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Home - CA Department of Developmental Services

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https://mchcinc.org/services/well-woman-care/

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Several studies have shown an increased risk for cognitive disorders (e.g., memory loss), mental illness, or psychological disorders among people with FASDs.

The most frequently diagnosed disorders are:

Attention problems, including attention-deficit/hyperactivity disorder (ADHD)

Conduct disorder (aggression toward others and serious violations of rules, laws, and social norms)

Alcohol or drug dependence

Depression

Anxiety

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Centers for Disease Control and Prevention

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Fetal alcohol spectrum disorders (FASDs) often lead to other disorders, called "secondary conditions." A person is not born with a secondary condition, but might develop one as a result of having an FASD. These conditions can be improved or prevented with appropriate treatments for children and adults with FASDs and their families.

Following are some of the secondary conditions that have been found to be associated with FASDs.

Common Mental Health Conditions

Several studies have shown an increased risk for cognitive disorders (e.g., memory loss), mental illness, or psychological disorders among people with FASDs.

The most frequently diagnosed disorders are:

Attention problems, including attention-deficit/hyperactivity disorder (ADHD)

Conduct disorder (aggression toward others and serious violations of rules, laws, and social norms)

Alcohol or drug dependence

Depression

Anxiety

Other psychiatric problems, such as eating disorders and posttraumatic stress disorder, also have been reported for some patients.

Disrupted School Experience

Children with FASDs are at a higher risk for being suspended, expelled, or dropping out of school. Difficulty getting along with other children, poor relationships with teachers, and truancy are some of the reasons that lead to their removal from the school setting. Many children with FASDs remain in school but have negative experiences because of their behavioral challenges.

In a 2004 study, disrupted school experience was reported for 14% of school children and 61% of adolescents and adults with FASDs. About 53% of the adolescents with FASDs had been suspended from school, 29% had been expelled, and 25% had dropped out.

Trouble with the Law

Teenagers and adults with FASDs are at a higher risk for having encounters with police, authorities, or the judicial system. Difficulty controlling anger and frustration, combined with problems understanding the motives of others, result in many people with FASDs being involved in violent or explosive situations. People with FASDs can be very easy to persuade and manipulate, which can lead to their taking part in illegal acts without being aware of it or being victims of crimes. Trouble with the law is reported overall for 14% of children and 60% of adolescents and adults with FASDs.

Inappropriate Sexual Behavior

People with FASDs are at higher risk for showing inappropriate sexual behavior, such as unwanted advances and inappropriate touching. If the person with an FASD is also a victim of violence, the risk of participating in sexually inappropriate behavior increases. Inappropriate sexual behaviors increase slightly with age from 39% in children to 48% in adolescents and 52% in adults with FASDs.

Alcohol or Drug Dependence

Studies suggest that more than a third of people with FASDs have had problems with alcohol or drugs, with more than half of them requiring inpatient treatment.

Dependent Living and Problems with Employment Over 21 Years

Adults with FASDs generally have difficulty sustaining employment or living independently in their communities.

References

1. Streissguth, A.P., Bookstein, F.L., Barr, H.M., Sampson, P.D., O'Malley, K., Young, J.K. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics. 2004;5(4):228-238.

2. Streissguth, A.P., Barr, H.M., Kogan, J. & Bookstein, F. L., 'Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE),' Final Report to the Centers for Disease Control and Prevention (CDC), August, 1996, Seattle: University of Washington, Fetal Alcohol & Drug Unit, Tech. Rep. No. 96-06, (1996).

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Fetal alcohol spectrum disorders (FASDs) often lead to other disorders, called "secondary conditions." Secondary conditions are problems that a person is not born with, but might get

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Although attention deficit hyperactivity disorder (ADHD) is diagnosed in up to 94% of individuals who experienced heavy prenatal alcohol exposure, the exact relationship between FASD and ADHD is still unclear.

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Abstract

Fetal alcohol spectrum disorders (FASD) are the physical and neurodevelopmental outcomes of fetal alcohol exposure. The behavioral phenotype of children with FASD includes difficulties with executive function, memory, planning, processing speed, and attention. Although attention deficit hyperactivity disorder (ADHD) is diagnosed in up to 94% of individuals with heavy prenatal alcohol exposure, the exact relationship between FASD and ADHD is unclear. There is some evidence that ADHD in FASD may be a specific clinical subtype and thus may require a different treatment approach. Although traditional behavioral observation scales may not distinguish between the two groups, there is evidence that children with FASD have a different profile on the four-factor model of attention than children with ADHD who do not have FASD. There is a paucity of good scientific evidence on effective interventions for individuals with ADHD and FASD. There is weak evidence that children with FASD and ADHD may have a better response to dexamphetamine than methylphenidate. There is a strong need for larger, high quality studies to examine the relationship between ADHD and FASD and identify effective treatments because management of inattention and hyperactivity may improve learning and ameliorate the common secondary disabilities associated with FASD.

Keywords: fetal alcohol spectrum disorders, attention deficit hyperactivity disorder

Introduction

Disruptive, hyperactive, and impulsive behaviors are highly prevalent in individuals with fetal alcohol spectrum disorders (FASD).1 In this paper we discuss the relationship between attention deficit hyperactivity disorder (ADHD) and FASD. Firstly, we define ADHD and FASD and review the epidemiology of these conditions. Then we discuss the rationale for distinguishing between ADHD with and without FASD and review the evidence regarding the relationship between ADHD and FASD. Finally, we discuss the approach to diagnosis and management of ADHD in individuals with FASD.

Attention deficit hyperactivity disorder

ADHD may be thought of as a group of conditions with similar behavioral symptoms consequent to different etiologies.2 ADHD is defined as a persistent pattern of behavior including hyperactivity and impulsivity, and/or inattention that is more severe and frequent than is usually seen in an individual at the same stage of development. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) defines three subtypes, ie, a combined type which includes symptoms of inattention and hyperactivity or impulsivity, a predominantly inattentive type, in which hyperactive and impulsive symptoms are minor, and a predominantly hyperactive-impulsive type, in which inattentive symptoms are minor.3 The subtypes may be discontinued in DSM-5.4 The mean intelligence quotient (IQ) score and IQ distribution in the ADHD population are similar to that in the general population.2,5 ADHD is a neurobiologic disorder with genetic and environmental origins. Family, adoption, and twin studies demonstrate a strong genetic contribution to ADHD, which involves polymorphisms in a number of genes, such as those which code for dopamine transporters. Environmental risk factors for ADHD include antenatal exposure to toxins, such as alcohol and tobacco, prematurity, adverse childhood experiences, childhood illness, head trauma, and exposure to environmental toxins.3 The heterogeneity of ADHD may be explained partially by the varying contribution of genes and environmental factors for individual children. ADHD is reported in all ethnic groups and social classes. The prevalence of ADHD in children in the general population ranges from 5% to 11%.3,6

Fetal alcohol spectrum disorders

Fetal alcohol syndrome (FAS) was first described in 1973,7 but descriptions of the effects of alcohol exposure during pregnancy date back to ancient history.8 FASD is a nondiagnostic umbrella term for the possible childhood outcomes of prenatal alcohol exposure. FASD includes FAS, partial FAS, alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects. Individuals with FAS have specific facial features (including short palpebral fissures, flat philtrum, and thin upper lip), impaired prenatal and/or postnatal growth, and structural or functional problems of the central nervous system. If all of these features are present and differential diagnoses are excluded, the diagnosis of FAS can be made even if alcohol exposure during pregnancy is not confirmed. Individuals with partial FAS have most, but not all, the features of FAS. Individuals with ARND have a complex pattern of behavioral and/or neurologic impairment without the physical features of FAS. Fetal alcohol effects (FAE) is an obsolete term previously used to describe individuals with incomplete features of FAS. The facial features of FAS occur with fetal alcohol exposure early in the first trimester, but neuropsychologic deficits may occur independent of the physical features of FAS.9 In FAS, IQ scores are reported to range from 20 to 120 with an average IQ score between 68 and 72. Individuals with ARND have a slightly higher IQ than individuals with FAS.2 Internationally, several diagnostic approaches to FASD have been proposed. Although the diagnostic criteria and terminology used differ only slightly, the use of different approaches is confusing and makes comparison of study results difficult.10⁻13 The estimated prevalence of FAS is 0.5-2.0 per 1000 births, although a prevalence of up to 68 per 1000 has been reported in some high-risk communities.14,15 The prevalence of the other FASD diagnoses is not well defined, but it is estimated that FASD affects 1% of all births in the US.14

Many studies have focused on defining the behavioral phenotype of FASD to assist diagnosis and intervention. Individuals with FASD frequently display deficits in executive functioning, memory, attention, visual-spatial abilities, planning, cognitive flexibility, processing speed, inhibition and inhibition/switching, deductive reasoning and verbal abstract thinking, problem solving, verbal and spatial concept formation, phonemic switching and phonologic working memory, and motor skills.16,17 Executive function deficits are present in individuals with FASD whether or not they have FAS.18,19 Older children with FASD are more impaired than younger children on verbal processing tasks.17 These deficits may contribute to lower IQ scores, poor academic achievement, and learning problems.17 Long-term studies show that adolescents and young adults with FASD have high rates of secondary disabilities including mental health problems (90%), inappropriate sexual behavior (49%), disrupted school education (60%), and trouble with the law (60%). More than one third experience drug and alcohol problems.20 These secondary disabilities may arise from the neurobehavioral deficits caused by prenatal alcohol exposure, with exacerbation or amelioration by environmental factors.9

Attention and hyperactivity problems in FASD

Children with FASD are often described as hyperactive, distractible, and impulsive, with short attention spans.21 ADHD is the most commonly reported mental health diagnosis in individuals with prenatal alcohol exposure.1,22 The prevalence of ADHD (diagnosed according to DSM-IV criteria) in children with heavy prenatal alcohol exposure is between 49.4% and 94%.1,22 Unfortunately, prevalence studies have included children with heavy prenatal alcohol exposure (variously defined), with and without a diagnosis of FASD, hence the wide prevalence range. However, the prevalence of ADHD in cohorts with FASD is consistently much higher than that in the general population. The proportion of children with a diagnosis of ADHD who also have FASD is not known and will be influenced by underdiagnosis of FASD. Underdiagnosis occurs due to a variety of factors, including health professionals' reluctance to ask about alcohol exposure in pregnancy or to make a diagnosis due to lack of knowledge or fear of stigmatizing the child.23⁻25 The proportion of children with FAS diagnosed with ADHD increases with the level of alcohol exposure.1 Attention deficit in individuals with FASD is independent of IQ and persists into adolescence and adulthood.22,26,27 Inattention symptoms are more commonly reported in children with FASD who meet DSM-IV criteria for ADHD, than in children with ADHD who do not have FASD.28

Rationale for distinguishing between ADHD and FASD

The prognosis and treatment responses for children with ADHD and FASD differ to those of children with ADHD alone. Children with FASD often present with early onset ADHD with predominant inattentive symptoms.6 They are at high risk of secondary disabilities, which can be ameliorated by early diagnosis of FASD and management of its symptoms, especially if diagnosis is before the age of six years. The reason for the improved prognosis is unclear because there are few specific interventions for children with FASD, but it may relate to improved understanding and appropriate expectations of the children by their caregivers and teachers.20

Individuals with FASD may respond differently to stimulant medication than other children with ADHD. Specifically, children with FASD appear to have a differential response to methylphenidate and dexamphetamine. In a case series of 30 children with FASD and ADHD, 22% (of 23 children) responded to methylphenidate, while 79% (of 19 children) responded to dexamphetamine. Of the children given both medications, eight did not respond to methylphenidate but later responded to dexamphetamine, one child did not respond to dexamphetamine but later responded to methylphenidate, and three children did not respond to either medication.29 The apparently increased response rate to dexamphetamine may be explained by animal work showing that rats who were prenatally exposed to alcohol and had physical hyperactivity showed "hyperresponsiveness" to methylphenidate and that alcohol exposure acts on the D ₁ dopamine receptors of the mesolimbic system, which is the site of action of dexamphetamine.6,30,31 Decreased effectiveness of methylphenidate in animal and human studies suggests that the front nigrostriatal pathway may not be the mechanism in patients with FASD and comorbid ADHD.6

ADHD and FASD

There may be multiple pathways to the coexistence of ADHD symptoms and FASD, so there may be different subsets of ADHD and FASD.6,32 The relationship between ADHD and FASD may be coincidental because ADHD is a common disorder affecting up to 11% of children in the general population. Adults with ADHD are more likely to drink alcohol, thus pregnant women with ADHD who drink alcohol during pregnancy may genetically transmit ADHD to their offspring.6

There may be common etiological pathways to ADHD and the behavioral phenotype of FASD. Alternatively, acquired ADHD secondary to prenatal alcohol exposure may be due to the effect of alcohol on the developing dopamine transmitter system. These two hypotheses are supported by changes in the neurochemistry seen in animal studies of fetal alcohol exposure in which deficits have been found in most neurotransmitter systems, including the dopaminergic, noradrenergic, serotonergic, cholinergic, glutaminergic, gamma aminobutyric acid (GABA)-ergic, and histaminergic systems. Deficits in noradrenergic and dopaminergic systems are the most likely ones to be related to the ADHD symptoms seen in animals with prenatal alcohol exposure. The D ₁ receptors of the mesolimbic dopamine system tend to be affected by alcohol exposure more than other dopamine systems.6

Some studies support the idea that ADHD in FASD is a particular clinical subtype with earlier onset, a different clinical and neuropsychologic profile, and a different response to psychostimulant medications. The Seattle Longitudinal Prospective Study suggests that infants with a history of prenatal alcohol exposure have an infant regulatory disorder and temperament disturbance which precede the diagnosis of ADHD. Research has shown that animals with prenatal alcohol exposure have an exaggerated response to psychostimulants, which is mediated by age, gender, and drug dosage. There is evidence suggesting that individuals with FASD and ADHD have a better response to dexamphetamine than methylphenidate. Patients, such as those with FASD, who have neurochemical or structural changes in the central nervous system are often hypersensitive to the effects and side effects of medication, and psychostimulant response in these patients may improve with age.6

