Faculty and graduate students are joining a nonprofit agency in curriculum training to teach independent living skills.

By University Communications June 13, 2008

Students and faculty in The University of Arizona’s department of speech, language and hearing sciences and the UA Strategic Alternative Learning Techniques Center are taking part in a training program where they will learn to teach independent living to those afflicted with autism and or Asperger’s Syndrome.
The training program is part of a specially designed curriculum by Chapel Haven West, a private nonprofit agency founded in 1972 that is dedicated to helping adults with special challenges live independent and productive lives.
The training puts UA graduate students in the department of speech, language, and hearing sciences at the cutting edge of research and the opportunity to provide clinical services to the Chapel Haven West residents, who will live within walking distance of the UA campus. The Chapel Haven curriculum includes recreation programs and lessons on social communication, residential life skills, education and employment.
According to the National Institute of Neurological Disorders and Stroke, or NINDS, Asperger’s is an autism spectrum disorder, one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. The disorder is characterized by poor social interactions, obsessions, odd speech patterns, motor delays, clumsiness, limited interests and peculiar preoccupations.
Overall, people with Asperger’s Syndrome are capable of functioning in everyday life. Chapel Haven West opens its new two-year residential program on June 30 and will house and teach 17 men and women on the high end of leaning ability in the autism spectrum. Chapel Haven West is a part of Chapel Haven Inc., a private nonprofit agency founded in 1972.
“There are programs for children and adolescents, including the Autism Clinic Extension of the Grunewald Blitz Clinic for Communication Disorders in Children, a partnership with the UA and Tucson Alliance for Autism, but Chapel Haven West is the only program in the county focused on serving the adult population,” said Betty McDonald clinical instructor of speech, language and hearing sciences at the UA.
Funding for the two-week training program that began June 12 at the UA department of speech, language and hearing sciences comes from a $22,000 grant from Autism Speaks.
“This is a unique opportunity for our students to receive training in a much needed area. In addition, we are very pleased to be able to partner with an organization that will serve the Tucson Community,” said Elena Plante head of the department of speech, language, and hearing sciences at the UA.
The goals of Chapel Haven students vary and range from sampling classes and perhaps college matriculation to vocational goals and the possibility of employment on the University campus or within the community.
The residential program offers opportunity for socialization, volunteer or paid employment, continuing education classes, mentoring by college students, athletic events, and the atmosphere of a vibrant, active college campus. In addition, Chapel Haven West will provide a lifetime of support for its clients as they transition to independent living in the Tucson area.
The training program is a partnership between the UA department of speech language, and hearing sciences, Strategic Alternative Learning Techniques, UA Disability Resource Center and Chapel Haven West, a satellite program of Chapel Haven, Inc., of New Haven, Conn.

Research Study on Autism Seeking Participants

DOES YOUR CHILD HAVE AUTISTIC DISORDER?
DOES YOUR CHILD HAVE REPETITIVE BEHAVIORS?

Get upset when interrupted from the usual routineRepeat the same activities or movements again and againHave intense preoccupations with certain topics or activitiesIf you answered "YES" to both questions, your child may be eligible toparticipate in research being conducted byresearchers at the Fay J. Lindner Center for Autism and DevelopmentalDisorders, North Shore-LIJ Health System

This is a 14-week research study testing the safety and effectiveness ofdifferent doses of an investigational medication in children andadolescents who have been diagnosed with or have symptoms of autism.Participants will also be offered an open-label trial of theinvestigational medication at the end of the 14-week phase.

To be eligible for this study, participants must:_ Be between the ages of 5 and 17_ Meet diagnostic criteria for autistic disorder_ Not have a significant medical condition (e.g., heart disease, highblood pressure, lung disease, liveror kidney failure, unstable seizure disorder, thyroid disease)All evaluations and medications for this study are provided without costto participants. In addition, families who participate will bereimbursed for their time.

If you are interested in finding out more information about this study,please contact the study coordinator,Linda Spritzer, by phone (516) 802-8608 or by e-mail atLspritze@nshs.edu.
The Fay J. Lindner Center for Autism and Developmental Disorders, NorthShore-LIJ Health System4300 HEMPSTEAD TURNPIKE, BETHPAGE, NEW YORK 11714 * (516) 802-8600

Do I Have Asperger Syndrome?

Do I Have Asperger Syndrome?

