Friday, January 8, 2016

IEP and 504?

There are many options for students to receive additional support and services in school. Parents are encouraged to discuss their child's needs with the school. Collaboration between parents and schools can help build a good relationship and tends to be far more helpful for the child. It may be possible for a child to receive unofficial accommodations (such as the child being seated closer to the teacher to improve on-task behavior) without the need of a formal plan. However, sometimes a child needs more support, which may include an Individualized Education Plan (IEP) or a Section 504 Plan. These terms and the processes involved in them can be confusing for parents. It can also be challenging for a school to explain these services to parents.

Individualized Education Plans (IEP) and a Section 504 Plans are both formal plans to help a child receive additional support and accommodation in school. They both offer protection for the child as well. Both require the child to have an identified disabling condition, and the disability must affect the child's ability to function in the school environment. This article provides a brief primer on these two options for students, but it is not exhaustive and cannot accurately capture the variations in each state's, district's, or school's implementation. It is important that parents consult with their schools to learn more about the processes involved in developing these plans.

Individualized Education Plan (IEP)
An IEP is part of the Individuals with Disabilities Education Act (IDEA), which is designed to ensure that all students receive an appropriate education regardless of a disability. I usually explain to parents that an IEP is basically a more substantial support system. It will involve more paperwork, more meetings, and can provide more protections for the child. IDEA is federally-mandated and partially federally funded. The funds supplied may not actually be sufficient to cover all of needs of students within a school (the notion that schools "profit" by identifying disabilities is not unsupported by evidence). A student may receive an IEP for any of 13 categories of disability. Some of these are fairly obvious and easy to understand (e.g., blindness, deafness, autism, learning disabilities...), while other disabilities tend to get lumped into the category of "Other Health Impairment" (or "OHI"). OHI includes medical disabilities that may have an educational impact, such as Attention-Deficit/Hyperactivity Disorder. Another category, Emotional Disturbance, can be harder to understand, but essentially includes any persistent, severe emotional disturbance that impacts the student's ability to function in the school (such as severe depression or anxiety). Students with severe behavioral problems may not be covered under an IEP.

An IEP includes identification of the primary (and secondary) disability, a set of goals for the student (e.g., significant improvement in academic skills) and a set of accommodations and services that will be put in place to help the student achieve the goals. All of this is established at a meeting with the parents and school representatives. Parents play an important role in setting and agreeing to goals and, if parents are not satisfied with the goals and accommodations, then they can refuse to sign the IEP and enter Due Process. However, whenever possible, the parents and the school should reach an agreement to help the child receive the support they need and to help maintain a collaborative relationship between school and home. It is important that parents ask questions when unsure about something, to prevent later disagreements or frustration. The meetings can be intimidating for parents, which is also why it is important that they take their time in reading through and understanding all of the materials and decisions involved. The school psychologist is an advocate for the child and an important resource for parents to make use of.

ADA - Section 504 Plan
A Section 504 Plan is part of the Americans with Disabilities Act, which is intended to ensure that all individuals with disabilities receive free and appropriate accommodations. Because of this, Section 504 Plans can serve a very broad range of situations, including temporary medical disability (for example, a broken leg). Any medical condition that may impact the child's ability to function in the school environment and school activities may receive accommodation under Section 504. As mentioned, this may include temporary medical conditions, but also long-term or persistent medical needs, such as Attention-Deficit/Hyperactivity Disorder. Section 504 Plans are typically "lighter" than an IEP in that they may not have as long of a duration, may require fewer meetings and less paperwork, and may not provide as extensive accommodations. Nevertheless, Section 504 Plans can be very valuable for students.

Section 504 is federally-mandated by law, but does not receive the financial support that may be available under an IEP. More intensive accommodations and needs are usually served under an IEP instead of a Section 504 Plan. However, it is possible to have both a Section 504 Plan and an IEP at the same time.

Labels
Parents are often concerned about their child being "labeled" by receiving services. This is a valid concern, though not always as likely as parents may fear. There are two broad types of services students may receive: pull-out and inclusion. Pull-out services involve the student being removed from the classroom or school activities for a period of time to receive services to meet their educational goals. Pull-out may range from very brief (e.g., 15 minutes) to very long (e.g., entire day in a self-contained classroom). Schools generally try to minimize the amount of pull-out time, partially because it has been found that students tend to develop better socially and are better adjusted if they are in the classroom with their peers. As a result, schools have increasingly relied on inclusion services, which keep the student in the regular classroom, but with additional supports or modifications to assignments or activities. Inclusion classrooms may feature two or more teachers to help tend to the individual needs of students receiving services. These teachers often help all of the students in the classroom, though, which helps reduce any stigma from receiving special education services.

