, NJ (201) 262-3771 Admission: Kids 2 & under: Free, 3-14$2, Ages 15-61-$4.00, Ages 62+ Over: $2, Disabled or Military: $2, Pony Rides: $3 2X around, Train: $1 1X around, Children under 2: Free, Carousel: $1.00 This zoo is a clean, relaxing place to take children. Farm animals, jungle animals, American prairie animals. Free parking. Adjacent to the zoo is a pony ride farm.
American Museum of Natural History 79th St & Central Park W (212)769-5100 Ancient animals and Wonderful exhibits. Suggested admission Brooklyn Children’s Museum 145 Brooklyn Ave Brooklyn, NY (718) 735-4400 Admission: $7.50 per person Free admission to families before 11am every Sunday; does not apply to groups. Closed on Mondays and Tuesdays Sun. 10am-6pm, Weds. 1-6pm, Thurs 1-6pm, Fri 1-6pm Hands on museum for children focusing on science & culture
Brooklyn History Museum 128 Pierrepont St Brooklyn, NY (718) 624 0890 Admission: Adults- $6, under 12- Free, Srs $4, Students 12 & over-$4 Displays more than 1,000 objects reflecting Brooklyn’s exciting history. Permanent exhibit areas cover The Brooklyn Bridge, Coney Island, Brooklynites, The Brooklyn Navy Yard, & The Brooklyn Dodgers.
Museums American Folk Art Museum 45 W 53rd St New York, NY (212) 265-1040 Admission: Adults- $9, Students- $7, Seniors- $7, Children under 12- Free Present exhibitions and programs that embrace a wide range of folk art, both traditional and contemporary, from the U.S. and abroad. Very accommodating towards DD
Brooklyn Museum of Art Brooklyn Museum 200 Eastern Pkwy Brooklyn, NY (718) 638-5000 Admission: suggested contribution of $8 for adults & $4 for Srs & Students with valid I.D. Members & Kids under 12 accompanied by an adult are admitted for free. 2nd largest art museum in NY.
RESOURCES PLACES TO GO Children’s Museum of Manhattan 212 W 83rd St between Broadway and Amsterdam New York, NY (212) 721-1234 Admission: Children and Adults- $10, Srs-$7, Children under 1- Free Go through blood tunnel and digestive tract. Art projects and daily workshops Children’s Museum of the Arts 182 Lafayette St bet Broome and Grand St New York, NY (212) 941-9198 Admission: $10/person (1-65 yrs. old); Thursday 4-6 pm: Pay As You Wish; Stimulating, interactive exhibitions and programs for children under age 10, encouraging them to develop their full creative potential through the visual and performing arts. Programs geared to integrate special needs children, their families and school into the life of the museum.
Cradle of Aviation Charles Lindbergh Blvd. Garden City, NY (516) 572-4111 Admission: Adults-$9, Kids (2-12) $8 Extra for the IMAX and for the Firefighters Museum many historic flights that transpired here and the many aviation companies that developed here, & helped to make aviation the integral part of our world that it is today. Fire Museum of New York 278 Spring St NY, NY (212) 691-1303 Admission: Adults- $5, Seniors/ Students- $2, Children under 12- $1 Houses a collection of fire-related art and artifacts from the late 18th century to the present, including painted leather buckets, helmets, parade hats and belts, lanterns, pre- Civil War hand pumped fire engines, horse drawn vehicles and early motorized apparatus.
Jersey Explorer Children’s Museum 192 Dodd St East Orange, NJ (973) 673-6900 Admission: Adults & kids-$6, Under 2-Free True-to-life, interactive exhibits that are the amazing handiwork of at-risk youth. The Jewish Children’s Museum 792 Eastern Pkwy Brooklyn, NY 11213 (718) 467-0600 Admission: Kids & Adults-$10, Under 2- FREE For children of all backgrounds, offering a positive perspective & awareness of the Jewish heritage, fostering tolerance & understanding.