<http://autism.about.com/od/aspergerssyndrome/a/adultsaspergers.htm>
Asperger syndrome (AS) is a pervasive developmental disorder at thehighest end of the autism spectrum. People with AS develop languagenormally, but often have difficulty with social interactions, fine andgross motor coordination, and eye contact. They may be extremelypassionate about just one or two topics, with little patience for smalltalk. They also may struggle to handle normal daily activities, such asorganizing time, managing conflict, or even facing the sensory overloadpresented by malls and grocery stores. Adults with AS may appear painfully shy, or they may be extremelyoutgoing - sometimes to the point of being "in your face." That'sbecause people with AS often misinterpret social interaction. Questionsthey may ask themselves: How far away do I stand from another person?How long can I talk about my favorite subject? What's the right answerto "how are you?" If these are the types of questions that puzzle you on a regular basis,you may already have considered the possibility that you have AS. And"if you think you have Asperger syndrome, you probably do," says MichaelJohn Carley, Executive Director of Global and Regional Partnership forAsperger Syndrome (GRASP) <http://www.grasp.org> . I Think I DO Have Asperger Syndrome - What Do I Do Now?<http://autism.about.com/od/aspergerssyndrome/f/dxasadults.htm> AS is in no way life threatening, and while there are therapiesavailable to aleviate symptoms and build new skills, there is notreatment which will cure it. That means you are under no obligation toseek a professional diagnosis, or to act on a diagnosis once you haveit. There are, however, good reasons to consider seeking a diagnosis<http://autism.about.com/od/aspergerssyndrome/a/www.autism.about.com/od/aspergerssyndrome/tp/whygetasdx.htm> , particularly if you feel thatAsperger syndrome may be causing problems or distress. If you do decide to seek a diagnosis of Asperger syndrome,<http://autism.about.com/od/aspergerssyndrome/f/dxcriteriaforas.htm>Carley recommends seeking out individual therapists, neurologists andautism centers that are familiar with tests for AS. The most criticalpoint is that you choose a therapist, neurologist or center withsignificant experience in diagnosing adults with AS. Since it isrelatively new to the DSM-IV (diagnostic manual), the diagnosis may besomething many practicing doctors will not have been trained in or haveexpertise in AS. Appropriate diagnosis will involve a variety of tests that focus onintelligence, "adaptive" social and communication skills, and personaldevelopmental history. An experienced professional can help distinguishbetween true AS and other disorders which have some of the same orsimilar symptoms (social phobias, anxiety, etc.). I Have an AS Diagnosis. Now What?<http://autism.about.com/od/adultsaspergersyndrom1/f/treatadultas.htm> Again, the decision is yours. The information may simply be interestingto you alone, and you may choose to keep it that way. Knowing that youhave AS can help you plan for and manage potentially difficult settingsor situations, and behavioral therapy geared to helping you buildsocial/communications skills may be helpful. If your medicalpractitioner feels that you have other, related disorders (such asanxiety, depression, or obsessive compulsive disorder), medication maybe appropriate. Carley also recommends seeking out books and websitesabout life as an adult with Asperger syndrome. On the other hand, you may choose to share your AS diagnosis withfriends and family. If you grew up with undiagnosed AS, your unusualsocial interactions may have created friction, and even bad feelings. Bysharing your diagnosis, you may open the door to better understandingand closer relationships. Are There Others Out There Like Me?Absolutely! GRASP is only one of several large organizations dedicatedto supporting teens and adults with AS. Others includeNeurodiversity.org <http://www.neurodiversity.org> , Asperger FoundationInternational <http://www.aspfi.org> , Wrong Planet<http://www.wrongplanet.net> and more. The purpose of theseorganizations is to provides adults with AS with support, socialcontacts, resources, treatment, and a sense of community. If you'reinteresting in learning more about these groups, click around thesites... join in the forums... and, if you can, attend a local groupmeeting. Sources: Asperger's Syndrome Fact Sheet, National Institutes of NeurologicalDisorders.<http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm>Prepared by: Office of Communications and Public Liaison NationalInstitute of Neurological Disorders and Stroke National Institutes ofHealth Bethesda, MD 20892 Publication date January 2005. Interview with Michael John Carley, Executive Director of the Global andRegional Asperger Syndrome Partnership. April, 2007. Online Asperger Syndrome Issues and Support (OASIS) Website.<http://www.udel.edu/bkirby/asperger/> "Adult Issues, Resources andContributions From and For Individuals with AS and Autism."Q. How Do Experts Diagnose Asperger Syndrome in Adults?From Lisa Jo Rudy <http://autism.about.com/mbiopage.htm> ,Your Guide to Autism <http://autism.about.com/> .About.com Health's Disease and Condition content is reviewed by StevenGans, MD <http://www.about.com/health/p4.htm> You've never really grasped small talk, and would rather talk to acomputer than another human being. Does that mean you have AspergerSyndrome (AS)? To find out, you'll have to see an expert. But howexactly do experts diagnose AS in adults?A. Dr. Shana Nichols of the Fay J. Lindner Center for Autism on LongIsland in New York specializes in diagnosing and treating teens andadults with Asperger Syndrome. While she uses several specificdiagnostic tools to identify specific symptoms, she says that even thosetools are somewhat out of date, as is the DSM IV, a psychiatricdiagnostic manual, which was last updated in 1994. "We've learned anenormous amount since then," she says. When adults come to the Lindner Center for a diagnosis, Dr. Nicholsbegins her exam with an IQ test. Since people with AS have normal orabove normal IQs, this is a good place to start. She also administers anassessment of adaptive skills which tests the patient's ability tomanage complex social situations. "If a parent is available," says Nichols, "we administer a parentinterview called the ADI (Autism Diagnostic Interview Revised). We're looking at current functioning and early history to get a sense ofthe patient's skills in social, communication and behavior domains."After all, as she says, "autism doesn't suddenly show up when you're 25,so most people with true AS showed symptoms throughout their childhood."If parents aren't available, Nichols and her colleagues ask the patientto recall their childhood, asking such questions as "Did you have a lotof friends?" and "What did you enjoy doing?" Nichols also administers the ADOS Module IV. ADOS is the autismdiagnostic observation schedule, and module four is for high-functioningverbal young adults and adults. Along with the ADI, it allows doctors tolook carefully at social and communication skills and behavior. Forexample, says Nichols, the tests look at such questions as "Can you havea reciprocal social conversation? Are you interested in the examiner'sthoughts and feelings? Do you demonstrate insight into relationships? Doyou use appropriate non-verbal gestures and facial expressions? Do youhave odd or over-focused interests?" The tests allow doctors to attach agrade in each each domain to determine whether the patient meets thecriteria for AS. It's not unusual, says Nichols, for a patient to come in expecting an ASdiagnosis and to leave with a different diagnosis. "Distinguishingbetween social phobias or shyness and actual impairment with AS can bevery tough for a layperson," she says. Other disorders, such asobsessive compulsive disorder (compulsions, hoarding, needing to dothings over and over) or social anxiety can sometimes look like AS. Ifdoctors do pick up on these other disorders, they can recommendappropriate therapy and/or medication. Sources: Ami Klin, Ph.D., and Fred R. Volkmar, M.D. Asperger's SyndromeGuidelines for Assessment and Diagnosis.<http://info.med.yale.edu/chldstdy/autism/asdiagnosis.html> Yale ChildStudy Center, New Haven, Connecticut. Published by the LearningDisabilities Association of America, June 1995 Interview with John Michael Carley, Executive Director, Global andRegional Asperger Syndrome Partnership (GRASP). <http://www.grasp.org>April, 2007. Interview with Dr. Shana Nichols, North Shore Long Island Jewish HealthSystem, Fay J. Lindner Center for Autism. May, 2007. [link url=http://www.nichcy.org/resources/asperger.asp]NationalDissemination Center for Children with Disabilities Asperger Syndrome page.FAQ Index <http://autism.about.com/od/aspergerssyndrome/f/> Q. What Treatments Are Available for Adults with Asperger Syndrome?Your symptoms seem to point to Asperger syndrome. But is it worth doingall the work of getting a diagnosis? What good will a diagnosis do andwhat therapies are available to you once you have an "official"diagnosis in hand?A. Children with Asperger syndrome (AS) and other forms of autismusually receive a set of treatments and therapies in school. Often,they'll receive physical,<http://autism.about.com/od/autismtherapy101/a/PTbasics.htm>occupational <http://autism.about.com/od/whatisautism/a/OTBasics.htm>and speech therapy <http://autism.about.com/od/whatisautism/a/SLP.htm>along with some kind of social skills training<http://autism.about.com/od/autismtherapy101/a/socskillbasics.htm> andbehavior support. If they over- or under-react to sensory input (lightsseem too bright, sounds seem too loud, etc.), their parents might alsosign them up for sensory integration therapy<http://autism.about.com/od/treatmentoptions/a/allaboutsi.htm> . As theyget older, they might get involved with social skills groups andcognitive therapy. While some of these therapies are appropriate for adults with AS, saysDr.Shana Nichols of the Fay J. Lindner Center for Autism, treatment foradults really depends upon the individual adult's response to thediagnosis. And responses can run the gamut from joy to anger -- andeverything in between. Says Dr. Nichols: "Some people are overjoyed because finally everythingmakes sense to them -- why they can't hold a job, keep a relationship.They have blamed themselves all their lives. Now they have a frameworkin which to understand their difficulties and their strengths. For a lotof people, it's a relief." Of course, there is no obligation to do anything about an AS diagnosis,and some people simply stop with the diagnosis and walk away. For thosepeople who are interested in exploring their AS further, says Nichols,"We do a debriefing and exploration focused what they feel now that theyknow about it. We do a diagnostic 'life mapping' and explore that; wetalk about how all people with AS are different from one another. Thenwe make a plan from there: We say you came there for a reason,' and weask, 'Where would you like to go next?'" Some of the issues Nichols explores with her patients include quality oflife concerns such as leisure interests, social activities, health,employment and family. "We look at all the different areas that make upquality of life, see how they're doing, and where they want to make somechanges." In addition to working on personal goals, says Nichols, "Family work isoften indicated. There are often rifts that have occurred where siblingsare no longer talking. We explore the questions, 'What do you want totell your family? How would you like to repair relationships?' Sometimeswe have families come in to work on issues together." Beyond cognitive therapy, adults with an AS diagnosis have a number ofother treatment options. They can request that their diagnostician writea report that clearly outlines diagnostic issues, IQ, and adaptivebehaviors. With that report, adults diagnosed with AS can often qualifyfor services provided by state and/or federal agencies. Such servicesrange from cognitive therapy to vocational training, job placement,health insurance, and, in some cases, housing. Some of the therapies that are useful for children are also helpful foradults with AS. For example, sensory integration therapy can be helpfulin alleviating hypersensitivity to sound and light; social skillstherapy (often in the form of life or job coaching) can improve jobsituations and even friendships. Perhaps most important, say AS advocates, is "do it yourself" therapy.Adults with AS have access to books, support groups, conferences andother resources that provide insight, ideas and information on allaspects of life with AS. The Global and Regional Partnership forAsperger Syndrome (GRASP) offers a whole page of links to sites andresources <http://www.grasp.org/links.htm#publishing> to support adultswith AS seeking ideas, insights, and next steps. Sources: Asperger's Syndrome Fact Sheet, National Institutes of NeurologicalDisorders. Prepared by: Office of Communications and Public LiaisonNational Institute of Neurological Disorders and Stroke NationalInstitutes of Health Bethesda, MD 20892 Publication date January 2005. Interview with Michael John Carley, Executive Director of the Global andRegional Asperger Syndrome Partnership. April, 2007. Interview with Dr. Shana Nichols, North Shore Long Island Jewish HealthSystem, Fay J. Lindner Center for Autism. May, 2007. Online Asperger Syndrome Issues and Support (OASIS) Website. "AdultIssues, Resources and Contributions From and For Individuals with AS andAutism."FAQ Index <http://autism.about.com/od/adultsaspergersyndrom1/f/