Adaptive behavior

Adaptive function is the ability to meet developmentally appropriate expectations of personal independence and social responsibility, including performance of everyday tasks, and adapt to changes in the environment.33 Adaptive behavior is affected in both FASD and ADHD. Using the Vinelands Adaptive Behavior Scale, three groups were compared, ie, children with heavy prenatal alcohol exposure, children with ADHD, and normally developing children. Children with prenatal alcohol exposure and children with ADHD had significantly lower scores on the communication domain than controls and, in the prenatal alcohol exposure group, age was negatively associated with score. Children in the prenatal alcohol exposure and ADHD groups had significantly lower scores on daily living skills, but the prenatal alcohol exposure group had significantly lower scores than the ADHD group. Children in the prenatal alcohol exposure and ADHD groups had significantly lower scores on socialization, but did not differ from each other. Again, age was negatively associated with the scores in the prenatal alcohol exposure group. Within the FASD group, children scored best in daily living skills and scored worst on socialization and communication domains. They demonstrated increasing adaptive behavior deficits with age. The children with ADHD had difficulty with socialization skills and their adaptive behavior skills improved with age. Overall, children in the prenatal alcohol exposure group were more likely than children in the ADHD and control groups to be rated as having inadequate adaptive skills. When analyzed with matched IQs, the prenatal alcohol exposure and ADHD groups did not differ from each other. For adaptive behavior skills, the differences between children with prenatal alcohol exposure and children with ADHD may be accounted for by IQ.33

Executive function

Executive function is the higher order process involved in thought and action under conscious control, usually to achieve a goal. It involves planning, inhibition, working memory, organized speech, set-shifting, strategy employment, flexible thinking, and fluency.17 Executive function is probably mediated by the frontal cortex, and prenatal alcohol exposure may affect frontal cortex development.17 Neuropsychologic measures of executive function assess organization, planning, working memory, inhibition of inappropriate responses, and set-shifting.2

The common symptoms of behavioral disinhibition and attention deficit in FASD and ADHD may be related to problems with executive function.2 There is evidence that executive function is a core deficit in FASD and ADHD, and neuroimaging shows that children with FASD and ADHD may have structural and functional abnormalities in the frontal-subcortical circuits, which are areas associated with executive function. Behavioral data also confirm that both populations have deficits in global adaptive abilities. There is conflicting evidence regarding executive function deficits in ADHD.2

Nanson et al21 conducted a prospective cohort study comparing children with FAS or FAE with normal developing (control) children and children with attention deficit disorder (ADD) without FAS or FAE. Behavioral characteristics were similar between the FAS/FAE and ADD groups. There were no differences on parental rating for the two groups, suggesting it is difficult to distinguish between the two groups using traditional observational scales. The FAS/FAE group tended to have slower performance and was more likely to improve with practice than the ADD group. Unlike the ADD group, the FAS/FAE group was not able to trade off accuracy in favor of increased speed.21

Coles et al34 compared children with prenatal alcohol exposure, children with ADHD without prenatal alcohol exposure, and control children with neither prenatal alcohol exposure nor ADHD. They used traditional behavioral and psychiatric measures of ADHD and externalizing behavior and neurocognitive measures of a four-factor model of attention. Children with FAS or FAE had similar global intellectual deficits to children with ADHD. Both groups had difficulty with sequential functioning, but the FAS/FAE group had greater difficulties on visual-spatial reasoning. The FAS/FAE group struggled on arithmetic, while ADHD group were poorer on reading/decoding. The FAS/FAE group had nonsignificant decreases in scores on reading/decoding. Both the FAS/FAE and ADHD groups had trouble with coding in the revised edition of the Wechsler Intelligence Scale for Children. The FAS/FAE children had problems with encoding on the second list of the paired-associate task and the number of categories completed on the Wisconsin Card Sorting Test (WCST). On behavioral measures, the ADHD group scored highest on the Child Behavior Checklist, the SNAP and the DISC (diagnostic interview schedule for children) interview items but the FAS/FAE group only differed from the control group on the attention score on the Child Behavior Checklist. On the Computer Performance Task, the ADHD group had poor speed and accuracy, slower reaction times, and more false alarms (associated with impulsivity). They also had fewer hits and more misses. However, there was a large dropout of children from the Computer Performance Task (60% of the ADHD group, 52% of the FAS/FAE group, and 43% of controls). Using the four-factor model of attention, the FAS/FAE group had problems with encoding and shift, while the ADHD group had difficulties with focus and sustain. The results of this study suggested that children with ADHD and FAS/FAE have unique attentional profiles, and thus the neurocognitive deficits may not be the same. The authors recommend that children with ADHD are best identified using behavior checklists and measures of the ability to focus and sustain attention, while children with FAS/FAE have deficits in visual-spatial skills, encoding of information, and flexibility in problem solving.34

Vaurio et al2 examined executive function in children with heavy prenatal alcohol exposure, children with ADHD who were not exposed to prenatal alcohol, and children with neither ADHD nor prenatal alcohol exposure. The children with prenatal alcohol exposure performed worse than the ADHD group on letter fluency and category fluency. On Trail making Test-B, the prenatal alcohol exposure group differed significantly from the control group. The ADHD group did not differ significantly from the control group on this test. The prenatal alcohol exposure and ADHD groups had similar deficits on the WCST and both performed more poorly on letter fluency than category fluency. However, letter fluency was significantly poorer in the prenatal alcohol exposure group. In this study the prenatal alcohol exposure group performed better on the WCST than predicted by IQ but the ADHD group performed more poorly than predicted by IQ. This finding for the prenatal alcohol exposure group was in conflict with previous studies in which executive function deficits remained or worsened when IQ was controlled.2

Summary

In summary, there is some evidence for distinguishing between children with FASD and children with ADHD. Using the four-factor model of attention it has been shown that children with FASD have difficulties with encoding and shift, while the children with ADHD have problems with focus and sustain. Other findings have not been consistently reproduced across studies and the usefulness of traditional behavioral observation scales for distinguishing between the two groups has not been proven. The main obstacles to comparison of study findings are the use of different inclusion criteria, definitions and outcome measures. In particular, published studies frequently include children with heavy prenatal alcohol exposure (variously defined) with or without confirmed FASD in one group.

Diagnosis of the impulsive, hyperactive, or inattentive child

The diagnosis of ADHD should only be made after a comprehensive assessment including a medical, developmental and psychosocial history, and examination. The DSM-IV criteria are the minimum requirement for a diagnosis of ADHD.3 ADHD is not an etiologic diagnosis, and assessment of the impulsive, hyperactive, or inattentive child should always include a thorough history and examination for potential causes, including alcohol exposure in pregnancy. Although enquiry regarding alcohol exposure in pregnancy should be routine, many health professionals do not ask.24,25

Behavioral rating scales can provide useful information, in a standardized format, from multiple informants, and can be used to monitor response to treatment. Many measures are available, such as the Child Behavior Checklist, the Strength and Difficulties Questionnaires, and specific ADHD scales, eg, the Conners' rating scales. The Behavior Rating Inventory of Executive Function (BRIEF) is a useful tool for evaluating behavioral, social, and emotional aspects of executive functioning in children with FASD.35

Standard criteria should be used for the diagnosis of FASD.10⁻13 The choice of diagnostic criteria will be determined by local guidelines and clinician preference. Assessment and diagnosis of FASD usually requires input from medical and allied health professionals due to the range of physical and neurologic structural and functional issues which can occur in FASD and are required to fulfill diagnostic criteria.

Treatment of ADHD in FASD

There is a paucity of high quality evidence assessing interventions for children with both FASD and ADHD.36 There are two very small, randomized, controlled trials which examine the use of stimulant medication. The first study compared methylphenidate with placebo (n = 4). Compared with placebo, methylphenidate improved hyperactivity and impulsivity symptoms but not attention.37 Adverse effects from the methylphenidate were reported for three of the four children, and one child had to discontinue methylphenidate 12 weeks into the trial due to excessive weight loss. In the second study, usual stimulant medication was compared with placebo (n = 12). Compared with placebo, stimulants improved hyperactivity symptoms but not attention.38 Psychopharmacologic agents have also been examined in retrospective and uncontrolled studies.29,39,40 In one study, stimulant medication improved hyperactivity and impulsivity scores, but inattention was less responsive to medication.40 In a retrospective study, there was a suggestion that children with ADHD and FASD had a preferential response to dexamphetamine.29 The role of atomoxetine is being assessed in two studies including one randomized controlled trial.36

There is one study of behavioral or psychological intervention for children with FASD and ADHD symptoms, in which 23 children were randomized to receive attention process training or contact control sessions.36 The group receiving attention process training had significantly more improvement on measures of sustained attention and non-verbal reasoning ability than controls, but not on measures of executive function.

Because there is little evidence specific to the management of ADHD in FASD, the approach to intervention is mostly extrapolated from the ADHD literature. Multimodal therapy is the recommended treatment for ADHD in all age groups. This could include pharmacologic and behavioral interventions. The Multi-modal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder demonstrated that pharmacologic management was superior to an intensive behavioral intervention at a 14-months follow-up. Compared with pharmacologic management alone, combined pharmacologic and intensive behavioral interventions did not significantly improve core ADHD symptoms, but treatment outcomes were achieved with a significantly lower dose of medication in the combined treatment group than in the pharmacologic management group.41 The management plan should also take into consideration the comorbidities of ADHD and FASD.3,6

Medication will not be needed for all individuals with ADHD and should only be used when the symptoms are pervasive across settings and are causing significant impairment in academic, social, or behavioral domains. Individuals receiving medication require regular review, at least six monthly. Medications for ADHD include stimulant (methylphenidate and dexamphetamine) and nonstimulant medications (eg, atomoxetine). Stimulant medications are thought to act by altering the availability of dopamine and noradrenaline, which influences behavior inhibition, impulse control, and attention.3 Clinicians should consider trialing dexamphetamine first, because there is some evidence suggesting that children with FASD have a preferential response to dexamphetamine over methylphenidate. Methylphenidate is available in immediate-release and extended-release formulations, but there is no evidence regarding the use of extended-release methylphenidate preparations in children with FASD. Atomoxetine is a nonstimulant medication which is classified as a noradrenaline reuptake inhibitor.3 The evidence regarding atomoxetine use in FASD is pending. There is no evidence available regarding the use of other nonstimulant medications in FASD.

Conclusion

ADHD is the most frequent comorbidity of FASD but the exact relationship between the two entities is not well defined. There is some evidence that a specific clinical subtype of ADHD occurs in FASD, with earlier onset and a different response to medication. However, the relationship between ADHD and FASD may be coincidental, may reflect a common etiologic pathway, or may reflect the frequent genetic origin of ADHD and its prevalence in the general population. It is likely that a range of these etiologic factors account for ADHD in FASD, resulting in a heterogeneous population, which makes it difficult to replicate or generalize findings across studies.

Impairment of executive function may be a common underlying factor in ADHD and FASD but, using the four-factor model of attention, there is evidence of difference between these two groups. Children with FASD have difficulties with encoding and shift, and children with ADHD without FASD have problems with focus and sustain. If this difference is reproducible in large cohorts, then it may be useful for diagnosis in the clinical population.

There are clinical benefits to clarifying whether an individual has FASD because early diagnosis of FASD can ameliorate the secondary disabilities. There may be a differential medication response in individuals with ADHD who also have FASD, in particular a possible preferential response to dexamphetamine. However, the evidence to support treatments for ADHD in FASD is scarce.

There is a need for large, high quality studies examining the etiology, diagnosis, and interventions for ADHD in FASD because there is the potential to modify significantly the poor adult outcomes associated with the secondary disabilities. Agreement on the most appropriate diagnostic criteria and terminology for FASD and standardization of outcome measures would improve the translation of research findings into clinical practice. The development of effective interventions will be guided by improved understanding of the etiology of ADHD in FASD and the ability to diagnose FASD more accurately.

Footnotes

Disclosure
The authors report no conflict of interest in this work.

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Articles from Neuropsychiatric Disease and Treatment are provided here courtesy of Dove Press

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Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: clinical guidelines

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Fetal alcohol spectrum disorders (FASD) are the physical and neurodevelopmental outcomes of fetal alcohol exposure. The behavioral phenotype of children with FASD includes difficulties with executive function, memory, planning, processing speed, and attention. ...

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Although some characteristics, such as strong sensory interests and aversions, cognitive delays, and deficits in executive functioning and adaptive skill, are the same or similar in those with FASD and ASD, they are not directly related.

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Medical Home Portal - Fetal Alcohol Spectrum Disorder Distinguished from Autism

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Information, Tools, and Resources to aid Primary Care Physicians in caring for Children with Special Health Care Needs (CSHCN) and providing a Medical Home for all of their patients.

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Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who was exposed to alcohol before birth. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems.

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The Lanterman Act creates a legal right for people with IDD to receive services and supports, based on individual needs, to live as independent and productive lives as possible in the community.

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California Policy Center - For Intellectual and Developmental Disabilities

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California is the only state in the nation that has an entitlement to services and supports for people with IDD and their families.

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More than 386,000 Californians with developmental disabilities live in California; they are our neighbors, classmates, coworkers, family and friends. However, their support structure has been grossly underfunded for more than two decades. Direct support staff are quitting the field or working multiple jobs due to low wages, essential programs are closing throughout the state, there is a critical shortage of accessible and affordable housing for adults with disabilities, the unemployment rate continues to grow, and individuals are forced to live with inadequate supports or with no supports at all. The COVID-19 pandemic has exasperated the challenges and put this population and their support system at high risk.

Lanterman Coalition member organizations across the state are working to protect the health and safety of those with disabilities during this unprecedented public health crisis. In 2021, Governor Gavin Newsom partnered with the Legislature to pass a historic budget that invested $2 billion over five years to help stabilize the foundation of the disability system and close the funding gap for disability services. While this budget was a major victory for Californians with disabilities, the bulk of the investments don't begin until 2024-2025. For 2023, there is still much work to be done to help address the disparities in the disability system so that every person has an opportunity to live their best life in an inclusive society.

YOUR ACTIONS MADE A DIFFERENCE!

On June 30, 2022, Governor Gavin Newsom and the Legislature reached an agreement on the 2022-23 State Budget. We are excited to announce that the Lanterman Coalition's proposal to accelerate funding to the disability system to address the staffing crisis is included in this year's budget! The $159 million general fund (GF) for accelerated funding will begin January 2023 and the final funding increases of $534 million GF will begin July 2024, a full year sooner than originally expected thanks to all your efforts. Overall, including federal matching funds, your advocacy efforts resulted in an additional $1.24 billion in funding for the developmental disability system over the next three years.

This success is a result of relentless advocacy from organization members of the Lanterman Coalition and from you and other members of the grassroots community across the state. During this effort more than 3,800 advocates took 11,800 actions of emails, calls, tweets and video messages to members of the Legislature and Governor.