Museum of Modern Art 11 W 53rd St, bet 5th & 6th ave New York, NY (212) 708-9400 Closed Tuesdays Admission: Adults-$20, Srs-$16, Full time students with ID- $12, ChildrenFree Events for the developmentally disabled free unless otherwise noted Gives guided tours to disabled, cater very well to specific needs
The Jewish Museum 1109 Fifth Ave New York, NY (212) 423-3230 Admission: Adults-$12, Srs over 65$10, Students-$7.50, Under 12- Free Devoted to Jewish Art and Culture Ancient & Modern Liberty Hall Museum 1003 Morris Ave Union, NJ Relive those magical moments of centuries ago with stories of family traditions that shaped our nation’s history. Admission: Adults- $10, Srs-$8, College students with valid ID-$5, Students, 3-17- $4 Madame Tussaud’s Wax Museum 234 W 42nd St Bet 7th and 8th Ave (212) 512-9600 Admission: Adults- $35, Children- $28, Srs- $32. Online rates in advance much lower. Lifelike wax figures of over 200 of the world’s top celebrities in an interactive environment. Metropolitan Museum of Art 1000 5th Ave at 82nd St (212) 535-7710 Closed Mondays Admission: Adult-$20, Srs -$15, Student-$10, Kids under 12 - Free Spans the History of the World Art
Museum of the City of New York 1220 5th Ave 103rd St (212) 534-1672 Admission: Family- $20, Adults-$9, Children, Srs & students-$5, Sundays10am -noon-Free Cultural History of New York New Jersey Children’s Museum 599 Valley Health Plaza Paramus, NJ (201) 262-5151 Admission: $10 Explore over 30 different play & learning areas, each designed to attract & engage the imagination! Your child is your guide. New York Transit Museum Boerum Place & Schemerhorn St (718) 243-8601 Admission: Free The largest museum in the US devoted to urban public transportation, explores the development of the NY region through the cultural, social & technological history of public transportation. It is housed in a historic 1936 IND subway station in Brooklyn Heights.
Palay Media Center 25 W 52nd St New York, NY (212) 621-6800 Admission: Adults - $10, Students & Srs-$8; Kids under 14-$5 Dedicated to audio-visual artifacts with a collection of over 50,000 TV & radio shows. Pick your selection from the library & watch it at one of the many video consoles Police Academy Museum 100 Old Slip New York, NY Bet Water St and South St (212) 480-3100 Admission: Family of 4+ - $15, Adults$7, Students, Srs & Kids-$5, Under 6 - Free Collection of Police Memorabilia Queens County Farm Museum 73-50 Little Neck Pkwy Floral Park NY (718) 347-3276 ext 14 Admission: call for information Queens County Farm is the only working historical farm in the City. Includes historic farm buildings, a greenhouse complex, livestock, farm vehicles and implements, planting fields, an orchard and herb garden. South Street Seaport Museum 207 Front St. New York, NY (212) 748-8600. Admission: General-$10, Srs/Students with valid ID- $8, Kids 5-12- $5, Under 5- Free Stores, sightseeing, cruises Yeshiva University Museum 15 W 16th St New York, New York (212) 294-8330 Admission: Adults-$8, Kids 16 & under$6, Under 5- Free Dramatic exhibitions exploring all aspects of Jewish culture
Avi Sacks has been the program director at Camp HASC for the past three summers. He is currently the Residential Area Coordinator for 14 HASC Center Residences. Avi also coordinates HASC Center’s After School program and its Weekend Respite program.