Doctors Seek Earlier Diagnosis for Autism

Doctors Seek Earlier Diagnosis for Autism

Posted on: Wednesday, 28 May 2008, 12:10 CDT

SEATTLE -- When her toddler son seemed not to notice a door slamming nearby during his checkup, Jo James thought nothing of it. Her husband, a Microsoft manager, also has an uncanny ability to block out his surroundings.
A check of Ben's hearing after a nurse's prompt found nothing amiss. It wasn't until two years and one perceptive Montessori teacher later that his parents finally learned the cause of Ben's obliviousness: autism.
"He didn't mix terribly well socially," Jo James, of Sammamish, Wash., recalled ruefully. "But then, what 2-{-year-old boy does?"
Autism typically isn't diagnosed until after age 2. Yet it may be detectable even in infancy _ before a baby is old enough to display telltale traits such as social ineptitude and compulsive preoccupations. Pioneering research at the University of Washington during the 1990s, for example, found that trained observers can spot, with remarkable accuracy, kids who were later diagnosed with autism by viewing videos of their first birthdays.
Now University of Washington researchers are aiming to decipher those early clues in hopes of short-circuiting autism before it becomes full-blown.
In January, they began an $11.3 million trial to identify latent signs of autism in infants for intensive behavioral therapy. It is the nation's first attempt to test a hypothesis that early intervention may actually prevent autism in high-risk infants by rewiring their brains.
"We know the brain has a lot of potential to respond" to the right stimulation, said Sara Webb, a research assistant professor of psychiatry and behavioral sciences and the principal investigator for the study at University of Washington Autism Center.
The goal is "to teach parents to give the child that missing piece that he's not getting on his own."
SKEPTICAL PARENTS
The study's very premise _ that autism may not be destiny _ has stirred unease and skepticism among some parents. They also fret that it may rekindle the discredited notion that autism is triggered by detached and unloving mothers.
"I object to the message that if parents don't rush out like headless chickens before the child is X age, they've lost them," said Lisa Rudy, a mother and autism advocate from Falmouth, Mass.
The implication is that "if only the mother spent more time bonding with the infant, that child will never develop autism," Rudy added.
But University of Washington researchers say they're not laying any blame on parenting. The goal is akin to averting diabetes through vigilance in a person with a family history of the disease, said Annette Estes, associate director of the Autism Center and a study investigator.
"If you are at risk for diabetes, you look for signs," Estes said. With autism, the genetic "risk factors are present at birth. What we are doing is heightening the parents' awareness."
Though some parents report concerns early on, tiny babies by definition don't have autism. That's because they can't manifest such diagnostic symptoms as language deficits and repetitive rituals.
Yet researchers suspect that babies exhibit subtle clues that precede overt symptoms. For instance, healthy babies react visibly to changes in a person's expression, such as switching from cooing to a sad face. A baby who doesn't seem to register the change may warrant watching, Estes said.
"At 6 months, a baby has a limited repertoire of signs" of autism, she said. "The question is `What are the real early signs?'"
HOW STUDY WILL PROCEED
To answer that, researchers will track 200 infant siblings, 6 months or younger, of kids with autism. The disorder's strong hereditary nature means that 10 or more of those babies will develop autism themselves. The odds for a typical American child are a little greater than 1 in 200.
The infants in the study will be randomly separated into two groups. Mothers in one group will be coached on engaging with their babies. Later, the children will receive up to 25 hours a week of a type of developmental intervention called the Denver Model that uses play to teach appropriate behaviors.
The other group will be monitored but not given treatment. All children will undergo regular brain imaging to measure brain activity during tasks.
In the University of Washington researchers' view, autism is both congenital and perhaps avoidable.
Genetics is the main cause of autism, yet there are cases where one identical twin has it and the other does not. That leaves room for possible environmental causes, but none has yet been definitively isolated.
At the same time, researchers are learning that the brain is a dynamic organ, capable of forging new neural networks well beyond the womb. Just as playing the piano might form particular synaptic connections, Webb said, environmental manipulation could help calm a brain that is threatening to go haywire.
"The unknown is the family environment," Webb said. "We do not know if the amount or the quality of stimulation is the culprit."
That some families with autism reacted warily to the University of Washington's study does not surprise Laura Schreibman, an autism investigator at the University of California, San Diego. Since it was first described in 1943, autism has largely remained a baffling challenge for parents and researchers alike.
In her book, "The Science and Fiction of Autism" (Harvard University Press, 2005), Schreibman debunks popular speculation about origins of and treatments for autism. They include the link to the measles/mumps/rubella vaccine (rejected by scientific consensus), chelation therapy, which is ridding the body of mercury and other metals (ineffective and potentially toxic) and the myth of the frigid "refrigerator" mother.
No cure has been found for autism. And only one type of therapy, behavioral intervention, has shown measurable, albeit mostly anecdotal, success in curbing outward signs of the disorder, Schreibman said.
"I feel so much for these poor parents," she said.
MISSED CLUES
James, the Sammamish mother, wonders how she could have missed it.
As a first-time parent, she didn't know that healthy babies instinctively look up to share a laugh. She didn't notice that Ben never uttered the toddler's universal refrain: "Why?"
Ben, now 4-{, began behavioral therapy shortly after his diagnosis. He made quick strides. He has become more engaging and inquisitive, and sometimes even offers hugs.
Ben's brother, 15-month-old Hugh, is enrolled in the University of Washington study to track whether he might share his sibling's affliction. That seems unlikely. Hugh loves to lock gazes with visitors, and expectantly crawls toward any interest that beckons.
Still, James said of her younger son, "You always have it in the back of your mind, `Could it happen to him, too?'"
James is reassured that although Ben still has autism, his condition has become much less obvious. She doesn't know whether researchers can find a way to cure autism instead of merely masking it. But the distinction may not matter.
Either, James said, "would be fantastic."
___
AUTISM IN INFANTS
Diagnosing autism in children younger than 2 is difficult. That's largely because babies develop at different rates and are too young to clearly exhibit autism's key symptoms, including abnormal speech, indifference to social cues and repetitive behaviors. Researchers at the University of Washington are hunting for the earliest clues of autism. Here are some of the possible signs in infants:
Lack of eye contact
Failure to follow another person's gaze or to point
Not responding to being called by name
Not recognizing a parent or caregiver's voice
Indifference to changes in a person's facial expression
Absence of babbling or vocalizing
Sources: University of Washington; Seattle Times reporting
Interested in enrolling?
___
A BAFFLING DISORDER
Autism was first described in 1943 by a psychiatrist at Johns Hopkins University in 1943, who noticed a group of children displaying extreme aloofness and indifference to other people. Since then, autism has become shorthand for a group of neurodevelopmental disorders, including autistic disorder and Asperger syndrome.
In general, to be diagnosed with autism, children must have marked impairment in social interactions (such as reciprocating emotionally); communication difficulties (delayed or lack of speech, inability to strike up conversation); and repetitive rituals or interests (refusal to deviate from routine, preoccupations with objects).

Source: The Seattle Times

Preschool girls with disabilities may be overlooked

Wendy or Tinkerbell?
Posted on: Sunday, 18 May 2008, 03:00 CDT

The underrepresentation of girls in early special education classesmakes it hard for some to develop socially or academically, and yetlittle special education research has focused on gender, writes JeanneS. Manwaring, a preschool special-educator and University of SouthFlorida doctoral student in special education. Since they are in theminority, preschool girls with disabilities must be encouraged toexpress themselves, she concludes. RedOrbit<(5/18" target=_blank>http://r.smartbrief.com/resp/lfzglErKkIyezDCibGwKOAhU?format=standard>(5/18)