While these investments will undoubtedly help to restore services and supports that were lost as a result of the pandemic and staffing shortages, the final budget package falls short of the Lanterman Coalition's full proposals. The accelerated funding is six months later than our proposal of July 2022 and does not include technical fixes to the rate models nor regular updates to funding the disability system to adjust for economic fluctuations. Additionally, the budget package does not include an update to the Regional Center service coordinator rates to lower caseload ratios and attract staff, even when this week a statement by the California State Auditor says it "found that regional centers have neither sufficient staff nor funding." This means that our work, and your work, is not done. In our ongoing efforts to advocate on behalf of Californians with developmental disabilities and the workforce, we will be requesting the Governor's administration make an effort to address the rate issues and we will start planning our advocacy strategy now to address the important service coordinator shortage issue that inhibits access to services and supports.

We thank every single person who contacted the Governor and your elected officials asking for their support! This year, many of you submitted powerful video messages that demonstrated the personal impact of the staffing crisis we are facing across the state. Your involvement made a difference!

Other items the final budget package includes are:

$157 million for stipends to recruit and retain direct support professionals (DSPs) and tuition reimbursement for regional center service coordinators. This funding is one-time and not ongoing.

$4.7 million to suspend the Regional Center Family Fees for one additional year.

$8.4 million over three years to establish a service model pilot program focused on expanding employment opportunities for individuals with intellectual and/or developmental disabilities who are currently served through Work Activity Programs (WAPs) or are recent high school graduates.

$15 million to support communication assessments that will be used in developing individual pro-gram plans to improve services for individuals with intellectual and developmental disabilities who are deaf (Deaf+).

Elimination of half-day billing, enhancements of tailored day services, and an extension of alternative services through December 31, 2022.

As always, we will continue to advocate on behalf of the 380,000 Californians with disabilities, their families and staff and the incredible service providers and regional centers who are working tirelessly to meet the needs of the community. There's more work to be done, and we are counting on you to continue to join us on this journey, but we hope you take a moment to feel proud of this accomplishment. We couldn't do it without you!

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KeepThePromise Advocating for California's intellectual and developmental disability community within the state capitol

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LBUSD Transitional Kindergarten - Developmentally Appropriate ...

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A five-minute video illustrating various developmentally appropriate indoor and outdoor settings for TK-aged students.

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Raise & Shine Family Resource Center | Ukiah CA

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Raise & Shine Family Resource Center, Ukiah, California. 567 likes · 6 talking about this. Raise & Shine Family Resource and Empowerment Center fosters resiliency through family engagement.

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@raiseandshinefrec

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Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, United States

Center for Neuropsychology and Neuroscience Research, Kessler Foundation, West Orange, NJ, United States

Department of Psychology, Michigan State University, East Lansing, MI, United States

Education Director of the VIA Institute, VIA Institute on Character, Cincinnati, OH, United States

The purpose of this study was to examine the differences in character strengths for people with disabilities by using an international dataset by the VIA Institiute on Character. Specifically, we aimed to explore (a) the top and bottom five character strengths reported by different disability groups and all people with disabilities more broadly, and (b) group differences in each character strength and total character strengths. The investigator contacted the VIA Institute on Character ( http://www.viacharacter.org/) for obtaining the dataset for the current study. After data cleaning, our sample size resulted in 11,699 people with disabilities. Among most people with disabilities, the top five character strengths scores were love of learning, honesty, appreciation of beauty and excellence, kindness, and fairness. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and prudence. Knowing that there is heterogeneity in character strengths across groups gives us a better understanding of the areas that people with different disabilities and conditions might thrive and provides clinicians and practitioners with a more nuanced understanding for how to possibly intervene with their clients. Positive psychiatry and psychology implications are discussed.

Introduction

According to the World Health Organization ( 1), over one billion people worldwide are living with some form of disabilities and chronic conditions, which translates to ~15% of the world's population. The number of people with disabilities is increasing due to simultaneous increases in chronic health conditions and aging populations ( 1). People with disabilities can face different psychosocial challenges, such as functional limitations, secondary health conditions, social stigma, limited vocational functioning, and compromised community participation ( 2- 8). Therefore, it is important to examine how to better support people with disabilities and chronic conditions and facilitate optimal psychosocial functioning through the lens of contemporary approaches such as positive psychiatry and psychology.

Shifting away from the traditional disease and pathology paradigm, positive psychology emphasizes building positive qualities rather than exclusively focusing on repairing weaknesses, aiming to understand what makes life worth living and enabling human thriving ( 9). Psychiatry has been defined as a subfield under medicine focusing on the diagnosis and treatment of mental illnesses ( 10). Recently, authors defined positive psychiatry as "the science and practice of psychiatry that seeks to understand and promote wellbeing through assessment and interventions aimed at enhancing behavioral and mental wellness" [( 10), p. 2]. In recent decades, understanding disability and chronic conditions including mental illnesses has focused on holistic human functioning and the identification of human strengths and potentials ( 11).

Dr. Beatrice Wright, a pioneer in the rehabilitation field, promoted that psychosocial adjustment to disability and chronic conditions can be considered from a positive framework and postulated a coping vs. succumbing framework ( 12, 13). In this framework, coping focuses on an individual's positive qualities and abilities, whereas succumbing focuses on an individual's impairments and deficits ( 14). Consistent with the foundations of positive psychology, the rehabilitation field focuses on individuals with disabilities' capabilities and strengths ( 13, 15). Many studies have examined the effects of positive psychological characteristics (e.g., hope, resilience) on functioning and quality of life from a strength-based paradigm within the disability and rehabilitation field ( 5, 16- 20). In the current study, we sought to illustrate variation in a particular classification of positive psychological characteristics-character strengths-in a large exploratory study of over 11,000 people with disabilities.

Character strengths are one of the foundations in the science of positive psychology ( 21, 22). Character strengths are defined as positive personality traits that reflect core identity, produce positive outcomes for oneself and others, and contribute to the collective good ( 21). Peterson and Seligman ( 23) developed VIA Classification of Character Strengths and classified 24 character strengths into six virtues: wisdom (i.e., creativity, curiosity, judgment, love of learning, perspective), courage (i.e., bravery, honesty, perseverance, zest), humanity (i.e., kindness, love, social intelligence), justice (i.e., fairness, leadership, teamwork), temperance (i.e., forgiveness, humility, prudence, self-regulation), and transcendence (i.e., appreciate of beauty and excellence, gratitude, hope, humor, spirituality). Character strengths are the psychological processes and mechanisms that depict virtues while virtues are described as the core moral characteristics that are universally valued ( 23). There is a large literature on the measurement, antecedents, and consequences of all 24 character strengths that suggest they play a critical role in positive psychological functioning and wellbeing [e.g., ( 23)]. Besides, Dahlsgaard et al. [( 24), p. 2010] aimed to "create a consensual classification of human strengths while avoiding the criticism that any specific list we proposed would be culturally or historically idiosyncratic ( 23)." They reported that there is a convergence across place, time, and intellectual trandition about certain core virtues.

Growing research has examined the role of character strengths and character strength assessments in various disability groups, including individuals with intellectual and developmental disabilities ( 25, 26), multiple sclerosis [MS; ( 27)], traumatic brain injury [TBI; ( 28)], veterans with and without disabilities ( 29), and chronic conditions and disabilities ( 8). For instance, Niemiec et al. ( 25) discussed how building on character strengths can enhance support systems and quality of life of people with intellectual and developmental disabilities. Shogren et al. ( 26) examined the endorsement and psychometric properties of the VIA Inventory of Strengths of Youth (VIA-Youth) by exploring differences between youth with and without intellectual disability. Smedema ( 27) found that many character strengths played roles in the quality of life directly and indirectly through the negative effects of MS. Hanks et al. ( 28) found that character strengths and virtues were moderately associated with subjective wellbeing in people with mild to severe TBI. Umucu et al. ( 8) found that character strengths moderated the association between COVID-19 stress and the wellbeing among individuals with chronic conditions and disabilities.

More specifically, researchers have also been interested in examining the character strengths that were most frequently reported by people with disabilities. In a sample of adults with autism spectrum disorder, the most frequently reported character strengths were open-mindedness, creativity, and love of learning ( 30). Having a broader understanding of the character strengths reported by people with disabilities, including their commonalities and differences, provides us a broader insight into their psychological experiences, the sources of their wellbeing and quality of life, and provide a roadmap for moving forward in intervention work.

With the WHO's ( 1) emphasis on promoting rehabilitation services (e.g., psychiatric rehabilitation) and the increasing research attention on how character strengths make an impact on the lives of people with disabilities and chronic conditions, the purpose of this exploratory study was to examine the differences in character strengths for people with disabilities by using an international dataset by the VIA Institiute on Character. Specifically, we aimed to explore (a) the top and bottom five character strengths reported by different disability groups and all people with disabilities and chronic conditions more broadly, and (b) group differences in each character strength and total character strengths. To our knowledge, this is the first study using a large international sample to explore the differences in character strengths among people with different types of disabilities and chronic conditions including emotional conditions. Given positive psychiatry and psychology focuses on positive attributes and strengths, the results of the study will contribute to the existing international positive psychology, disability, and positive psychiatry literature on the role of character strengths in people with disabilities.

Methods

Procedure and Participants

This study was evaluated and approved by the Institutional Review Board of [blinded for review]. Upon approval of the study, the investigator contacted the VIA Institute on Character ( http://www.viacharacter.org/) for obtaining the dataset for the current study. After data cleaning, our sample size resulted in 11,699 people with disabilities from across the globe.

Measures

Sociodemographic Characteristics

Sociodemographic characteristics were measured via a demographic survey. Participants responded to questions regarding their age, gender, education, employment status, disability category, urban/rural living status, and countries. Regarding countries, although most participants reported their countries; some did not. More than half of the participants were from the US (>53.9%). There were participants from Canada (>6.7%), Australia (>6.0%), and United Kingdom (>4.9%), and Brazil (>3%). There were also participants from numerous other countries such as France, Estonia, Germany, Denmark, Belgium, Argentine, Turkey, India, Japan, Mexico, Netherlands, South Africa, and New Zealand.

Character Strengths

VIA Classification of Strengths and Virtues (character strengths) were measured using the VIA Inventory of Strengths-Positive [VIA-IS-P; ( 31)], which is a version of the original VIA-IS ( 23) but exclusively uses positively worded items. The VIA-IS-P consists of a total of 96 items, measuring 24 character strengths (4 items per character strengths). Each item is rated on a 5-point Likert-type scale ranging from 1( Very Much Unlike Me) to 5 ( Very Much Like Me), with higher scores indicating higher character strengths. McGrath and Wallace ( 32) suggested researchers use the VIA-IS-P when there are concerns regarding participants' cognitive capacity to process negatively worded items. The mean alpha coefficient of the VIA-IS-P across strengths was 0.78 ( 32). The mean omega (ω) value of the VIA-IS-P was 0.78 ( 32). For our analyses, we examined disability group differences in each of the 24 character strengths and a composite measure in which all the character strengths were averaged together to yield one total score.

Disability Status

Disability status was asked with the following question: "Are you challenged by any of the following?" Participants had the option to select any disability status among multiple options (e.g., traumatic brain injury). We categorized disability types into eight categories, which included intellectual disabilities, sensory disabilities, emotional disturbance, orthopedic impairments, other health impairments, specific learning disabilities, traumatic brain injury, and multiple disabilities.

Data Analysis

We conducted descriptive statistics to identify means and standard deviations for study variables. We used Shapiro-Wilk to check for data normality for each character strengths and total character strength scores. None of the scores fulfilled the criteria for normal distribution.

Next, we conducted Levene's test to examine homogeneity of variance on each dependent variable to test the assumption that individuals in each disability group varied in roughly homogeneous or similar ways. All of the Levene's tests were significant, showing that the groups did not have equal variances. As parametric assumptions were not met, we conducted a Kruskal-Wallis, non-parametric alternative to one-way ANOVA, to assess mean differences in character strengths and total character strengths among eight disability groups.

Finally, we used Dunn Bonferroni post-hoc tests to determine specific significant differences among groups. All analyses were conducted via SPSS 26.0 and DescTools ( 33), GmAMisc ( 34), and ggpubr ( 35) using the R Software ( 36).

Results

Descriptive Statistics

The majority of participants (~71%) were in the age range of 25-54. Most participants were women (72.3%), followed by men (25.7%) and others (2.0%). Regarding participants' education, about 72% of participants had at least a bachelor's degree. About 81% of participants were employed. Only 14.7% of participants reported they live in rural area. Regarding disability group, most participants had multiple disabilities (26.7%), followed by other health impairments (26.4%), emotional disturbance (23.1%), sensory disabilities (11.5%), specific learning disability (4.8%), orthopedic impairment (3.6%), intellectual disability (2.6%), and traumatic brain injury (1.2%). Table 1 demonstrates means and SDs for variables across disability groups.

Table 1. Demographic information and character strengths group characteristics and differences.

Character Strengths Profiles

We created character strengths profiles for each disability based on participants' mean scores for each CS scores. Figures 1, 2 demonstrate character strengths profiles for each disability group and overall character strengths profile. Figure 3 represents radar chart for disability groups by character strengths.

Figure 1. Character strengths profiles for each disability group.

Figure 2. Overall character strengths profile. TBI, Traumatic brain injury; OI, Orthopedic impairment; SD, Sensory disabilities; SLD, Speech-language disabilities; OHI, Other health impairments; MD, multiple disabilities; IDD, Intellectual disabilities; ED, Emotional disturbance.

Figure 3. Radar chart for disability groups by character strengths. TBI, Traumatic brain injury; OI, Orthopedic impairment; SD, Sensory disabilities; SLD, Speech-language disabilities; OHI, Other health impairments; MD, multiple disabilities; IDD, Intellectual disabilities; ED, Emotional disturbance.

Intellectual Disability Group (IDG; 2.6%)

Among people with intellectual disabilities, the top five character strengths scores were love of learning, honesty, fairness, judgment, and appreciation of beauty and excellence. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and leadership.

Sensory Disability Group (SDG; 11.5%)

Among individuals with sensory disabilities, the top five character strengths scores were honesty, love of learning, fairness, appreciation of beauty and excellence, and kindness. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and bravery.

Emotional Disturbances Group (EDG; 23.1%)

Among people with emotional disturbances, the top five character strengths scores were appreciation of beauty and excellence, love of learning, kindness, honesty, and fairness. The bottom five character strengths scores were self-regulation, zest, perseverance, spirituality, and hope.

Orthopedic Impairment Group (OIG; 3.6%)

Among people with orthopedic disabilities, the top five character strengths scores were honesty, love of learning, appreciation of beauty and excellence, kindness, and fairness. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and humility.

Other Health Impairments Group (OHIG; 26.4%)

Among people with other health impairments, the top five character strengths scores were love of learning, honesty, appreciation of beauty and excellence, kindness, and fairness. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and prudence.