Students and teachers are often unaware of the specific needs or category under which a student is receiving services. That information is considered "privileged", so only those who need to know about it are granted access. Nevertheless, it is likely that students will be able to identify differences between them and their peers, regardless of measures taken to prevent it. Students are very sensitive to differences, and even if a student received no accommodations for a disability, their peers will likely be aware of a difference anyway. Therefore, it is usually best to ensure that the student is receiving whatever services are most helpful, regardless of the potential for stigma. The benefits typically outweigh the costs.

Monday, January 4, 2016

Brain Exercise

It can be helpful to think of the brain like a muscle: exercise makes it grow and improves its capabilities. There are plenty of commercial products that claim to improve brain power (memory, processing speed, attention...), but the actual evidence for these products indicates either no real benefit or a very specific benefit (that is, improvement in that specific task, but not other tasks). There are simply no shortcuts for a "supercharged brain." That does not mean that various brain challenges are without value though. For example, crossword puzzles appear to help maintain the strength of long-term memory later in life. This article discusses a little bit about early brain development and why diverse experiences are important for children's brains, and a few specific ideas to keep in mind when trying to help your child develop their abilities.

Immature and Slow to Develop
Humans have an unusually long period of development. Our children are largely helpless for a very long time and their brains will not "fully develop" until possibly early to mid-20's. However, you can clearly see a lot of differences in the abilities of very young children and adolescents, with adolescents capable of understanding more abstract concepts and engaging in more complex discussions (Piaget and his colleagues generally explored these ideas long ago). Because the period of development is so long, that leaves a lot of time to help build a child's abilities and improve on areas that they may be struggling in. Children's brains are also very adaptable (a concept called "plasticity"). One example of that is how young children are more able than adults to recover from brain trauma. On the other hand, some neurological differences do not appear likely to ever be fully addressed. It would be difficult to discuss all of the types of abilities and differences that are "plastic" and those that are not, but we can cover some important areas that parents can work on with their children.

Critical Periods/Sensitive Periods of Development
Sometimes you may hear the term "critical periods" of brain development. This concept means that certain abilities (such as the ability of the brain to process visual information) must develop within a certain time window or else it will never develop. It may be an overstatement for us to say with certainty that some abilities will never be able to develop, but there are certainly times during which it is easiest for a child to acquire a certain skill (such as language). These times during which it is easiest for the child to develop an ability or skill are often called, "sensitive periods" instead of critical periods to help emphasize that the window of opportunity is not necessarily completely shut. Usually these periods are for very specific abilities, such as the ability to process certain types of sensory information, or to develop motor skills or language skills. We are still learning more about human development, however, and there are many areas that are less clear (such as social skills).

Impulse Control and Emotional Regulation
The ability to inhibit a behavioral impulse or an emotional response is important for success in many areas of life (jobs, social interactions, relationships...). Our capacity to do this seems to reside heavily within the front part of the brain (the prefrontal cortex). Fortunately, this appears to be the last part of the brain to reach full maturity, which means there is a lot of time to exercise it. On the other hand, this also partly explains why children, adolescents, and even young adults can be extremely impulsive or make some very questionable decisions at times. The development of the prefrontal cortex also seems to coincide nicely with our "cognitive peak." You could say that we are, essentially, at our smartest in early adulthood (though the decline afterward is actually rather slow). This means that for children we should continually encourage them to practice impulse control and emotional regulation. We can do this most effectively by giving them mild "patience challenges" that push slightly at their limits and providing them with appropriate feedback, encouragement, and (if necessary) rewards for achieving their goals. I would not recommend doing this with an overly high frequency (such as multiple times per hour, every hour, every day) as it's likely to produce so much frustration that you'll get resistance from them in the future. However, if it can be made slightly playful, then the child is building an invaluable ability and also building confidence in their abilities.

An important thing to keep in mind is that emotional regulation and impulse control (or "behavioral regulation") appear to rely on basically the same neurology. To build greater emotional regulation, it is often helpful to teach the child to voluntarily withdraw from a situation when needed (by rewarding them for doing so if necessary). This can give their brain (prefrontal cortex actually) time to catch up and reassert its control over the situation. I've seen parents use many approaches to explaining this to their child, but I think my favorite has been the idea of an "overheating engine" that needs to cool off. Teaching the child how to recognize the signs of getting emotionally overwhelmed is a helpful (possibly critical) step in teaching them to self-regulate their emotions more effectively. A variety of physical cues can help, including their heart rate and breathing, as well as how impatient they're feeling.