By Manwaring, Joanne S

In a public elementary school in the southeastern United States, aself-contained class of prekindergarten children with disabilities isplaying with PlayDoh. As the children are molding and shaping themodeling compound, the only girl is helping the boys press shapes intotheir Play-Doh. She flutters around the other children showing them howto use the various shapes and encouraging them to roll and press thePlay-Doh. The class comprised 10 boys and 1 girl. When questioned aboutthe disparity in gender because of concern for the lone girl, theteacher commented, "Oh, she does okay, she mothers all the boys." Inanother classroom in the same school district, the single girl in aclass of nine boys struggles to articulate her fantasy role model. Thechildren are talking about their desire to be superheroes, vying foradult attention and pointing to their shuts to help illustrate theirwords describing popular cultural icons such as Superman, Batman, andSpiderman. The boys' exuberant, combined voices dominate the discussionand the adult listeners' attention is drawn to reinforcing the boys' useof language and participation in a discussion. Meanwhile, the littlegirl is overwhelmed by the sheer volume of the boys but persists inattempting to be an active participant in the discussion. Many times shetries to enter the conversation repeating the same phrase of which onlythe word "bell" is understandable. Despite many attempts and promptsfrom the adults for more information, her words are not understood andshe never gets to be a part of the discussion. Later, when the childrenare acting out their favorite superheroes, one of the adults puts allthe clues together to finally comprehend that the little girl wassaying, "Me Tinkerbell." These incidents underscore theunderrepresentation of girls in preschool special educationself-contained classes, leaving them with almost no same gender friendsor peers and thereby limiting them to the single role of motherly"Wendy" as they struggle to identify themselves as "Tinkerbell."Historically, boys have outnumbered girls in special education. Acrossthe developmental age span, the prevalence rates indicate that boys aremore often identified with a disability than girls with a rate of 12%for boys and 8% for girls, respectively. This 4% difference does notaccount for the 33 % difference in enrollment in special education[American Association of University Women, AAUW, 2006). In one largeschool district in the southeastern United States, this disparity inenrollment has resulted in preschool self-contained special educationclasses of predominately male students. The scope of this article is todiscuss the underrepresentation of girls in these special educationclasses and the impact it has on their development. These classes are adistortion of social reality and place girls with disabilities at riskfor appropriate language, peer, and play models. One of the greatestcriticisms of separate, self-contained special education classrooms isthe lack of peer role models, which has prompted a push toward moreinclusive environments for preschoolers. Gallagher (2006], among others,reported increased social interactions by children with disabilitieswhen taught with typical peers in inclusive environments and confirmedthat typical children help to foster social interactions. Therefore, inthese particular self- contained preschool classes, not only areopportunities for typical peer interactions lacking but same gender peerinteraction even between girls with disabilities is not available. Thislack of same gender role models for preschool girls with disabilitiesand the long-term impact on their developing social skills andself-esteem may not be noticed in the education world (Colwell &Lindsey, 2005; Maccoby, 1990). Little research has been conducted on gender and disability and genderroles in self-contained separate special education classes. Recently thedisproportionality of students of color and older girls in specialeducation has come to the attention of the public [Oswald, Best,Coutinho, & Nagle, 2003). Research is beginning to closely examine theidentification of school-age girls with disabilities and the effect ofbeing placed in classrooms that have predominantly boys. In a study onchildren with learning disabilities, the fear and isolation the girlsfelt in separate classrooms and the subsequent effect on theirself-esteem was discussed. Using personal interviews, McGrady, Lerner,and Boscardin (2001) conveyed the girls' sense of isolation anddiscomfort surrounding their being the only girl in a class full ofactive, aggressive boys with varying exceptionalities and behaviors.Popular thought also has it that girls are quieter, more passive, andtheir temperaments suit the sedentary, paper and pencil approach of thepublic schools and therefore do not get identified as having specialneeds. Perhaps in some cases, they do not even get noticed. Or even iftheir needs are identified, they are overwhelmed in a special educationplacement where they are the single girl in a classroom of boys.Furthermore, if older girls are relating the ill effects of theseplacements, then think what may be happening to the preschool- age girlwho may not have the language skills to convey her feelings about thenegative aspects of her placement in special education. The Underrepresentation of Girls The scope of this article is to discuss the impact ofunderrepresentation of girls in separate, self-contained specialeducation classes for preschool children in a large school district inthe southeastern United States. On a regular basis, preschool girlsidentified with special needs are being placed in self- containedclasses where there they may be the only girl. They will not have samegender playmates, language, or readiness models. The girls may beoverlooked in the classroom of 9 or 10 boys or they may adopt theteacher's role because it is the only gender model available to them.This writer contends that girls need same gender peers to develop ageappropriate social, language, and preacademic skills. The articleincludes a simple analysis of the composition of self-containedprekindergarten classes in one school district and the implications ofthe effects of disproportionality of girls within these classrooms basedon research and teacher interviews. Identifying Preschool Children With Special Needs The article focuses on the federally mandated preschool program forchildren ages 3 to 5 with disabilities that is funded through a federalprekindergarten (pre-K) grant and administered by the school district.The children are found eligible through an initial Child Find screeningfollowed by an assessment process conducted by one of the schooldistrict's pre-K assessment teams. These teams consist of apsychologist, a social worker, a speech pathologist, and an occupationaltherapist or physical therapist if necessary. To be eligible to beplaced in the program, a child must have a delay of 2 standarddeviations below average in at least one developmental domain or 1.5standard deviations below average in two domains such as social skills,pre-readiness, independent living skills, motor skills, or behavior. Placement in Self-Contained Classrooms When placing children in self-contained special education classes,several assumptions are made concerning the placement. The primaryassumption is that the placement is in the best interest of the child.Other assumptions include: (a) the class will be taught by a welltrained special educator with an assistant in a small adult to childratio, (b) the curriculum will be developmentally appropriate andmodified to meet individual needs, and (c) the identified special needsof the child will be met in this type of environment. These classesintegrate the Division for Early Childhood's (DEC) and NationalAssociation for the Education of Young Children's [NAEYC) best practiceswith a commercial preschool curriculum. Little thought is given to thecomposition of the class because the focus is on the individual child.This is not necessarily a bad thing, but perhaps a closer look at theclass composition would afford the opportunity to consider the wholechild in terms of the considered placement. Most of the children whoenter these self-contained classrooms are identified at age 3 and havenot had any school experience to determine if their needs could be metin a typical environment. Sometimes a 4- or 5-year-old child is notfunctioning well in a typical preschool or day-care center and afterassessment is found eligible for placement in a special educationclassroom. The school district does not routinely provide instructionfor all preschoolers. The state funds a 3-hour-a-day program for4-year-old children who will be entering kindergarten the following yearthrough private preschools and day cares. The majority of preschoolchildren who are identified with mild to moderate special needs areplaced in self-contained special education classrooms in public schools.With the 2004 reauthorization of the Individuals With DisabilitiesEducation Improvement Act [IDEA), there is a concerted effort toincrease more natural placement opportunities, but the lack of fundingand well- trained personnel impact these placements. Composition of theSelf- Contained Class The reality is that the class by definition is entirely composed ofchildren with special needs. The children's needs range from mild tomoderate and may occasionally be severe in these settings. Many of thechildren are nonverbal or have very limited speech in addition to otherdevelopmental delays. There usually are no typical models forpreacademics, language, play, or child-to-child interaction. Typical isdefined as a child without special needs. Sometimes, a teacher will beable to include 1 or 2 children from the community to be "typicals" inthe self-contained classroom. These children generally have a parent whois on the faculty or has some connection to the school. Because ofincreasing numbers of children with disabilities being enrolled thatresults in large class sizes, this practice is disappearing. The schooldistrict is experiencing huge growth and there is not a limit on thenumber of children placed in a special education classroom. The districtdoes address the very large classes but lack of space, personnel, andfunds often leave the classes overcrowded. Some have as many as 16 or 17children with 2 adults. Most of these pre-K classrooms have as many as 8or 9 boys and only 1 or 2 girls. Disproportional Pattern Emerges The self-contained classrooms are in elementary schools across thedistrict. As this writer traveled throughout the district, more and