Specific Learning Disabilities Group (SLDG; 4.8%)

Among people with specific learning disabilities, the top five character strengths scores were love of learning, honesty, fairness, judgment, and appreciation of beauty and excellence. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and leadership.

Traumatic Brain Injury Group (TBIG; 1.2%)

Among people with TBI, the top five character strengths scores were honesty, love of learning, appreciation of beauty and excellence, fairness, and kindness. The bottom five character strengths scores were self-regulation, perseverance, zest, prudence, and spirituality.

Multiple Disability Group (MDG; 26.7%)

Among people with multiple disabilities, the top five character strengths scores were kindness, love of learning, appreciation of beauty and excellence, honesty, and fairness. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and prudence.

Summary

Among all people with disabilities, the top five character strengths scores were love of learning, honesty, appreciation of beauty and excellence, kindness, and fairness. The bottom five character strengths scores were self-regulation, perseverance, zest, spirituality, and prudence.

Group Differences in Character Strengths Score

Kruskal-Wallis test results revealed that there were statistically significant differences in total character strengths score among the eight disability groups, χ ²(7) = 255.78, p < 0.05. Please see Appendix for group differences in each character strength score.

Dunn Bonferroni post-hoc Analyses

Follow-up Dunn's pos-hoc tests were conducted to examine pairwise differences among the disability groups. Significance values have been adjusted by the Bonferroni correction for multiple tests. Regarding total character strengths (CS) total scores, SDG [mean rank difference (MRD) = 924.44, p < 0.05], OIG (MRD = 1255.23, p < 0.05), OHIG (MRD = 662.52, p < 0.05), and TBIG (MRD = 1864.94, p < 0.05) had significantly higher CS total scores compared with IDG. SDG (MRD = 1298.14, p < 0.05), OIG (MRD = 1628.94, p < 0.05), OHIG (MRD = 1036.23, p < 0.05), SLDG (MRD = 1073.41, p < 0.05), TBIG (MRD = 2238.65, p < 0.05), and MDG (MRD = 722.90, p < 0.05) had significantly higher CS total scores compared with EDG. OHIG (MRD = −592.71, p < 0.05) had significantly lower CS total score compared with OIG. TBIG had significantly higher CS total scores compared with OHIG (MRD = 1202.41, p < 0.05), SDG (MRD = 940.50, p < 0.05), and SLDG (MRD = 1165.23, p < 0.05). MDG had significantly lower CS total scores than SDG (MRD = −575.24, p < 0.05), OIG (MRD = −906.03, p < 0.05), OHIG (MRD = −313.32, p < 0.05), and TBIG (MRD = −1515.74, p < 0.05). Please see Appendix and Table 1 for Dunn Bonferroni post-hoc Analyses results for each CS.

Discussion

This study is the first attempt, to our knowledge, to examine character strengths in individuals across a wide range of disability and chronic condition groups around the world. Growing research has suggested that positive approaches to psychological treatment (such as increasing awareness and usage of character strengths) in individuals with disabilities may be a powerful asset in meeting therapeutic goals and increasing quality of life and wellbeing ( 8, 11, 25, 29). An alternative to deficit-based methods, which attempt to reduce negative behaviors or symptoms associated with a given disability, character strengths provide a language with which individuals can focus on the aspects of themselves that potentially benefit themselves and society ( 25). The current study used a well-validated and widely-used classification system and its measurement tool, the VIA Inventory of Strengths, in a large international sample across multiple disability types, including emotional conditions and disabilities.

One of the strengths of the study was the inclusion of individuals with physical, cognitive, and emotional disabilities. In addition, disabilities occurring at different developmental stages of life are represented in the sample. For example, intellectual disabilities, like autism, constitute disabilities that emerge relatively early in life and have an enduring presence. The character strengths of individuals with these disabilities might differ compared to individuals with more acute or sudden/adult-onset disabilities, like a traumatic brain injury. Interestingly, we found that commonly reported character strengths in individuals with disabilities include love of learning, honesty, appreciation of beauty and excellence, kindness, and fairness. We found that the least commonly reported strengths in our disability sample included self-regulation, perseverance, zest, spirituality, and prudence. A previous study ( 27) found the top five strengths were honesty, kindness, fairness, humor, and gratitude, and the bottom five strengths were forgiveness, humility, spirituality, zest, and self-regulation in people with multiple sclerosis. In another study, authors found that the most common character strengths were curiosity, fairness, kindness, judgment, honesty, and leadership, while the least common character strengths were zest, prudence, perseverance, humility, hope, self-regulation, and spirituality in people with dysclexia ( 37). These results are partially consistent with our findings; however, it is also important to highlight that the most and least common character strengths may change based on disability groups.

Generally, individuals within the TBI group rated their strengths higher overall than other disability groups. For example, the TBI group's endorsements of creativity, curiosity, love of learning, bravery, honesty, perseverance, zest, love, social intelligence, fairness, leadership, prudence, self-regulation, gratitude, hope, and spirituality were significantly higher compared to other disability groups. The only character strength in which the TBI group was lower than others was teamwork, in which they were significantly lower than the MDG group, but significantly higher than IDG group. No significant differences were observed between TBI and other disability groups in judgement, perspective, kindness, forgiveness, humility, appreciation of beauty, excellence, and humor. These findings may provide some interesting avenues of future research in the TBI field. Given that individuals with TBI can often experience mood issues ( 38, 39), reduced quality of life ( 40- 42), and reduced wellbeing ( 43), using character strengths knowledge and awareness appears to be an interesting treatment avenue to address these concerns.

One important consideration is that individuals with TBI can have significant self-awareness issues, including both under- and overestimating their skills and abilities ( 44- 46). Therefore, endorsing strengths higher than other comparison groups may be indicative of this phenomenon. However, it would not be useful to dismiss these endorsements as "self-awareness" discrepancies in the TBI group. Rather, in the future, it may be useful to also assess the strengths of an individual with TBI through the perceptions of a trusted "other" who may give a realistic profile of an individual's strengths (e.g., friends, family). Having both the perception of the client as well as a significant other may elucidate which strengths the person expresses in daily life, which may aid in development of therapeutic goals, and which strengths might be inflated because of their limitations in accurately evaluating their strengths.

Those with emotional disturbances reported lower character strengths than other disability groups, which may reflect the poorer self-esteem and lower self-concept commonly observed in those with depression and anxiety. This lower endorsement of character strengths, however, may also provide an opportunity for clinicians to utilize strength identification in their therapy goals. Those with emotional disturbance may be less aware of strengths and therefore merely the identification of strengths may be a powerful exercise.

Another group with low endorsement of character strengths was the IDG group. There is a growing consensus in the field of intellectual disabilities, including autism, that using only a deficit-based approach when treating individuals with autism can compromise self-esteem and leave individuals unaware of their strengths. Therefore, recently a shift has emerged in the autism field to focus on not only strength-based approaches but character strengths-based approaches ( 25, 30, 47). Our findings indicated lower strength ratings in this group compared to other disability groups indicates that indeed, strength identification needs bolstering in this group. Interestingly, their love of learning endorsements was higher than other disability groups, which may reflect a commonly reported trait of autism: restricted interests. Specifically, those with autism may seek information about a restricted topic to a greater degree than what is typically observed in others, which is generally referred to as a "symptom" or "challenge." However, reframing this trait as a love of learning may be beneficial as it could help autistic individuals, as well as others, understand how this trait may benefit society as well.

Some strength endorsements may reflect the commonly observed traits in individuals with disabilities. For example, low levels of zest, which was consistently one of the lowest reported strengths of the current study may be correlated with significant fatigue levels observed in individuals with disabilities. Fatigue is one of the most commonly reported symptoms in clinical care in the general population and is one of the most commonly reported symptoms in individuals with illness or disability. Thus, low levels of zest may be related to the significant feelings of fatigue felt by this population. In addition, previous literature reported that zest was one of the lowest five character strengths among university students ( 48) and people with disabilities ( 27). While increasing zest may represent a treatment target for positive psychology interventions, it may also be helpful for clinicians to keep in mind that chronic fatigue due to illness, disability, comorbidity, medications, and other reasons may make it difficult for certain disability groups to unilaterally increase their zest and energy levels. Rather, setting goals and working on the strengths of perseverance or self-regulation may be more useful, as they involve making choices to overcome obstacles or making choices (such as conserving energy). Together, these proximal goals may be more realistic for someone suffering from fatigue.

Our study findings may provide some significant clinical implications for the use of character strengths interventions in the fields of rehabilitation, psychiatry, and psychology for people with disabilities and chronic conditions. Previous research has demonstrated positive associations between character strengths and subjective health status ( 49). In a cross-cultural longitudinal study, researchers found that using character strengths is not only beneficial for self-perceived physical health when going through difficult situations, but using strengths is also for enhancing meaning in life, social connectedness, and mental health ( 50). Given the association between character strengths and health outcomes, clinicians may include interventions such as using signatures in a new way or identifying signature strengths ( 51) and strengths reframing and the aware-explore-apply model of strengths ( 25) when working with people with disabilities. By helping people with disabilities and chronic conditions identify and utilize their personal character strengths, this may potentially improve their perceived health, psychosocial functioning, and quality of life.

In addition, given this is an international study with multiple countries and disabilities [we consider each disability category as a cultural subgroup (e.g., deaf culture)], it is important to consider cross-cultural and demographic differences in character strengths. If each disability subgroup is considered a cultural subgorup, we suggest each disability group may, on average, have different top and bottom character strengths. For example, people with physical disabilities may experience or express character strengths different compared to people with psychiatric disabilities, just as individuals from different countries and cultures may express character strengths in a different ways reflecting their culture.

Positive psychiatry and psychology aims to examine positive attributes and strengths ( 10). Besides, positive psychiatry researchers focuses on protective psychosocial factors in chronic conditions. Given our research (a) identifies and describes character strengths in people with chronic conditions, including emotional conditions and (b) demonstrates the top and bottom character strengths among different disability subgroups, findings from this study may contribute to clinical and research practice. This research will help health professionals understand what character strengths are being used among people with different disabilities, which could be helpful in developing tailored and personalized interventions.

There are several limitations that should be considered in this study. The study comprised a convenience sample of individuals with self-reported disabilities, and some participants may not have accurately reported their disability status. As functional and cognitive abilities were not directly assessed, participants' responses may not accurately reflect their perceived character strengths and virtues when navigating an online survey. Further, the ability to complete the survey (and even have access to the survey) assumes that we may have recruited a higher functioning sample; however, there was no way to evaluate this concern. We interpreted the findings by considering that people with learning disabilities, intellectual disabilities, and TBI may have experienced difficulties understanding some concepts and questions. The majority of participants were women, had at least a bachelor's degree, and were employed, which could also limit the generalizability of this study's findings to the general disability population. Another limitation in this study was that participants were categorized into eight disability groups. A more systematic way of categorizing various disabilities could be beneficial. Also, some specific disability types may have been left out and not enough participants were present in different countries for us to formally model between-country variation in the disability group differences that we observed. Future studies are warranted to further examine character strengths in people with disabilities around the globe. We interpreted the findings considering the demographic characteristics of the respondents. For example, the majority of participants were in the age range of 25-54. Therefore, we cannot generalize our findings for all age groups. Similarly, the majority of participants were women, which decreases our ability to generalize our findings. Gender differences are especially important given previous research reported that women typically score higher on strengths than men although the top five strengths were similar among men and women ( 52).

In conclusion, it is important to highlight that we comment on what has been established in this unique data set and also summarize future considerations to be explored although we are aware that there are many important points to be highlighted in this study. Character strengths has been recently examined in different disability populations ( 3, 8, 25, 53, 54). In addition to other studies, our study provided a greater understanding of character strengths in a heterogeneous international sample of individuals with disabilities. Overall, this sample of people with disabilities reported their top five character strengths as love of learning, honesty, appreciation of beauty and excellence, kindness, and fairness, and reported their bottom five character strengths as self-regulation, perseverance, zest, spirituality, and prudence. Knowing that there is heterogeneity in character strengths across groups gives us a better understanding of the areas that people with different disabilities might thrive and provides clinicians and practitioners with a more nuanced understanding for how to possibly intervene with their clients.

Data Availability Statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.863977/full#supplementary-material

References

23. Peterson C, Seligman MEP. Character Strengths and Virtues: A Classification and Handbook. Oxford University Press (2004).

PubMed Abstract

25. Niemiec RM, Shogren KA, Wehmeyer ML. Character strengths and intellectual and developmental disability: a strengths-based approach from positive psychology. Educ Train Autism Dev Disabil. (2017) 52:13-25.
Google Scholar
31. McGrath RE. Technical report: The VIA Assessment Suite for Adults: Development and initial evaluation (rev. ed.). Cincinnati, OH: VIA Institute on Character (2019).
Google Scholar
33. Signorell. DescTools: Tools for Descriptive Statistics. R package version 0.99.42. (2021).

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Character Strengths Across Disabilities: An International Exploratory Study and Implications for Positive Psychiatry and Psychology

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The purpose of this study was to examine the differences in character strengths for people with disabilities by using an international dataset by the VIA Institiute on Character. Specifically, we aimed to explore (a) the top and bottom five character strengths reported by different disability groups and all people with disabilities more broadly, and (b) group differences in each character strength and total character strengths.

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Tony Hawk on Instagram: "Thank you @dexter_ricardo & @skate_anima for sharing our passion by providing these golden moments to kids with special needs. 🌞🇧🇷🛹"

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635K likes, 14K comments - tonyhawk on October 15, 2023: "Thank you @dexter_ricardo & @skate_anima for sharing our passion by providing these golden moment..." 

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GW student with Tourette syndrome finds inspiration through boxing | NBC4 Washington

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https://www.ndcs.org.uk/information-and-support/parenting-and-family-life/families-magazine/your-stories/

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Welcome to

Showcasing Real People,

Real Stories, Real Community

My Tourette

About

The Tourette Association of America has designed a virtual quilt to showcase the Tourette Syndrome and Tic Disorder community, entwined with stories of inspiration, hope and community. This virtual quilt is a narrative of our unique experiences and stories to embrace and comfort one another. TS may impact everyone differently, but we are all woven together in community. It symbolizes our resilience, resourcefulness, and optimism. We are stronger together.

​

Get Involved with Tourette Syndrome Awareness

Get Social:

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Share your story #MyTourette.

Customize your photo on Facebook and Twitter.

Download Cover Images for Facebook and Twitter.

Take the Tourette Pledge to stop using Tourette Syndrome as a punchline. #TourettePledge

Attend an Event:

View events happening virtually and around the nation.

Local Chapters and Support Groups are hosting fun, informative and engaging virtual programs.

