Sensory integration therapy (SIT) has been one of the treatment mainstays for thousands of children diagnosed with autism spectrum disorders, ADD/ADHD, or other developmental disorders. According to the American Occupational Therapy Association (AOTA), approximately 5 to 15% of children in the general population have sensory processing issues.School-based and private occupational therapists and parents have brushed, swung, and bounced on balls countless children in an effort to improve their ability to process sensory input. Yet, the effectiveness of this therapy, despite accolades it has received from therapists and parents, has been questioned. Now a new study by Lang et al that assesses the benefits of SIT by reviewing 25 existing studies adds additional fuel to the debate. In a nutshell, the study authors state that SIT is neither effective nor research-based and that agencies (such as schools) that are mandated to provide research-based interventions should not be using SIT.
Lang et al culled electronic data bases for different studies that purported to measure the effectiveness of SIT. To be included in the Lang review, the study had to meet certain inclusion criteria; namely, at least one participant had to be diagnosed with an ASD and some form of SIT had to be implemented in an effort to ameliorate the symptoms of the ASD. The SIT was then classified as positive, negative, or mixed depending on its effectiveness. Additionally, the methodological rigor of the study was examined to determine if the study had a true experimental design that among other things could be replicated.
That you can’t fight city hall is a time-honored truism, but how much harder does it become when different city halls join forces to fight you? Parents in Orange County, California unfortunately are discovering just this fact as they advocate for services for their children with special needs. Since 2005, 28 school districts plus the Orange County Department of Education have formed an alliance, which among other functions, contributes financially to school districts engaged in legal battles against parents.
The Orange County Special Education Alliance was ostensibly formed to ally school districts in their ongoing campaign against parents. A single school district is a formidable opponent but fighting a coalition of districts that gives me a headache just to contemplate. Again lets remember they are not the victims of parents in the vast majority of cases.
Even 6 months after the tragedy at Shady Hook Elementary School, we’ve all been asking what may have caused the horrific shooting. We may or may not agree that the ready availability of assault weapons and the playing of violent video games may have contributed to the rampage, but we can surely agree that failures in the mental health system also played a significant role. We don’t know if his mother struggled to obtain mental health services for her son, although we know that she had home-schooled him for a time. What we do know, however, is that for many families, providing mental health services for their desperately ill children is an extraordinary challenge. And many, many children, as well as adults, are falling through the cracks. I see the struggle for mental health services occur on a daily basis.
According to the National Alliance on Mental Illness (NAMI), 4 million children and adolescents in this country suffer from a serious mental disorder that causes significant functional impairments at home, at school, or with peers. Additionally, 21% of children between ages 9 and 17 have been diagnosed with a mental or addictive disorder that causes at least minimal impairment. Despite this high prevalence rate, NAMI reports that in any given year, only 20% of children with a mental disorder are identified and treated. That’s a lot of kids to not receive treatment, and the consequences can be tragic. Suicide is now the third leading cause of death among youth aged 15 to 24. Of those children who commit suicide, over 90% have been diagnosed with a mental disorder. Additionally, 50% of teens with a mental disorder will drop out of school. Many of these youth will wind up in the criminal justice system. The National Institute of Mental Health found that 65% of boys and 75% of girls in juvenile detention have at least one mental disorder.
The fundamental challenge in finding an appropriate placement for the student with higher-functioning autism or Asperger’s syndrome is meeting the child’s emotional or behavioral needs yet not short-changing him or her academically. Notwithstanding the various challenges the student may have related to the disability, the student may likely be extremely bright. Many day therapeutic day programs are well-equipped to help the student develop social skills and learn to maintain a sense of equilibrium, but many programs lack academic rigor for the student.
A recent due process case from Massachusetts recognized this placement tension for a student with Asperger’s whose parents had unilaterally placed him in an out-of-state private residential program that they believed better met his needs. The hearing officer, in agreeing with the parents, stated that although the school district was not required to provide a program that would maximize the student’s potential to ensure FAPE, the school still needed to consider the student’s potential in order to determine whether or not he was receiving “meaningful benefit” from the IEP. To be meaningful, the student must be able to progress, even when his potential is high. In this particular case, the student had challenges with reading fluency and poor social skills. Additionally, he could be argumentative and withdraw socially. Yet the student was very talented mathematically and desired to attend college where he would study math. The hearing officer stated that the placement proposed by the school failed to provide FAPE. Although the program specialized in students with Asperger’s and could help with the social skills and learning issues, its three teachers, none of whom had content certification, could challenge the student academically. The program, which was unable to offer students any science labs, had also not sent any students on to college. This relatively flexible view of the FAPE requirement is new twist and one that is not applied in all cases, making this case very interesting to see if it gets applied in other cases.