moreclassrooms with ratios of at least 3 boys to 1 girl were noted. Oftenthere were much greater differences. As this pattern emerged, a simplecomparison analysis of the total number of pre-K self-containedclassrooms was done to discover if the initial impression ofdisproportionality was correct. Teachers were interviewed to determineif they were aware of the underrepresentation and to discover if theywere concerned about the effects of it on the girl or girls in theirclassrooms. The District's pre-K classes that serve children who are identified withmore intense needs are not included in this article. These children arecategorically labeled and placed in different separate self-containedclassrooms in regular public schools or center-based schools. Theirnumbers were not available. A future comparison study could prove to beinformative about the identification and representation of thesepopulations in special education. Earlier Study of Disproportionality Interestingly, Hayden-McPeak, Gaskin, and Gaughan (1993) conducted asimilar study that examined gender differences in enrollment, andassessment and educational practices in self- contained pre-K classroomsfor children with disabilities. The study was prompted by concern thatboys were being overidentified, and the researchers wanted to cautionteachers to be sure to teach to the boys* strengths and needs. Over a1-year period they tracked enrollment numbers and determined that boyswere being enrolled at a ratio of 2 boys to 1 girl. They stated thattheir findings match the national enrollment numbers at the time with aratio of 217 boys to 100 girls (Hayden-McPeak et al.). Their researchindicated that teachers pay more attention to boys than girls and theywere more likely to reinforce boys' interactions and initiations even ifthey were being disruptive (Hayden-McPeak et al.). The study concludedwith an admonition to teachers to be more aware of the boys' needs inthe classroom. Teachers were encouraged to have more male- orientedmaterials available and to play more in male-preferred centers such asblocks or cars and trucks. Although certainly there should be concern for overidentification, onecannot help but wonder how the girls fared in those classrooms when theywere outnumbered by 2 to 1, particularly if teachers were beingencouraged to teach to the boys' interests. Furthermore, if these ratioshave remained constant, this has meant girls have been underrepresentedin pre-K self-contained special education classrooms for the last 13years. One has to wonder if their needs have been addressed. That is not to say that teachers have ignored girls but the reality in abusy preschool classroom is that boisterous and more behaviorallychallenging boys will receive more attention. Certainly, this writerrecognizes that there are loud and boisterous girls who can advocate forthemselves but even this type of girl may be overwhelmed in apredominantly male class (Holmes-Lonergan, 2003; Maccoby, 1990). Composition of the Self-Contained Classes in the District Eighty-nine self-contained preschool special education classes forchildren with mild to moderate disabilities were analyzed for thisarticle. These classes were fairly evenly spread out through sevengeographic areas delineated within the district. Although this pre-Kprogram is not available in every elementary school, an effort was madeto place the children in schools closest to their homes or in aneighboring school that does have the program. Some of the schools mayhave two units of this particular special education program. A total of715 children are served in the program. Of the 715 children, 522 areboys and 193 are girls in 75 schools. The ratios throughout the areasvaried from as much as 3:1 to 2:1. For example, in 12 schools, therewere no girls enrolled. In 2 schools, the numbers were even. Girlsoutnumbered boys in three schools but only by one or two. It should be noted that these schools may include one or two typicalchildren in their programs, which may skew the numbers. It is importantto know that these enrollment numbers are not constant because childrenenroll throughout the school year as they reach their third birthday orare otherwise identified with special needs. The only pattern thatclearly emerged is that in most schools boys outnumber girls in theseclassrooms, consistent with the national numbers and with the study of13 years ago. A more detailed analysis would need to be done todetermine if cultural or socioeconomic factors play a role in theenrollment patterns of specific areas in the school district.Nevertheless, the confirmation of the underrepresentation of girls inthe preschool program makes it imperative to examine the effects of thelack of same gender role models for girls on their development ofsocial, language, and play skills. Interviews With Pre-K Teachers Interviews with pre-K special education teachers around the districtindicate their concern over the small number of girls enrolled in theirclasses. The teachers worry that the girls have a tendency to "mother"the boys because it is the only way they know how to interact. If thereare 2 girls in one class, they will play together regularly by choice.If girls from other classrooms visit, the pre-K girls are immediatelydrawn to them and form a single gender play group. They also revealedtheir worry and concern that the single girl in a classroom was lonely.This is not to say that the boys and girls do not play together. They doand their play is fun, engaging, and interactive within the confines ofthe environment. Boys and girls do choose to play together and willchoose a different gendered playmate but the paucity of girls takes awaythe choice to choose a female playmate (Alexander & Mines, 1994). Hence,one also has to wonder about how the lack of girls in the class may havean impact on the boys. It must change the quality, type, and activitylevel of play within the classroom (Alexander & Mines; HaydenMcPeak etal., 1993; Sanders & Harper, 1976). Impact on Play Although there is a growing body of research on play in typicalpreschoolers in typical environments, there is a paucity of research onthe play of children with disabilities in both typical andself-contained environments (Colwell & Lindsey, 2005; Freeman, 2007;Green, Bigler, & Catherwood, 2004; HolmesLonergan, 2003; Ostrov &Keating, 2004). Available research has shown that children preferplaymates of the same gender and usually find same gender playmates morecompatible (Alexander & Hines, 1994; Maccoby, 1990). Each gender alsodisplays preferences for play choices, type of play, and type of toys.Although there are individual differences in preference explained bypersonality type, the preferences run along gender lines. Awareness ofgender differences among children prompts their self-prescribedseparation into same-sex play groups (Hayden- McPeak et al., 1993;Maccoby). The reasons why the genders segregate themselves in play arenot completely understood or known. Some possible explanations includeseparation from boys as a protection, similar interests, similar verbalskills, or adult encouragement for accepted social behavior(HaydenMcPeak et at.J. Maccoby also postulated that girls may becautious of boys' active play styles which feature characteristics ofdominance and competition, and perhaps even more importantly, girls havedifficulty influencing the play scenario when boys are involved. Boyshave been found to be more likely to engage in solitary outdoor fantasyplay whereas girls engage in traditional roles of "house" and "school"(Sanders & Harper, 1976). Sanders and Harper also indicated that boysplay outdoors more, and are encouraged to engage in active, large motor,physically challenging play. Girls on the other hand are encouraged toplay quietly, be more dependent, and are acknowledged and reinforced fortheir communication attempts (HaydenMcPeak et al.). Turner (1991) foundthat certain forms of assertiveness and aggression in boys was not onlytolerated but encouraged. These same types of behavior were discouragedfor girls. These differences in preferences in terms of playmates and play stylesand adult expectations lead to the conclusion that a balance of genderin the classroom is necessary for the optimal development of socialskills (Colwell & Lindsey, 2005). This is particularly true for childrenwith disabilities who may have social skill delays and need every chanceavailable to practice those skills to minimize their delay. Previousresearch provided evidence that girls needed opportunities to choosesame gender playmates, encouragement to engage in rowdy, outdoor play,and to foster assertiveness and independence [Alexander & Mines, 1994J.They also need to be provided opportunities to explore and expandtraditional play roles of "house" and "school" into fantasy play rolesthat encourage greater use of their imaginations (Turner, 1991). Iftheir only knowledge of gender roles is mother or teacher, then girlsare limited as to the type of fantasy play in which they are able toengage. A girl's fantasy role model play may also go unnoticed or shemay be overwhelmed by the volume and number of boys in the classroomlike the girl in the vignette in this article's opening. In addition,her fantasy role model may be unfamiliar or even unknown in the morepopular lexicon of male superheroes in a predominantly male classroom.It is also highly likely that as the single girl, she will not have aleadership role in the classroom and will not determine play choices orplay scenarios during free play time (Colwell & Lindsey;Holmes-Lonergan, 2003; Maccoby, 1990). Although joining the boys'fantasy play is more socially acceptable for girls, the likelihood thatthe boys will follow a girl into girl fantasy play is negligible(Hayden-McPeak et al., 1993; Maccoby). For these very reasons, the lackof girls in a self- contained pre-K special education classroom may bedetrimental to the healthy development of social skills and interactiveplay for girls because of the limited opportunities for same-genderplaymates with similar interests (Colwell & Lindsey). Impact on SocialSkills Currently, there are a number of studies concerning social skilldevelopment. Research has shown that well-developed social skills aregood predictors of academic success (Gallagher & Lambert, 2006; Johnson,Ironsmith, Snow, & Poteat, 2000). Preschool teachers are beingencouraged to teach social skills through direct instruction to preparechildren for kindergarten. In an article on peer relationships inkindergarten and preschool, Johnson et al. stated that good socialskills are a predictor of adjustment in adulthood. In addition, sheclaimed