RESOURCES BOOK REVIEW By Brocha Holczer
The Out of Sync Child Has Fun Activities for Kids with Sensory Processing Disorder Author: Carol Stock Kranowitz, M.A. (Author of The Out-of-Sync-Child) Publisher: Perigee by The Penguin Group, NY, NY
Between one therapy appointment and another, out-of-sync children can seem to miss out on just plain fun. Even when other children around them are having a ball, as Trude Turnquist, PhD, OTR/L, observes in the foreword, children who have sensory issues just don’t appear to have fun easily. Children with sensory processing disorders have difficulty responding to everyday sensations. But, as the author of the book so convincingly argues, “We gotta have fun - or else we rust. Good sensations are neither an ‘extra’ nor a reward; they are a necessity.” Carol Stock Kranowitz, M.A., (author of the must-read book about children with poor sensory integration, “The Out-of-Sync Child”) offers many activities that are so inclusive, the out-of-sync child will feel comfortable joining the ‘fun.’ She lays out guidelines that ensure the best outcomes and stresses matching activities with the sensory needs of a particular child. The activities in this book are all “SAFE”: Sensory-motor, Appropriate, Fun, Functional and Family-Builders, and Easy, Economical, Environmentally Friendly, and Emotionally Satisfying. Many of these are activities are variations of activities that you played as a child and loved, and that every child deserves to experience. “Clapping Bubbles”, using both hands to clap old-fashioned mouth-blown
soap bubbles, is suggested to promote bilateral coordination, among other benefits. One oral-motor activity called “Applesauce Through a Straw” is described as “hard work, as well as silly, fun, and nutritious.” For this activity, a child is encouraged to suck applesauce through straws, as well as blow bubbles. Imagine the whole family eating a snack of yogurt like this. What fun! Various benefits of this activity include promoting oral-motor development and force, gustatory and tactile sensation, strengthening eye-motor skills, and general organizing and calming. Interspersed throughout are tidbits such as ways to vary activities for different ages and needs, comments from parents and therapists, and coping techniques for children with specific challenges. The book also includes a cross referenced chart to guide the choice of an activity involving specific sensory systems and sensory related skills for specific ages. Families with an out-of-sync child will find do-able, fun ideas for activities that will not end in the usual frustration and tears. Kranowitz, with her clear understanding of the sensory needs of individuals with Sensory Processing Disorder and her infectious language will make you want to try an activity right away. Have fun!
The Elephant in the Playroom Ordinary Parents Write Intimately and Honestly About Raising Kids with Special Needs Author: Denise Brodey Publisher: Plume by The Penguin Group, NY, NY
Reading this book is best described as attending a support group for parents of children with special needs. While describing her own son’s story, the author presents stories from individual parents, in their own words about life with special needs children. The issues will ring true and familiar to anyone who has a connection to the special needs community. We share the frustration of knowing something is not right with a child, but not having a useful diagnosis. We cry with a mother as she realizes her child cannot live safely at home. We cry with another mother who has an infant with multiple special needs as she notices yet another issue her baby girl developed and feel helpless as she describes her intense panic and fear, prompting her to meltdown in despair. We cheer with her as she regains her equilib-
rium and finds support as she attends to her daughter’s many needs. Along with another mother we question the safety of anti-depressants for children, when they prescribed for her eight-year old, and hold our breaths as we wait to if the benefits outweigh the risks. We yawn with the exhausted parents of an autistic little girl who wakes up ready to play many times a night. Those parents actually invite us, if we think we can help, to spend a night at their house. We relate to the author’s own account of “going public” with her son who others only saw as a bad child, a victim of bad parenting. We relive her embarrassment at her son’s out of control behavior and the onlookers’ disapproval, and take strength in her ability to do right by her son. We also partake in the absolute love the children offer their parents and their friends. When one autistic boy tells his mother, “My friends are waiting for me,” it is hard not to be uplifted. We are exhilarated when one mother finally gets the call that her son was accepted into the school that had no room for him but was the best around. Readers’ pity and fear about families living with children who have these conditions will be replaced with compassion, support, and respect. This is an excellent book to share with relatives, neighbors and friends to encourage understanding of special needs, or to give as a gift with some herbal tea and a box of tissues.