In December the U.S. Senate held hearings on ending the “School to Prison Pipeline.” As discussed previously in this blog and elsewhere, the “school to prison pipeline” refers to exclusionary disciplinary practices (e.g., suspension, expulsions, or even arrests) resulting from blind adherence to zero tolerance policies, which critics harshly state criminalize otherwise normal behavior and are disproportionately used on minority and special needs students. African American males are 3 ½ times more likely to be suspended or expelled than are their white peers, and students with special needs are twice as likely to be suspended or expelled than are their non-disabled peers. The Senate hearings, which were held before the Senate Judiciary Subcommittee on the Constitution, Civil Rights and Human Rights and chaired by Senator Dick Durbin, were the first ever held to address the overall question of school discipline and how it has gone so terribly wrong. But perhaps more importantly, the hearings discussed what needs to happen to “plug” the pipeline.
So how many students are being suspended or expelled? According to data collected by the Civil Rights Project and released last March, 3 million students were suspended from our nation’s schools in 2009-2010. As graphically illustrated in the report, “Opportunities Suspended: The Disparate Impact of Disciplinary Exclusion from School” and discussed in a previous blog, this is enough students to fill every seat at every major league ball park and NFL stadium in the country. And for many of these students, suspensions or expulsions may be their entry into the school to prison pipeline. According to a Texas study, students who are expelled or suspended are three times more likely to become involved with the juvenile justice system within the year.
Although it seems almost a contradiction, children can be both gifted and have special needs, such as learning disabilities. Yet, because of their unique blend of talents and challenges, these students, known as “twice exceptional” or 2e students, can be difficult to identify and diagnose. Often their combinations of intelligence and special needs mask each other, leaving the child performing at grade-level. Other 2e children have been identified as learning disabled with teachers who may be unaware of the student’s high cognition. Conversely, those students who are identified as gifted but not LD may fail to meet their potential, leaving them underperforming, frustrated, and often with significant emotional issues. School districts may label these students lazy or unmotivated, and it can be difficult for parents to convince schools that the student has a disability that is affecting their performance in school.
“Giftedness” is not recognized as a disability under the Individuals with Disabilities Education Act (IDEA), and it can be difficult for some families to obtain special programming for gifted children. Where families live can make a difference. According to the National Association for Gifted Children, only about half of states (28 in 2008-2009) had a mandate to identify gifted children. How many of these states go further to identify those students who are both gifted and have a disability is unclear. Some states, such as Colorado and Idaho, have clear policies with accompanying guidelines on their websites. The National Association for Gifted Children has an interesting web page that provides data on gifted education by state, which parents may find useful.
I am still reeling from the depth and magnitude of what happened last week with the killing of so many young children and their heroic teachers and staff. I am not sure when, if ever, I will be able to make any sense of this extreme violence. However, in the media frenzy that always follows such events there have been irresponsible statements attributing autism as a possible explanation. Below is the Autism Society's reponse on this issue.
The following is the heartfelt wisdom and pathos from my own daughter. She is a beautiful, wonderful person who has had to face the challenges of being a sibling to a brother with special needs and the internal identity struggles of being adopted from China. We are all a work in progress, but her essay below captures in poignant terms her thoughts about her "difference."
Well, if you had to ask, a difference that I have had to overcome was my family. Being adopted kind of bothered me, and my brother has spastic cerebral palsy and epilepsy. I know being unique and different is good, but this to me was VERY unusual. I mean how many people do you know have a family of an adopted daughter from China, and a son with a disability? Just as I thought, I may be the first. As you continue to read you may find yourself asking question about your own family. Just know your family is something you should appreciate and enhance.
The use of seclusion and restraint for children with special needs in our nation’s schools has received national attention. These practices have been deemed as cruel and dangerous, and various pieces of legislation have been proposed to eliminate their use. Yet, these practices are being used on an ongoing basis on our nation’s incarcerated youth. Up to 81,000 teens are incarcerated in juvenile facilities on any given night, and an additional 10,000 teens are in adult prisons. According to the ACLU, which released a report on solitary confinement in October, a significant number of these facilities isolate youth for days, weeks, months, or even years. The use of solitary confinement, according to the ACLU, causes “anguish, provokes serious mental and physical health problems, and works against rehabilitation for teenagers.”
One of the most tragic outcomes for incarcerated youth is suicide, and half of teen suicides occur while youth are placed in solitary isolation. A position paper published by the National Commission on Correctional Health Care, which expresses concern about the high rate and potential underreporting of teen suicides in jails, states that further research is needed to delineate better the relationship between suicide and isolation. Yet, according to the American Academy of Child & Adolescent Psychiatry (5), the research is in already. The potential psychiatric consequences of prolonged use of solitary confinement on these “developmentally vulnerable” adolescents are “well recognized” and include depression, anxiety, and psychosis.