that "children with good social skills who have more friends inpreschool make a better transition into kindergarten. Children's socialbehavior and peer relationships in preschool have a lasting effect ontheir social development as they enter grade school" (p. 209).Therefore, the isolation and limited social opportunities of girls inself-contained preschool special education may impact their socialdevelopment and may impede their academic success in elementary school. Impact on Language As a result of these limited social opportunities, the languagedevelopment of girls may be affected negatively. Male dominatedclassrooms reduce language development for girls because there is alimited number of female conversation partners and topics of interest togirls (Alexander & Hines, 1994). Maccoby (1990) found that boys were notresponsive to girls' verbal requests and that girls avoided interactionswith boys because of their nonresponsiveness. A single girl in a classof 9 or 10 boys has few opportunities to practice interactive languageskills. If similar play interests are valued by children of bothgenders, then similar verbal skills also can play a weight inestablishing and maintaining peer relationships. To promote languageusage, the girls need motivation to talk about topics that interestthem. Ideally, same-gender friends with good verbal skills would enhancethe language development of the girls in self-contained pre-K classes.Many of the children in these classes may be nonverbal. Often most ofthe talking in the room may be done by the adults. Adults prompt forlanguage usage and model language for the students. Although adults maymodel appropriate language, their use of language is not the same as achild's. Children need opportunities to talk with each other independentof adults (Johnson et al., 2000). In addition, boys and girls do notnecessarily use language in the same ways (Hayden-McPeak et al., 1993;Holmes-Lonergan, 2003). Despite limited verbal skills, the girls andboys do talk to each other to some degree in these classrooms. But iftheir skills are limited and their interests dissimilar, the chancesthat language usage will substantially increase and languages skillsimprove are minimal. Impact on Preacademics In a longitudinal study of preschoolers and academic outcomes, Dale,Jenkins, Mills, and Cole (2004) found that there was a significantcorrelation between social skills and academic skills, and that goodpeer relationships help to foster academic motivation. With minimalopportunities for peer relationships, girls will have difficultyestablishing strong enough bonds to mutually motivate each other towardacademic success. In another longitudinal study, Coutinho, Oswald, and Best (2006)followed the long-term outcomes for special education students. Coutinhoet al. found that girls were less likely to earn a high school diploma,more likely to be unemployed or to earn less if working, and more likelyto be a parent. Both Dale et al. (2004) and Coutinho et al, foundsimilar negative outcomes the longer any child was in special education.Dale et al.'s study revealed that extended time in special education canlead to poor academic achievement. These findings are certainly worthconsidering when thinking about preschool girls in self-containedspecial education classes. If long- term studies are beginning to revealnegative outcomes for children in special education, then efforts shouldbe made to limit the negative effects on girls who are underrepresentedin the classroom. Suggestions for Practice Teachers should know and value the individual differences andpreferences of each of their students. They should also be aware ofgender differences and preferences when reflecting on the composition oftheir classes. Teachers can incorporate opportunities that promoteinteraction within and between the genders in the daily schedule. Forexample, they can build on curricular themes and produce various playscenarios in center areas of the classroom. Ideas include setting up aveterinary clinic in the housekeeping area in a theme about animals or abeauty parlor in a theme about community helpers. Promoting and buildingon interactions in these play scenarios will help both boys and girlsfunction more competently in various social settings (Holmes-Lonergan,2003). A study by Green et al. (2004) suggested using stories in whichchildren are engaged in counterstereotypic play to promote cross- genderplay. Teachers could expand on their suggestions by engaging thechildren in cross gender discussions and activities. When facilitatingplay, teachers can create play scenarios that allow for girls to be inleadership roles in balance with the boys. By promoting cross-genderplay, the girls will have increased opportunities to develop theirlanguage and social skills. If girls are overwhelmingly outnumbered intheir classrooms, teachers can look for friendships within the schoolcommunity by collaborating with other teachers who may welcome the samefor their students. Communicating the value of friendship t andsame-gender peer experiences to parents may encourage them to plan playdates in their neighborhoods. Conclusion The underrepresentation of girls in preschool self-contained specialeducation classes results in social isolation and places the girls atrisk for appropriate language, social, academic, and play skills. Theplacement also limits their opportunities to establish same-gender peerrelationships that help to promote prosocial behavior and futureacademic success. Teachers need to be sure to teach to all of thelearning styles in their classrooms and to promote social interactionsbetween both genders to help alleviate the lack of same-genderopportunities for girls. Preschool girls with disabilities need to be encouraged to creativelyexplore their fantasies in an effort to reach their full potential.Given the opportunities to express themselves, not only would"Tinkerbell" take flight and soar through her preschool experience but awhole new generation of female superheroes would capture theimaginations of children everywhere. Research is beginning to closely examine the identification of schoolage girls with disabilities and the effect of being placed in classroomsthat have predominantly boys. On a regular basis, preschool girls identified with special needs arebeing paced in self-contained classes where there they may be the onlygirl. Little thought is given to the composition of the class because thefocus is on the individual child. To promote language usage, the girls need motivation to talk abouttopics that interest them. Teachers can incorporate opportunities that promote interaction withinand between the genders in the daily schedule. References Alexander, G, M., & Hines, M. (1994). Gender labels and play styles:Their relative contributions to children's selection of playmates. ChildDevelopment, 65, 869-879. American Association of University Women. (2006). Women and girls withdisabilities. Retrieved October 15, 2007, from http://www.aauw.org/advocacy/issue_advocacy/actionpages/disabilities.cfm Colwell, M. J., & Lindsey. E. W. (2005). Preschool children's pretendand physical play and sex of play partner: Connections to peercompetence. Sex Roles, 52, 497-509. Coutinho, M. J., Oswald, D. P., & Best, A. M. (2006). Differences inoutcomes for female and male students in special education. CareerDevelopment for Exceptional Individuals, 29, 48-59. Dale, P. S.,Jenkins, J. R., Mills, P. E., & Cole, K. N. (2004). When paths diverge:"Errors of prediction" from preschool test scores to later cognitive andacademic measures. Journal of Special Education, 37, 237-248. Freeman, N. K. (2007). Preschoolers' perceptions of gender appropriatetoys and their parents' beliefs about genderized behaviors:Miscommunication, mixed messages or hidden truths? Early ChildhoodEducation Journal, 34, 357-366. Gallagher, J. (2006), Driving change in special education. Baltimore:Brookes. Gallagher, P. A., & Lambert, R. G. (2006). Classroom quality,concentration of children with special needs and child outcomes in HeadStart. Exceptional Children, 73, 31-52. Green, V. A., Bigler, R., & Catherwood, D. (2004). The variability andflexibility of gender-typed toy play: A close look at children'sbehavioral responses to counterstereotypic models. Sex Roles, 51,371-386. Hayden-McPeak, C., Gaskin, S. T., & Gaughan, L. K. (1993, April). Badboys, good girls: A review of the research on gender differences inpreschoolers and a reexamination of assessment, child rearing, andeducational practices. Paper presented at the Annual Convention of theCouncil for Exceptional Children, San Antonio, TX. Holmes-Lonergan, H. A. (2003). Preschool children's collaborativeproblem-solving interactions: The role of gender, pair type and task.Sex Roles, 48, 505-517. Johnson, C., Ironsmith, M., Snow, C. W., & Poteat, G. M. (2000). Peeracceptance and social adjustment in preschool and kindergarten. EarlyChildhood Education Journal, 27, 207-212. Maccoby, E. E. (1990). Gender and relationships. American Psychologist,45, 513-520. McGrady, H., Lerner, J., & Boscardin, M. L. (2001). The educationallives of students with learning disabilities. In P. Rodis, A. Garrod, &M. Boscardin (Eds.), Learning disabilities and life stories (pp.177-193). Needham Heights, MA: Allyn & Bacon. Ostrov, J., & Keating. C. F. (2004). Gender differences in preschoolaggression during free play and structured interactions: Anobservational study. Social Development, 13, 255-277. Oswald, D. P., Best, A. M., Coutinho, M. J., & Nagle, H. A. L. (2003).Trends in the special education identification rates of boys and girls:A call for research and change. Exceptionality, 11, 223- 237. Sanders, K. M., & Harper, L. V. (1976). Freeplay fantasy behavior inpreschool children: Relations among gender, age, season and location.Child Development, 47, 1182-1185. Turner, P. J. (1991). Relations between attachment, gender and behaviorwith peers in preschool. Child Development, 62, 1475-1488. Jeanne S. Manwaring (CEC FL Federation), Pre-K Exceptional StudentEducation (ESE) District Resource Teacher, Hillsborough County PublicSchools, Tampa, Florida and Doctoral Student, Department of SpecialEducation, University of South Florida, Please address correspondence toJoanne S. Manwaring, 6507 Seabird Way, Apollo Beach, FL 33572 (e-mail:Joanne.Manwaring@sdhc.k12.fl.us). TEACHING Exceptional Children, Vol. 40, No. 5, pp. 60-65. Copyright 2008 CEC. Copyright Council for Exceptional Children May/Jun 2008 (c) 2008 Teaching Exceptional Children. Provided by ProQuest Informationand Learning. All rights Reserved.Source: Teaching Exceptional Children