RESOURCES BOOK REVIEW BOOK REVIEWS continued Defying Autism Keeping Your Sanity and Taking Control Authors: Stephanie B. Lockshin, M.Ed, Ph.D., BCBA, Jennifer M. Gills, MA, BCBA, and Raymond G. Romanczyk, Ph.D., BCBA
Publisher: DRL Books, Inc, NY, NY
The stress a family experiences when a child has ASD symptoms can throw the most organized household into chaos. The necessary “normal” models of children busying themselves for a few moments when parents attend to chores, families spending ‘fun’ time together, and even simply getting ready for a school day can unfortunately disintegrate. While the needs of child with ASD have the focus of therapists and professionals and even the parents, the family as a whole is left to stumble along, often with so much stress that there is minimal enjoyment of family life. The authors of this book, with more than seventy combined years of working with families of children with ASD have culled the scientific research and formed a straightforward system to alleviate chaotic family situations. This book offers a step-by-step approach to identifying goals for the family, with a focus on reducing stressors each member is affected by and encouraging growth. The authors provide forms, which make it easy for families and those helping them to assess available resources and work together thoughtfully. With this program, parents can more easily gain perspective and parent all their children more effectively as well as enjoy their own relationship with each other. For example, a family may realize
that a sibling needs help with knowing how to explain their sibling with ASD’s ‘embarrassing’ behavior to friends, or that teaching a child with ASD to self-feed with a spoon is the skill that has top priority for enhancing family meal time. Once stressors are identified and goals prioritized, a program for teaching each behavior is put into effect. Skills sequence flowcharts help parents see where their children are at developmentally in various areas of daily living and where they can encourage growth for the children’s and the family’s benefit. The authors emphasize a scientific approach with careful record keeping for each behavior. Measurement of behaviors and evaluating progress (how many pinches are acceptable anyway?) is explained in detail so periodic re-evaluation of goals and growth reflect reality. This book is reminiscent of a textbook and needs to be read with serious intent. It offers a valuable technique to facilitate families keeping sane and having control of an often-uncontrollable situation. The program offered can help any family living with chaos and stress, not just one living with a child with ASD.
an adult with Asperger’s who has worked hard to learn how to communicate and interact effectively in social settings, as well as enjoy two different hugely successful careers, she offers her personal experience and thoughts to parents, teachers, therapists and anyone who wants to help people with autism spectrum disorders (ASD). Over the last eight years, she has authored insightful and informative articles in Autism Asperger’s Digest and has now compiled a selection in this book, updated and grouped in helpful categories. The articles are short and extremely focused, ideal for when you only have a few minutes and wish to read something meaningful, or for reading an entire section when you enjoy
the luxury of a longer period of time. As a whole, the book offers an encouraging and optimistic view of life with ASD. Her attitude of insisting on developing positive adaptive behaviors is strong and convincingly relayed. Temple strongly encourages parents with concerns about their child’s development to act aggressively rather than ‘wait and see.’ Over and over she has contributed her success to heavy early intervention obtained by her mother. Temple emphasizes the individuality of those affected by the disorder. Each person, she stresses, has a unique set of characteristics and levels of intensity, and this must be taken into account when set-
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BOOK REVIEW BOOK REVIEWS continued ting up communication systems, solving behavior problems and teaching tasks. In one convincing article, “The Importance of Developing Talent,” the author reminds us about valuing and broadening special talents many people on the spectrum possess, not just trying to eliminate all traces of autism through behavioral programs. She posits that fixations and special interests, common to individuals with autism spectrum disorders (and actually, without as well!) can be useful in social success and career building. Her own famous career in designing livestock facilities is based on a fixation on cattle squeeze chutes she developed as a teenager, along with her visual way of thinking, also common to these individuals. Suggestions are offered to accomplish “Turning Video Game Obsession into Learning” in an article by that name that all parents of all children who play video games must read. Multi-faceted issues such as medication, brain research and adult employment are discussed logically and with patience. Reading this book will make you feel like Temple Grandin with all of her knowledge and experience is sitting with you and explaining how things are.