Make Your Voice Heard:

Your voice makes a difference. Contact to your Congressional leaders in a pre-populated virtual letter to advocate for the most pressing public policy issues that face the Tourette Syndrome community. Learn about the difference each of you made in March of 2021 and how we can continue that trend. #Rally4Tourette

Make a Donation

42-40 Bell Boulevard, Suite 205, Bayside, NY 11361

​​Tel: 718-224-2999 support@tourette.org

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About ​ Get Involved with Tourette Syndrome Awareness Get Social: ​ Share your story #MyTourette. Customize your photo on Facebook and Twitter. Download Cover Images for Facebook and Twitter. Take the Tourette Pledge to stop using Tourette Syndrome as a punchline. #TourettePledge Attend an Event: View events happening virtually and around the nation.

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Inspired by the book , the new full-length documentary SPELLERS challenges conventional wisdom regarding a group relegated to society's margins: nonspeakers with autism, who most "experts" believe are cognitively disabled. As the film opening asks, "What if we've been wrong...about every single one of them?"

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KQEDNews on Instagram: "Jacob Rock is autistic and couldn’t speak for many years. After years of practicing typing on an iPad, he surprised everyone by expressing himself fully, in sentences with perfect spelling and grammar. Six months later, he told his parents he wrote a 70-minute symphony in his head. It will debut at the Alex Theatre in Glendale, Calif., on Sept. 30.
“It was damn, damn satisfying that I could claim my terrific identity and show everyone my intelligence,” said Jacob.
“He just wanted to say, ‘Look, I’m here,’” said his father Paul Rock. “‘And you’ve been underestimating me the whole time. But I’ve been watching and listening.’”

Sasha Khokha, reporter for this story, verified with Jacob's longtime neurologist that Jacob is in fact typing independently and this is not 'facilitated communication.' Check out our full story for more: https://www.kqed.org/news/11962056/non-verbal-teen-symphony-debut-los-angeles""

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608K likes, 6,314 comments - kqednews on September 26, 2023: "Jacob Rock is autistic and couldn’t speak for many years. After years of practicing typing on a..."

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Every month Cyberwise Chats hosts talks about trending tech topics.

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Join Diana Graber of Cyberwise and Dr. Pamela Rutledge, Director of the Media Psychology Research Center , every month for our Cyberwise Chats where we talk with special guests about trending tech topics. You can also listen to all of our Chats on your favorite podcast platform including:
Apple Podcasts Google Podcasts Spotify Amazon Music/Audible

Find podcasts and webinar recordings of previous chats below.

NEXT CHAT:
A Conversation with Epic Games:
Making Games Safe for Kids

11/28, Noon PST | 3 pm EST

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Every month we put the spotlight on a technology topic or issue like: Internet Safety, Digital Citizenship, Online Privacy, Social Media, Facebook and more.

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My Child is Being Bullied | Bullying Resources for Parents

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Is your child being bullied? STOMP Out Bullying information and resources for parents of children being bullied.

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Resources and support for families of special needs.

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Follow the link to sign-up.
imaginationlibrary.com/
Your child must be under 5 years of age, and you must be a Mendocino County resident to qualify.

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Map of Mendocino County General Resources

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Map of Mendocino County General Resources

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Mendocino County Resource Map - Google My Maps

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This map shows the location of common and general resources for the County of Mendocino. This is not a comprehensive resource map.

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This map shows local Ukiah, CA resources for families. It will serve as a tool to help navigate people to nearby supports.

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There are 22 local fire agencies (20 cites/districts and 2 volunteer fire companies) plus Cal Fire for a total of 23.

Four cities/districts have combined into 2 JPA's - Fort Bragg and Ukiah. That said, 20 local fire departments exist plus Cal Fire.

All 20 local fire departments rely on volunteers, Cal Fire does not.

Most of the local departments do not have a paid cheif & the majority of local departments are ALL volunteers.

Each of the 20 departments receive some tax monies. However, Westport and Whale Gulch ("volunteer fire companies") are not associated with any special district and receive no property-tax related revenues.

But, only half of Mendocino County is in a fire district. The other half receives emergency services but doesn't pay for them.

All agencies do receive Proposition 172 sales tax monies ($10,000 minimum).

Starting in 2020 the County begin collecting Transient Occupancy Tax from place like camp grounds that will provide some additional funding for the local districts. The agency distributions will be ~$30,000 for the first year.

Together, taxes collected and allocated fall woefully short of the Board of Supervisors estimate of $10,000,000 needed by local fire agencies.

The county government has provided only limited help to fire departments and ambulance services. Most departments rely on federal grants and fundraisers to survive.

Basic firefighting gear costs $1,200 per person. A new fire engine costs $250,000 or more.

Volunteer firefighters spend huge amounts of time in training. Training is expensive.

Volunteer firefighters are usually the first at scene of medical emergencies and traffic accidents.

Your life could depend on how well your fire department is equipped and its firefighters trained.

Headquarters........459-7414
Boonville................895-3323
Covelo.....................983-6499
Fort Bragg..............964-5673
Hopland..................744-1111
Laytonville.............984-6777
Leggett.....................925-6414
Woodlands.............937-5765
Point Arena............882-2151
Ukiah .......................462-7448

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County Fire Agencies - Mendocino County Fire Safe Council

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There are 22 local fire agencies (20 cites/districts and 2 volunteer fire companies) plus Cal Fire for a total of 23. Four cities/districts have combined into 2 JPA's - Fort Bragg and Ukiah. That said, 20 local fire departments exist plus Cal Fire. All 20 local fire departments rely on volunteers, Cal Fire does not.

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Mendocino County Sheriff's office: (707) 463-4411

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Welcome - Mendocino County Sheriff’s Office

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To be an effective, professional, community-oreinted public safety agency through cooperative effort.

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If you need to report child abuse/neglect, call 1-866-236-0368

FAX Mandated Reporter Forms to (707) 463-7908

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Family and Children’s Services | Mendocino County, CA

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Additional resource, Mendocino County Alcohol and Drug Treatment public rehab. Follow the link below to learn more:
https://www.rehab.com/mendocino-county-alcohol-and-drug-treatment

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A list of Mendocino County and national recovery resources
In case of an emergency, please call 911.
Lake County

Narcotics Anonymous - (707) 485-9110
Alcoholics Anonymous -(707) 462-7123
​Public Health -(707) 456-3800
Adventist Health Howard Memorial -(707) 459-6801
Adventist Health Ukiah Valley -(707) 462-3111
Big Brothers/Big Sisters -(707) 263-7281

Hotlines

Veterans Crisis Line - (800) 273-8255
Veterans Crisis Online Chat - veteranscrisisline.net
IMAlive Crisis Chatline - imalive.org
IMAlive Crisis Text Line - Text HOME to741-741
Trans Lifeline -(877) 330-6366
The Trevor Project Lifeline -(866) 488-7386
Trevor Text - Text TREVOR to(202) 304-1200 (available M-F from 3PM-10 p.m. ET)
Trevor Chat - thetrevorproject.org/get-help-now

National

Suicide and Crisis Lifeline (English and Spanish) - 988
For TTY Users: Use your preferred relay service or dial 711 then 988.
Suicide and Crisis Chat - Lifeline Chat

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Adventist Health is a renowned healthcare provider serving the West Coast and Hawaii. We pride ourselves on providing comprehensive, high-quality medical services to the communities we serve.

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Click the link below for a list of LGBTQ+ resources.
https://glaad.org/resourcelist/

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The Trevor Project | For Young LGBTQ Lives

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The Trevor Project provides 24/7 crisis support services to LGBTQ young people. Text, chat, or call anytime to reach a trained counselor. Free and confidential.

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Click the two links below to learn more about Transition Services and how to support your child. https://sites.ed.gov/idea/regs/b/a/300.43
AND
https://www.disabilityrightsca.org/publications/transition-services-for-students

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California law is quite ambitious and specific in its descriptions of transition services and state and local education agencies' responsibilities to provide them.

The California Legislature has found and declared that improvements in special education have not resulted in paid employment or maximum integration of special education students into the community. The Legislature states that there is no formalized process that bridges the gap between school and post-school services and resources. It also declared that there is insufficient coordination between educators, adult services providers, employers, and families which would lead to paid employment and social independence. Because of this, the majority of options available to adults with disabilities foster dependence rather than independence. The Legislature's goal for transition services is a planned movement from school to adult life that provides opportunities which maximize economic and social independence in the least restrictive environment. [Cal. Ed. Code Sec. 56460.]

State law requires that the superintendent establish capacity to provide transition services to a broad range of students with exceptional needs such as employment and academic training, strategic planning, interagency coordination, and parent training. [Cal.Ed. Code Sec. 56461.]

Transition services include but not limited to:

1. In-service training programs, resource materials, and handbooks that identify the following:

The definition of "transition," including the major components of an effective school-based transitional program;

Relevant laws and regulations;

The roles of other agencies in the transition process including, but not limited to, the scope of their services, eligibility criteria, and funding;

The components of effective transition planning;

The role of families in the individualized transition process;

Resources and model programs currently available in this state.

2. Development of the role and responsibilities of special education in the transition process, including the following:

The provision of work skills training, including those skills that are necessary in order to exhibit competence on the job;

The provision of multiple employment options and facilitating job or career choice by providing a variety of vocational experiences;

The collection and analysis of data on what happens to students once they leave the school system and enter the adult world;

The coordination of the transition planning process, including development of necessary interagency agreements and procedures at both state and local levels;

The provision of instructional learning strategies that will assist students who find learning difficult in acquiring skills that will enable them to obtain diplomas, promote a positive attitude toward secondary and post- secondary life.

3. The development and implementation of systematic and longitudinal vocational education curriculum including the following:

Instructional strategies that will prepare students with significant disabilities to make a successful transition to supported employment and the community;

The introduction of vocational and career education curriculum in the elementary grades for those students who can benefit from it.

4. Materials, resource manuals, and in-service training programs to support the active participation of families in the planning and implementation of transition-related goals and activities;

5. The development of resources and in-service training that will support the implementation of individualized transition planning for all special education students.

6. The development of a network of model demonstration sites that illustrate a wide variety of transition models and implementation strategies;

7. Coordination with other specialized programs that serve students who face barriers to successful transition;

8. A research, evaluation, and dissemination program that will support the major programmatic aspects of transition services.

Through a variety of competitive grants, bids, contracts, and other awards specific content areas will be developed in cooperation with a variety of field-based agencies, including local education agencies, special education local plan areas, county offices, institutions of higher education, and in-service training agencies. [Cal. Ed. Code Sec. 56462.]

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(10.3) What transition services are included in California special education laws?

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California law is quite ambitious and specific in its descriptions of transition services and state and local education agencies' responsibilities to provide them. The California Legislature has found and declared that improvements in special education have not resulted in paid employment or maximum integration of special education students into the community.

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SSI provides monthly payments to people with disabilities and older adults who have little or no income or resources.

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Protective Supervision is an IHSS for people who, due to a mental impairment or mental illness, need to be observed 24 hours per day to protect them from injuries, hazards, or accidents. Follow the link to learn more!
https://www.disabilityrightsca.org/publications/in-home-supportive-services-protective-supervision

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Rules for Assessing Minors for Protective Supervision as Stated in ACL 98-87 & ACL 15-25

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Seeds of Partnership provides an array of learning resources. The site gives you learning modules and other resources for parents / caregivers, family, and professionals about their  rights in regard to special education.

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Seeds of Partnership is a project funded by the California Department of Education (CDE), Special Education Division (SED) and is under the auspices of the Sacramento County Office of Education. We assist the CDE, SED in providing technical assistance as part of the Statewide System of Support withi…

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LEA stand for Local Educational Agency. It is a public board of education or other public authority within a state that maintains administrative control of public elementary or secondary schools in a city, county, township, school district, or other political subdivision of a state. MENDOCINO COUNTY OFFICE OF EDUCATION is Ukiah's LEA.

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In Home Support Services (IHSS) is a Medi-Cal program and is funded by federal, state, and county dollars.

More information can be found below.
https://www.cdss.ca.gov/inforesources/ihss/fact-sheets

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In-Home Supportive Services (IHSS) Program Overview and Expedited Application Process

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Click the link below for more information on Early Start programs.
https://first5mendocino.org/for-community-partners/early-start/

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Early Start - MENDOCINO COUNTY OFFICE OF EDUCATION

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Service | Excellence | Innovation | Teamwork

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Family Empowerment Centers (FECs) provide training and information to families of children and young adults with disabilities, between the ages of 3 and 22 in California.

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Seeds of Partnership - Family Empowerment Centers

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The H.R.4519 Amendment was set in place to amend part B of the Individuals with Disabilities Education Act. H.R.4519 is a bill that was recently introduced to provide full Federal funding for services needed under the IDEA.

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The Individuals with Disabilities Act (IDEA) supports the educational rights of people with disabilities.
Watch the video below to understand more about the IDEA.
https://www.youtube.com/watch?v=3XMndYNEGFA

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Parents of children with disabilities from ages three through twenty-one have specific educational rights under the Individuals with Disabilities Education Act (IDEA). These rights are called procedural safeguards. Individuals serving as surrogate parents and students aged eighteen receiving special education services, are also entitled to these rights.

A number of staff in the child's district and special education local plan area (SELPA) may answer questions about the child's education and the parents' rights and responsibilities. When the parent has a concern, it is important that they contact their child's teachers or administrators to talk about their child and any problems they see. This conversation often solves the problem and helps maintain open communication.

Parents must be given opportunities to participate in any decision-making meeting regarding their child's special education program. Parents have the right to participate in individualized education program (IEP) meetings about the special education eligibility, assessment, educational placement of their child and other matters relating to their child's free appropriate public education (FAPE).

When a parent cannot be identified or located, a district may appoint a surrogate parent to represent a child with a disability.

What Are Parents' Rights in California Special Education?

Parents and students over age eighteen have the right

Parents have the right to refer their child for special education services, to participate in the development of the IEP and to be informed of all program options and alternatives, both public and nonpublic.

Parents have a right to receive prior written notice, in their native language, when the school district initiates or refuses their request to initiate a change in their child's identification, assessment, or educational placement in special education.

Parents must provide informed, written consent before their child is assessed or provided with any special education services. Parental consent must also be provided before any change in special education services may occur. The district must ensure that parents understand proceedings of the IEP team meeting including arranging for an interpreter for parents with deafness or those whose native language is other than English.

Parents may refuse to consent to an assessment or the placement of their child in special education.

Children must be assessed for special education through the use of methods that are not culturally biased or discriminatory.

If parents disagree with the results of the assessment conducted by the school district, they have the right to ask for and obtain an independent educational evaluation (IEE) at public expense.

The parent is entitled to only one IEE at public expense each time the public agency conducts an evaluation with which the parent disagrees.