Common Q&A's ABOUT EXTENDED SCHOOL YEAR PROGRAMS AND SERVICES

QUESTIONS AND ANSWERS

1. Who is eligible for extended school year programs and services? The Committee on Special Education (CSE) must determine whether astudent requires extended school year special education services inorder to prevent substantial regression. Substantial regression would beindicated by a student's inability to maintain developmental levels dueto a loss of skill, set of skill competencies or knowledge during themonths of July and August. In accordance with Section 200.6 (j) of theCommissioner's Regulations, students must be considered for twelve-monthspecial services and/or programs to prevent substantial regression ifthey are:* Students whose management needs are determined to be highlyintensive and require a high degree of individualized attention andintervention and who are placed in special classes;* Students with severe multiple disabilities, whose programsconsist primarily of habilitation and treatment and are placed inspecial classes;* Students who are recommended for home and/or hospitalinstruction whose special education needs are determined to be highlyintensive and require a high degree of individualized attention andintervention or who have severe multiple disabilities and requireprimarily habilitation and treatment; students whose needs are so severethat they can be met only in a seven-day residential program; or* Students receiving other special education services who, becauseof their disabilities, exhibit the need for twelve-month special serviceand/or program provided in a structured learning environment of up to 12months duration in order to prevent substantial regression. Both quantitative and qualitative information should be reviewed by theCSE to substantiate the need for providing such services and programs. Astudent is eligible for a twelve-month service or program when theperiod of review or reteaching required to recoup the skill or knowledgelevel attained by the end of the prior school year is beyond the timeordinarily reserved for that purpose at the beginning of the schoolyear. The typical period of review or reteaching ranges between 20 and40 school days. As a guideline for determining eligibility for anextended school year program, a review period of eight weeks or morewould indicate that substantial regression has occurred.

2. What is the CSE's obligation to provide integrated extendedschool year programs and services for students whose IndividualizedEducation Programs (IEPs) must be implemented in integrated settings inorder for the student to benefit from the special education servicesneeded to prevent substantial regression?If a student's IEP specifies that special education services must beprovided in a setting with nondisabled peers in order for the student tobenefit from the special education services to prevent substantialregression, and the school district operates summer programs fornondisabled students, then the school district must provide methods formeeting the Least Restrictive Environment (LRE) requirements thatinclude, but are not limited to:* locating special classes in settings where nondisabled childrenattend during the summer; and* having students with disabilities interact with theirnondisabled peers to the greatest extent possible duringnon-instructional parts of the school day (e.g., during lunchtime forstudents attending full-day 9000 special classes).However, if a student's IEP specifies that special education servicesmust be provided in a setting with nondisabled peers in order for thestudent to benefit from the special education services to preventsubstantial regression, and the school district does not operate summerprograms for nondisabled students, then the school district must providealternative methods for meeting the Least Restrictive Environment (LRE)requirements. These include:* providing opportunities for participation (even part-time) inother summer programs operated by the school district or those availablein a neighboring district and in programs operated by BOCES;* providing special education services to students in approvedsummer school programs for nondisabled children that integrate childrenwith disabilities;* locating special classes in settings where nondisabled childrenattend during the summer; and* providing special education services to students in settingsthat the parent has arranged and pays for the child to attend. The CSEmust determine whether the student's IEP goals can be appropriately metat the setting identified by the parent and the district must ensurethat such programs are approved by a governmental agency to operate asummer program, and approved by local authorities for fire, health andsafely requirements.

3. Must the IEP for the extended school year program be identicalto the IEP developed for the school year program?An IEP developed for an extended school year program may differ from theIEP developed for the school year program. The Committee determines thetype and amount of services that a student needs for an appropriateextended school year program. The IEP developed for the extended schoolyear program should focus on the areas in which the student is expectedto experience regression. Extended school year programs or services may, at the recommendation ofthe CSE, be provided in a location that differs from one in which thestudent attends during the school year, provided that the CSE determinesthat the setting is appropriate for the student to benefit from thespecial education services and meet their IEP goals.

4. What programs and services can be recommended for July-August? A Committee should first determine if a student with a disability iseligible for an extended school year program. The IEP for theJuly-August program should indicate those areas where the student needsservices to prevent substantial regression. While some students withdisabilities require a continuation of their full-day 10-month programs,others may only require services in specified areas of development toprevent substantial regression. In order to provide the specific programs and services to meet thestudent's needs, a variety of program options can be considered. A CSEmay recommend any one of the following special education programs andservices as determined appropriate to the needs of the individualstudent:* related services at a site determined by the CSE including, butnot limited to, an approved summer school program*<http://www.vesid.nysed.gov/specialed/applications/esy/qa2008.htm#_ftn1>recreational program, or the student's home; or * specialized instruction in combination with related services asappropriate, provided by a certified special education teacher at a sitedetermined by the CSE including, but not limited to, an approved summerschool program, a community recreational or educational program, or thestudent's home; or * full or half-day**<http://www.vesid.nysed.gov/specialed/applications/esy/qa2008.htm#_ftn2>daily instruction in special class programs which may include relatedservices. (Home or hospital instruction may be required by some students inaccordance with Section 200.6 of the Regulations of the Commissioner.)

5. What is the required length of time that extended school yearprograms and services must be provided? The approved program providing half-day or full-day special classinstruction must operate for at least 30 days. However, the frequencyand duration of the special education programs and services provided toan individual student would be determined by the CSE and could be lessthan 30 days in duration.

6. If the CSE recommends the provision of specialized instructionand/or related services to be provided at summer recreational oreducational program in which the parent has enrolled the students, whois responsible for the fees to enroll the student in the program? Camping and recreational programs are not to be construed as extendedschool year special education programs and related services. Whilespecial education services identified on a student's IEP must be madeavailable as part of a free appropriate public education (FAPE), schooldistricts are not required to pay for the enrollment and other fees atsummer recreational or nonapproved educational programs in which theparents have enrolled their school-aged child. FAPE is defined asspecial educational related services that are provided at public expensein conformity with a student's IEP.

7. If a local school district recommends an appropriate integratedextended school year program for a student with a disability and theparent unilaterally places the student in another setting such as asummer camp program, must the school district make services available atthe other setting?No. The school district would have the option of providing therecommended extended school year program or making the servicesavailable at another setting.

8. Who can provide specialized instruction to students receivingextended school year services in settings other than approved specialclass programs? Specialized instruction can be provided by an appropriately certifiedspecial education teacher as a special education itinerant teacherservice and, in certain circumstances, as a consultant teacher service.For example, if specialized instruction is to be provided at the site ofa summer camp or recreational program or nonapproved educational programat which a student's parents/guardians have enrolled their child, theCSE could recommend specialized instruction provided by a specialeducation itinerant teacher.Some students who are eligible for extended school year services may bereceiving consultant teacher services during the school year to aid themin benefiting from regular education classes. Consultant teacherservices means direct and/or indirect services provided to a studentwith a disability who attends general education classes on a full-timebasis and/or to such student's general education teachers. In individualcases, it may be appropriate to continue consultant teacher services forthose students who attend approved summer school programs (8NYCRR 110).

9. Must transition services be provided as an extended school yearservice? For some students with disabilities, ages 15-21, transition services maybe required to prevent substantial regression. These activities mayinclude instruction, community experiences, related services,preparation for employment or other post-school living objectives and,when appropriate, the acquisition of adult daily living skills orfunctional vocational evaluation. A school district may establish formalagreements with other programs to obtain transition services such asvocational training programs approved by the Education Department oranother State agency.