How to Compromise with Your School District Without Compromising Your Child Author: Gary Mayerson, ESQ Publisher: DRL Books, Inc, NY, NY
One of the first lessons parents of children with special needs must learn is how being their child’s strongest advocate ensures that their overall educational experience is the best possible one. Dealing with school districts who often want to rubber stamp cookie-cutter educational plans can be intimidating, confusing, and frustrating Mayerson represents children in educational rights disputes with school districts. His primary goal, and to which end he wrote this book, is for parents to somehow make peace with the school district and achieve a compromise that will benefit the child without a full blown due process hearing. He offers parents insights into how school districts operate and concrete strategies that will help secure an appropriate education from public school districts. Preparing for The initial IEP (Individualized Education Plan) meeting, Mayerson explains, can involve a whole group people who do not really know your child and try to decide a year’s worth of education and therapies in less than an hour. Being properly prepared can go a long way in setting up success. Mayerson describes some obviously intimidating language school districts may resort to (“Your child is going to need us for many years. Do you really want to start our relationship off on the wrong foot by being so demanding?”), and some more subtly intimidating (“We
RESOURCES BOOK REVIEW BOOK REVIEWS continued want to get services started for your child right away, but we cannot start services until you give consent to the IEP.”). Parents may find that the evaluation after referral is rushed or not representative of their child’s actual skills and abilities. Mayerson suggests a course of action for when this occurs, and provides sample letters to use as communication models. He advises parent to keep their own records and periodically inspect the district’s records. He also suggests other types of records to keep, such as videotapes highlighting the child’s deficits. He discusses “least restrictive environment” and school discipline issues that may arise. In his practical and informative matter, complete with relevant legal information, Mayerson bolsters parents’ confidence in obtaining what the child needs when the district tries to cut corners at the child’s expense. This slim volume goes a long way in setting up the parents of children with special educational needs to effectively advocate for and protect the educational integrity of their children’s school experiences. It should ideally be read before an initial IEP meeting, although the information gained is valuable at any stage of the process.
Bipolar Kids Author: Rosalie Greenberg, M.D. Publisher: Da Capo Press, Pereus Books Group, Philadelphia, PA
Early Intervention & Autism Author: James Ball, Ed.D., BCBA Publisher: Future Horizons Inc., Arlington, TX
When one’s child is diagnosed with a lifelong disorder, a natural instinct is to educate oneself with quality information. We present two books, one about children who are bipolar and another about autism spectrum disorders (ASD), that are comprehensive, clear and realistic, and are valuable in providing answers to many initial questions as well as ones that will come up as life goes on. Both books begin with extensive definitions and descriptions of their respective disorders and symptoms and discuss wide-ranging therapy and treatment options, both medically and educationally. Both books are valuable in providing answers to many initial questions as well as ones that will come up in the future. Both books focus on strengths and challenges children with these disorders may exhibit and also how the
family and its social circle are affected. Bipolar Kids includes many relevant accounts of children and parents to help alleviate the isolation parents may feel. The ages discussed in the book are from infancy through adolescence, and some surprising hidden symptoms are presented, such as difficulty waking up in the morning and experiencing normal temperature as way too hot. Early Intervention and Autism presents issues in a question and answer format, and includes useful lists, such as the seven strategies Dr. Jim (Ball) finds to be effective within an EI (Early Intervention) program and five things to do to keep a family healthy. It also features a foreword by Temple Grandin, PH.D, and an entire chapter devoted to toileting issues. The
bulk of the book focuses on the first three years of life, and a chapter is devoted to transitioning into the next stage. Anyone who encounters children with these issues would do a great service to the youngsters and their parents to read these books and learn how to optimize conditions for their continued development and improved social interactions.