When a parent requests an IEE at public expense, the school district must, without unnecessary delay, either ensure that an IEE is provided at public expense, or request a due process hearing if the district believes their assessment was appropriate and disagrees that an IEE is necessary. The school district also has the right to establish the standards or criteria (including cost and location) for IEEs at public expense.

Parents have a right to inspect, review, and obtain copies of their child's educational records.

If parents disagree with the district regarding their child's special education placement or a proposed change in placement, the law requires the student to "stay put" in the current program until the dispute is resolved.

Parents have the right to present a complaint relating to the provision of a FAPE for their child; to have an attorney, an advocate, and the student, if appropriate, present at the due process hearing; and to make the hearing public. Under certain conditions, the hearing officer may award, reduce, or deny the reimbursement of attorneys' fees and fees paid to nonpublic institutions by parents in the settlement of a case. To request a due process hearing or to receive a complete notice of procedural safeguards related to a due process hearing, contact the Office of Administrative Hearings (see contact information below).

Parents are encouraged to consider settling disagreements regarding their child's special education program through voluntary mediation, a process through which parties seek mutually agreeable solutions to disputes with the help of an impartial mediator. Mediation is available for:

1. Mediation of State Complaint - the California Department of Education is required to offer mediation to the parent or the local educational agency (LEA) but both must agree, and participation is voluntary.

2. Office of Administrative Hearings (OAH) Mediation Only - Parent or LEA may file for OAH mediation only. Participation is voluntary.

Parents may seek mediation alone or separate from due process, or they may participate in mediation pending a due process hearing. Mediation cannot be used to delay parents right to a due process hearing.

If parents believe their child's school district has violated the law, they may file a complaint with the California Department of Education. The Department must investigate complaints alleging violations of noncompliance with IDEA, state special education laws, or regulations, and issue a written report of findings within 60 days of receiving the complaint.

There are specific rules regarding the suspension and expulsion of students with IEPs. Generally, a student with a disability may be suspended or placed in an alternative educational setting to the same extent that these options apply to students without disabilities.

If the student with a disability is in such a placement for more than ten days, an IEP meeting must be held to consider the appropriateness of the child's current placement and the extent to which the disability is the cause of the misconduct. Regardless of the child's placement, the district must provide FAPE

School districts are responsible for identifying, locating and assessing students with disabilities enrolled in private schools by their parents. However, school districts are not required to provide special education or related services to these students. There is no entitlement for services, though some private schools and students attending private schools may receive some services from the school district.

Additional Resources

This notice is an abbreviated summary of procedural safeguards under federal and state laws (20 United States Code Section 1412[d]; 34 Code of Federal Regulations 300.504; California Education Code sections 56301[d][2], 56321, and 56341.1[g][1]). Special Education Rights of Parents and Children, a more extensive description of these rights, is available from the California Department of Education, Special Education Division.

To obtain more information about parental rights or dispute resolution, including how to file a complaint, contact the California Department of Education, Special Education Division, Complaint Support Unit, by telephoning 800-926-0648 or writing to:

Email: speceducation@cde.ca.gov
Fax: 916-327-3704

California Department of Education
Special Education Division
Complaint Support Unit
1430 N Street, Suite 2401
Sacramento, CA 95814

To file for mediation or a due process hearing, contact:

Office of Administrative Hearings
Special Education Division
2349 Gateway Oaks, Suite 200
Sacramento, CA 95833-4231
Telephone: 916-263-0880
Fax: 916-376-4207
Secure Electronic Filing

Hearings and Mediations Accessibility and Accommodation Program Guidelines (Posted 17-Oct-2018)
This web page states a California Department of Education contractor conducting special education hearings and mediations must have and follow policies and procedures for equitable services to all participants.

Last Reviewed: Thursday, August 31, 2023

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A brief summary of Procedural Safeguards for students with disabilities receiving special education services.

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The Center for Appropriate Dispute Resolution in Special Education is here to increase the capacity of State Departments of Education, OSEP Funded Parent Centers, and Early Intervention Lead Agencies. They provide technical assistance on dispute resolution options between family and other services.

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Self-Determination Programs (SDP) allow participants the opportunity to have more control in developing their individual service plans.
Explore the link below for more information on SDPs.
https://www.dds.ca.gov/initiatives/sdp/frequently-asked-questions/

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State of California & Department of Developmental Services

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Self-Determination Program (SDP) - CA Department of Developmental Services

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Agency through which the State of California provides services and supports to individuals with developmental disabilities.

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IFSP stands for Individualized Family Service Plan. An IFSP is a written, legal document that lays out the supports and services children with developmental delays need in order for them to get the educational support they need and not fall continue to fall behind.
Lean more about IFSPs below.
https://www.bing.com/videos/search?q=ifsp&&view=detail&mid=41F249F029646384F32141F249F029646384F321&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Difsp%26FORM%3DHDRSC4

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At a glance

An Individualized Family Service Plan (IFSP) is both a process and a document.

An IFSP is provided if your child is found eligible for early intervention services.

An IFSP can help infants and toddlers develop to their fullest potential.

When infants and toddlers need early intervention services, you may hear the term IFSP. IFSP stands for Individualized Family Service Plan. An IFSP is a written legal document that lays out the supports and services kids with developmental delays need to start catching up.

IFSPs are covered by special education law, or the Individuals with Disabilities Education Act (IDEA). They're created for eligible kids from birth to age 3 who need extra help with physical, communication, self-help, cognitive, or social-emotional skills.

The "family" part of an IFSP is important. An IFSP outlines what families need to help kids with early intervention. An IFSP takes into account kids' present level of functioning and needs. But because young children develop skills so quickly, it's key for family members to be involved in supporting development.

About the author

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IFSP: What Is an Individualized Family Service Plan?

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An Individualized Family Service Plan (IFSP) is both a process and a document. An IFSP is provided if your child is found eligible for early intervention services. An IFSP can help infants and toddlers develop to their fullest potential. When infants and toddlers need early intervention services, you may hear the term IFSP.

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Accommodations change how the child is learning; Modifications change what the child is learning.
Both accommodations and modifications are provided to a child after an IEP or 504 Plan has been established.
Read below for more information.
https://www.understood.org/en/articles/the-difference-between-accommodations-and-modifications

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In order to access a 504 Plan, a person must have a physical or mental impairment that substantially limits at least one major life activity but does not need special education services. The rules about who is on the 504 team are less specific than they are for an IEP. Parent involvement or consent is not required for a 504 plan.

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Similarities and Differences Between an IEP and a 504 Plan in K-12 education?

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Individual Education Plan (IEP) are designed for people with various disabilities that fit into 13 categories. A child's parent or guardian has a say in the child’s education plan and will work with the school and other health care providers to create the best plan for the child.
The video below explains the steps in accessing an IEP.
https://www.bing.com/videos/search?q=how+to+get+an+iep&&view=detail&mid=58973A601458FC42F23658973A601458FC42F236&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dhow%2Bto%2Bget%2Ban%2Biep%26FORM%3DHDRSC4

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You've learned the basics of what an IEP is, and how it can help your child. But how do you request an IEP and get your child's special education program started?

The more you know about how to get an IEP and how it's put into place, the more active a role you can take in the process.

Getting the IEP process started

Determining IEP eligibility

Once your child has been evaluated and testing results are in, the school has to determine if your child is eligible for an IEP. To do this, they have to answer two questions:

If the school finds that your child is eligible, together you'll start creating the IEP. And if your child doesn't qualify for an IEP, there are steps you can take.

Weighing options if your child isn't eligible for an IEP

One thing you can do is request a 504 plan for your child. Like an IEP, this plan would provide accommodations or other supports that give your child access to learning.

You can also look into getting an independent educational evaluation (IEE). This kind of evaluation is done by professionals outside of the school. Learn more about IEEs.

There are also measures you can take to dispute the school's findings. These include mediation and something called a due process complaint. That's typically a last resort to resolving a dispute, however.

Download: Chart showing how kids get IEPs

Use this visual guide to see how kids meet eligibility requirements for special education.

If the school finds your child eligible for an IEP, there's nothing you need to do to get the IEP ball rolling. That will happen automatically and quickly - within 30 days. But you'll be part of the IEP team creating and overseeing your child's IEP. Under IDEA, you have the right to participate in every step of the IEP process.

Here are the next steps in the IEP journey:

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What are the steps in the IEP process? Do you have to request an IEP? Read about the IEP process timeline and how to get your child an IEP in this guide.

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Tourette Syndrome is a nervous system disorder that causes individuals to have "tics". These tics can be motor (physical) or vocal. Students are eligible for an IEP or 504 Plan.
Click below for more information.
https://tourette.org/

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Centers for Disease Control and Prevention

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Tourette Syndrome (TS) is a condition of the nervous system. TS causes people to have "tics".

Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things. For example, a person might keep blinking over and over. Or, a person might make a grunting sound unwillingly.

Having tics is a little bit like having hiccups. Even though you might not want to hiccup, your body does it anyway. Sometimes people can stop themselves from doing a certain tic for a while, but it's hard. Eventually the person has to do the tic. Depending on the type of tics a person has, and how long the tics last, a person might be diagnosed with Tourette syndrome or another type of tic disorder.

Types of Tics

There are two types of tics-motor and vocal.

Motor Tics

Motor tics are movements of the body. Examples of motor tics include blinking, shrugging the shoulders, or jerking an arm.

Vocal Tics

Vocal tics are sounds that a person makes with his or her voice. Examples of vocal tics include humming, clearing the throat, or yelling out a word or phrase.

Tics can be either simple or complex:

Simple Tics

Simple tics involve just a few parts of the body. Examples of simple tics include squinting the eyes or sniffing.

Complex Tics

Complex tics usually involve several different parts of the body and can have a pattern. An example of a complex tic is bobbing the head while jerking an arm, and then jumping up.

Symptoms of Tourette syndrome

The main symptoms of TS are tics. A person can have tics ranging from simple, temporary tics lasting a few weeks or months, to having many complex tics that are long-lasting. Symptoms of TS usually begin when a child is 5 to 10 years of age. The first symptoms often are motor tics that occur in the head and neck area.

The types of tics and how often a person has tics changes a lot over time. Even though the symptoms might appear, disappear, and reappear, these conditions are considered chronic.

In most cases, tics decrease during adolescence and early adulthood, and sometimes disappear entirely. However, many people with TS experience tics into adulthood and, in some cases, tics can become worse during adulthood.

Although the media often portray people with TS as involuntarily shouting out swear words (called coprolalia) or constantly repeating the words of other people (called echolalia), these symptoms are rare, and are not required for a diagnosis of TS.

Diagnosing Tourette syndrome

There is no single test, like a blood test, to diagnose TS. Health professionals look at the person's symptoms to diagnose TS and other tic disorders. The tic disorders differ from each other in terms of the type of tic present (motor or vocal, or combination of the both), and how long the symptoms have lasted. TS can be diagnosed if a person has both motor and vocal tics, and has had tic symptoms for at least a year.
Learn more about how TS and other tic disorders are diagnosed "
Treatment for Tourette syndrome

Although there is no cure for TS, there are treatments available to help manage the tics. Many people with TS have tics that do not get in the way of their daily life and, therefore, do not need any treatment. However, medication and behavioral treatments are available if tics cause pain or injury; interfere with school, work, or social life; or cause stress.
Learn more about treatments "
Other Concerns and Conditions
Watch the video "
TS often occurs with other conditions. Most children diagnosed with TS also have been diagnosed with at least one additional mental, behavioral, or developmental disorder such as attention-deficit/hyperactivity disorder (ADHD), anxiety, or obsessive-compulsive disorder (OCD). It is important to find out if a person with TS has any other conditions, and treat those conditions properly.
Learn more about other concerns and conditions "
Risk Factors and Causes

Doctors and scientists do not know the exact cause of TS. Research suggests that it is an inherited genetic condition. That means it is passed on from parent to child through .
Learn more about risk factors and causes "
More Information

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition, text revision. Washington, DC: American Psychiatric Association, 2022.

2. Bloch, MH, Leckman, JF. Clinical course of Tourette Syndrome. J Psychosom Res. 2009; 67(6): 497-501.

3. Centers for Disease Control and Prevention. Prevalence of diagnosed Tourette Syndrome in persons aged 6-17 years - United States, 2007. MMWR Morb Mortal Wkly Rep. 2009; 58(21): 581-5.

4. Bitsko, RH, Holbrook, JR, Visser, SN, Mink, JW, Zinner, SH, Ghandour, RM, Blumberg, SJ (2014). A National Profile of Tourette Syndrome, 2011-2012. J Dev Behav Pediatr 35(5), 317-322.

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Facts, causes, signs, diagnosis, and treatments for Tourette Syndrome.

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"Orthopedic impairment" means a severe bone and or muscle impairment that adversely affects a child’s educational performance. This is covered under the IDEA as "Orthopedic impairment". Examples include Muscular Dystrophy, Spinal Cord Injuries, Multiple Sclerosis.

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Sensory processing disorder (SPD) is a condition that affects how one's brain processes sensory information (stimuli). Sensory information includes things you see, hear, smell, taste, or touch. SPD can affect all of your senses, or just one. Although not covered under the IDEA, students could be eligible for a 504 Plan.

Read more below:

https://childmind.org/article/sensory-processing-issues-explained/

https://www.franciscanhealth.org/community/blog/sensory-processing-and-school-success

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The symptoms of SPD vary greatly depending upon the sense that is affected, how that sense is affected, and the severity of the condition.

SPD may occur in each sensory system: Visual, Auditory, Tactile, Smell, Taste, Vestibular, Proprioception, Interoception AND symptoms may vary depending on subtype. That is why SPD is so difficult to understand and diagnose. The person may have 1, 2 or up to 8 sensory systems involved and 1, 2, or up to 6 different subtypes. 8 ⁶ or > 260,000 different patterns of expression of SPD. Each person with SPD must be individually assessed and treatment never looks the same for different children!

People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may crave intense sensory experiences, or they may be unaware of sensations that others feel. They may also have sensory-motor symptoms such as a weak body, clumsiness or awkwardness or delayed motor skills.

If a person has SPD often the symptoms result in emotional, behavioral, social, attentional, or motoric problems. These secondary problems can take many forms and look different depending on the child and family context.

Our current knowledge suggests that there are six subtypes of SPD. Almost all individuals with SPD have a combination of symptoms from more than one subtype. The chart below shows the three major patterns and the six subtypes of SPD.

* Although SPD is described as one of the three primary patterns because a person can be affected in 1, 2, or 8 different systems it could actually be considered another 8 different subtypes, bringing the total number for subtypes to 13 (3 in SMD; 2 in SBMD; and 8 in SDD).