10. What is the role of the paraprofessional in providing extendedschool year services? A teacher aide or a teaching assistant recommended on a student's IEPcan be provided only if a certified teacher provides the specialeducation instruction and the required supervision of theparaprofessional. Teacher aides may assist a certified teacher byperforming non-teaching duties otherwise performed by teachers (e.g.,assist students with behavioral/management needs, assist in physicalcare tasks). Persons hired as teacher aides may not perform the teachingduties of a general or special education teacher, even if they hold ateaching license or certificate.A teaching assistant may provide direct instructional services tostudents under the general supervision of a certified teacher. However,the duties and responsibilities of a teaching assistant do not includeacting as a primary instructor. As appropriate, a consultant teacher orspecial education itinerant teacher providing direct instructionalservices to a student could provide the required on-site supervision***<http://www.vesid.nysed.gov/specialed/applications/esy/qa2008.htm#_ftn3>of a teaching assistant for a student enrolled in a summer schoolprogram, a summer camp or a community recreation or education program.General supervision requires that certified teachers provide directionand guidance to teaching assistants concerning the direct instructionalservices they are providing to students.

11. Can the school district apply for reimbursement of the cost of ageneral education teacher employed by a public school or BOCES as aspecial education cost for services provided in an integrated setting?No. The school district will receive reimbursement only for the cost ofspecial education services provided by appropriately licensed orcertified staff to a student during the months of July and August. Forstudents attending approved summer school programs following Part 110 ofthe Regulations of the Commissioner, the district may include thestudent's attendance for purposes of State Aid.

12. How can the school district apply for State Aid reimbursementfor the provision of related services only or specially designedinstruction provided during extended school year programs?The Department is authorized to approve programs and to establish ratesfor all special services and programs provided during July/August, bothpublic and private. Therefore, any school district or agency that plansto operate a July/August program must first apply to the Department forapproval. Applications for programs serving school-age students can beobtained by going to:http://www.vesid.nysed.gov/specialed/applications/home.html. Foradditional technical assistance regarding the July/August extendedschool year application process, please call the Office of VESID/CentralOffice Administrative Support Services Team (COASST) at (518) 473-6108.Funding approval must be granted through the System to Account forChildren (STAC) for each eligible student who is to receive specialeducation and/or related services during July and August in order fordistricts to receive the correct amount of State Aid under Section 4408of the NYS Education Law. Questions regarding the filing of STAC formsmay be directed to the STAC and Special Aids Unit at (518) 474-7116.*<http://www.vesid.nysed.gov/specialed/applications/esy/qa2008.htm#_ftnref1> Approved summer school programs are those elementary, secondary andBOCES general education programs approved in accordance with Part 110 ofthe regulations of the Commissioner of Education.**<http://www.vesid.nysed.gov/specialed/applications/esy/qa2008.htm#_ftnref2> STAC forms for school-age students enrolled in a special class on ahalf-day basis should indicate half-time in item 11b.***<http://www.vesid.nysed.gov/specialed/applications/esy/qa2008.htm#_ftnref3> A certified teacher must provide periodic on-site generalsupervision of the paraprofessional. A paraprofessional may provideservices related to a student's IEP at times when the teacher is not atthe program site. However, the supervision must be accessible to theparaprofessional by telephone or other means during the time whenon-site supervision is not occurring at the program.

Are Anxiety Disorders All in the Mind?

Are Anxiety Disorders All in the Mind?

Researchers Find Link Between Altered Dopamine Activity and Social Anxiety Disorder According to an Article in The Journal of Nuclear Medicine
Reston, Va.—Using single-photon emission computed tomography (SPECT), researchers in The Netherlands were able to detect biochemical differences in the brains of individuals with generalized social anxiety disorder (also known as social phobia), providing evidence of a long-suspected biological cause for the dysfunction.
The study, which was reported in the May issue of the Journal of Nuclear Medicine, compared densities of elements of the serotonin and dopamine neurotransmitter systems in the brains of 12 people diagnosed with social anxiety disorder, but who had not taken medication to treat it, and a control group of 12 healthy people who were matched by sex and age.
Both groups were injected with a radioactive compound that binds with elements of the brain's serotonin and dopamine systems. Once administered, the radiotracer revealed functional alterations in these systems by measuring the radioactive binding in the thalamus, midbrain and pons (known to be acted upon by serotonin) and in the striatum (known to be acted upon by dopamine). The altered uptake activity in these regions indicated a greater level of disordered function.
"Our study provides direct evidence for the involvement of the brain's dopaminergic system in social anxiety disorder in patients who had no prior exposure to medication," said Dr. van der Wee, M.D., Ph.D., at the department of psychiatry and the Leiden Institute for Brain and Cognition at the Leiden University Medical Center, Leiden (and previously at the Rudolf Magnus Institute of Neuroscience, University Medical Center in Utrecht, The Netherlands). "It demonstrates that social anxiety has a physical, brain dependent component."
Serotonin and dopamine (neurotransmitters, or substances responsible for transferring signals from one neuron to another) act upon receptors in the brain. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts to normal social situations, leading to anxiety.
Other neuroimaging studies have shown abnormalities in glucose and oxygen consumption in the brain, according to van der Wee, who also points to causality as an additional issue. "Most of the people involved in these earlier studies were known to be already suffering from the disorder, so we do not know if the abnormalities were present before the onset of the disorder," he said.
Based on earlier studies, some researchers have suggested that social anxiety disorder is a result of the interplay between a genetic or acquired biological vulnerability and environment. More recent research has indicated that social anxiety disorder might be related to an imbalance of the neurotransmitter serotonin. This is the first time the brain's dopaminergic system was examined directly.
"Although there are no direct implications for treatment as a result of this study yet, it is another piece of evidence showing biological abnormalities, which may lead to new therapeutic approaches and insight into the origins of the disorder," said Dr. van der Wee.
According to the National Institute of Mental Health, social anxiety disorder affects approximately 15 million American adults and is the third most common mental disorder in the United States, after depression and alcohol dependence. The essential feature of the disorder is the fear of being evaluated by others, with the expectation that such an assessment will be negative and embarrassing. It tends to run a chronic and unremitting course and often leads to the development of alcoholism and depression. The disorder most often surfaces in adolescence or early adulthood, but it can occur at any time, including childhood.
Co-authors of "Increased Serotonin and Dopamine Transporter Binding in Psychotropic Medication-Naïve Patients With Generalized Social Anxiety Disorder Shown by 123-I-β-(4-Iodophenyl)-Tropane SPECT" include J. Frederieke van Veen, Irene M. van Vliet, Herman G. Westenberg, Department of Psychiatry; and Henk Stevens, Peter P. van Rijk, Department of Nuclear Medicine, all from the Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
To obtain a copy of this article—and online access to the Journal of Nuclear Medicine—please contact Kathryn Wiley at (703) 326-1184 or send an e-mail to kwiley@snm.org. Current and past issues of the Journal of Nuclear Medicine can be found online at jnm.snmjournals.org. Print copies can be obtained by contacting the SNM Service Center, 1850 Samuel Morse Drive, Reston, VA 20190-5316; phone (800) 513-6853; e-mail servicecenter@snm.org; fax (703) 708-9015. A subscription to the journal is an SNM member benefit.

About SNM—Advancing Molecular Imaging and TherapySNM is an international scientific and professional organization of more than 16,000 members dedicated to promoting the science, technology and practical applications of molecular and nuclear imaging to diagnose, manage and treat diseases in women, men and children. Founded more than 50 years ago, SNM continues to provide essential resources for health care practitioners and patients; publish the most prominent peer-reviewed journal in the field (The Journal of Nuclear Medicine); host the premier annual meeting for medical imaging and sponsor research grants, fellowships and awards. SNM members have introduced and continue to explore biological and technological innovations in medicine that noninvasively investigate the molecular basis of diseases, benefiting countless generations of patients. For more information visit www.snm.org.

Related Items
JNM article: "Increased Serotonin and Dopamine Transporter Binding in Psychotropic Medication-Naïve Patients With Generalized Social Anxiety Disorder Shown by 123-I-β-(4-Iodophenyl)-Tropane SPECT"
Figure 1: Binding ratios for 5-HTT in left and right thalamus
Figure 2: Binding ratios for DAT in striatum