To have your book reviewed for our next issue, send review copy to: Building Blocks Magazine C/O Jewish Press 338 3rd Ave. Brooklyn, NY 11215-1897 You can also contact us at 718-330-1100 ext 352
i uo ld i ng l cks
A SPECIAL EDUCATION MAGAZINE MAY - JUNE 2009
Join us for our Next Exciting Edition of Building Blocks in May-June 2009 b
RECRUITMENT AHRC-NYC Special Ed. Schools have the following positions available immediately: Therapists: Speech and Language Pathologists (bilingual a plus), Physical Therapists, Occupational Therapists, and Certified Dietician/Nutritionists. Head Teacher- Assist Principal with Program Administration. Immediate tuition reimbursement for SAS or BCBA candidates. MA in Special Ed. & Certification req’d. Min 5 years classroom exp. ABA experience a plus. Teachers/Behavior Trainers- BA/MA in Special Ed.& Certification req’d. (Internship and Transition B certification candidates are encouraged to apply). Teacher Assistant/Behavior Trainer Assistant- NYS Teacher Assistant Certification (NYSATAS) & min. 45 college credits req’d. Please e-mail or FAX resume *Excellent salary & benefits package including medical, dental, vision & and cover letter to: 403b retirement plan. Many locations: steps away from Central Park, Borough Park, Dyker Heights, Bensonhurst, Parkchester, Astoria, and Honor Friberg, Sheepshead Bay. Home Based fee-for-service positions also available. Fax: 212-477-9696 Email: Honor.Friberg@ahrcnyc.org AHRC is an Equal Opportunity Employer
THERAPISTS! Immediate openings: SEIT (mono/bilingual) • SLP • CFY • OT • PT • LCSW Mental Health Counselor (MHC: professional license only)
Fax resume: 718.686.2395 or call Leah: 718.686.2376 Flatbush • Williamsburg • Crown Heights • Borough Park
i uo ld i ng l cks
A SPECIAL NEEDS MAGAZINE Many OT’s, PT’s, SL/P’s and Special Ed Teachers will see this magazine. Wouldn’t this be a good place to reach them? Join us for our next issue in May-June 2009
NYSED A pproved Bi-lingual Pre-school Program
invites certified, qualilfied and talented individuals to join our team and provide:
For more info. contact: David Hoppenwasser at email@example.com or 718-330-1100 ext 374
• Comprehensive Evaluations • Special Education-SEIT • Occupational Therapy • Physical Therapy • Speech Therapy • Audiology • Counseling / Play Therapy • Bi-Lingual a plus ista nts a nd Te a c he rs , a ssna ls fo r o ur p a rap ro fe ssiol Y iddish b iling ua asse s inte g rate d cl
* Services provided at no cost to parent for eligible children at child’s home, school or at our center
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B r ig h t S m ile C e n te r
1 0 5 1 5 9 th S tr e e t • B r o o k ly n , N Y 1 1 2 1 9 Te l. 7 1 8 .4 3 7 .5 7 7 4 • F a x . 7 1 8 .4 3 7 .1 1 4 8 in fo @b rig h tsm ile c e n te r.c o m
*Our pre-school special education programs and evaluation site are funded and regulated by the New York State Education Department and New York City Department of Education
is currently seeking highly qualified individuals for positions within our agency. We are looking for SEITs, Speech, Occupational, and Physical Therapists, and Counselors to service our students in Queens, Brooklyn, and Long Island. If you are interested in obtaining a uniquely satisfying job with an exceptional agency, email your resume with a cover letter to firstname.lastname@example.org
RECRUITMENT Outstanding, caring professionals providing excellence through Early Intervention, ABA (autism services), SEIT-Preschool Special Education Services. Winner of Best Companies to Work For NY. Join us. To learn more go to
Human Care Services
Job Opportunities Available!
Are you looking for a job that offers benefits, a competitive salary and a chance to work in the mental health field? We are currently looking for Res Hab workers and Direct Care workers to work with male and/or female consumers.
Please call Frimy at 718-854-2747, ext. 244 or e-mail F.Kopel@humancareservices.org
Womenâ€™s League Community Residences Inc.
A tradition of caring, in our homes and yoursâ€Ś
Seeking enthusiastic men and women to make a difference in the lives of special children and adults at our Brooklyn residences. Weekdays 3 â€“ 11 p.m. and other shifts available.
Requirements: â€˘ NYS licensed teachers (K-12) â€˘ MS in Special Education â€˘ Experience with ASD age 5+ â€˘ Board Certified Behavior Analyst a plus!