Subtypes of SPD Explained

Sensory Modulation Disorder

Difficulty regulating responses to sensory stimuli

Sensory-Based Motor Disorder

Difficulty with balance, motor coordination, and the performance of skilled, non-habitual and/or habitual motor tasks

Sensory Discrimination Disorder

Difficulty interpreting subtle qualities of objects, places, people or other environments

Individuals with sensory over-responsivity are more sensitive to sensory stimulation than most people. Their bodies feel sensation too easily or too intensely. They might feel as if they are being constantly bombarded with information. Consequently, these people often have a "fight or flight" response to sensation, e.g. being touched unexpectedly or loud noise, a condition sometimes called "sensory defensiveness." They may try to avoid or minimize sensations, e.g. withdraw from being touched or cover their ears to avoid loud sounds.

Individuals who are under-responsive to sensory stimuli are often quiet and passive, disregarding or not responding to stimuli of the usual intensity available in their sensory environment. They may appear withdrawn, difficult to engage and or self-absorbed because they do not detect the sensory input in their environment. Their under-responsivity to tactile and deep pressure input may lead to poor body awareness, clumsiness or movements that are not graded appropriately. These children may not perceive objects that are too hot or cold or they may not notice pain in response to bumps, falls, cuts, or scrapes.

Individuals with this pattern actively seek or crave sensory stimulation and seem to have an almost insatiable desire for sensory input. They tend to be constantly moving, crashing, bumping, and/or jumping. They may "need" to touch everything and be overly affectionate, not understanding what is "their space" vs. "other's space." Sensory seekers are often thought to have Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD). A key factor with Sensory Craving is that when the individual receives more input it does not regulate him/her; in fact, those with true craving disorders become disorganized with additional stimulation.

An individual with postural disorder has difficulty stabilizing his/her body during movement or at rest in order to meet the demands of the environment or of a motor task. When postural control is good, the person can reach, push, pull, etc. and has good resistance against force. Individuals with poor postural control often do not have the body control to maintain a good standing or sitting position.

Individuals with Dyspraxia have trouble processing sensory information properly, resulting in problems planning and carrying out new motor actions. They may have difficulty in forming a goal or idea, planning a sequence of actions or performing new motor tasks. These individuals are clumsy, awkward, and accident-prone. They may break toys, have poor skill in ball activities or other sports, or have trouble with fine motor activities. They may prefer sedentary activities or try to hide their motor planning problem with verbalization or with fantasy play.

Sensory discrimination refers to the process whereby specific qualities of sensory stimuli are perceived and meaning attributed to them. Discriminate means understanding accurately what is seen, heard, felt, tasted, or smelled. Individuals with SDD difficulties have problems determining the characteristics of sensory stimuli. The result is a poor ability to interpret or give meaning to the specific qualities of stimuli or difficulty detecting similarities and differences among stimuli. (Do I see a "P" or a "Q"? Do I hear "cat" or "cap"? Do I feel a quarter or a dime in my pocket? Am I falling to the side or backwards?). Individuals with poor sensory discrimination may appear awkward in both gross and fine motor abilities and/or inattentive to people and objects in their environment. They may take extra time to process the important aspects of sensory stimuli.

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The symptoms of SPD vary greatly depending upon the sense that is affected, how that sense is affected, and the severity of the condition.

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There are three types of Down syndrome:

Trisomy 21 (nondisjunction)

Translocation

Mosaicism

Down syndrome is marked as an "Intellectual Disability" under the IDEA.
Click the link above to learn more about Down syndrome
Click the link below for a list of interventions:
https://www.nichd.nih.gov/health/topics/down/conditioninfo/treatments

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Centers for Disease Control and Prevention

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Down syndrome is a condition in which a person has an extra chromosome

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Epilepsy is covered under the IDEA as "Other Health Impairment". Click the link to learn more details about this neurological condition.

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Epilepsy is the fourth most common neurological disorder in the world. If you have epilepsy, surges of electrical activity in your brain can cause recurring seizures. We can help you understand everything you need to know about epilepsy and what you can do about it.

Understanding Epilepsy Basics

Epilepsy is a brain disorder that causes recurring, unprovoked seizures. Your doctor may diagnose you with epilepsy if you have two unprovoked seizures or one unprovoked seizure with a high risk of more. Not all seizures are the result of epilepsy. Seizures may relate to a brain injury or a family trait, but often the cause is completely unknown.

The word "epilepsy" simply means the same thing as "seizure disorders." It does not state anything about the cause of the person's seizures or their severity.

Bri's Story

I was diagnosed with epilepsy at five years old. I had around twenty-one seizures a week, experienced multiple EEGs, trialed multiple medications, and was prescribed twenty pills a day.

Read More

Find an Epilepsy Specialist

Ready for help? Find an Epilepsy specialist who can help guide you through your epilepsy journey.

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Epilepsy, the fourth most common neurological disorder, affects people of all ages and can cause unpredictable seizures. Learn more from the Epilepsy Foundation.

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Those who are deaf or hard of hearing will likely use American Sign Language (ASL). Children are covered under the IDEA and can access a 504 Plan or IEP depending on their needs. They can also access accommodations or modifications to ease their learning. Some accommodations could include using:

A sign language interpreter

Speech-to-text services

Captioned media

An assistive listening device

https://www.handspeak.com/

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Some children are born with a hearing loss. Others may develop one due to injury, infection or even loud noises. Children with hearing loss can do well in school, but they often need extra help to learn at their full capacity. Every child is different. This handout can help schools find ways to meet the needs of the child with a hearing loss.

Teaching a Child With Hearing Loss

Children with hearing loss may benefit from all or just a few of these tips to help them learn. It is important for the school and the family to work together to decide what is best for the child.

Pause during lessons. Take time to be sure the child understands what was said.

Repeat and/or rephrase information when needed.

Talk slowly and clearly. Use a comfortable volume.

Change your speech pattern, rhythm, stress and tone. This shows that you are excited about what you are teaching. Children hear it in your voice. Make lessons predictable by repeating the content. Pre-teach new words before the actual lesson. Review lessons that were taught earlier.

Use visual models and cues.

Provide a peer note-taker or lecture outlines to help with understanding what the lesson was about. It may be hard for a child with hearing loss or an auditory processing disorder (APD) to take notes while listening. This is because it is hard to watch the teacher's face for visual and speech cues while trying to listen and take notes.

Be aware of how close you are to the child. The closer you are, the better they can understand what you are saying.

Face the child when speaking. Do not turn your back and speak while writing on a board.

Teach in a well-lit area. This helps the child see speech signals on your lips and face. The light should be on your face, not in the child's eyes. Do not stand in front of a window or bright light.

Seat the child where they can easily turn and follow classroom discussion or allow them to move to other seats, as needed, for demonstrations, discussions or other activities.

Arrange chairs in a circle. This allows the child with hearing loss to interact well with other classmates.

Do not hold your hand over your mouth or near your face when speaking

Classroom Acoustics

The classroom setting is not always easy for children with hearing loss. Poor sound (acoustics) can be caused by background noise in or out of the classroom, echoes from hard surfaces, such as walls, and the level of the teacher's voice compared to background noise.
Poor acoustics can make it hard to:

understand

focus and stay on task

pay attention

read

reach educational goals

Ways to improve classroom acoustics:

Close the classroom door.

Fix squeaky doors, windows and fans.

Cut an 'X' in tennis balls and place them on classroom chairs and table legs.

Place the students' desks as far away as possible from sources of noise. This includes audio-visual equipment, HVAC systems, pencil sharpeners and open windows.

Modify the classroom. Consider putting carpet, permanent walls or sound panels on the walls. Use an FM system.

FM Systems

An FM (frequency modulated) system helps a person with hearing loss listen in noisy places, such as a classroom. There are two main parts of this system:

the microphone (transmitter) unit worn by the teacher and

a receiver used by the student to pick up the teacher's voice.

The child's audiologist can help select the best FM system for the child based on their learning needs.

IEP and 504 Plans

Hearing loss is legally considered a disability. Children with hearing loss may benefit from being placed on an IEP (Individualized Education Plan) or a 504 Plan. An IEP is a document that identifies what special education services a child must receive. A 504 Plan is for any child with a disability that does not need special education services. Both allow the school and parents to work together, discuss and monitor classroom performance and prepare the school environment.

A Multi-Factored Evaluation checks to see if the child is eligible for special education services. It is typically recommended for all children with hearing loss. Children with hearing loss are at high risk for speech and/or language delays, educational and learning problems, behavior issues and attention deficits. It is best if an educational audiologist helps write the child's IEP or 504 Plan. The child's clinical audiologist at Nationwide Children's Hospital can also provide helpful information and recommendations.

Nationwide Children's is here to partner with the school and the family. The Audiology Department can be reached at 614-722-3951, Monday through Friday, from 8:00 a.m. to 4:30p.m. Please note that the child's parent or guardian must sign a release of information before we can talk to the school about a child.

For more information, you can log onto our websites at nationwidechildrens.org/audiology or nationwidechildrens.org/ear-nose-throat.
Children with Hearing Loss: Guidelines for Schools (PDF) HH-IV-237 ©2021, Nationwide Children 's Hospital

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Children With Hearing Loss: Guidelines for Schools

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Some children are born with a hearing loss. Others may develop one due to injury, infection or even loud noises. Children with hearing loss can do well in school, but they often need extra help to learn at their full capacity.

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Cerebral Palsy (CP) affects a person's ability to move and maintain balance and posture. Click the link below to learn more specifics about CP.

https://www.cdc.gov/ncbddd/cp/facts.html#:~:text=Cerebral%20palsy%20(CP)%20is%20a,problems%20with%20using%20the%20muscles.

Children are covered under the IDEA as an "Orthopedic Impairment" and can access a 504 Plan or IEP depending on their needs.
Follow the link to learn about 504 Plans and CP.

http://www.warmlinefrc.org/uploads/5/9/5/8/5958794/section_504_accomodations.pdf#:~:text=Arrange%20for%20instructional%20aide%20support%20Install%20handle%20style,student%20give%20reports%20orally%20rather%20than%20in%20writing

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The Individuals with Disabilities Education Act (IDEA) defines “Visual Impairment Including Blindness” as an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness.
Click the link below for resources
https://www.parentcenterhub.org/visualimpairment/

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The philosophy of the Intermediate Unit 1 vision support program is that all students who are visually impaired are valuable and important individuals, much more like other children than different from them. The ultimate goal of the vision support program is to prepare students with varying degrees of visual impairment to function as productive members of society.

The Individuals with Disabilities Education Act (IDEA) defines "visual impairment including blindness" as an impairment in vision that, even with correction, adversely affects a child's educational performance. The term includes both partial sight and blindness.

Vision support services may be direct or indirect in the areas of:

Concept skills

Academic skills

Auditory skills

Sensory and motor skills

Orientation and mobility skills

Career and vocational skills

Organizational and productivity skills

Braille skills

Recreation and leisure skills

Assistive technology skills

Social skills

Independent daily living skills

Utilization of low vision skills

Assistive Technology

In today's society, technology plays an important part in the lives of all individuals. For students with visual impairments, the need for assistive technology is of paramount importance in assuring a student's access to a wide-range of functional, educational, and social opportunities.

The legal definition of an assistive technology device according to IDEA is any item, piece of equipment or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. For students with visual impairments, it also creates a more even "playing field" which permits those students to compete more effectively within the educational setting and with their sighted peers in today's job market.

In the area of visual impairment assistive technology is divided into two broad categories depending upon the individual's functional vision capabilities or lack of vision: low vision devices and blindness devices.

Assistive technology may run the continuum from "no tech" environmental adaptations and modifications to "low tech" magnification including magnifiers and large print materials; audio books and tape recorders; use of a cane or the use of a Braille Writer or slate and stylus to "high tech" devices such as modified computer systems, portable note takers, Closed Circuit Television (CCTV), refreshable Braille displays, and reading systems for both low vision and blind students.

The provision of assistive technology is highly individualized and should only be provided after the student has had an assistive technology evaluation. It should be remembered that there is no "best way or best device," only the one that works best for each student based upon their specific needs in a variety of settings. The goal for each student should be to maximize their independence in all areas of life and to prepare them to be contributing members of society.

Orientation and Mobility Instruction

The Individual with Disabilities Education Act includes orientation and mobility services under the category of "related services", which are defined as "supportive services as are required to assist a child with a disability to benefit from special education".

Specifically, according to IDEA, orientation and mobility services are services provided to blind or visually impaired students by qualified personnel to enable those students to attain systematic orientation to and safe movement within their environments in school, home, and community. Orientation and mobility services include teaching students the following, as appropriate: spatial and environmental concepts and use of information received by the senses to establish, maintain or regain orientation and line of travel; to use the long cane to supplement visual travel skills or as a tool for safely negotiating the environment for students with no available travel vision; to understand and use remaining vision and distance low vision aids; and other concepts, techniques, and tools.

As part of the expanded core curriculum, orientation and mobility is a vital area of learning. Both components are necessary for safe and efficient travel within the environment. Orientation involves knowledge of one's distance and direction relative to things observed or remembered in the surroundings and keeping track of these "self-to-object" spatial relationships as they change during locomotion. Mobility means moving safely, gracefully, and comfortably. Areas of instruction include concept development, gross motor skills, visual efficiency skills, pre-cane and cane skills, orientation techniques and aids, accessing transportation systems, personal safety, and self-advocacy. These skills should be instructed at age-appropriate levels throughout the school years in a variety of indoor and outdoor environments.

Every visually impaired student has the right to an assessment by an orientation and mobility instructor who can determine the student's instructional needs in the areas of orientation and mobility. Based on the needs identified in the assessment, every visually impaired student has the right to instruction by an orientation and mobility instructor which will lead to the most independent, safe and efficient movement skills, appropriate for each student.

Downloads

Guidelines for Case Selection, Continuance, and Dismissal of Services for Students with Visual Impairments (PDF Document)

Online Resources

For More Information

For more information about the Vision Impairment Support program at IU1, please contact:

Walinda Nicholson
Supervisor of Special Education
724-366-0056
walinda.nicholson@iu1.org

Leigh Dennick
Director of Special Education
724-938-3241 ext. 273
leigh.dennick@iu1.org

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The philosophy of the Intermediate Unit 1 vision support program is that all students who are visually impaired are valuable and important individuals, much more like other children than different from them. The ultimate goal of the vision support program is to prepare students with varying degrees of visual impairment to function as productive members of society.

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Dissociative disorders are covered by the IDEA under "Emotional Disturbance". What cases them? Toxic stress, trauma (emotional and physical), abuse.
Follow the links to learn more.
https://www.perkinsasbill.com/does-the-ada-cover-psychiatric-disabilities/
https://www.instagram.com/p/CyB-XT5Sg8G/?img_index=1

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Overview

What are dissociative disorders?