Frustration Tolerance and Patience
Similar to building greater impulse control and emotional regulation, the capacity for frustration tolerance and greater patience are likely to be great contributors to a child's long-term success. Tolerance for frustration or setbacks increases the likelihood a child will persist at a challenging task and, as a result, learn more skills and ultimately enjoy more success. Explaining this to a child is not likely to convince them to keep working on a particularly frustrating homework assignment though. As the parent, you effectively coach your child by encouraging them to persist, giving them just enough help when they need it (called "scaffolding"), and showing them how their continued effort has paid off. Then celebrate their success with them! The more they do this (and enjoy the success that follows), the more likely they are to persist at challenging tasks again in the future.

Building patience may be more challenging because "having it now" is always more appealing than "having it later." Individuals who are unable to wait (called "delayed gratification") are less likely to enjoy bigger successes later in life. Those who are able to wait can develop more complex plans and enjoy bigger rewards as a result of their patience. One way to help is to require the child to do "just one more time" or wait "just one more minute" on a fairly frequent basis (ideally at least a few times per day if circumstances permit it). I would not recommend prompting them to do a second round (at least not at first), because they may just get too frustrated, doubt your sincerity in the future, and decide they'll just make it happen on their own (whether you agree or not). You can also offer them bigger rewards for their patience (though starting with praise and allowing them what they originally wanted is a good idea). For example, "Sure, I'll let you have a cookie, but if you can wait until we're done with this, I'll let you have two cookies instead."

Training with ADHD
All of this comes to one final point. While reading this far (good patience and persistence!), you may have thought several times that the skills discussed sounded kind of like what is lacking in a child with ADHD, and you would be right. The neurology of ADHD appears to primarily be underactivity of the area of the brain involved in impulse control, emotional regulation, frustration tolerance, and patience. These skills are important for helping a child to persist at challenging tasks, maintain focus on one thing for an extended time, develop a complex plan, and carry out that plan. They're also important for preventing the types of impulsive or hyperactive behaviors that often get kids in trouble when they have ADHD. Because of that, the exercises discussed here are especially important for children with ADHD (though helpful for all children). This doesn't mean that children with ADHD just needed to do these exercises more, or that their parents committed "bad parenting", which lead to the problems with ADHD (there is clearly a strong genetic component to neurological development and a difference in brain chemistry for individuals with ADHD). Many children with ADHD may have more difficulty with completing these exercises successfully as well, and therefore may need a combination of medication and behavior therapy (rather than just behavior therapy). Progress in developing these skills may also be very slow for a child with ADHD (which can frustrate the parent), but slow progress eventually produces significant progress, and the time is well-spent. Remember, the prefrontal cortex seems to be the last area of the brain to mature, which means that "exercising that muscle" may help to reduce the neurological difference by the time your child is much older.

Friday, January 1, 2016

Getting Compliance

Parents typically expect that if they ask their child to do something (for example, "Put on your coat"), that the child should get up and comply with the request. Though this may be the expectation, in reality compliance happens far less often (perhaps anywhere from 10% of the time to 70% of the time). There are many factors that affect the likelihood of compliance. Understanding some of these can help parents to increase the likelihood of compliance and reduce their frustration. Additionally, it actually reduces the child's frustration as well, which has the added benefit of reducing a variety of undesirable behaviors. This article presents some of the factors that affect compliance in children.

1. Phrasing - Simply put: If a request is open-ended, then the the likelihood of compliance is much less. Some examples of open-ended requests:
  • "Can you put your shoes on?"
  • "Is it time to go?" or "Can we go now?"
  • "Would you like to give ____ a turn now?" 
In contrast, if a request is clearly made as a request, then the child at least knows what you want and you're not merely "making a suggestion" that the child is free to decline if they so choose. You can still be polite in making the request, and not all requests need to be "closed", but if you really want the child to comply, then the request should not be open-ended. To rephrase the above in a closed manner, you could try the following:
  • "Please put your shoes on."
  • "It's time to go, let's get ready." 
  • "Give ____ a turn now" or "Let's share and give ____ a turn now."
2. Finality - Strangely, children (especially very young children) tend to interpret events as "the last time ever." If you want a child to stop an activity for the time being (to go eat, give someone else a turn, to go home, etc.), they may react as if you have told them they may never do that activity again. This means they really need to tantrum, possibly even ramp up their tantrum to a new level, so you understand how important the activity is and how much they enjoy doing it. In reality, you're probably just asking them to stop doing the activity at that time, but they will be able to do it again later. The problem lies in the way children perceive the flow of time. If they're feeling impatient (or excited, scared, nervous, angry, anxious...), then 5 minutes is an eternity. Suggesting they can do something "tomorrow" is a very fuzzy thing. They can certainly tell you what it means (in literal terms) and may have some basic idea of the fact that "tomorrow" is a real thing and it will eventually come, but it is still an inconceivably long time away. Similarly, chores that would require 10 - 15 minutes can produce a tremendous amount of resistance because, if 5 minutes is an eternity, you just gave them something that takes 2 or 3 eternities (aka, "forever!").