Please call Imagine Academy for Autism at 718 376 8882 or fax resume to 718 376 8118
For job opportunities, call Brenda at
(718) 853-0900 or fax resume
to (718) 853-0818
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Positions available at ofďŹ ces and residences in Brooklyn, oklyn, Q Queens, ueens, Manhattan, Staten Island, Long Island and New Jersey
Call Human Resources at 718-686-3102 2 Or fax resume to 718-851-6428 Or e-mail email@example.com
Yaldeinu School, a school for children on the autistic spectrum is seeking an OT and a Specch Therapist. A combined model of SI and ABA is utilized. Comprehensive supervision provided.
Expanding Early Intervention Program
Seeks Qualified ABA Special Educators, PTs, OTs, SLPs NYS License & DOH Approval Bilingual a Plus All A Areas off B Brooklyn, kl Q Queens, Staten Island and Manhattan Fax Resume:718-851-3377 E-mail: Ibel.Challenge@thejnet.com 91
RECRUITMENT Index of Advertisers 123 Let's Play ..........................................................56 The Ability Center................................................. 79 Accessible Vans & Mobility.................................63 Dr. Marilyn Agin..................................................... 77 AHRC NYC................................................................90 Aim High Children's Services ..........................15 Arrowsmith Program...........................................02 Autism Superstore ...............................................63 Lauren A. Baum, P.C...............................................79 Bright Smile Center...............................................90 Brooklyn Community Management 29, 74,93 Camp Ahuvim.........................................................76 Catapult Learning..................................................03 Center for Alternative Teaching........................74 Challenge Early Intervention.............................91 ChewyTubes.com..................................................69 Cogmed Working Memory Training...............62 Command Copy.....................................................88 Connecticut Birth to Three System.................93 Creative Business Resources.............................59 Das Center................................................................07 David M. Schlachter...............................................75 Different Roads to Learning...............................63 Down Syndrome Among Us..............................64 Family Physical Therapy.......................................07 Frishman & Faber...................................................77 FrumSupport.com..........................................44,74 Fun and Function..................................................67 Future Horizons......................................................94 HASC Center............................................................13 HASC School Age Program................................35 Human Care Services....................................21,91 Imagine Academy...........................................37,91 IncludEd.............................................................90,96 The Institute for Special Education.................53 Interborough Development.......................48,93 Michael I. Inzelbuch Esq......................................72 IVDU Schools for Special Education...............77 JCC of the greater 5 Towns................................58 Jumpstart Early Intervention............................93
Keyboard Town Pals.................................................70 Kidi Splint.................................................................... 65 KosherVitamins.com................................................87 Kulanu Torah Academy...........................................39 LosNinos Services.....................................................91 Manhattan Beach Speech Language Center. 78 Maxi-Health Research Inc......................................68 Metro SportsMed......................................................93 Miracles in Communication..................................72 Mishkon-JBFCS..........................................................20 Mobility Elevator & Lift Co.....................................62 The New Seminary...................................................11 Ohel Bais Ezra ....................................................33,91 Ohr Halimud...............................................................72 Omni Childhood Center...................................41,93 On Our Way.................................................................45 Pocket Full of Therapy.............................................64 P'TACH ..........................................................................31 R.E.A.L. Design ...........................................................69 S. Pollak Audiological ............................................73 SEAD..............................................................................75 Shema Kolainu/Hear our Voices..........................32 SleepSafe