Dissociative disorders are mental health conditions that involve feelings of being detached from reality, being outside of your own body or experiencing memory loss ( amnesia).

The word "dissociation" means to be disconnected from others, from the world around you or from yourself.

Dissociative disorders typically develop after short-term or long-term trauma.

Types of dissociative disorders

The three types of dissociative disorders include:

Dissociative identity disorder (DID): People with DID have two or more separate identities. These identities (called "alters") control their behavior at various times. Each alter has its own personal history, traits, likes and dislikes.

Dissociative amnesia: This condition happens when you can't remember essential information about your life. The forgetting may be limited to specific aspects of your life or may include much of your life history and/or identity.

Depersonalization/derealization disorder: This is a condition in which you feel detached from your thoughts, feelings and body (depersonalization), and/or disconnected from your environment (derealization).

There's also a symptom called dissociative fugue. It's a temporary mental state in which a person has memory loss and ends up in an unexpected place.

Because dissociative disorders appear on the trauma spectrum, many people with a dissociative disorder may have co-occurring trauma-related mental health conditions, such as:

Who do dissociative disorders affect?

People of all ages and racial, ethnic and socioeconomic backgrounds can develop a dissociative disorder. Women and people assigned female at birth are more likely to have a diagnosis.

People who experienced physical and/or sexual abuse in childhood have the greatest risk of developing dissociative identity disorder (DID). About 90% of people who have DID in the United States, Canada and Europe experienced childhood abuse and neglect.

How common are dissociative disorders?

Dissociative disorders are rare. About 2% of people in the United States have them.

Symptoms and Causes

What are the symptoms of dissociative disorders?

The symptoms of dissociative disorders depend on the type. Symptoms usually first develop after a traumatic event.

Stressful situations can worsen symptoms and cause issues with daily functioning.

Symptoms of dissociative identity disorder (DID)

A person with DID has two or more distinct identities. The "core" identity is the person's usual personality. "Alters" are the person's alternate personalities. The core is the identity you had before developing DID and alters.

Each alter has a particular set of behaviors, attitudes, preferences, memories and ways of thinking. Other people may be able to tell the difference between the alters, as well as the person with DID. Shifting from one alter to another is involuntary and sudden.

Another symptom of DID is ongoing gaps in memory about everyday events, personal information and/or past traumatic events.

These symptoms can range widely in severity. For some people, the condition minimally interferes with their life. For others, it causes significant issues.

Symptoms of dissociative amnesia

In dissociative amnesia, the main symptom is an episode of amnesia (memory loss) that comes on suddenly. It can last months or years.

There are three types of amnesia:

Localized: You can't remember an event or period of time (the most common form of amnesia).

Selective: You can't remember certain details of events within a given period of time.

Generalized: You can't remember anything about your identity and life history (the rarest form).

You may not be aware of your memory loss or have only a little awareness. But loved ones usually recognize the memory loss.

Symptoms of depersonalization/derealization disorder

The symptoms of depersonalization/derealization disorder include experiencing one or both of the following episodes in a recurring pattern over a lengthy period of time:

Depersonalization: This involves feelings of unreality or of being detached from your mind, body or self. It feels as if you're observing your life and the events from afar rather than being an active participant.

Derealization: This involves feelings of unreality or of being detached from your surroundings. People and things may not seem real.

During these episodes, you're aware of your surroundings and know that what you're experiencing isn't normal.

These symptoms may start as early as childhood. The average age of the first episode is 16. Fewer than 20% of people with this condition will have their first episode after age 20.

What causes dissociative disorders?

Dissociative disorders often develop as a way to deal with a catastrophic event or with long-term stress, abuse or trauma.

This is particularly true if such events take place early in childhood. At this time of life, there are limitations to your ability to fully understand what's happening. In addition, your coping mechanisms aren't fully developed and getting support and resources depends on the presence of caring and knowledgeable adults.

Mentally removing yourself from a traumatic situation can be a coping mechanism that helps you escape pain in the short term. This coping mechanism can become an issue if it continues to separate you from reality and removes memories of entire periods of time.

Traumatic situations may include:

Repeated physical, mental or sexual abuse.

An accident.

A natural disaster.

Military combat.

Being a victim of a crime.

Scientists have recently been studying specific brain structures and functions that are related to dissociation. So far, they've found that during dissociation, structures in the memory regions deep in your brain show rhythmic activity but seem disconnected from other regions responsible for thought and planning.

Diagnosis and Tests

How are dissociative disorders diagnosed?

Healthcare providers diagnose dissociative disorders by assessing your symptoms and personal history.

Your provider may order tests to rule out possible medical conditions that can cause similar symptoms (such as memory loss), including:

Once they rule out possible causes, they'll likely refer you to a mental health specialist, such as a psychologist, to make a diagnosis through clinical interview and observations.

Mental health professionals use criteria in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders to diagnose specific dissociative disorders.

Management and Treatment

How are dissociative disorders treated?

Treatment of dissociative disorders usually consists of psychotherapy (talk therapy) to help you gain control over the dissociative process and symptoms.

Psychotherapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. It can provide support, education and guidance to you and/or your family to help you function better and increase your well-being.

Specific types of psychotherapy commonly used for dissociative disorders include:

Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of psychotherapy. Your therapist or psychologist helps you take a close look at your thoughts and emotions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

Dialectical behavior therapy (DBT): DBT is specially adapted for people who experience emotions very intensely. The main goal is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.

Therapy can be difficult, as it involves remembering and learning to deal with past trauma. But it can significantly help your symptoms in the long term.

Other therapies that can help include:

Hypnosis: Hypnosis (hypnotherapy) is a state of deep relaxation and focused concentration. When you're under hypnosis, this intense level of concentration and focus allows you to ignore ordinary distractions and be more open to guided suggestions to make changes to improve your health.

EMDR therapy: Eye movement desensitization and reprocessing (EMDR) therapy involves moving your eyes a specific way while you process traumatic memories. EMDR's goal is to help you heal from trauma or other distressing life experiences. Compared to other therapy methods, EMDR is relatively new.

No specific medications treat dissociative disorders. But your provider may recommend certain medications, such as antidepressants, to treat co-occurring mental health conditions.

Outlook / Prognosis

What is the prognosis for dissociative disorders?

The prognosis (outlook) for dissociative disorders varies.

With professional treatment (usually psychotherapy), many people with a dissociative disorder can address the major symptoms of the condition and improve their daily functioning.

For some people, the dissociative disorder, especially dissociative identity disorder (DID), severely impacts their life.

Suicide attempts and self-harm are common in people with DID. More than 70% of people with DID attempt suicide.
If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone will be available to help you 24/7.
Living With

When should I see my healthcare provider?

If you're experiencing symptoms of a dissociative disorder, talk to a healthcare provider or mental health professional.
A note from Cleveland Clinic
As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Talk to a healthcare provider if you're experiencing symptoms of dissociation. Mental health professionals can offer treatment plans that can help you manage your condition.

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Dissociative Disorders: Causes, Symptoms, Types & Treatment

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Dissociative disorders are mental health conditions that involve feelings of being detached from reality, being outside of your own body or experiencing memory loss ( amnesia). The word "dissociation" means to be disconnected from others, from the world around you or from yourself. Dissociative disorders typically develop after short-term or long-term trauma.

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There are several forms of anxiety disorders. With all struggling with anxiety, the limbic brain is overactive which tricks your body into thinking it is constantly in danger. Anxiety disorders are covered under the IDEA as "Emotional Disturbance".
Follow the links to learn more.

https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/expert-answers/coping-with-anxiety/faq-20057987
AND
https://www.mendocinocounty.org/departments/behavioral-health-and-recovery-services/mental-health-services/

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Overview

Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. You may avoid places or situations to prevent these feelings. Symptoms may start during childhood or the teen years and continue into adulthood.

Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. You can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment.

Whatever form of anxiety you have, treatment can help.

Symptoms

Common anxiety signs and symptoms include:

Feeling nervous, restless or tense

Having a sense of impending danger, panic or doom

Having an increased heart rate

Breathing rapidly (hyperventilation)

Sweating

Trembling

Feeling weak or tired

Trouble concentrating or thinking about anything other than the present worry

Having trouble sleeping

Experiencing gastrointestinal (GI) problems

Having difficulty controlling worry

Having the urge to avoid things that trigger anxiety

Several types of anxiety disorders exist:

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.

Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events - even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.

Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they've occurred.

Selective mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.

Separation anxiety disorder is a childhood disorder characterized by anxiety that's excessive for the child's developmental level and related to separation from parents or others who have parental roles.

Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.

Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.

Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.

Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.

When to see a doctor

See your doctor if:

You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life

Your fear, worry or anxiety is upsetting to you and difficult to control

You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety

You think your anxiety could be linked to a physical health problem

You have suicidal thoughts or behaviors - if this is the case, seek emergency treatment immediately

Your worries may not go away on their own, and they may get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It's easier to treat if you get help early.

Causes

The causes of anxiety disorders aren't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor.

Medical causes

For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

Heart disease

Diabetes

Thyroid problems, such as hyperthyroidism

Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma

Drug misuse or withdrawal

Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications

Chronic pain or irritable bowel syndrome

Rare tumors that produce certain fight-or-flight hormones

Sometimes anxiety can be a side effect of certain medications.

It's possible that your anxiety may be due to an underlying medical condition if:

You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder

You didn't have an anxiety disorder as a child

You don't avoid certain things or situations because of anxiety

You have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety

Risk factors

These factors may increase your risk of developing an anxiety disorder:

Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.

Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.

Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety - for example, a death in the family, work stress or ongoing worry about finances.

Personality. People with certain personality types are more prone to anxiety disorders than others are.

Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.

Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.

Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.

Complications

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:

Depression (which often occurs with an anxiety disorder) or other mental health disorders

Substance misuse

Trouble sleeping (insomnia)

Digestive or bowel problems

Headaches and chronic pain

Social isolation

Problems functioning at school or work

Poor quality of life

Suicide

Prevention

There's no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:

Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.

Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.

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Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

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Autism Spectrum Disorder (ASD) affects the the way people take in and process information. Their brains are able to take in more information than those who are not on the autism spectrum. Children are covered under the IDEA and qualify for IEPs or 504 Plans.
Follow the links below for more information and trainings:
https://www.livebinders.com/b/2665813
https://afirm.fpg.unc.edu/node/137

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The child's rights

People with autism have many legal protections. The Individuals with Disabilities Education Act (IDEA) was enacted in 1975 and revised in 2004. It requires all states to provide free and appropriate education that meets the unique needs of qualifying students.

Appropriate education refers to an education tailored to the child's needs to make sure they make academic progress. Appropriate does not always mean "best."

An individual with autism is also entitled to learn in the "least restrictive environment" that allows them to interact with others who do not have a disability. Accommodations can help the student with autism to participate in the general education curriculum.

Modifications for students with autism

There are many adaptations for students with autism that can set the classroom up for success.

Minimize distractions

People with autism may be easily distracted because they have difficulty regulating attention and response to stimuli. Some common distractions might be children playing outside, students asking for help, or conversations between classmates.

Minimizing distraction is a common adaptation for autism. Some strategies for minimizing distractions include:

Earplugs

Low distraction work areas

Optimized seating

Sensory tools

Use visual cues

People with autism commonly think in pictures. Visual support can be a simple accommodation for autism spectrum disorder.

Using a daily schedule and monthly calendars with visual cues may help reduce anxiety for students with autism by allowing them to understand what is coming next better than a written schedule alone.

Teachers can also use visual flashcards for common tasks. For example, a flashcard can be used to identify the current subject being taught or that it is time for a break.

Take breaks

All students can benefit from an opportunity to take a break. Exercise breaks give students a chance to give their brains a rest, get their blood moving, and get ready for the next lesson.

A break in a sensory retreat can be especially helpful for students with autism, who can feel overwhelmed by the amount of sensory input they receive while in class. Studies show that access to a visual-sensory-based quiet room can decrease unwanted behavior in stressful situations like school.

A sensory retreat should:

Model appropriate behavior

Modeling appropriate behavior is helpful in any classroom and is not just a modification for students with autism. Fostering a welcoming environment that teaches understanding and acceptance can go a long way in providing opportunities to develop social interaction skills.

Another common strategy is to pair students with positive role models and allow time for students to work in small groups.

A small but impactful modification for students with autism is to use positive instruction instead of negative instruction by minimizing words like "don't" and "stop." An example of using positive instruction is saying "please sit down" instead of "don't stand up."

Incorporate alternate media

Students with autism may have different learning styles.

Visual learners benefit most from:

Auditory learners benefit most from:

Tactile learners benefit most from:

Whenever possible, teachers should provide alternate instruction in the method that best suits the child's learning style. For example, after verbal instruction, a visual learner may require additional pictures or videos to understand.

Use assistive technology

Assistive technology (AT) can help include a student with ASD by supporting and enhancing the student's communication and functional capabilities.

Low-tech AT includes anything that does not require electricity, such as:

Mid-tech AT is easy to operate and usually inexpensive, including:

High-tech AT is the most complex and includes digital media like:

Classroom aides

A one-to-one aide, also known as an education support professional (ESP), is assigned to just one student. They assist the student with various tasks to maximize independence.

An ESP can assist students with many tasks, including:

Learning social skills

Transitioning between locations

Staying on task

Encouraging group play

Reducing challenging behavior

Completing tasks of daily living

Workplace accommodations for autism

As students transition out of school and into the workplace, they can take many of the same classroom accommodations and adapt them to the workplace. Common workplace accommodations for autism are:

Noise canceling headphones or earplugs

Dim lights

Sitting in a quieter part of the office, away from foot traffic

Extra time to process information

Peer mentors

Conclusion

There are many classroom accommodations for students with ASD. Finding the best and most appropriate interventions is a collaboration between the student, caregivers, teachers, and the school district.

‍ ‍Songbird Therapy is a technology-enabled provider setting a higher standard for children's autism care. With a deeply passionate team and innovative technology, we're building a world where every child can access world-class care at home, uniquely tailored to them.

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Accomodations for students with autism | Autism Resources

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School can be a challenging environment for any student but can be especially difficult for children with autism spectrum disorder (ASD). Students are required to sit still for long periods, endure lengthy lectures, and navigate changing schedules. Schools are filled with loud noises and bright colors that can cause sensory overload.

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Those experiencing ADHD have low amounts of the neurotransmitter dopamine. Dopamine plays a role in many body functions, including sleep, learning, memory, etc.

ADHD is considered an “Other Health Impaired” under the IDEA. Individuals qualify for accommodations, an IEP or 504 Plan.
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