We can greatly reduce the resistance that comes from this sense of finality by mentioning that they will be able to do the activity again and some idea of when that will be. For example, "I want you to stop doing that for a moment and put up that other toy. You can continue playing afterward." In my practice with children, simply providing them with some idea of when they can do the activity again, and making clear that we're not actually stopping the activity, merely pausing it, greatly reduces their resistance. There are many situations where an activity must be truly stopped for an extended time, in which case providing them with an alternative of what they will be able to do can help. For example, "Go ahead and put up those toys please. We're going home and you can play with your toys there."

 3. Credit - The relationship between a parent and a child can significantly affect the likelihood that the child will perform the parent's request. If there has been a history of opposition, frustration, or conflict, then the child is less likely to comply with the request (and more likely to actually oppose the parent directly). Spending time with the child in a non-directive, and non-corrective way can help "build credit" with the child. This credit is consumed when making requests. Building more credit can help to make interactions much easier overall. Credit-building requires planned periods of time doing activities together (without the parent correcting the child, if possible), which should usually be daily at first and for about 20-30 minutes at a time. This can be very challenging, but the pay-off is worth it. (More info on having Planned Together Time)

4. Choices - Choices can greatly reduce resistance, especially with children who act as if they want control over their lives (Note: it's hard to know what the true motivation is, but many children act in a way that suggests they want control). There are two kinds of choices you can offer: a) choice between your request and getting something they want, or not doing your request and not getting what they want, b) choice between two or three activities that you want.

The first one is basically where you tell the child what you want them to do and then offer them an incentive for doing so. For example, "Please clean up the den. Then you can go outside." For this to work, you absolutely must follow through. If they do not clean the den, then they do not get to go outside. At the same time, you offered them a choice and they can choose to not do it with no further consequence. If "I'm not cleaning the den." is not an option, then do not offer the choice.

The second is where you are offering a few options, but they are expected to choose one. For example, "You can clean your room, vacuum the den, or load the dishwasher." The child is expected to perform one activity, but only one. Using additional rewards with this approach is often much more effective (see Token systems).

5. Placating/Reasoning - Don't do this. If at all possible, do not try to reason with the child about why your request is a great idea and that they should comply because they want to. It is extremely unlikely that reasons (no matter how compelling) will make a significant difference over the long-run. In the process, you risk undermining your authority (what if the child thinks your reasons aren't very good?) and give the impression that everything is negotiable. There are certainly times for those kinds of discussions, but when you're making the request is not the best time for it.

Even more importantly, try to avoid the (natural) temptation to begin offering up more incentives for the child to comply with your request (aka "placating"). Decide before what approach you want to use with the request (if you're going to offer a reward for completing the request) and then decide what you will offer. If the child finds your offer undesirable, then that should be the end of it. If you start to add more, then you're teaching your child to hold out for better offers in future requests as well. Certainly teaching children to be effective negotiators has some value, but there are better ways to develop that skill without undermining your authority as the parent.

6. Short Interactions - This is an interesting one. Research has repeatedly shown that long interactions between a parent and child (during conflicts, arguments, requests, etc.) are likely to escalate and that the result is seldom desirable. Simply put, you should keep the request interaction short. Make your request, lay out your terms, and if the child refuses, carry through a brief plan for how you're going to deal with it. Just imagine there is a timer counting down and if it hits 0, then the time limit for the interaction is up. Conversely, do not try to rush a child either. If a child is rushed, they are put under stress. If they are put under stress, then frustration and resistance are likely to increase, and the interaction may escalate. It is somewhat difficult to explain without showing, but essentially you are working under an imaginary time limit, but trying to keep your "game face" on and not let the child see that you're trying to hurry through. So allow the child a moment to wrap up what they were doing, then repeat the request (while indicating that they will be able to resume the activity or engage in another afterward), and if necessary try to help them begin doing what you requested.

More info on Child Defiance