Beds..........................................................67 Special Care for Families & Children's Services...93 TAFKID .........................................................................56 Tech4Everyone..........................................................71 Therapro......................................................................66 Therapy for Kids........................................................73 Therapy in Motion...................................................40 Thivierge & Rothberg P.C.......................................73 Tikvah at Ohel ...........................................................76 Touro College.............................................................35 Touro College Speech and Hearing Center.....11 TTI - Testing & Training International ..............75 Watermatic Coolers.................................................95 Women's League Community Residences......91 The Yaldeinu School.........................................19, 91 Yeled V'Yalda Early Childhood Center.......17, 90 Yeshiva Bonim Lamokom......................................42 YESS - Yeshiva Education for Special Students04,90
i u o l d i ng Information l cks
We are already looking for material for our next exciting edition of Building Blocks. Here is information to submit items to any of our departments: Book Reviews Product Reviews Directory Section Family Forum and Sibs Speak Story Ideas or for Organizations Send review item to: Send review copy to: Contact: Perel Grossman at General Suggestions Contact: Resource Editor Jewish Press Jewish Press firstname.lastname@example.org at email@example.com Contact: Chumie Friedman Building Blocks – Building Blocks – or you can mail her at At Book Review Product Review Ask the Advocates 7 Greenhill Lane firstname.lastname@example.org Att. Ilene Klass Att. Brocha Holczer Contact: Juby Shapiro Spring Valley, NY 10977 at email@example.com 338 3rd Ave 338 3rd Ave Brooklyn, NY 11215 Brooklyn, NY 11215 For General Information or to Advertise contact You can also contact us at Moshe Klass at firstname.lastname@example.org or 718-330-1100 ext. 352 email@example.com or 718-330-1100 ext. 352
NEW CAREER OPPORTUNITIES WITH OMNI CHILDHOOD CENTER! PHYSICAL, OCCUPATIONAL AND SPEECH-LANGUAGE THERAPISTS SPECIAL EDUCATION TEACHERS EARLY INTERVENTION HOME CARE
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$$ COMPETITIVE RATES $$ *FLEXIBLE SCHEDULING* *NYS LICENSED THERAPISTS*
Don’t forget to ask about our ADDITIONAL JOB OPPORTUNITIES –
Department of Education – Evaluations and Treatments Center Based Therapy Programs School Based Therapy Programs
Tailor your job to meet your needs- Hours. Location and Caseload Call Today – Howard 718-998-1415 ext. 104 FAX: 718-627-1855 Or E-mail: howard@OMNIREHAB.COM
Make your next career move to OMNI Rehab!
OT's, PT's, Speech SI, Social Workers Center based & Home based
In the Williamsburg area fax resume to 718-303-9496 or email firstname.lastname@example.org
Call Margie at
(718) 853-9700 or fax resume to (718) 853-5533
A private multidisciplinary facility seeks FT/PT, OTs, PTs and STs to work with a diverse client population. Pediatric and adult clients across the age span. Aquatic therapy, pediatric and adult treatment gyms, fully equipped SI room. New grads welcome. Immediate positions available. Contact Chuck at (718) 951-8800 x 2181 Fax (718) 951-0846
is currently seeking therapists (Speech, OT, PT, Special Instructors) to work with infants and toddlers in all Brooklyn neighborhoods. Bilingual abilities (i.e., Spanish, Creole, Yiddish, Russian, etc.) preferred.
Brooklyn Community Medical & Rehabilitation Center
T HERAPISTS AND P SYCHIATRISTS Interborough Developmental and Consultation Center (IDCC) is looking for Fee for Service LCSWs, LMSWs, licensed psychologists and Child Psychiatrists. Cultural competency with the populations that we serve is essential. The right candidate will have the ability to work with a multi-ethnic population that includes the Orthodox and Chasidic Jewish population as well as the African-American, Caribbean and Hispanic population. Candidate should be able to collaborate with a team in providing services for children, adolescents as well as adults. Clinic centers located in Flatbush, Crown Heights, Canarsie, and Williamsburg.
IDCC Provides: • Competitive compensation • Excellent clinical supervision • Group and peer supervision • Training opportunities Resumes can be emailed to HR@Interborough.org or faxed to 718-778-1375 FIND A THERAPIST @ www.frumtherapist.com/directory
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Providing High Quality Services For Preschool Children (Ages 3-5) Including: • Evaluations (which can be conducted in your home - call for details) • Special Education Itinerant Teachers (SEIT) • Speech, Occupational & Physical Therapies • Counseling • Bilingual Integrated Program (Full Day) All services are provided at no cost to you and are funded by the NYC Board of Education and the NYS Department of Education.
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